Journal of Doctoral Nursing Practice最新文献

Background: Nurse practitioner (NP) fellowship programs assist the novice NP in transitioning to advanced practice while emphasizing building confidence and competence. The Veteran's Health Administration (VHA) offers an NP primary care fellowship program. The purpose of this project was to develop an acute care transition to practice fellowship program at a Midwestern VHA hospital.

Methods: A prospective, descriptive design utilizing a convenience sample of senior adult-geriatric nurse practitioner (AGNP) students during a pilot study of an acute care fellowship program. Outcome measures included evaluation of skills interpreting electrocardiograms (ECG), chest x-rays (CXR), and self-reported confidence in performing these skills over the initial 6-week period of the 12-month program.

Results: There were three participants (N = 3, 100%). There was a 33% increase in self-reported confidence of readiness to practice at completion of the pilot. However, ECG scores decreased 66% and CXR interpretation scores decreased 33%.

Implications for nursing: Despite training and targeted clinical experiences in ECG and CXR interpretations during an acute care fellowship, competence in these skills decreased while self-reported confidence increased at the end of 6 weeks. Continued education and training throughout the 12-month program is recommended to increase the novice NP's competence in these skills while transitioning to their new role.

Objective: To provide an acute care fellowship to facilitate with transition into advanced practice while increasing confidence and competence in the novice NP.

Conclusion: The novice NP may benefit from an NP fellowship program.

Background: Atherosclerotic cardiovascular disease (ASCVD) is a major contributor to nationwide morbidity, mortality, and healthcare costs in the United States. Over 92 million adults have at least one form of ASCVD, and annual costs for treatment are anticipated to surpass one trillion dollars within the next 15 years.

Objective: The objective of this study was to evaluate the medication therapy of a population of adults in comparison to the American College of Cardiology/American Heart Association (ACC/AHA) recommendations for statin therapy for ASCVD risk reduction.

Methods: The adult population receiving care from a group of hospital outpatient clinics was examined using a database query. Rates of ASCVD in a multicounty area were compared and provider adherence to current guidelines was assessed.

Results: Rural counties showed higher rates of ASCVD. Rates of statin medication prescribing for patients of each ACC/AHA statin benefit group ranged from 66.2% to 74.8%.

Conclusions and implications for nurse practitioners: Adherence to guidelines varied among counties and optimal adherence was not achieved. Providers were also more likely to prescribe statin medications to men than women within each group regardless of risk. These findings can assist nurse practitioners and other providers in addressing areas of nonadherence to guidelines.

Background: One-third of the U.S. population has prediabetes, but 90% remain undiagnosed because healthcare providers are not screening for this condition.

Objective: The purpose of this quality improvement project was to monitor prediabetes screening and identification, and implement evidence-based recommendations including registered dietician referral.

Methods: This project involved using an evidence-based screening tool to measure individual risk of prediabetes. Aggregate data was collected to evaluate screening implementation, evidence-based recommendations offered by providers, and assess patient risk factors.

Results: The percentage of patients at risk for prediabetes was 41.3% (n = 111). The most frequent risks were identified as overweight, history of hypertension, family history of type 2 diabetes mellitus (T2DM), and older age. Providers offered education on weight loss 68.5% (n = 76) and exercise 76.6% (n = 85) but referred 33.3% (n = 37) patients for nutrition education. The screening rates were 52.3% (n = 176) and 72.5% (n = 244) in clinics A and B respectively.

Conclusions: A gap remains in using evidence-based recommendations to decrease risk of prediabetes. Prediabetes screening identified a greater percentage of persons in this population.

Implications for nursing: There is a need for consistent practice of evidence-based recommendations. This project set the benchmark for future efforts to educate, encourage, and measure providers successes.

Background: Deliberate inclusion of clinical decision-making nursing skills in the didactic setting will assist students in potentially making better patient care decisions. This can be optimized through use of the flipped learning andragogy. Flipped learning promotes an interactive classroom environment. It fosters teamwork and collaboration. Direct content instruction is the responsibility of students.

Objective: This cohort pilot study investigated how the flipped and nonflipped approach to teaching impacted clinical decision-making and student participation.

Methods: The Clinical Decision-Making in Nursing Scale (CDMNS) was administered to the students in the flipped classroom and the nonflipped classroom on week 1 and week 6. A student participation checklist was used to observe class activities at three separate intervals (baseline, mid-semester, and end-semester). A repeated measures analysis of covariance was conducted with Instruction Group as the between subjects factor (Flipped and Nonflipped) and Time (preinstruction and postinstruction) as the within subjects factor, and covarying age. The Time by the Instruction group was significant. The Flipped group showed an increase in Clinical decision-making scores (p < .001) after instruction while the Nonflipped group did not (p = .40).

Results: The Flipped group (n = 24) showed an increase in Clinical decision-making scores (p < .001) after instruction while the Nonflipped group (n = 23) did not (p = .40). The Flipped classroom showed 100% participation at baseline, mid-semester, and end of semester. The Nonflipped classroom showed overall lower levels of participation, with 42%, 33%, and 39% at each point respectively.

Conclusion/implications for nursing: Students who were taught using the flipped instruction were able to apply what they learned in relevant case studies, virtual simulations, and practice National Council Licensure Examination RN (NCLEX-RN) type questions. Through teamwork and collaboration, students had time to practice clinical decision-making skills. This was evident in the increased CDMNS scores and increased levels of participation over time in the flipped group when compared to the nonflipped group.

