Journal of the American Association of Nurse Practitioners最新文献

Abstract: Hypophosphatasia (HPP) is a rare genetic metabolic bone disorder that is underdiagnosed. Although there are many forms of this disease, based on age of onset, symptoms, and severity, HPP is characterized by low serum alkaline phosphatase levels, bone fractures, and dental complications. Diagnosis of HPP is made from clinical, laboratory, and radiologic findings. Genetic testing for an ALPL gene variant responsible for causing HPP confirms a molecular diagnosis. Distinguishing HPP from other more common bone disorders, such as osteoporosis, is important as the treatment for these diseases differs greatly. Although there is no known cure for HPP, treatment should be holistic and multidisciplinary.

Background: Despite improved survival, one in five patients with heart failure (HF) is readmitted within 30 days of discharge. Assessing fluid status is challenging, with an estimated 50% accuracy when relying on physical examination alone. Pulmonary congestion is a risk factor for readmission and can manifest weeks before symptoms occur.

Purpose: To conduct a pilot study to assess for pleural effusion with point-of-care ultrasound (POCUS) and to evaluate inferior vena cava (IVC) noncollapsibility as a marker of volume status.

Methods: A convenience sample of adults with HF (n = 21) were seen in a nurse practitioner (NP)-led postdischarge clinic within 12 days of hospitalization. The setting was a large tertiary care hospital. Inclusion criteria were patients with an HF diagnosis and Medicare insurance. The NP measured IVC diameter, assessed for collapsibility, and examined pleural cavities using a VSCAN POCUS device. Data were analyzed descriptively.

Results: Pleural effusions were identified in three (14.3%) patients with POCUS and referred for thoracentesis. Inferior vena cava was noncollapsible in 5 (23.8%) patients; each of these patients required intervention for volume overload.

Conclusions: Point-of-care ultrasound can be used by NPs to identify patients with pleural effusions who may benefit from thoracentesis. Inferior vena cava noncollapsibility may be a predictor for volume overload.

Implications: Point-of-care ultrasound equips NPs with an extra tool to effectively manage HF.

Background: Nurse practitioners with roles in specialty environments face challenges including uncertain role expectations and achieve urology expertise with on-the-job training, mentoring, and independent study. This creates a wide variety of preparation and role descriptions.

Purpose: This study employed Delphi methodology to identify essential components of the urology nurse practitioner (NP) role in Australia and New Zealand, representing an inaugural description of the role.

Methodology: This Delphi study was completed in two rounds. Participants were a nonrandom panel of experts with experience as a full-time urology NP.

Results: A definition for the urology NP in Australia and New Zealand is proposed: "The urology nurse practitioner uses critical thinking, complex decision-making, clinical reasoning, advanced assessment skills and clinical expertise, offering acute and chronic care to individuals needing urologic health care, including office-based urology procedures as appropriate. This care is provided in an environment of autonomous practice, with a basis of graduate education and relevant specialty clinical experience, and this practice can extend across health care settings and serve as a model to the wider NP profession."

Conclusions: Outpatient urology procedures were ranked highly and deemed integral to the Urology NP role. This may reflect the declining number of urologists and efforts to maintain urology access for local populations. Professional roles of the NP were given less weight by participants.

Implications: The project offers a contemporary definition of the urology NP role that can be offered to educators and other stakeholders as the role continues to evolve in Australia and New Zealand.

Background: There are approximately 872 certified nurse practitioners (NPs) in Japan as of April 2024. However, research on the results of their specific activities is still scarce.

Purpose: This study aimed to compare health care outcomes before (i.e., 2019) and after (i.e., 2021) employing NPs in cardiovascular hospitals in Japan.

Methodology: We conducted a retrospective chart review and analyzed 114 patients who underwent cardiac surgery in Hospital A and 381 patients who received pacemaker implantation/replacement in Hospital B. Hospital A hired one NP for cardiac surgery service, and Hospital B hired one NP for pacemaker device service. The NPs assisted in the surgical procedures and provided postsurgical management.

Results: In Hospital A, the median length of hospitalization and intubation were shorter in 2021 than in 2019 ( p = .02 and .01, respectively). In Hospital B, medical fee reimbursement was lower in 2021 ( p < .001) than in 2019, and the median procedure duration was shorter ( p = .01), which remained statistically significant after controlling for age, comorbidities, and device types. Some outcomes improved following the employment of NPs, whereas others remained unchanged.

Conclusions: Nurse practitioners managed surgical patients well and contributed to the quality care of cardiovascular medicine.

Implications: The employment of NPs in Japan is encouraged because even a single NP can have a positive, although not large, impact on patients and organizations.

Background: Among Asian Americans, Filipino Americans (FAs)-who constitute the fourth largest US immigrant group and who fill in health care workforce shortages-experience high prevalence but low control rates of high blood pressure (HBP). Research reveals that patients' illness perceptions, their common-sense model (CSM) of the illness, influence treatment behaviors, and management outcomes. However, scarce information exists about FAs' perceptions about HBP.

