Journal of the American Association of Nurse Practitioners最新文献

Abstract: Mobile health units (MHUs) in the United States have grown to over 3,000 nationwide, increasing health care access and equity to underserved communities. Although MHUs have demonstrated improved patient outcomes, there is a lack of literature on partnering with nursing colleges and their faculty. This report will share how a college of nursing and their office of faculty practice and partnerships in a large midwestern state university implemented a nurse-led MHU to deliver reproductive health care to rural communities in central Illinois, incorporating advanced practice registered nurses (APRNs) faculty and graduate nursing students. Point-of-care screening for sexually transmitted infections (STIs) was the focus due to Centers of Disease Control and Prevention reports of more than 2.5 million cases of chlamydia, gonorrhea, and syphilis threatening the health of women and babies. Central Illinois was the selected region due to high rates of poverty, teen pregnancy, crime, and incidence of STIs. With few reported MHUs in this region, there was a health care desert for reproductive care. This partnership between a college of nursing and their APRN faculty, graduate nursing students, and underserved patients offered a mutually beneficial opportunity for improved health equity and access to reproductive care.

Abstract: The white coat has become a contested symbol in nursing-a garment once exclusive to medicine that now reflects deeper tensions about professional identity, legitimacy, and visual authority. Although some nurses wear it out of practicality or institutional policy, its broader adoption risks reinforcing hierarchies that devalue nursing's distinct epistemology, which emphasizes relational, experiential, and embodied care. Drawing from critical theory, poststructuralism, and postmodernism, this essay explores how the white coat perpetuates colonial mimicry and epistemic violence by aligning nursing with a model of clinical detachment and scientific supremacy. Through both historical analysis and personal reflection, the author examines how uniform symbolism affects nurse-patient dynamics, role clarity, and self-perception. Practical counterarguments-including hygiene, patient trust, and professional image-are acknowledged and addressed. The essay ultimately advocates for context-specific attire and meaningful professional rituals, such as pinning ceremonies and value-based tokens. These alternatives better align with nursing's pluralistic philosophy and can empower nurses to define their visual and symbolic identity on their own terms. Letting go of the white coat is not a dismissal of professionalism but an invitation to reimagine it through the lens of care, justice, and authenticity.

Background: Preceptors are an integral part of nurse practitioner (NP) education; they mentor students and facilitate experiential learning in the clinical setting. Understanding factors that motivate clinicians to serve as preceptors can inform recruitment and retention of preceptors.

Purpose: To understand factors that motivate and challenge clinicians to choose to precept NP students.

Methodology: A survey was emailed to preceptors of NP students asking them to rate the importance of factors on a scale from not at all important (1) to extremely important (5) in influencing their decision to precept. Factors were categorized into five domains: university process, finance/time/productivity, recognition, certification/education, and intrinsic/other. Descriptive statistics were calculated.

Results: Seventy-three of 224 preceptors responded (33% response rate). Highly rated motivating factors included having the role of preceptor clearly defined (mean = 4.00, SD = 1.01), coworkers support (mean = 4.07, SD = 0.91), and enjoying precepting NP students (Mean = 4.32, SD = 0.72). Lowest rated motivating factors include faculty presence during site visit (Mean = 2.74, SD = 1.11), financial renumeration (M = 2.13, SD = 1.38), and receiving gifts (mean = 1.66, SD = 0.98).

Conclusion: Our findings indicate having coworkers who are supportive of their role as a preceptor, and clearly defined roles are more important than financial renumeration and faculty site visits.

Implications for practice: Building relationships with staff, administrators, and preceptors could strengthen academic-clinical partnerships resulting in an environment supportive of precepting NP students. Faculty may be able to reduce travel to clinic sites by communicating more frequently through email or telephone.

Abstract: Concurrent bronchoesophageal fistulas (BEF) and spinal-esophageal fistulas (SEF) are exceedingly rare complications of esophageal perforation, particularly in cancer patients undergoing multimodal therapies. This report describes a patient with metastatic papillary thyroid cancer who developed BEF and SEF following thyroidectomy, radiotherapy, and systemic antineoplastic therapies. Despite multiple interventions, including esophageal stenting, nutritional support, and antifungal therapy, the patient's condition deteriorated due to recurrent infections and progressive organ dysfunction. This case highlights the complex interplay between oncologic treatments and their complications, underscoring the need for early recognition, multidisciplinary management, and novel therapeutic strategies for high-risk patients.

Background: This study explored nurse practitioner (NP) recall relative to men's urology/sexual/reproductive health content in NP educational programs, which often require separate women's health content.

Purpose: This study explored practicing NPs' recall of (1) curricula content relative to men's urology/sexual/reproductive health topics and (2) specific physical examination and laboratory interpretation content relative to men's urology, sexual, and reproductive health topics.

Methodology: This exploratory study used a cross-sectional, descriptive design. A convenience sample of NPs working with adult male patients were recruited among attendees of the 2023 American Association of Nurse Practitioners (AANP) National Conference. Respondents completed a one-time, anonymous, online survey assessing recall of the amount of time dedicated to learning about various men's urologic/sexual/reproductive health issues.

Results: Ninety NPs completed the survey, averaging 9.9 ± 6.9 years in practice. 84% of participants felt that their NP program offered more content focused on women's health care needs compared with men's health content. Using a 0 (not prepared) to 10 (thoroughly prepared) Likert scale for a response to "How well do you feel your NP program prepared you to manage the specific health care needs of," the average was 4.1 for men and 6.9 for women.

Conclusions: This is the first project to quantify men's health topics as part of the NP curriculum, creating groundwork for discussion of apparent disparity in gender-specific curricula content and a potential gap in NP knowledge relative to men's urologic/sexual/reproductive health issues.

Implications: These results suggest a need for a formalized men's health curriculum to complement the women's health curriculum present in most NP programs.

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.

Abstract: Nurse practitioners demonstrate a moral soundness, unmistakable sincerity, and unquestionable character by embracing the impact of social drivers of health on patient and system outcomes. Opportunities abound to address patients' social drivers of health in clinical and leadership settings. Facilitating patients' access to care navigators and resources can improve the patient's experience and exemplifies the role of the nurse practitioner as a holistic provider.

Abstract: Alzheimer's disease (AD) is a progressive, neurodegenerative disorder that currently affects an estimated 6.9 million people in the United States. Despite the growing prevalence of AD, management of this common condition remains suboptimal. To address knowledge and practice gaps related to cognitive evaluation and Alzheimer's diagnosis and treatment, the American Association of Nurse Practitioners (NPs) developed a 1.5-contact hour NP-focused continuing education (CE) program on AD. Changes in learner knowledge, competence, and confidence were assessed with preactivity and postactivity surveys; qualitative follow-up interviews were conducted to evaluate retention of CE material and behavior changes. In total, 4,793 learners (NPs, 93.6%) who completed the activity and self-reported providing patient care were included in the outcomes analysis. In the pre-activity assessment, notable knowledge and competence deficiencies were identified related to the diagnosis, classification, and pharmacotherapeutic management of AD. The CE activity was associated with significant improvements in knowledge and competence, with a 20-percentage point increase in correct response rate from the pre-activity to post-activity survey ( p < .001). Learner confidence in their ability to perform key clinical tasks related to Alzheimer's management also improved. Twelve NPs participated in follow-up interviews; most reported that the CE activity reinforced their current practices. Despite improvements in knowledge and competence, certain knowledge gaps persisted, and learners identified several ongoing barriers to optimal management, including lack of access to specialists. Given the changing Alzheimer's landscape, ongoing educational interventions targeted to the NP workforce are needed to serve the growing population of adults at risk for AD.