Journal of the American Association of Nurse Practitioners最新文献

Background: Increasing patient demand and clinician burnout in rheumatology practices have highlighted the need for more efficient models of care (MOC). Interprofessional collaboration is essential for improving patient outcomes and clinician satisfaction.

Local problem: Our current MOC lacks standardization and formal integration of Nurse Practitioners (NPs) and Physician Assistants (PAs), resulting in reduced clinician satisfaction and limited patient access. To optimize care quality, clinician satisfaction, and patient access, we sought to develop an interprofessional MOC tailored to an academic rheumatology practice.

Methods: We used a mixed methods sequential-exploratory design within a quality improvement (QI) framework to create a blueprint for MOC redesign.

Intervention: Intervention development proceeded in four phases: needs assessment, data collection, socializing key ideas, and team design and planning.

Results: In the needs assessment phase, divisional leadership was interviewed to identify shared goals for an optimized MOC. Data collection included surveys distributed to 12 physicians and 8 NPs/PAs, addressing 11 key domains related to current and future MOC needs. In phase 3, we communicated key findings to divisional leadership, clinicians, and staff. Phase 4 involved iterative team building and MOC design. Survey results revealed low satisfaction with the current MOC and a strong preference for parallel practice, standardization, and formal NP/Physician Assistant integration. Several barriers to MOC implementation were also identified.

Conclusion: Redesigning the MOC in rheumatology requires aligning clinician, leadership, and organizational priorities. A mixed methods QI approach effectively uncovers clinical needs and potential barriers, supporting the successful implementation of a new MOC.

Background: Clinician turnover is costly for health care organizations.

Local problem: A retention strategy for newly hired nurse practitioners (NPs) and physician associates (PAs) was needed at our organization.

Methods: A quality improvement project was conducted to determine whether a mentorship program could improve retention and employment experiences of newly hired NPs and PAs.

Interventions: A one-to-one mentorship program was implemented for newly hired NPs and PAs. (a) Retention and productivity data were compared for mentee participants vs. nonparticipants. (b) Mentee and mentor participants completed two program evaluation surveys to examine the program's impact on their employment experiences.

Results: Sixty-eight mentee-mentor pairs completed their mentoring relationship during the first 3 years of the program. Retention was higher among mentee participants vs. nonparticipants during their first (96% vs. 85%, p = .0332) and second year of employment (83% vs. 65%, p = .0480). Productivity during the first year was similar for mentee participants and nonparticipants (38th percentile vs. 37th percentile, p = .84). Most participants (≥69%) believed the program improved onboarding, personal and professional growth, work environment, and NP and PA community connection.

Conclusions: The mentorship program improved first- and second-year retention of newly hired NPs and PAs and employment experiences of program participants. By our estimates, the program helped retain 15 NPs and PAs who would have otherwise left the organization, yielding potential organizational savings of $1.29M-$1.72M. A mentorship program can be an effective retention strategy for reducing health care turnover and related costs.

Background: Individuals adopting health promotion behaviors benefit from improved health and reduced risk of chronic diseases. Patient engagement and a strong provider-patient partnership may play a role in health promotion.

Purpose: This study examined the relationships between patient engagement, the nurse practitioner-patient partnership and health promotion behaviors among adults in a primary care setting.

Methodology: A descriptive correlational study using convenience sampling to recruit 85 participants from a nurse practitioner primary care practice. Participants completed questionnaires measuring health promotion behaviors (Health Promoting Lifestyle Profile II), the quality of the nurse practitioner-patient partnership (Patient Reactions Assessment), and a person's capacity to engage in their health care (Person Engagement Index).

Results: Moderate to strong correlations were found among the main study variables. Multiple regression analysis found a person's capacity to engage in health care significantly predicted health promotion behaviors ( R2 = 0.362, p < .001) and explained 36.2% of the variance in health promotion behaviors.

Conclusions: Patient engagement is a significant predictor of health promotion behaviors. The interactive care model can serve as a framework for nurse practitioners to build partnerships and facilitate patient engagement. Nurse practitioners can serve as a coach, navigator, collaborator, and trusted health care partner with their patients.

Implications: Nurse practitioners in primary care may need to restructure the health care encounter to allow for adequate time to communicate, listen, educate, and enlist patients in the shared decision-making process. Nurse practitioners can provide the support patients need to engage in their health care as they accept greater responsibility for their health.

Background: With the expansion of professional autonomy and prescriptive authority of advanced practice registered nurses (APRNs), interactions with industry are under greater scrutiny. As of July 1, 2021, pharmaceutical and medical device companies must publicly report all payments to APRNs through the Centers for Medicare and Medicaid Services' Open Payments website.

Purpose: To gauge APRNs' familiarity with, and perceptions of the Open Payments database and discuss whether and how APRNs should respond.

Methodology: Virtual workshops consisting of a didactic presentation and interactive exercises with APRNs recruited through professional networks, associations, and conferences. Transcripts were analyzed using a qualitative interpretive approach, grounded in an everyday ethics theoretical framework.

