Journal of the American Association of Nurse Practitioners最新文献

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.

Background: Patient engagement leads to improved disease outcomes; however, an unmet need exists for understanding and disseminating the benefits of patient engagement and shared decision making (SDM) in pulmonary arterial hypertension (PAH).

Purpose: To develop an expert consensus on strategies for patient engagement and SDM in PAH.

Methodology: United States (US)-based physicians (n = 5), Advanced Practice Providers (n = 5), and Registered Nurses (RNs; n = 3) who are responsible for managing patients with PAH were recruited to a double-blinded modified-Delphi panel (two survey rounds and a virtual consensus meeting). Consensus was defined as ≥80% of panelists rating their agreement or disagreement using a 9-point Likert scale.

Results: Engaged patients actively participate in SDM by asking questions, providing feedback, and following up routinely, which in turn leads to improved disease management in PAH. Factors that motivate engagement include provider encouragement and social support. Factors that discourage engagement include frustration due to symptom severity and medication side effects, poor health literacy, and financial burden. Communicating the importance of risk assessments and resources to address poor health literacy are areas that require improvement. Creating an action plan that involves patients and family members and educating and encouraging patients to research and understand PAH are essential components of SDM.

Conclusions: Consensus was reached on the importance of SDM and strategies to empower patients to be more engaged in their PAH management.

Implications: The identified areas of improvement may motivate greater involvement of patients, and their caregivers, in the management of PAH to advocate for their goals and preferences.

Background: Filipino Americans experience disproportionately high rates of hypertension and remain understudied in health disparities research. Although food insecurity (FI) is a recognized social determinant of health, its influence on psychological distress and chronic illness in this population is not well understood.

Purpose: This study examined the relationship between FI and psychological distress among Filipino Americans with hypertension, guided by an adapted Minority Stress Model.

Methodology: A cross-sectional, descriptive, correlational study was conducted with 135 Filipino American adults recruited from a primary care clinic in Southern Nevada. Participants completed validated instruments assessing both FI and psychological distress. FI was measured using a standardized FI scale, whereas psychological distress was assessed using the Distress Thermometer and Problem List. Data were analyzed using multivariate logistic regression and nonparametric tests.

Results: Income level was the only demographic variable significantly associated with FI (p = .0002). Food-insecure participants reported higher distress (median score = 4) than food-secure peers (median score = 2, p < .001). After adjusting for age, gender, and income, FI remained strongly associated with sleep problems (OR = 3.4, p = .008), worry (OR = 3.83, p = .009), and sadness (OR = 3.85, p = .02). No significant associations were found between FI and other physical symptoms.

Conclusions: Food insecurity is a critical psychosocial stressor linked to increased psychological distress among Filipino Americans with hypertension.

Implications: Nurse practitioners and primary care providers should incorporate culturally responsive, community-engaged approaches when screening for both FI and psychological distress in this population.

Background: Pregnant women and their unborn children are often overlooked in the opioid crisis, despite increased rates of both maternal complications and neonatal opioid withdrawal syndrome. Although medications for opioid use disorder (MOUD) are considered the gold standard for pregnant women, many either do not have access to or are not offered MOUD as an option.

Objectives: To describe the characteristics of MOUD care models and assess the effectiveness of MOUD Care Models on initiation, adherence, and engagement in treatment for pregnant women with OUD.

Data sources: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol directed the process of this scoping review. A search for English, peer-reviewed, quantitative studies, published between 2012 and 2023 was conducted in eight scholarly databases. The Joanna Briggs Critical Appraisal tools were used to assess study quality.

Conclusions: The integrated care models included medication management, psychotherapy support, behavioral health care, and medical care management, with added focus on prenatal and postpartum care. Synthesis revealed that treatment engagement, medication adherence, breastfeeding rates, and postdelivery MOUD referrals were higher in integrated care models compared with nonintegrated care models. Pregnant women with OUD in integrated care models have better outcomes compared with those in nonintegrated care models.

Implications for practice: Improvements in care models are necessary to tackle provider shortages, stigma, and financial, geographic, and technological barriers. Addressing these issues will enhance nurse practitioners' ability to provide comprehensive and accessible care to this vulnerable population.

Background: This concept analysis provides an operational definition on mentorship exclusive to the advanced practice nurse (APN), whereas previous works have focused on mentorship within the wider scope of nursing. This work includes the International Council of Nurses' broad understanding of mentorship to bring an international perspective.

Purpose: The aim of this work is to propel development of strong mentorship programs for APNs who may be new to practice or in a transitional phase to a subspecialty.

Methodology: A thorough evaluation of contemporary literature was conducted. Walker and Avant classic framework was used to analyze and dissect the concept of mentorship for APNs.

Results: Effective mentorship of APNs should include facilitation of knowledge, confidence, and competence, as well as emotional and psychosocial support. There should be a transition period where the APN can develop identity and professional skills and resolve "imposter syndrome." Mentorship needs to be recognized as separate from preceptorship, orientation, or career planning.

Conclusions: Mentorship should occur during the transitional period of professional development. It should include emotional and cognitive support to help develop competence and confidence. The mentor needs support to have time and resources to support the mentee. It is ideal for mentors to be seasoned APNs.

Implications: All APNs should have access to mentorship as part of their transition to a new scope of practice. Effective mentorship is best provided by experienced APNs. Mentorship should be recognized as separate from preceptorship and orientation. Mentorship should be a long-term commitment, with time and resources allocated.

Background: Engaging primary care providers in HIV prevention, particularly through the use of preexposure prophylaxis (PrEP), is essential to ending the HIV epidemic.

Purpose: To assess the extent to which PrEP education is included in family nurse practitioner (FNP) and adult-gerontology primary care nurse practitioner (AGPCNP-AG) program curricula and the level of knowledge program leaders have regarding PrEP.

Methodology: An internet survey was distributed between January and June 2024 to program leaders from 463 US institutions offering AGPCNP and/or FNP programs. The survey examined participants' familiarity with PrEP and whether PrEP was included in each program's curriculum. Participants rated their agreement with statements across 3 exploratory PrEP care domains: (1) effectiveness, impact, and access, (2) safety and risks, and (3) clinical practice and patient management.

Results: Of the 188 institutions represented in the sample, 84% reported addressed PrEP in their curriculum. However, only 67% could correctly identify the clinical indications for PrEP, and just 18% identified all 3 Food and Drug Administration-approved PrEP medications. Exploratory analysis of Likert-style PrEP beliefs items revealed variability in perceptions of PrEP among faculty respondents that could affect curriculum.

Conclusions: Although PrEP is addressed in U.S. FNP and AGPCNP-AG programs, gaps in faculty knowledge remain, particularly concerning its clinical indications and approved medications. These knowledge gaps could hinder the integration of PrEP into primary care practice.

Implications: Freely available resources, such as online modules and expert-led webinars, could be an effective strategy to augment PrEP education in the classroom.