Journal of the American Association of Nurse Practitioners最新文献

Abstract: Inherited thrombophilias are genetic conditions that increase the lifetime risk of venous thromboembolism (VTE), specifically deep vein thromboembolism and pulmonary embolism. However, most people with thrombophilia never develop a VTE. The five classic inherited thrombophilias, such as Factor V Leiden, prothrombin G20210A mutation, protein C deficiency, protein S deficiency, and antithrombin deficiency, differ in prevalence and VTE risk, influenced by factors such as zygosity and coinheritance. Current clinical guidelines discourage universal thrombophilia testing, recommending it only when a positive result would alter patient-management decisions or where family members might benefit. These recommendations are based on low-certainty evidence due to the lack of high-quality outcome data. Conflicting guidance is common, and questions remain about some clinical scenarios clinicians encounter in practice. Two national guidelines from the American Hematology Association and the American College of Obstetricians and Gynecologists illustrate thrombophilia testing considerations. Advanced practice nurses play a central role in providing individualized risk assessment, working collaboratively with others to guide testing decisions and interpretation of results, and coordinating care. When used selectively, thrombophilia testing can enhance VTE prevention while avoiding unnecessary and expensive screening.

Background: Stroke is a major global health issue, causing significant morbidity, mortality, and economic burden. Approximately 11% of individuals experience a recurrence within a year of their initial stroke, resulting in substantial disability and increased health care costs. Secondary stroke prevention is essential in reducing the risk of recurrent strokes and improving patient outcomes, but adherence to prevention guidelines remains inconsistent.

Purpose: This integrative review evaluates adherence to the American Heart Association/American Stroke Association (AHA/ASA) guidelines for secondary stroke prevention across various clinical settings. It identifies gaps in adherence, assesses the impact on patient outcomes, and provides insights for improving guideline implementation.

Methodology: A comprehensive literature search was conducted across databases including PubMed, CINAHL, Ovid, and Embase. This integrative review used 5-stage framework of Whittemore and Knafl to synthesize findings from quantitative and qualitative research studies on using the guidelines in reducing recurrent stroke. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist served as the reporting guideline.

Results: Twenty studies from 2019 to 2020 met inclusion criteria, showing substantial variability in adherence to secondary stroke prevention guidelines. Key findings include a significant proportion of patients not receiving optimal therapies, varying adherence rates across settings, and notable gaps in recommended practice implementation.

Conclusions: Adherence to AHA/ASA guidelines for secondary stroke prevention is inconsistent, with several barriers affecting optimal implementation. Addressing these gaps is important in reducing recurrent stroke rates.

Implications: Health care providers must stay updated on AHA/ASA guidelines and integrate them into practice to ensure optimal outcomes.

Abstract: Abstracts are critical components of scientific communication and conference planning. The digital age, through general search and academic search engines, has influenced the ability to locate and retrieve information. With such transformation, abstracts should be considered a marketing tool for manuscripts or presentations. Strategic forethought of keywords and synonyms will aid discoverability and help authors develop a legacy.

Abstract: Doctor of Nursing (DNP) scholarly projects serve as an educational capstone to the practice doctorate in nursing. These projects have the potential to address systems-level challenges, inform organizational inquiries, create solutions, and pilot emerging processes in care. However, poor alignment between the expectations of educational programs and the resources, needs, and priority initiatives of health care systems diminish the DNP scholarly project potential. Academic practice partnerships have shown to be a potential solution. School of Nursing (SON) faculty at a Midwestern university partnered with health care system leaders to collaboratively develop a structured partnership to optimize DNP student scholarly project design, impact, sustainability, efficiency, and dissemination of findings. The partnership included mutual contributions and resulted in high-quality, rigorous, system-level DNP projects that were finished on time, demonstrated sustainability, had decreased resource utilization, and were in alignment with the health care system and SON's initiatives and goals. The process was well received by the DNP students and has fostered the increase of group and legacy DNP projects. Ultimately, the partnership and structured DNP project implementation plan resulted in a mutually beneficial solution for both the SON and health care system.

Background: This study explored the lived experience of moral distress among intensive care unit (ICU) nurse practitioners (NPs). Although ICU NPs were interviewed, many reflected on their prior experience as registered nurses (RNs) to describe the differences in responsibility, authority, and moral burden in their advanced practice role.

Purpose: This study aimed to describe the lived experience of moral distress in ICU NPs, specifically emphasizing its effect on their professional and personal lives.

Methodology: The researcher used a descriptive phenomenological study design to examine moral distress among the ICU NP population. Employing purposive sampling, the researcher conducted one-on-one interviews with 17 ICU NPs to explore moral distress, identify themes, and provide thematic analyses using the Colaizzi method.

Results: The overarching theme, A Unique NP Experience, captured how moral distress was shaped by the dual expectations of advanced clinical decision making and constrained authority in hierarchical care settings. Three themes supported this experience: moral distress causes, negative emotional and psychological effects, and participants' reflective interpretations. Moral distress was described as distinct from that experienced in RN roles, often surfacing during ethically complex ICU cases such as end-of-life decisions.

Conclusion: This research aimed to catalyze a thoughtful conversation regarding moral distress as experienced by NPs and to promote interventions that mitigate moral distress and its negative effects.

Implications: The findings hope to encourage further moral distress research in NPs of all specialties, as well as to examine the perceived hierarchy that exists in the acute care setting.