Results: Thirty-six APRN clinicians, students, and faculty participated in nine workshops. Seeing sponsored meals reported in Open Payments as "payments" prompted participants to see familiar interactions in a new way. Participants valued the enhanced transparency as a way to identify risks of bias but were concerned that reporting might undermine public trust in APRNs. Emphasizing awareness as a precursor to action, participants desired greater preparation for ensuring independence in practice.

Conclusions: The importance of tackling the ethical issues associated with industry interactions is heightened within the context of an existing climate of distrust within health care. However, many participants were concerned about the effects of transparency on public trust rather than how APRNs individually or collectively can be more trustworthy.

Implications: Open Payments can serve as a useful tool to catalyze broader conversations about ethics, integrity in decision making, and health policy advocacy.

Abstract: There is a wide variation in the curricular emphasis and implementation nationally across programs for teaching quality improvement (QI) in family nurse practitioner (FNP) programs. This variation among curriculum plans often leaves NP graduates unsure as to how to identify and effect change within their organizations. This manuscript describes the development of an initial QI curriculum and subsequent enhancements over a 3-year time frame and outlines the curriculum development process, implementation, and program outcomes within an FNP residency program. This report also focuses on the importance of reinforcing the role of QI within the personal identity of the FNP, ensuring quality care to patients.

Background: Obesity is a chronic, complex, relapsing disease requiring medical intervention that has reached epidemic proportions globally. Most patients are still experiencing bias and stigma related to their disease-even by health care providers. Our goal in this pilot study is twofold: to develop a scale to accurately measure nurse practitioner knowledge and attitude regarding the disease of obesity to determine whether bias exists and to potentially identify gaps in knowledge that can be targeted with future educational interventions.

Purpose: To determine whether nurse practitioners in the Northeast have less stigmatized knowledge and attitudes regarding obesity.

Methodology: A survey was created by the primary investigator as the "Nurse Practitioner Knowledge and Attitudes of Patient Obesity Scale" and distributed through email to New York State Nurse Practitioner Association members. Questions explored knowledge related to treatment of the patient living with obesity and nurse practitioner attitudes toward the disease.

Results: The sample ( N = 45) was homogenous, which did not allow for generalization. Preliminary results show that a large percentage of respondents were aware of the definition of obesity as a disease and treatment guidelines. The scale met reliability and validity criteria and showed that Nurse Practitioners (NPs) with continuing education had more positive views.

Conclusions: More research is needed to understand nurse practitioner knowledge and attitudes regarding the disease of obesity and the benefit of continuing education in reducing bias and stigma.

Implications: This may serve to improve NP obesity continuing education.

Abstract: Puberty is a particularly vulnerable time for individuals with autism spectrum disorder (ASD) during which baseline challenges are exacerbated, functioning often deteriorates, and additional barriers emerge. Specific concerns include increased vulnerability, decreased safety, and increased mood and behavioral disturbances. Youth with ASD need guidance and explicit instruction/skill development on topics such as hygiene/self-care, appropriate sexual activity, and menstruation management. Lack of provider preparation, knowledge, and confidence, along with stigma about the needs and capabilities of individuals with ASD, are major barriers to care. Initiatives to expand the preparation of health care personnel, including nurse practitioners, to provide quality care to individuals with ASD are essential. This article describes the results of a pilot project using a brief, self-guided educational intervention for developing and practicing family nurse practitioners. Before and after viewing the educational module, participants completed author-created surveys assessing their self-perceived knowledge, attitudes, and intent to change practice. Expert analysis of survey items provided face validity. Comparison of mean presurvey and postsurvey responses showed significant increases in self-perceived knowledge, attitudes, and intent to implement practice changes. Lack of confidence was endorsed as the most common remaining barrier to change. Findings indicate that the brief module improved participants' self-reported knowledge, attitudes, and intent to implement practice recommendations. Such interventions can be easily incorporated into nursing education and professional development and are appropriate for dissemination to nurse practitioners working within and outside primary care settings, as well as to related service providers.

Abstract: Peer review is a time-honored cornerstone of publishing. Peer reviewers, often blinded to the author, provide feedback to clarify the manuscript and validate the key messages and sciences. Authors may openly accept the feedback outright and make revisions. Authors may also view the feedback as intrusive and ill-mannered. Authors must revise the document promptly and consider each comment for merit. Tips for handling feedback are reviewed.

Abstract: This case report presents a 34-year-old Middle Eastern woman with atypical symptoms of Type II Necrotizing Soft Tissue Infection (NSTI). Due to the difficulty in diagnosing Type II NSTI, the patient experienced protracted illness. Once diagnosed, the patient underwent multiple surgical debridement procedures requiring antibiotic and pain management therapy before being successfully discharged home. Initial diagnosis of Type II NSTI is challenging to the provider due to vague symptoms and late occurrence of cutaneous changes. When cutaneous lesions are identified, rapid surgical evaluation is imperative to minimize morbidity and mortality. This paper emphasizes the complexity of diagnosing Type II NSTI and the need for a comprehensive history and frequent physical examinations.