Journal of the American Association of Nurse Practitioners最新文献

Abstract: Patients with opioid use disorder (OUD) represent a complex population that benefits from interprofessional care. Educating future providers of medications for OUD (MOUD) regarding the benefits of interprofessional care provides an opportunity to improve patient outcomes. We describe the delivery and impact of a 3.5-hour interprofessional education (IPE) OUD case-based workshop for nurse practitioner (NP), physician assistant, medical, and social work students related to MOUD knowledge, confidence in treating OUD, and attitude toward MOUD. In 2024, 231 students from four disciplines attended the workshop, with 170 completing pre- and postsurveys (73.6% response rate) of knowledge, confidence, and attitudes toward OUD. Paired sample t -tests and Wilcoxon signed-rank tests (with adjusted p values) showed significant improvements in all measured domains. Free-response feedback was positive, with requests to broaden participation to include pharmacy students and persons in recovery. Findings indicate that students benefit from IPE workshop delivery, leading to improvements in their role on IPE teams and increased confidence treating OUD. This study underscores the critical role of NP students in interprofessional learning environments, particularly in treating complex conditions such as OUD. Early IPE prepares NP students to lead and thrive in real-world settings, where teamwork is essential in delivering high-quality care for OUD patients.

Abstract: The growing number of Doctor of Nursing Practice graduates providing direct clinical care has reignited public and professional debate about the use of the title "Doctor." Although based on academic achievement, the title can unintentionally create confusion among patients and team members regarding provider roles and responsibilities. This commentary reexamines this issue in the context of doctorally prepared health care professionals who, through their education, training, and licensure, provide direct patient care. Recognizing that it truly "takes a village" to deliver the highest quality health care to society, health care professionals and educators can collaboratively turn this potential conflict into an opportunity to promote interprofessional learning and foster greater professional respect.

Abstract: The geriatric nurse practitioner role was sanctioned in Israel over a decade ago to improve care for the aging population and address provider shortages. Key health system actors have expressed concern whether the current education program adequately prepares geriatric nurse practitioners for practice. As a result of these concerns, geriatric nurse practitioners often lack confidence, and colleagues resist working with and employing them. To address these issues, research documenting perspectives toward the program and its strengths and weaknesses should be conducted. Such research can produce recommendations for education program improvement and, if implemented, assuage concerns. This study aimed to identify and describe components of the geriatric nurse practitioner education program affecting perceptions toward readiness for practice in Israel. This qualitative, descriptive study included multiple perspective interviews among four groups-geriatric nurse practitioners, physicians, managers, and education regulators. A semistructured interview guide was used. Inductive content analysis was applied to identify program components affecting perceptions toward practice readiness. Valence and strength ratings were used to determine the extent of impact. Overarching factor categories included selectivity, program structure, clinical education, didactic/simulation learning, individual skill set adaptability, and postgraduation training. Strengths included evaluation of learning abilities, requiring nursing experience for admission, and mentorship. Weaknesses included critical thinking development, physical examination skills, building confidence, and postlicensure education. Results suggest a need for more robust admissions screenings and longer education programs focusing on physical assessment skills. Contrary to international norms, the education program does not need to confer graduate degrees in university-based programs, as long as they are rigorous.

Background: It is important for nurse practitioners (NPs) who take care of older adults to understand and assess patient social determinants of health (SDOH) due to this population's growth and unique physical and social concerns.

Purpose: The aims of this study were to explore NP student identification, assessment, incorporation, and comfort level using SDOH while caring for geriatric patients.

Methodology: Graduate NP students in a clinical setting with geriatric patients were recruited to complete a five-item survey: The NP SDOH Plan of Care Survey, which assessed their knowledge and familiarity of the SDOH, incorporation of SDOH, and comfort level discussing SDOH in their interactions with older adults.

Results: Sixty-eight eligible family NPs and adult-gerontology primary care NPs students completed the survey. They most frequently and most comfortably incorporated the SDOH of social support, access to care, and transportation into their plan of care with geriatric patients in primary care settings.

Conclusions: Knowledge of SDOH and comfort with SDOH are related to the likelihood of NP students assessing SDOH and incorporating them into the patient plan of care.

Implications: Continued focus and emphasis on incorporating SDOH in NP programs may increase the comfort of NP students, as well as proficiency in assessment and adjustments in care with identified health-related social needs to improve the health of geriatric patients.

Background: Given their emphasis on holistic, patient-centered care, nurse practitioners (NPs) and physician assistants (PAs) play an increasingly critical role in the care of patients with gastrointestinal conditions, including irritable bowel syndrome (IBS).

Objectives: To review key clinical considerations for the diagnosis and management of IBS, focusing on IBS with diarrhea (IBS-D), alongside 2 case presentations.

Data sources: PubMed and Google Scholar searches of English-language articles published between January 1, 2009, and April 2, 2025, were conducted to identify publications on the burden, diagnosis, and treatment of IBS-D.

