Journal of the American Association of Nurse Practitioners最新文献

Background: The CHOICES intervention is tailored specifically for young adults with sickle cell disease (SCD) or sickle cell trait (SCT). The face-to-face (F2F) delivery format is feasible with efficacy for improving knowledge about reproductive health for those with SCD or SCT.

Purpose: The purpose of the study was to compare the participant adherence to a remote online CHOICES intervention study ( N = 107) and a F2F CHOICES intervention study ( N = 234).

Methodology: In both studies, participants with SCD or SCT were randomized into experimental or usual care control groups. Descriptive statistics were collected for all participants by group in both studies. Adherence was measured by retention at each data collection time point. Independent t -tests were conducted to compare mean participant adherence of the F2F and online studies postbaseline (6, 12, 18, and 24 months).

Results: There was a significant difference in mean adherence postbaseline between the studies ( p = .005). The results suggest that more research is necessary for proper online participant retention.

Conclusion: Advance practice nurses that are well informed on CHOICES can transmit the availability of this evidence-based intervention to this special population. Special referral for the CHOICES intervention, which is tailored specifically for young adults with SCD or SCT, may increase adherence to the intervention if it comes from trusted health care providers.

Implications: Nurse practitioners are educators in primary and acute care settings. Encounters with reproductive age populations with SCD or SCT can occur in both settings.

Abstract: Polypharmacy in cancer care can be complex and detrimental, particularly among younger patients, who can be easily overlooked. This report showcases a 54-year-old woman with cancer, treated for dapsone-induced methemoglobinemia with methylene blue (MB), subsequently developing serotonin syndrome (SS) due to concurrent serotonin-active medications. This case highlights the critical impact of polypharmacy, emphasizing the necessity for acute care providers to diligently assess medication interactions, especially in emergencies. It underscores the importance of considering alternative treatments and the vigilant monitoring of symptoms indicative of adverse drug interactions to ensure patient safety and optimize outcomes in complex therapeutic scenarios.

Background: Diagnostic reasoning is a complex cognitive process that requires intuitive, heuristic processing from knowledge and experience, as well as deliberate and reflective thinking. Evidence on interventions to improve diagnostic reasoning is inconsistent, in part because different terms and models are used to guide research.

Purpose: To present a model of the factors of diagnostic reasoning in Advanced Practice Registered Nurses (APRNs), based on a review of the literature supporting the Metacognitive Diagnostic Reasoning (MDR) Model © .

Methodology: A review of the literature through systematic database search, historical articles, texts, and documents was conducted from inception through August 2023 ( N = 41).

Results: The MDR model depicts the following concepts: (1) metacognition is viewed as the driving force of diagnostic reasoning; (2) dual cognitive processing and knowledge representations are used; (3) once a diagnosis, treatment plan, and evaluation are complete, APRNs use metacognition for the next patient encounter, using repetition for improvement of the process.

Conclusions: The model combines key concepts of diagnostic reasoning, providing a framework for researchers to develop and test, and faculty to teach and evaluate this complex process in learners.

Implications: The MDR model provides research opportunities to validate its usefulness and effectiveness and a framework to guide educational research, contributing to the body of evidence-based practice in nursing. In addition, it may foster ongoing education and training that could lead to more accurate diagnoses and treatment plans, ultimately improving patient care by reducing diagnostic errors.

Abstract: Research indicates that knowledge gaps and unfavorable attitudes among primary care advanced practice registered nurses (APRNs) are linked to stigma surrounding psychiatric care, affecting the management of patients experiencing mental illness. Despite standards of practice and educational guidelines set forth by professional nursing organizations to increase quality of care, challenges exist when delivering care to patients with mental health disorders. Lack of integration of mental health education throughout graduate nursing courses contributes to an underestimation of its significance and applicability within advanced practice nursing in primary care. Advancing mental health education across primary care APRN curricula promotes access to psychiatric care, reduces disparities, and enhances health outcomes in the United States. Such practices increase competence and skills for primary care APRNs in the care of patients with mental health illness. This cultivates an advanced practice nursing workforce prepared to meet the evolving needs of diverse patients across the lifespan. Primary care APRNs offer a combination of clinical knowledge, holistic approach to care, and a strong focus on patient advocacy; therefore, we feel that enhancing primary care APRNs' knowledge in mental health may lead to decreased health care costs, increased access to psychiatric care, and decreased need for emergency mental health services.

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.