Journal of the American Association of Nurse Practitioners最新文献

Background: The world faces a mental health crisis with elevated rates of depression, anxiety, and post-traumatic stress, leaving a profound impact on daily quality of life (QOL). Current treatments show varying degrees of efficacy and carry burdensome challenges. Evidence exists for use of an innovative neurotechnology to reduce symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD), but the science is lacking for use in the general population.

Purposes: The purpose of this pilot study was to explore the effects of microcurrent neurofeedback on depression, anxiety, PTSD symptoms, and QOL in adults.

Methodology: This was a one-group, exploratory pilot study that tested outcomes of depression, anxiety, PTSD risk, suicide risk, and QOL in 20 adults using convenience sampling. IASIS microcurrent neurofeedback (I-MCN) was the intervention that was delivered twice a week for 10 weeks; data collection was baseline, 5 weeks, and 10 weeks.

Results: Depression, anxiety, PTSD risk, and QOL improved significantly by the 10th and 20th session; suicidal risk showed nonsignificant reduction. Use of a more feasible interventional procedure established a foundation for use in clinical settings for the population.

Conclusions: Using a more simpler procedure than what was used in a previous study reflected positive outcomes earlier and sustained over 10 weeks. This safe and effective technology carries rare but easily overcome adverse effects and could be an alternative to existing treatments or treatment-resistant conditions.

Implications: Advanced practice nurses can apply the evidence to reduce symptoms of depression, anxiety, and PTSD. Randomized controlled trials and testing on diverse populations are needed.

Abstract: Nurse practitioners (NPs) are well positioned to provide inclusive, person-centered care to patients who are transgender and gender diverse (TGD); however, few NPs have been trained on how to do so. This study demonstrates the longitudinal effect of an educational intervention that used readings, lecture, a patient panel, and a standardized patient encounter on NPs' and nurse practitioner students' cultural competency, knowledge, skills, and attitudes toward patients who are TGD. The study followed participants for 3 months and used the Sexual Orientation Counselor Competency Scale version 3 tool to measure changes across three data points. Significant improvements were demonstrated in cultural competency and clinical skills, with knowledge and attitude increases that did not reach significances. The findings from this study have implications for the inclusion of TGD content in graduate nursing curriculum and continuing education activities and provide educators with best practices to integrate this content into learning activities.

Background: Psychiatric-mental health nurse practitioners (PMHNPs) in the Netherlands have been allowed to perform the role of coordinating practitioner (CP) since 2018. This role is reserved for mental health care specialists who are trained and qualified at the master's degree level. Earlier studies have not addressed how PMHNPs perform that role and what mechanisms and contextual factors determine their performance. This understanding could help optimize their performance in this role and promote effective deployment of PMHNPs in mental health care.

Purpose: To understand how PMHNPs perform this role and what mechanisms and contextual factors underlie that performance.

Methodology: A multiple case study involving PMHNPs who work in various settings as CPs. Data were collected and analyzed using the realistic evaluation approach.

Results: We identified four mechanisms related to the performance of PMHNPs in the role of CP: (1) autonomous performance; (2) unique expertise; (3) accessibility, availability, and professional involvement; and (4) additional roles. The extent to which these mechanisms are present is largely determined by organizational factors, team factors, and individual factors.

Conclusions: Psychiatric-mental health nurse practitioners are seeking to identify and interpret the role of CP. This study helps to elucidate the mechanism of role performance by PMHNPs and what they should focus on to deliver effective and patient-centered mental health care.

Implications: Policymakers, health care professionals, and educators should consider the mechanisms and contextual factors to facilitate and support PMHNPs' employment and training in the role of CP.

Background: Uncontrolled blood glucose may lead to serious complications in patients with type two diabetes mellitus (T2DM). Patients may not have the support, motivation, or encouragement to adhere to the lifestyle changes necessary to control their T2DM.

Local problem: More than 75% of the primary care clinic's patients are diagnosed with T2DM, with most patients at the practice site having an average hemoglobin A1c (HbA1c) level of 8.5%. The primary care clinic did not use text messaging to disseminate diabetes self-management education and support (DSMES) as outlined in Standard 4 of the American Diabetic Association's (ADA) clinical practice guideline.

Methods: This evidence-based quality improvement project was conducted in a rural outpatient primary care clinic to determine whether implementing the ADA's 2022 National Standards for DSMES using text messaging would affect HbA1C levels among adult patients with T2DM.

