Advanced Practice Nursing (APN)
Interventions
Eileen Sullivan-Marx, PhD, CRNP, FAAN, RN

Dr. Eileen Sullivan-Marx (Associate Professor of Nursing, Shearer Term Professor for Healthy Community Practices, and Associate Dean for Practice and Community Affairs) has studied outcomes of care for frail older adults with a focus on reduction and elimination of physical restraints. Dr. Sullivan-Marx's initial research examined the impact of an advanced practice nurse (APN) intervention on functional status for hospitalized older adults. Patients receiving the APN intervention, which included monitoring, mobility, medication management, environmental modification, discharge planning, and limited use of physical restraint, were less likely to decline in function at discharge regardless of the presence of delirium or dementia (Wanich, Sullivan-Marx, Gottlieb, & Johnson, 1992).

Dr. Eileen Sullivan-Marx

This work is frequently cited to support use of advanced practice nurses in hospitals including the Institute of Medicine (1996), Nursing Staff in Hospitals and Nursing Homes: Is It Adequate? In a later study employing secondary analysis, Dr. Sullivan-Marx examined predictors of physical restraint following concentrated efforts to reduce restraint use among nursing home residents. Whether restraint reduction efforts employed education, education plus APN consult, or regulatory mandate, the predictors of physical restraint use included cognitive impairment of residents, nurses' rationale that fall risk necessitated restraint use, and higher ratios of licensed practical nurses to nurses aides (Sullivan-Marx, Strumpf, Evans et al., 1999).

The American Nurses Association used these findings as part of testimony to the Joint Commission on Accreditation of Healthcare Organizations endorsing a standard of restraint-free care in hospitals and adequate staffing patterns for assessment of patient behaviors. Using a data set of 9598 hip fracture patients in 20 hospitals, Dr. Sullivan-Marx has been extending this research to examine predictors of physical restraint in hospital settings (Sullivan-Marx, Baumgarten, Strumpf et al., 1999). Nursing home residents hospitalized with hip fracture were more likely to be physically restrained if they were confused on admission, had a diagnosis of dementia, or were dependent in function prior to hip fracture. Moreover, those hospitalized and restrained nursing home residents were also more likely to be incontinent and decline in function at time of discharge. The preceding two studies and others (Strumpf et al., 1998; Talerico et al., 1998) increasingly suggest a relationship between restraint use in hospitals and nurse staffing. The paucity of research concerning these relationships led to another study by Dr. Sullivan-Marx, which explores the effect of hospital staffing, physical restraint, and patient outcomes.

Eileen Sullivan-Marx's work has documented the conditions that lead nursing homes and hospitals to use physical restraints. She found that physical restraints were used most often when residents were disoriented or suffered from dementia, and in nursing homes where there was a higher ratio of licensed practical nurses to registered nurses. This work is now being linked to outcomes research showing how nursing care influences the quality of life, health, and well-being of elders.

To learn more about Advanced Practice Nursing Interventions, please contact Dr. Eileen Sullivan-Marx

For more information about the Adult Health Nurse Practitioner Program and Penn's #1 ranked Gerontology Nurse Practitioner Program (GNP), please contact Valerie Cotter, MSN, CRNP.
Thank you.

FUNDING

Currently Funded Grants

PUBLICATIONS

Sullivan-Marx, E. M., Kurlowicz, L. H., Maislin, G., & Carson, J. (2001). Physical restraint among hospitalized nursing home residents: Predictors and outcomes. Clinical Gerontologist, 24, 85-101. Sullivan-Marx, E.M,, Maislin, G., & Carson, J. (2001). Hospital staffing, physical restraint, and patient outcomes. Journal of the American Geriatrics Society, 49, S9. Sullivan-Marx, E. M. (2000, April). Achieving restraint-free care of acutely confused older adults. Journal of Gerontological Nursing, 27(4), 56-61. Sullivan-Marx, E. M., Happ, M. B., Bradley, K., & Maislin, G. (2000). Nurse practitioner services: Content and relative work value. Nursing Outlook, 48, 269-275. Sullivan-Marx, E. M., & Maislin, G. (2000). Comparison of nurse practitioner and family physician relative work values. Journal of Nursing Scholarship, 32, 71-76. Richmond, T. S., Thompson, H. J., & Sullivan-Marx, E. M. (2000). Reimbursement for acute care nurse practitioner services. American Journal of Critical Care, 9, 52-61. Sullivan-Marx, E. M., Strumpf, N. E., & Evans, L. K. (1999). Restraint-free care of the elderly. In S. Salisbury, J. T. Stone, & J. Wyman (Eds.), Clinical gerontological nursing: A guide for advanced practice, 2nd edition. Philadelphia: W. B. Saunders, pp. 573-588. Sullivan-Marx, E. M., Strumpf, N. E., Evans, L. K., Baumgarten, M., & Maislin, G. (1999). Initiation of physical restraint in nursing home residents following restraint reduction efforts. Research in Nursing & Health, 22, 369-379. Sullivan-Marx, E. M., Strumpf, N. E., Evans, L. K., Baumgarten, M., & Maislin, G. (1999). Predictors of physical restraint use in nursing home residents following restraint reduction efforts. Journal of the American Geriatrics Society, 47, 342-348. Sullivan-Marx, E. M. (1998). Medicare reimbursement for advanced practice nurses: In the front door! Nursing Outlook, 46(1), 40-41 Sullivan-Marx, E. M., & Strumpf, N. E. (1996). Restraint-free care for acutely ill hospitalized patients. AACN: Advanced Practice in Acute and Critical Care, 7(4), 572-578. Lang, N.M., Sullivan-Marx, E.M., Jenkins, M. (1996). Advanced practice nurses and success of organized delivery systems. American Journal of Managed Care, 2(2), 129-135. Sullivan-Marx, E. M. (1996). Restraint-free care: How does a nurse decide? Journal of Gerontological Nursing, 22(9), 7-14. Sullivan-Marx, E. M., & Strumpf, N. E. (1996). Restraint-free care for acutely ill patients in the hospital. AACN: Clinical Issues: Advanced Practice in Acute and Critical Care, 7, 572-578. Sullivan-Marx, E. M. (1994). Physically restraining the elderly: Protection or victimization? Violence Update, 4(11), 3,8. Jenkins, M., & Sullivan-Marx, E. M. (1994). Nurse practitioners and community health nurses: Partnerships and future visions. Nursing Clinics of North America (29), 459-470. Sullivan-Marx, E. M. (1994). Physical and chemical restraints: Meeting the challenge. Dimensions of Critical Care Nursing, 13, 58-59. Sullivan, E. (1992). Nurse practitioners & reimbursement: Case analyses. Nursing & Health Care, 13(5), 236-241.

SELECTED LINKS

APNs Make a Difference (Neville E. Strumpf) - Nursing Spectrum Bibliography on Medicare Reimbursement for Advanced Practice Nurses (ICN) International Nurse Practitioner / Advanced Practice Nursing Network (INP/APNN) NJ Board of Nursing - Advanced Practice Nurses NURSING FACTS - Advanced Practice Nursing: A New Age in Health Care (ANA) AACN Awards Grant Monies to 23 Schools of Nursing in Support of Careers in Geriatric Nursing

To request a CONSULTATION, please contact Rebecca Snyder Phillips, MSN, RN at the Penn Nursing Consultation Service (PNCS). Send an email with your question, or call Becky at 215-898-4998. Your request can also be submitted online.