Journal of the American Association of Nurse Practitioners最新文献

Abstract: Nurse practitioner (NP) educators play a critical role in ensuring that students attain the competencies required for safe and effective independent practice. However, some students encounter challenges in mastering key competencies and require targeted remediation to address performance gaps. As health care delivery grows increasingly complex and competency-based education (CBE) becomes the standard in nursing curricula, the demand for evidence-based remediation strategies increases. Despite this need, faculty often hesitate to initiate remediation due to uncertainty about the process and the lack of widely accepted best practices in NP education. This article proposes a three-phase, evidence-informed framework for supporting underperforming students: (1) identifying and clarifying performance issues, (2) developing individualized plans for success, and (3) providing ongoing assessment and feedback. Grounded in CBE principles, this framework emphasizes the value of individualized remediation plans and advocates for further research to establish best practices in NP student remediation.

Abstract: The National Task Force Standards for Nurse Practitioner (NP) Education recommendation for NPs to complete a minimum of 750 patient-contact hours before certification has been met with some hesitation. As the profession discusses the evidence behind this change and resources needed, we anticipate the eventual adoption by nursing education, state boards of nursing, and national certifying bodies. This transition will require a planned and sequential rollout, beginning with the national NP certifying bodies. Here, we discuss the collective implications for students, faculty, and nurse leaders.

Background: Nurse practitioners (NPs) provide high-quality, comprehensive health care at Veterans Health Administration (VHA) medical centers in various practice settings. Accurately determining the productivity of NPs is essential to understanding their overall contribution to veteran care. There is a lack of understanding of the contributors to the variability among VHA medical centers regarding their processes for capturing these data. Using benchmark data from the VHA Support Service Center Capital Assets application, this quality improvement (QI) initiative implemented a series of plan-do-study-act (PDSA) cycles to determine whether increased education regarding billing and coding, along with person classification and labor mapping accuracy, could increase NP productivity.

Local problem: The problem identified through an analysis of NP productivity revealed variability across multiple VHA facilities.

Methods: The PDSA method was employed in this QI project. The QI team compared the total workload relative value units (wRVU) for NPs in each participating facility pre and post a three-phase intervention.

Interventions: Nurse practitioners' person classification and labor mapping accuracy was evaluated at each site. An educational program regarding billing and coding was developed and delivered to the NP frontline staff. The QI team compared the total wRVUs for the NPs at each facility pre- and postintervention.

Results: An increase in the wRVUs was observed following the intervention across six facilities. Five of the seven facilities displayed stability in relative value unit improvement postintervention.

Conclusion: Educating frontline NPs on billing, coding, person classification, and labor mapping can improve NP productivity.

Background: Substance use remains a public health crisis. Fewer than 25% of nurse practitioners report agreeing that they have the education and training needed to manage the care of patients with substance use disorders and often feel as though managing substance use disorders is beyond their scope of practice. Educational interventions during nurse practitioner education can improve knowledge and confidence related to treating substance use disorders, ultimately increasing the likelihood that nurse practitioners will choose to treat patients affected by substance use.

Purpose: The purpose of this study was to explore what substance use-related content is essential to include in nurse practitioner curricula, focusing on emerging public health threats, knowledge and skills necessary to prepare nurse practitioners to manage substance use disorders, specific content necessary for substance use-inclusive curricula, and barriers to and facilitators of substance use-inclusive curricula.

Methodology: A qualitative, descriptive design was used, leveraging individual, semistructured key informant interviews.

Results: Eight themes emerged, including diagnostic knowledge and neurobiology; substance use severity; nonpharmacological interventions; pharmacological treatment interventions; the importance of addressing provider characteristics; treatment access and quality; psychosocial and historical considerations; and emerging issues and special populations.

Conclusions: Nurse practitioners can effectively address the substance use epidemic but must be adequately prepared with the knowledge and skills to do so. By adequately preparing nurse practitioners during their graduate education, nurse practitioners can mitigate gaps in substance use care, further advancing population health.

Implications: Nurse practitioner educators should be aware of evolving topics essential to substance use-inclusive curricula.

