Health Problems and APN Interventions in Pregnant Women with Diabetes

The purpose of this study was to compare health problems and advanced practice nursing (APN) interventions in two types of APN care provided to 41 childbearing women with diabetes. The study's design involved content analysis of interaction logs containing the process of APN care during two clinical trials: 1) APN care was added to physician care (n = 22); and, 2) half of physician care was substituted with APN care (n = 19). Women's' health problems and APN interventions were classified using the Omaha System's Problem Scheme and Intervention Scheme. The women, in the study, had a mean age of 30, and were predominantly Black, high school graduates, with a low income. The findings identified 61,004 health problems and 60,980 APN interventions from the interaction logs. APNs provided significantly more interventions antenatally to the women in the substitution group than to those in the additive group. However, the overall categories of problems were the same in both groups. Surveillance and health teaching/counseling were the top APN interventions antenatally and postpartum. Case management interventions were third most common for both groups, while treatments and procedures constituted the least number of APN interventions in each group before and after birth. When APNs shared care more equally with physicians, they intervened differently in type and number of interventions. Their broad range of skills and depth of understanding in clinical practice, health systems, family and personal issues allowed them to intervene early and effectively.