Journal of the American Association of Nurse Practitioners最新文献

Abstract: The discipline of geography is an increasingly necessary lens required to understand population-level diseases. Syndemics, or co-occurring diseases or epidemics within a specific population, are contextualized by place-preexisting social, economic, and political structures. Nurse practitioners are well-positioned to critically assess the impact of geography on patient health and well-being. This perspective provides a brief summary of syndemic crises, with a case example in the West Virginia coalfields. The position of this paper is one that supports geography, in addition to social determinants of health, as a framework for syndemics. A geographic perspective provides a more comprehensive picture of marginalized populations and regions facing the phenomenon. Given the significance of holistic nursing, attention to the role of geography in syndemics provides an increased dimension of care and treatment.

Abstract: Professional advancement models (PAM) are paramount in the growth of nurse practitioners (NP) and physician associates/assistants (PA) who seek professional challenges, clinical recognition, job satisfaction, upward mobility, and incentives for retention. Professional advancement models for NPs and PAs were born out of literature on clinical career ladders that date back to the 1970s for the nursing work force. Over time, PAMs have evolved to offer NPs and PAs structured pathways to guide and reward professional growth, education, advocacy, research, and quality improvement (QI). Although the first institutional account of PAM development for NPs and PAs was published in 1998, there has been a recent spike in case reports of PAMs from individual medical centers. This article (1) provides a historical timeline of published data on the development and implementation of PAMs for NPs and PAs, (2) critiques features of existing PAMs, and (3) offers recommendations regarding PAM innovation for more uniform adoption in medical institutions across the country.

Background: Diabetes management is challenged by the complexity of treatment regimens and the need for frequent injections, affecting patient adherence and quality of life. Insulin icodec, a once-weekly basal insulin analog, represents a significant innovation, potentially simplifying diabetes care and improving outcomes.

Objectives: This review aims to evaluate the safety, efficacy, and clinical implications of insulin icodec for individuals with type 1 and type 2 diabetes, highlighting its potential to affect current treatment paradigms.

Data sources: A review was conducted comparing once-weekly insulin icodec with daily basal insulin analogs using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to ensure transparent reporting of systematic reviews. A search was performed in the following databases: PubMed, Google Scholar, Embase, and ClinicalTrials.gov, focusing on efficacy and safety outcomes.

Conclusions: Insulin icodec has demonstrated effective glycemic management and a safety profile comparable to daily basal insulins. Its extended half-life and steady-state glucose-lowering effect have the potential to reduce the burden of daily injections and improve patient adherence.

Implications for practice: The introduction of once-weekly insulin icodec represents an advancement in diabetes care. For front-line clinicians, this innovation aligns with the need for more straightforward medication regimens. Coupled with continuous glucose monitoring systems, it enables a more personalized and efficient approach to diabetes management, with the potential to improve patient satisfaction and clinical outcomes. This underscores the impact of integrating such advancements into practice, highlighting the role of nurse practitioners and physician assistants in adopting these innovations to optimize patient care.

Background: Obstructive sleep apnea (OSA) is an often overlooked, widespread disease and a public health concern. Evidence-based practice guidelines do not exist to guide primary care clinicians' OSA screening practices. Clinicians must be competent in OSA; however, clinicians lack competency about this disease.

Local problem: Elevated rates of undiagnosed OSA potentially exist in two rural and one suburban counties in Kansas, as indicated by the increased weight and elevated chronic disease prevalence in these counties' populations.

Methods: A one-cohort, pretest-posttest, quasi-experimental design was used for this quality-improvement project implemented over 11 weeks. Clinicians' competencies on OSA were measured before and after the intervention using the Obstructive Sleep Apnea Knowledge and Attitude Survey.

Intervention: A brief educational video on OSA was developed for this project. Definition, risk factors and complications, screening methods, definitive diagnosis, and treatment options were covered in this video.

Results: Participants (N = 14) showed improved OSA competency after watching the educational video. Participants improved OSA competency after watching the interventional video (M = 16.3, SE = 0.194) versus preintervention (M = 14.2, SE = 0.318). Participants also improved OSA attitude scores postintervention.

Conclusion: Primary care clinician OSA competency scores improved after engaging in a brief educational video intervention when measured using the OSA knowledge and attitude survey. Practicing clinicians can benefit from participating in education about the disease.

Abstract: Nurse practitioners (NPs) are the fastest growing group of health care providers, with an increase of 8.5% over the past year and anticipated growth of more than 40% by 2031. Improving NPs' knowledge of how genes influence health enables them to assess, diagnose, and manage patients in all states of health in a safe, efficient, and competent manner. Nurse practitioners may also care for patients who obtain direct-to-consumer (DTC) genetic tests without provider oversight and share their results; improved knowledge of genetics can provide NPs with the information and resources needed to interpret and understand DTC test results. The literature indicates that NPs have limited understanding of basic genetic concepts and guidelines for prescribing drugs affected by genomic variability. As a result, NPs report low confidence in their ability to accurately interpret and apply genetic test results, which inhibits genomics-informed precision health care. This article provides resources and clinical recommendations for using the 2021 American Association of Colleges of Nursing Essentials and the American Nurses Association Essentials of Genomic Nursing to facilitate the integration of genomics into NP curricula and practice. These resources will help future and practicing NPs integrate genomics into practice and improve precision health care.

Abstract: Nurse practitioners (NPs) take on diverse and essential roles. In an exclusive interview, Representative Tarik Khan, PhD, FNP-BC, highlights the impact NPs can have in the political arena. Transitioning from an NP to a legislator in Pennsylvania, Dr. Khan's journey reflects his commitment to health care reform, driven by hospital closures, lack of patient care access, and the COVID-19 pandemic. Elected in 2022, Dr. Khan leverages his health care background to address a wide range of legislative issues, passing significant bills. He advocates for NPs to engage politically, emphasizing their unique perspective and problem-solving skills. Dr. Khan's story underscores the transformative potential of NPs in shaping public policy and advancing systemic change.

Background: Uncontrolled blood glucose may lead to serious complications in patients with type two diabetes mellitus (T2DM). Patients may not have the support, motivation, or encouragement to adhere to the lifestyle changes necessary to control their T2DM.

Local problem: More than 75% of the primary care clinic's patients are diagnosed with T2DM, with most patients at the practice site having an average hemoglobin A1c (HbA1c) level of 8.5%. The primary care clinic did not use text messaging to disseminate diabetes self-management education and support (DSMES) as outlined in Standard 4 of the American Diabetic Association's (ADA) clinical practice guideline.

Methods: This evidence-based quality improvement project was conducted in a rural outpatient primary care clinic to determine whether implementing the ADA's 2022 National Standards for DSMES using text messaging would affect HbA1C levels among adult patients with T2DM.

Interventions: Patients were sent weekly text messages over a 12-week period. Text messages contained information promoting self-care, tips about healthy diet, exercise reminders, instructions about proper blood glucose monitoring, and reminders about medication adherence.

Results: A total of 160 patients were included. A paired-sample t -test showed a reduction in HbA1c levels after the intervention from baseline (M = 7.53, SD = 1.72) to postimplementation (M = 6.91, SD = 0.89), t (159) = 11.88, p = .001.

Conclusion: Based on the results, implementing the ADA's National Standards for DSMES Standard 4 may affect HbA1c levels in this population.