Abstract: Hypertension is a prevalent and challenging comorbidity in patients with diabetic kidney disease (DKD), contributing significantly to cardiovascular risk and the progression of renal disease. This case report discusses the primary care management of a middle-aged woman with hypertension and DKD who, despite adhering to triple antihypertensive therapy, continues to have uncontrolled blood pressure (BP). The clinical report explores evidence-based strategies for optimizing BP control while decreasing kidney disease progression. Dietary sodium restriction is highlighted as a particularly effective intervention for lowering BP in patients with volume-overloaded DKD. Angiotensin inhibition remains the cornerstone of therapy because of its renal and cardiac benefits, but additional antihypertensive agents are often necessary to achieve target BP levels. Long-acting thiazide or loop diuretics, along with calcium channel blockers and steroidal mineralocorticoid receptor antagonists, are recommended as additional pharmacological options to lower BP while reducing albuminuria. The newly approved nonsteroidal mineralocorticoid receptor antagonist, finerenone, sodium-glucose cotransporter-2 inhibitors, and glucagon-like peptide-1 receptor agonists have been shown to offer kidney- and heart-healthy benefits, making them integral to treatment strategies. Routine monitoring of BP, serum creatinine, estimated glomerular filtration rate, potassium, and albuminuria is critical to guiding treatment adjustments. This case underscores the necessity of a patient-centered approach to managing hypertension in DKD. By using a comprehensive strategy, primary care nurse practitioners can improve BP control, slow renal disease progression, reduce cardiac events, and prolong the life of these high-risk patients.

Abstract: Meetings are crucial for collaboration, strategizing, and decision making in any workplace, professional organization, or community agency. The effectiveness of a meeting relies significantly on the leader's skills. Occasionally, individuals are assigned or elected to positions with minimal preparation for running an effective meeting. This article explores the stages of planning and executing an organized meeting and highlights the leader's role in guiding the meeting effectively to ensure its goals are met.

Abstract: This reflective commentary is a response to a recent publication in Artificial Intelligence (AI), Computer Science, and Robotics Technology, which evaluated ChatGPT's performance on nurse practitioner (NP) certification examination questions. The provocative framing questioning whether AI nurse practitioners may become a reality prompted this critical reflection on what truly defines NP expertise, particularly in an era of expanding AI capabilities. Our response challenges the notion that correct examination answers alone constitute clinical readiness and instead highlights the depth of contextual judgment, human connection, and advanced clinical reasoning-the capability we term clinical intelligence-that nurse practitioners uniquely bring to patient care. Although AI literacy is a growing part of essential NP knowledge, caution is needed around any assertion that large language models like ChatGPT can replicate or replace nursing roles of any kind.

Abstract: Functional seizures, also known as psychogenic nonepileptic seizures (PNES), present a significant challenge in correctional settings, where stress and limited medical resources complicate management. This case study explores the evaluation and treatment of a 20-year-old man detainee with functional seizures and comorbid borderline personality disorder (BPD). Initially misdiagnosed with epilepsy and schizophrenia, he underwent extensive medical evaluations and hospitalizations, including intubation following a seizure episode. His history of self-injurious behaviors, particularly swallowing foreign objects, further complicated his care. A multidisciplinary approach was implemented, including gradual withdrawal of unnecessary antiseizure medications, targeted treatment of BPD symptoms with quetiapine, and intensive therapeutic engagement. Structured interactions, emotional regulation strategies, and nonpharmacological interventions were emphasized. Over time, the patient demonstrated significant improvement, with cessation of self-harming behaviors and a reduction in seizure episodes. This case highlights the complexities of managing functional seizures in detention centers and the importance of accurate diagnosis, individualized treatment plans, and the integration of psychiatric and behavioral interventions. A therapeutic environment, combined with appropriate pharmacologic and nonpharmacologic strategies, can lead to meaningful clinical improvements in patient with PNES and co-occuring personality disorders.

Substandard and falsified (SF) medicines, also referred to as counterfeit drugs, represent a global public health emergency. These products range from drugs with no or little active ingredient to medicines laced with illicit fentanyl. Counterfeits can be copies of brand, generic, or over-the-counter medicines. In some cases, sophisticated counterfeiters will add some of the active ingredient, making the fake medicines harder to detect. Substandard and falsified medicines affect treatment outcomes, exacerbate health inequities, and undermine health care systems around the world, including in the United States. Although significant strides have been made to enhance oversight and bolster regulatory frameworks, recent evidence underscores a glaring omission: insufficient education and training of US health care providers, including nurse practitioners, on the detection, management, and prevention of the harms related to SF medicines. Keywords: substandard and falsified medicines; counterfeit drugs, nurse practitioner education; pharmaceutical safety; online pharmacies; patient counseling.

Abstract: Professional nursing organizations depend on a volunteer workforce to fulfill their mission and activities. Professional altruism and a desire to contribute to the profession motivate individuals to participate in volunteer activities that align with their personal interests, match their areas of expertise, and fit specific time commitments. Volunteerism benefits not only the profession and organization but also the individual volunteer and their employer. This column provides insight into the personal and professional advantages of purposeful engagement in roles, initiatives, and activities within professional organizations to support the growth and advancement of the profession. Various types of opportunities are often available to contribute time and talent and engage meaningfully within professional organizations.