Background: The ever-changing health care landscape and emerging disease threats in recent years have significantly strained the global health care system. Nurse practitioners (NPs) face greater challenges at work today than ever. However, over time, poor working conditions affect NPs' coping mechanisms, organizational cohesion, and ability to maintain control over their professional and personal lives.

Purpose: To explore the relationships between organizational commitment, coping, and resilience among Taiwanese NPs and assess the mediating role of coping.

Methodology: Cross-sectional design, convenience sampling. We conducted an online questionnaire survey and recruited 610 Taiwanese NPs. The survey featured questions about organizational commitment, coping, and resilience.

Results: Taiwanese NPs exhibited moderate to high resilience and organizational commitment levels. The most commonly reported coping strategy was emotional adjustment. Organizational commitment and coping were found to be important predictors of resilience. The overall regression prediction model exhibits 28% exploratory power. The final mediation model confirms that coping, directly and indirectly, influenced resilience while partially mediating the influence of organizational commitment on resilience.

Conclusions: Taiwanese NPs should cultivate awareness of positive behaviors and emotion-focused coping strategies. Strengthening coping abilities and organizational commitment can enhance their resilience in recovering from major incidents.

Implications: To reduce the lasting psychological impact of unexpected workplace stressors on NPs, hospital administrators should prioritize their awareness and utilization of positive and negative coping strategies. Developing a supportive working environment based on organizational cohesion, reinforcing positive coping behaviors, and enhancing resilience can further strengthen their ability to recover from adversity.

Abstract: Lung cancer remains the leading cause of cancer-related mortality in the United States, yet profound advances in screening, diagnosis, treatment, and survivorship have redefined what is possible for patients. Despite this progress, nihilism, fatalism, and stigma continue to shape public and professional perceptions, discouraging screening and delaying help-seeking. Nurse practitioners occupy a central and trusted position across the lung cancer continuum and are uniquely equipped to counter these barriers through compassionate, stigma-informed communication. This perspective article synthesizes current evidence to illuminate how nurse practitioners can translate empathy, equity, and behavioral science into tangible practice actions that reduce stigma and nihilism and instill compassion and hope. Key strengths-language, empathy, tobacco treatment integration, social context awareness, community engagement, and hope-form the "Permission to Hope" framework. By leveraging these strengths, nurse practitioners can transform everyday interactions into opportunities to rebuild trust, improve screening participation, and redefine what survivorship means in lung cancer care.

Background: Haitians frequently encounter barriers during screening for depression. This quality-improvement project evaluated the effectiveness of depression screening tools specifically adapted for Haitian Creole-speaking populations.

Local problem: The English version of the Patient Health Questionnaire-9 (PHQ-9), widely used to screen for depressive symptoms, may not accurately assess depression due to cultural and linguistic nuances.

Methods: The plan-do-study-act method was used to evaluate the effectiveness of the culturally adapted Haitian Creole PHQ-9 and Zanmi Lasante Depression Symptom Inventory (ZLDSI) in comparison to the English PHQ-9 among 50 Haitian adults who had completed the English PHQ-9 six months before implementing this quality-improvement project.

Interventions: The Haitian Creole PHQ-9 and ZLDSI were administered over 3 months during routine clinic visits to screen Haitians for depression. Patients who met diagnostic criteria for depression were identified and referred for further mental health services.

Results: Diagnostic accuracy was comparable across the three tools: 6% scored mild-to-moderate depression on the English PHQ-9 and the ZLDSI, whereas 10% did so on the Haitian Creole PHQ-9 and were referred to mental health services. The Haitian Creole PHQ-9 and ZLDSI were more sensitive in detecting culturally nuanced symptoms, flagging near-threshold cases at higher risk of depression. Internal consistency reliability was 0.905 for the ZLDSI, 0.798 for the Haitian Creole PHQ-9, and 0.710 for the English PHQ-9.

Conclusions: Nurse practitioners should use culturally and linguistically responsive screening tools for Haitian immigrants to better capture depressive symptoms, identify those at risk, bridge the diagnostic gap, and ensure appropriate referrals.

Background: Phenylketonuria is a rare inherited metabolic disease associated with cognitive and psychological complications. Despite global recommendations for routine mental health screening, implementation in metabolic care settings remains inconsistent. Screening barriers include time constraints, reimbursement concerns, and infrastructure for follow-up care.

Local problem: Mental health conditions often go undiagnosed by phenylketonuria clinical teams; the staff of a United States metabolic disorder clinic lacked a formal screening process to identify depression and anxiety in this high-risk population.

Methods: Following a structured quality-improvement framework, the nurse practitioner-led project team created a clinical pathway and toolkit for using validated depression and anxiety screening tools. Staff received training on these resources, and data collection occurred during 2024 through surveys and electronic medical records.

Interventions: The training outlined all toolbox elements and the clinical pathway, including when and how to perform screening, interpret results, and referral systems for mental health services. Implementation included identifying eligible patients, following new clinical workflows, and evaluating project outcomes.

Results: Staff (n = 19) knowledge, confidence, and screening practices improved, with most eligible individuals receiving screening. The project facilitated earlier recognition of mental health concerns, although some barriers to implementation remained.

Conclusions: Implementing a structured screening process was feasible and enhanced clinical practice. The project highlights the role of nursing leadership and clinical expertise in advancing access to mental health care and integrating screening into routine diagnostic services for adolescents with metabolic disease.