Interventions: Patients were sent weekly text messages over a 12-week period. Text messages contained information promoting self-care, tips about healthy diet, exercise reminders, instructions about proper blood glucose monitoring, and reminders about medication adherence.

Results: A total of 160 patients were included. A paired-sample t-test showed a reduction in HbA1c levels after the intervention from baseline (M = 7.53, SD = 1.72) to postimplementation (M = 6.91, SD = 0.89), t (159) = 11.88, p = .001.

Conclusion: Based on the results, implementing the ADA's National Standards for DSMES Standard 4 may affect HbA1c levels in this population.

Abstract: Clinicians report experiencing bias at work. Although previous studies have characterized these experiences among trainees and clinical faculty, ours is the first to describe experiences of bias within a multidisciplinary hospital medicine group. In our study, 82.5% of surveyed nurse practitioners (NPs), physician assistants (PAs), and physicians reported experiencing gender, racial, or other forms of bias in the workplace. In addition to women reporting higher rates of gender bias and Asian/Black/Latinx/multiracial/other race respondents reporting higher rates of racial bias, half of participants reported experiencing other forms of bias related to gender expression, perceived sexual orientation, body habitus, age, accent, country of origin, or perceived socioeconomic status. Respondents infrequently addressed bias with the person expressing it. Our study expands on the existing literature about experiences of bias by studying a large, multidisciplinary, academic hospital medicine group. With the increasing inclusion of NPs and PAs in hospital medicine, understanding their experiences will enable development of tailored interventions to reduce harm from experiences of bias.

Abstract: New graduate neonatal nurse practitioners (NNPs) need more than an orientation; they need mentoring to facilitate successful role transition and enhance job satisfaction. A gap exists in the literature about mentoring participant training and launching of successful programs for NNPs. This article provides an overview of the development and evaluation of a nurse practitioner (NP) mentoring workshop before the start of a formalized mentoring program. Workshop participants attended a half-day education event with an emphasis on mentoring program expectations, mentor and mentee roles, and effective communication. After the workshop, participants completed an electronic survey to evaluate satisfaction with the teaching and areas for improvement. From January 2022 through January 2023, newly hired NPs paired with experienced NP mentors participated in this structured workshop. Twenty-eight participants in two cohorts evaluated the workshop to identify meaningful aspects of the presentations and areas for improvement. Participants reported high levels of satisfaction with the interactive components of the 4-hr workshop. An interactive mentoring workshop helps participants establish realistic expectations and mutual goals. Further study is needed to identify time- and cost-efficient strategies in the preparation of effective mentoring participants to enhance the quality of mentoring programs.

Abstract: Since 1993, when the Gold Foundation held its first White Coat Ceremony (WCC) to highlight humanism in medicine, many health professions have launched these ceremonies. In 2021, the University of Colorado College of Nursing hosted its first WCC. Postevent, a seven-question survey was sent to all faculty, staff, and student participants. The analytic question driving this program evaluation was as follows: "What is the significance of the White Coat Ceremony to APRN students?" Quantitative data from survey items were overwhelmingly positive; qualitative analysis of open-ended survey text reinforced the central WCC concept of Being/Becoming an APRN and elicited four themes: recognition, transition, symbolism, and connection. A detailed analysis of these themes is presented.

Abstract: Professional nursing standards and guidelines form the foundation for nurse practitioner curriculum. Nurse educators should understand the role these professional standards and guidelines have in the development of curriculum. Recently, nursing education has moved to a competency-based education with the release of the new American Association of Colleges of Nursing Essentials and the National Organization of Nurse Practitioner Faculties Nurse Practitioner Role Core Competencies. Competency-based curriculum allows for a common understanding of the knowledge, skills, and experiences nurse practitioner graduates require for entry to practice. Competency-based education also provides consistent and uniform expectations for novice nurse practitioners on entry to practice. With the change to a competency-based curriculum, nurse educators can review and revise curriculum through refinement of courses, student learning objectives, assignments, and evaluations. Nurse educators have a responsibility to critically analyze student assignments and evaluations to ensure competencies are met multiple times through a variety of methods. In addition, nurse educators have the opportunity to use assignments that meet multiple competencies to modernize student learning. Refinement and revision lead to enhanced student critical thinking and provide opportunities for real-world training to improve student outcomes.