Related Experiment Video
Updated: Mar 31, 2026

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Implications of the Patient-Centered Medical Home for Nursing Practice
Kenda R Stewart1, Greg L Stewart, Michelle Lampman
1Author Affiliations: Qualitative Analyst (Dr K. R. Stewart), Associate Director of Operations (Ms Lampman), Codirector (Dr Wakefield), Core Investigator (Dr G. L. Stewart), Director (Dr Rosenthal), Investigator (Dr Solimeo), US Department of Veterans Affairs, VISN 23 Patient Aligned Care Team Demonstration Lab; Research Health Science Specialists (Ms Lampman and Drs K. R. Stewart, Solimeo, Rosenthal, and Wakefield), US Department of Veterans Affairs, Center for Comprehensive Access & Delivery Research and Evaluation; and Qualitative Analyst (Dr K. R. Stewart), US Department of Veterans Affairs, Veteran Rural Health Resource Center Central Region, Iowa City VA Health Care System; Professor (Dr G. L. Stewart), Tippie College of Business, University of Iowa; and Interim Chair and Department Executive Officer (Dr Rosenthal), Assistant Professor (Dr Solimeo), College of Medicine, Division of General Internal Medicine, University of Iowa Carver, Iowa City.
Objective:
The experiences of RNs and licensed practical nurses (LPNs) implementing a patient-centered medical home (PCMH) in the Department of Veterans Affairs (VA) primary care clinics were examined to understand model implications for nursing practice and professional identity.
Background:
National implementation of the PCMH model, called patient-aligned care teams (PACTs) in VA, emphasizes areas of nursing expertise, yet little is known about the effect of medical homes on the day-to-day work of nurses.
Methods:
As part of a formative evaluation to identify barriers and facilitators to PACT implementation, we interviewed 18 nurses implementing PACT.
Results:
Challenges to nurse's organizational and professional roles were experienced differently by RNs and LPNs in the following areas: (1) diversified modes of care and expanded clinical duties, (2) division of labor among PACT nurses, and (3) interprofessional status in the team.
Conclusions:
Healthcare managers implementing PCMH should consider its inherent cultural and practice transformations.
Related Concept Videos
Patient-centered Care
Introduction To Health Care Delivery System
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
Documentation in Long-Term and Home Healthcare Setting
Long-Term Care Facilities
Nursing Code of Ethics
Aims Of Nursing
Ethical Standards I
The Code of Ethics provisions outline the nurse's duty to the patient, the healthcare team, the profession, and society. The Code's fundamental principles include advocacy,...