Journal of Doctoral Nursing Practice最新文献

Background: Advanced practice nurses (APNs) have been responding to worldwide changing patient comorbidities, inequalities within access to care, and a shortage of primary care physicians. The scope of practice for these nurses has been expanding internationally but varies across different jurisdictions. For a period of time during the COVID-19 pandemic, APN trainees' opportunities to work with international mentors in-person were limited. Objective: This study aimed to evaluate the effectiveness of a virtual seminar series in supporting growth in clinical judgment, skills in nursing leadership, and advocacy to optimize APNs' scope of practice. Methods: A preexperimental study was conducted in one cohort of students in the Doctor of Nursing (DN) program at The Chinese University of Hong Kong. A total of 10 prerecorded seminars were presented by nurse practitioners (NPs) in Canada on various disease topics. The evaluation of these seminars focused on the effectiveness of teaching by each speaker and the perceived confidence of learners in carrying out each domain of the APN scope of practice. Results: The study found that the virtual seminar series was effective in improving learners' perceived confidence in carrying out each domain of the APN scope of practice. The perceived teaching effectiveness of each speaker was also evaluated and found to be positive. Conclusions: The virtual seminar series was an effective strategy in supporting newly graduated APNs' professional transitions, particularly when opportunities for collaboration and education were limited due to the COVID-19 pandemic. Implications for Nursing: Mentorship, experiential learning, interprofessional training, and professional socialization are vital strategies for supporting APNs' professional development. The virtual seminar series can be an effective strategy for supporting APNs' scope of practice growth, especially in the current global pandemic context.

Background: The prevalence of childhood asthma in the United States is 6.5%. During the COVID-19 pandemic, a Federally Qualified Health Center (FQHC) implemented metered-dose inhalers (MDIs) with spacers instead of nebulized albuterol to reduce aerosolization of pathogens and reduce costs. Objective: The objective of the study is to assess the safety, efficacy, and efficiency of a change to the asthma exacerbation protocol at an urban FQHC. Methods: A retrospective chart review compared nebulized albuterol versus an MDI with a spacer in pediatric patients experiencing asthma exacerbation. The evaluation aimed to measure (a) the 30-day return to care in either the emergency department (ED) or clinic, (b) the total number of treatments administered, and (c) the documented use of an oral steroid with albuterol treatments. Results: Return to clinic was the only statistically significant variable. Zero MDI patients returned, whereas 61% of those nebulized returned within 30 days (p < .00001). Conclusions: Albuterol MDI with a spacer was more effective than a nebulizer in reducing follow-up visits to the clinic and was effective at reducing ED visits within 30 days. Implications for Nursing: Treating asthma exacerbations in the primary care clinic with an MDI is effective and reduces cost and airborne exposure.

Background: In 2019, 1.8 million new cancer cases occurred, and 500,000 cancer deaths were expected in the United States, costing $21 billion. Regular primary care screenings have correlated with early cancer detection, treatment, health promotion, and reduced costs. Objectives: The aim was to increase effective primary care screenings in adults in St. Thomas U.S. Virgin Islands Department of Health Community Clinic to 75% within 8 weeks. Methods: This quality improvement initiative used four Plan-Do-Study-Act cycles over 8 weeks. Two core interventions, each with four tests of change, were implemented. Interventions: Core interventions included screening utilizing a checklist for body mass index, depression, and colorectal, lung, breast, cervical, uterine, and prostate cancer and engagement utilizing a checklist for correlated screening-related education, interventions, shared decision-making, and referral. Results: Primary care screenings increased from 55% to 96%, and patient engagement increased from 6% to 82%. Effective primary care screenings increased to 89%, exceeding the aim. Conclusions: This project improved primary care screening and engagement and effectively applied patient-centered care. Achievements were made through standardized screening and engagement. Implications for Nursing: This quality improvement project may be spread to other clinics to improve patient health outcomes.

Background: Postoperative sore throat, dry throat, and difficulty swallowing are frequently reported complications following general anesthesia, imposing discomfort and challenges to patients during their recovery. Objective: The aim of this study was to determine the effect of cold vapor application for 15 minutes at 0, 2, and 6 hours after extubation on sore throat, dry throat, and difficulty swallowing. Methods: This was a randomized controlled experimental study. The research was carried out with 64 patients who underwent cholecystectomy in the operating room and general surgery clinic of a state hospital between December 2016 and August 2017. Research data were collected using the American Society of Anesthesiologists classification, Mallampati scoring, patient identification form, intraoperative patient evaluation form, Ramsey Sedation Scale, Numerical Rating Scale, dry throat and difficulty swallowing evaluation form, and cuff pressure gauge. Results: It was found that cold vapor application at the 0th, 2nd, and 6th hours postoperatively had no effect on sore throat and swallowing difficulty. Mean dry throat scores of the patients in the intervention group at the second and sixth hours were significantly lower than those in the control group. At the 24th hour, there was no statistically significant difference between the mean scores of sore throat, swallowing difficulty, and dry throat in the intervention and control groups. Conclusion: According to the results of this study, it was found that cold vapor application in the early postoperative period had no effect on sore throat and swallowing difficulty but reduced throat dryness at the second and sixth hours. Implications for Nursing: In the early postoperative period, cold vapor can be applied to relieve hoarseness due to extubation.