Purpose: To address this gap, we conducted a cross-sectional study to (a) identify the illness perceptions of hypertensive FAs, (b) classify these perceptions into clusters, and (c) determine the association between illness perceptions and BP control.

Methodology: The responses of 248 FAs with HBP to the Brief Illness Perception Questionnaire were analyzed using JMP Pro version 17 to discover their CSMs or illness perceptions. We used iterative K means cluster analysis to classify variations in CSMs and analysis of means chart to determine the association of illness perceptions and BP control.

Results: Hypertensive FAs expressed threatening (negative) views of HBP through their emotional perceptions of the illness and its chronic time line, whereas their positive views centered on their cognitive beliefs about understanding HBP and its controllability. Based on the biomedical model of HBP, the overall illness perceptions or CSMs encompassed three clusters. Generally, threatening illness perceptions were associated with stage 2 HBP.

Conclusions/implications: The findings underscore the need for nurse practitioners to elicit, listen, discern, and understand the illness perceptions or CSMs of hypertensive FAs to improve BP treatment and control with scientifically and culturally tailored interventions.

Background: Fragility fractures have significant sequelae, including pain, loss of mobility, and increased risk of mortality. Fracture liaison services (FLS) represent a coordinated, interdisciplinary approach to secondary prevention and reduce mortality.

Purpose: To investigate the effectiveness and patient outcomes regarding readmission and mortality of a newly developed, nurse practitioner (NP) coordinated FLS in Chile.

Methodology: Retrospective longitudinal analysis of 214 patients who agreed to participate in a FLS was conducted. Variables studied include patient age, gender, anatomical fracture site, dual x-ray absorptiometry scans, medication, readmission information, and mortality. Demographics and clinical data were collected and analyzed with bivariate and multivariate statistics. Kaplan-Meier curves and log-rank tests were performed to compare survival curves between those who did and did not participate in the FLS.

Results: The study sample was predominantly female (85%) with a mean age of 76 (SD: 12; range 41-101) years. The most frequently noted fracture sites were hip (n = 167), wrist (n = 132), and spine (n = 72). At one-year follow-up, the FLS group had a significantly lower mortality (5%, 10 patients) than those who did not participate in the program (12% [N = 50], p = .005). The Kaplan-Meier analysis indicated that patients who participated in the FLS had significantly better survival rates than those who did not participate.

Conclusions: Significantly improved survival rates were observed in FLS patients. Chile's first FLS demonstrated improved patient outcomes, specifically a reduced mortality in patients who were enrolled in the FLS.

Implications: The NP role was fundamental in the screening, diagnosis, and treatment of patients with osteoporosis.

Background: Guatemala, a country with high rates of pediatric malnutrition, has significant challenges including food and potable water insecurity and a lack of health care providers.

Purpose: This study examined the impact of telehealth clinic attendance on pediatric malnutrition scores.

Methodology: A sample of 42 Guatemalan children aged 6-59 months with malnutrition were recruited to participate in eight clinic events, including two in-person and six telehealth clinics. Six telehealth clinics were held at 4- to 6-week intervals, bookended by an initial and concluding in-person event. Nonparametric tests were used to analyze changes between baseline and last visit z-scores for height, weight for length, mid-upper arm circumference (MUAC), and body mass index (BMI) and to examine the relationship between the number of telehealth visits and z-score measurements at baseline and last visit.

Results: The number of children with severe malnutrition at baseline by weight for length, BMI, and MUAC decreased by the last visit. A decrease occurred in the number of children with stunted height. Changes in z-scores for height, weight for length, BMI, and MUAC between study onset and last visit did not reach statistical significance. Statistically significant relationships existed between clinic attendance and baseline and last visit weight for height/length z-scores and baseline MUAC z-scores.

Conclusions: Positive improvements in nutritional status occurred, especially among children with severe malnutrition. Children with severe malnutrition had significantly better telehealth attendance.

Implications: Studies with larger sample sizes are needed. Study results indicate that telehealth may be a tool to battle global pediatric malnutrition.

Abstract: This article highlights the essential role of reflexivity in research, using a qualitative project involving interviews with nurse practitioners during the COVID-19 pandemic as an example. It discusses the potential biases inherent in research, particularly when the researcher's experiences closely align with those of the participants. Drawing on the perspective of a nurse practitioner engaged in both research and health care provision, this article explores the importance of reflexivity in addressing these biases. Examining the lead author's experiences conducting interviews with fellow nurse practitioners, the article illustrates how reflexivity was used, particularly in data collection and analysis, to enhance transparency and minimize subjectivity. By advocating for the integration of reflexivity in qualitative research, this article emphasizes the significance of shared experiences between nurse practitioner researchers and participants in reducing biases and improving research outcomes. It demonstrates how reflexivity contributes to a more authentic and comprehensive methodology, especially when researchers share similar experiences with participants. Furthermore, this article offers practical suggestions to assist nurse practitioners in enhancing reflexivity throughout the research process, thereby contributing to ongoing discussion and strategy development in the field.