Nurse practitioner adoption of clinical innovations

Adoption of clinical innovations by Nurse Practitioners (NP) is a complex

phenomenon, rooted in personal values and influenced by challenges within health care

environments. When clinical innovations are adopted or rejected by NPs, this decision

has meaning for patients, NPs, health care agencies, and society. The decision controls

the opportunity for patients to access a clinical innovation that could reduce morbidity

and mortality, save money, and provide satisfaction related to the health care encounter.

The purpose of the study was to increase knowledge about NP adoption of clinical

innovations, particularly emotionally-laden clinical innovations. The lines of inquiry

focused on what clinical innovations were thought by NPs to be emotionally-laden,

whether the NPs adopted or rejected the emotionally-laden clinical innovation, the

reasoning behind their decisions, and an examination of how they were involved in

providing information or treatment to patients related to the innovation.

A qualitative approach using grounded theory methodology was chosen. Sixteen

nurse practitioner participants, practicing in adult primary care settings, were individually

interviewed. Data analysis was accomplished using the constant comparative method. Analysis generated a grounded theory.

Philosophy of Care (context) involved the development of an individual

philosophy of care and included patient choice, equal treatment, provision of information,

and advocacy. Work Environment (conditions) involved aspects of the NP's work

environment and included work setting, economics, time, power and role, and coworkers.

Innovation Adoption (process) included the aspects of discovery, evaluation,

and adoption or rejection of the innovation. Doing the Right Thing was a sub

theme of the process. The Adoption Spectrum showed that innovation adoption could be

consistent, intermittent, or conditional. Innovation rejection could be overt or covert.

Values Continuum: Congruence to Dissonance (consequences) involved aspects of being

at risk, being ambivalent, and being satisfied. Congruence occurred when NP personal

and professional values were in agreement with the perspectives of the patient and

agency; dissonance occurred when values were in conflict.

Support of timely and appropriate adoption of clinical knowledge benefits society.

A sophisticated understanding of how new knowledge is incorporated or rejected by NPs

is a prerequisite to the intelligent development of nursing research and education