Background: Depression is a common mental illness that increases the risk of suicide, substance abuse, and chronic pain. Nationally, 21 million adults have had one untreated depressive episode, 1.4 million people have had suicide attempts, and 1 death occurs every 10 minutes. Depression has an annual economic burden of $326 billion for the American economy. Objectives: This quality improvement project aims to review the existing literature on depression, audit local businesses, survey clients, and team members to identify a gap in practice and then collect and analyze data to draw conclusions and make recommendations based on the findings. Methods: This initiative used four Plan-Do-Study-Act rapid quality improvement cycles. Data were collected and analyzed, and the results were used to make iterative changes. Results: Depression screening improved by 90%, and 317 clients were screened over 8 weeks. Twenty-eight percent of those screened had depression and were engaged in managing their symptoms. Both screening and care improved, and the aim of 89% was met. Conclusions: This initiative bridged a gap in depression screening and care. It also demonstrated a positive outcome, had the potential for sustainability, and spread to other faith communities. Implications for Nursing: A system should be put in place for depression screening, care, and referrals.

Background: Although breast milk provides the most robust human nutrition and offers extensive immunological protection, many mothers are still hesitant to breastfeed exclusively, and the rate of exclusive breastfeeding declines significantly over time in the postpartum period. Objective: The objective is to educate nurses on the practice of exclusive breastfeeding. Methods: Breastfeeding education was provided to nurses (n = 11) at an urban academic medical center. The education included hands-on skills training, case scenarios, and interactive games. Knowledge was measured using an eight-item multiple choice pre- and posttest. Exclusive breastfeeding rates were measured before and after the 10-week intervention period using a report on infant feeding practices. Results: Comparison of pre- and posttest scores revealed nurses' knowledge increased by 25%; however, exclusive breastfeeding rates were not impacted. Conclusion: Several limitations may have impacted the rates of exclusive breastfeeding. Other strategies may be needed to provide a holistic and effective approach. Barriers related to the lack of exclusive breastfeeding should be explored further. Implications for Nursing: Ongoing education is an effective method to increase nurses' knowledge. Advanced practice nurses, in a unique position to impact nursing practice and influence health, are encouraged to continue to identify and evaluate methods to increase rates of exclusive breastfeeding.

Background: Despite the innovative advancements in diabetes care, providers may not recognize patients with type 2 diabetes mellitus (T2DM) who qualify for a continuous glucose monitoring (CGM) device or the benefits of a telemedicine program for improving self-management behaviors. Objective: This quality improvement (QI) project aimed to determine if an advanced practice registered nurse (APRN)-led telemedicine program using CGM could improve glycemic control and self-management in patients with insulin-dependent T2DM. Methods: A 6-week telemedicine program was developed and implemented using the CGM's time-in-range to deliver patient-specific education. Clinical metrics were collected at each visit. All patients completed a pre- and postintervention Diabetes Self-Management Questionnaire-Revised (DSMQ-R) survey. Results: A repeated measures analysis of variance revealed that the telemedicine program had a statistically significant impact on time-in-range outcomes, F(2, 14) = 18.203, p < .001. Paired-samples t tests indicate that APRN-led education improved body mass index, t(8) = 4.232, p = .002; decreased systolic blood pressure, t(8) = 2.90, p = .010, and diastolic blood pressure, t(8) = 3.21, p = .007; and increased self-management skills as evidenced by DSMQ-R, t(8) = -5.498, p < .001. Conclusions: This QI project highlights multiple interventions for improving diabetes management in a primary care facility. Implications for Nursing: An APRN-led telemedicine program integrating CGM time-in-range data can improve glycemic control and self-management skills in patients with T2DM who administer insulin.

Background: Transgender (TG) clients experience provider bias, erasure, refusal to treat, and violence. Objective: The purpose of this article is to identify barriers to healthcare for TG individuals and discuss recommendations for providers treating this population. Methods: Literature review of prime research was conducted using the Whittemore and Knafl methodology (2005). Results: Evidence suggests that barriers to TG healthcare include lack of provider TG knowledge and trans sensitivity, lack of provider communication, and lack of emotional and physical safe healthcare environments. Conclusions: TG clients face barriers to accessing healthcare, and specific recommendations to improve provider practice will decrease these barriers. Implications for Practice: Lack of provider education affects TG individuals accessing quality healthcare. Recommendations to improve provider practice are essential to improve care.

Background: The Doctor of Nursing Practice (DNP) degree prepares nurses for engagement in practice scholarship to improve health outcomes at multiple system levels. Organizational leaders' and employers' perceptions and expectations of DNP-prepared nurses require further study. Objective: To explore the perception of organizational leaders regarding expectations and engagement of DNP-prepared nurses in practice scholarship activities. Methods: Guided by the Actualized DNP Model, a cross-sectional design was used to survey organizational leaders (N = 87) regarding DNP-prepared nurses' engagement in practice scholarship. Results: Findings indicate that 92% (n = 80) of participants believed practice scholarship should be an expectation of DNP-prepared nurses serving in a variety of roles. Of the 77 respondents to the scholarship engagement questions, 97.4% (n = 75) reported that DNP-prepared nurses engaged in one or more practice scholarship activities over the past year. Conclusions: Aligning DNP practice scholarship competencies, as outlined in the American Association of Colleges of Nursing 2021 Essentials, with organizational needs, expectations, and provision of sufficient time to support these scholarship activities is needed. Implications for Nursing: Opportunities exist for DNP-prepared nurses to articulate and demonstrate their value by conducting practice scholarship through innovative advanced nursing roles to realize organizational goals. Organizational support is necessary for practice scholarship activities to transform DNP education.