Results: Data indicate that IBS-D impairs quality of life, daily activities, and work productivity and imposes a substantial socioeconomic burden. A positive diagnostic approach involving a detailed medical history and physical examination, with limited laboratory testing in the absence of alarm features, is recommended to facilitate timely and accurate diagnosis. Effective ongoing management relies on a patient-provider relationship that uses shared decision making, patient education and empowerment, and a personalized treatment strategy targeting the IBS subtype and most bothersome symptoms. Treatments considered for IBS-D include dietary management, over-the-counter agents, United States Food and Drug Administration-approved medications, neuromodulators, and gut-brain behavioral therapies.

Conclusions: Positive diagnosis of IBS-D and an evidence-based, symptom-targeted therapeutic approach are recommended to minimize disease burden.

Implications for practice: Both NPs and PAs are well positioned to provide individualized, compassionate, and competent care to patients with IBS-D. Communicating a confident, positive diagnosis and collaborating on a treatment plan that considers symptom presentation and most bothersome symptoms can improve patient outcomes.

Background: A mass shooting incident (MSI) occurs where four or more people are shot and injured or killed. Mass shooting incidents have increased in frequency since the 1960s with 2,700 injured and 600 individuals killed in 2022. Advanced Practice Registered Nurses (APRNs) and Physician Associates (PAs) are front-line caregivers, who may engage with victims, their families, perpetrators, and potential perpetrators. Advanced Practice Registered Nurses and PAs provide care to these people across care settings.

Objective: Identify the pertinent literature describing the roles, responsibilities, and skills that APRNs and PAs must possess surrounding MSIs.

Data source: An integrative review was completed using Covidence. Search engines included Ovid Medline, Ovid Emcare, PsycInfo (Ovid), CINAHL (EBSCO), Scopus (Elsevier), and Cochrane Central Register of Controlled Trials (Wiley). Two team members independently reviewed each citation, and a third member resolved conflicts.

Conclusions: Eleven studies met inclusion criteria. Four phases of the Federal Emergency Management Agency framework (Prevention, Preparedness, Response, Recovery) were represented, and, in some studies, more than one phase was discussed. The review showed strong support for APRN and PA roles in prevention and preparedness of an MSI, and less support surrounding the response and recovery phases of an MSI. Additional research is needed to further define the distinct role that APRNs and PAs can have encompassing MSIs.

Implications for practice: Advanced Practice Registered Nurses and PAs possess the skills to intervene in prevention, preparedness, response, and recovery surrounding an MSI. Although some evidence exists to define the role APRNs and PAs can assume, the focus was primarily on prevention with screening for access to firearms and safe storage.

Background: Continuous glucose monitoring (CGM) has been associated with improved glycemic control in individuals with non-insulin-treated type 2 diabetes (T2D), but adoption in endocrinology clinics remains limited.

Local problem: This quality improvement (QI) project aimed to explore the use of CGM for non-insulin-treated patients with T2D within an endocrinology clinic in Los Angeles County and to evaluate feasibility of its adoption in this practice setting.

Methods: It was a retrospective chart review.

Interventions: Eligible patients were adults (≥18 years) with T2D and hemoglobin A1c (HbA1c) >7% who had not been treated with insulin. Ten patients met inclusion criteria. Descriptive statistics summarized HbA1c and time-in-range (TIR) over 6 months. An interrupted time series was also conducted on two patients with sufficient longitudinal data to assess HbA1c changes before and after CGM use.

Results: After 6 months of initial CGM use, 8 of 9 patients achieved HbA1c reductions of ≥0.3%. One patient demonstrated a ≥8% increase in TIR with adequate device use. Interrupted time series analyses illustrated individual HbA1c trajectories, showing immediate reductions after CGM initiation and nonsignificant downward trends over time.

Conclusion: This QI project showed that patients with T2D treated with noninsulin medications successfully initiated and used CGM. Early improvements in HbA1c were observed; however, sustained glycemic outcomes varied depending on consistent CGM wear and adherence to follow-up, underscoring the need for individualized support. Nurse practitioners can play a key role in promoting sustained CGM use through structured diabetes education, integration of CGM data into lifestyle counseling, and regular follow-up.

Background: Nurse practitioners (NPs) are a rapidly growing segment of the US health care workforce and are increasingly integral to patient care in hospital settings. Despite their expanding roles, little is known about the work environment factors that affect their well-being in hospital settings.

Purpose: To examine the factors that influence hospital-based NPs' work environments and identify strategies to enhance their well-being and support retention.

Methodology: This qualitative descriptive study used directed content analysis to examine responses from 493 NPs across 264 hospitals in 10 US states with varying scope-of-practice laws to three open-text survey questions regarding their workplace experiences and work environment, drawn from the 2024 Penn Nurses4All Study. To identify factors influencing healthy work environments, themes were developed using both inductive and deductive analytic approaches, guided by the American Association of Critical-Care Nurses' Healthy Work Environment (HWE) framework.

Results: Six emergent themes related to factors that influence NPs' work environments included the following: (1) structural barriers to effective communication; (2) workplace incivility and lack of inclusion; (3) limited clinical autonomy and organizational influence; (4) misalignment between NP roles and staffing demands; (5) invisibility and devaluation of NP contributions; and (6) leadership gaps in supporting NP practice and well-being.

Conclusions: Hospital-based NPs face unique barriers to a HWE that affect their well-being and hinder optimal practice.

Implications: Implementing NP-informed strategies can foster supportive work environments that enhance NP well-being, retention, and the quality of patient care.