Background: Heart failure (HF) has become a national concern, with approximately 5.7 million adults in the United States suffering from this life-altering disease. Improved education of these patients prior to discharge helps patients manage their disease adequately and reduce symptom exacerbations.

Objective: This quality improvement initiative aimed to determine the effectiveness of an educational intervention in improving nurses' knowledge of HF discharge teaching and documentation of this education in patient charts.

Methods: This project was conducted at a Magnet-recognized acute care hospital with 39 critical care step-down beds. Twenty-nine nurses employed on the step-down unit participated in the educational intervention. Pre/post nurse knowledge and chart review data were analyzed.

Results: There was a statistically significant increase in the percentage of patients receiving HF education from unit nurses from preintervention 77.0% (n = 81) to postintervention 96.4% (n = 138) (p < .001). There was also a statistically significant increase in the mean number of days patients were educated from 1.64 to 2.58 days (p < .001). Nurse knowledge also increased from pretest (69.7%) to posttest scores (100%) (p < .001).

Conclusions: Providing HF educational opportunities enhanced nurse knowledge and increased their documentation of HF education in patient charts.

Implications for nursing: Nurse educators may use the study results to improve nurse education and practices aimed at reducing HF readmissions.

Background: More than 130 Americans die from opioid overdose each day. To address the opioid epidemic, opioid treatment programs are in place to treat substance use disorder. These programs have seen an influx of patients and are not able to accommodate the number of patients. Primary care practices can help with the crisis by providing an office-based opioid treatment (OBOT) program.

Objective: To describe the necessary steps and considerations to put in place for implementing a telehealth OBOT program. Establishing a telehealth program for patients controlled on medication-assisted treatment can improve access to care, improve patient compliance, and redirect the workflow of the family practice.

Methodos: After a literature review of established OBOT programs, state and federal laws, Medicare and reimbursement policies, a telehealth opioid treatment program was designed for private primary care practice.

Conclusions: Primary care practices can should implement an office based opioid treatment program via telehealth to improve workflow and accessibility to care.

Implications for nursing: To offer improved access to care for patients with opioid addiction and seamless workflow in the office-based setting, primary care practices should consider establishing their telehealth OBOT program based on the following recommendations.

Background: Treating children and adults with autism spectrum disorders (ASDs) is challenging, whether for mental health concerns, underlying healthcare conditions, or a variety of behavioral challenges, such as self-injury, aggression, or irritability.

Objective: This article highlights evidence-based approaches to inform prescribing practices in treating children and adults with ASDs and mental health or behavioral challenges.

Methods: Current and historical literature focusing on treating individuals with ASDs using psychotropic medications was analyzed.

Results: Psychotropic medications may not be the best choice for treating individuals with ASDs and mental health or behavioral challenges. Inappropriate use of psychotropic medications in this population can cause significant side effects and lead to long-term health related issues.

Conclusions: Prescribers should use evidence-based approaches when treating this population.

Implications for nursing: Nurse practitioners are likely to encounter patients with ASDs in their practice. Understanding special considerations in prescribing for this population is highly relevant and important to improve health outcomes.

Background: Healthy People 2020 has introduced a new initiative focused on adolescent health, ages 10-17, and young adults, ages 18-25, due to health and social problems starting or peaking during these years. The initiative focuses on decreasing such problems including substance use. Cannabis is one of the most popular illegal substances used among young adults for recreation in the United States. Multiple consequences of cannabis use are well documented in the literature including the development of medical problems, developmental delays, and social issues. Furthermore, academic success is linked to overall health outcomes.

Objective: The aim of this study was to explore cannabis use and knowledge of consequences among college students at a university in southwest Texas.

Method: Secondary analysis of survey results from students at a small, private university. The Core Alcohol and Drug Survey, a self-report questionnaire, was utilized to measure alcohol and drug usage, attitudes, perceptions, and opinions regarding drug and alcohol usage. The survey was distributed to all 6,537 undergraduate students. The survey results were collected over a 3-month period and provided to the authors for interpretation.

Results: Eighty-two survey responses were received. Analysis indicated that 24.7% of the students used marijuana in the past year, and 16% had used cannabis within 30 days of the survey. Of the respondents surveyed, 13.3% reported they used cannabis occasionally and 38.7% reported they used cannabis regularly. Furthermore, survey results indicated that 12.7% of respondents reported some of the consequences from cannabis use experienced within the past year included public misconduct, such as fighting, arguing, and vandalism. In addition, 13.9% reported having experienced serious personal problems due to cannabis use at least once during the past year including injuries, suicidal thoughts, and sexual assault. Reported attitudes and perceptions of cannabis use include 13.3% perceived great risk associated with cannabis use. Moreover, 62.3% of respondents believe that their friends would disapprove of cannabis use. A negative correlation was identified between cannabis use within the previous 30 days and low grades.

Conclusion: The consequences of cannabis use are well documented in the literature, yet cannabis remains a popularly used illegal substance among college students. Despite experiencing known consequences of cannabis use, much of the sample reported regular use of the substance.

Implications for practice: Results of the study may be used to improve education and interventions aimed at reducing cannabis use among college students. In addition, providers may use the information to provide patient education at routine visits.

Background: Type 2 diabetes mellitus and depression are frequently comorbid health conditions. Outcomes are generally poorer when the two diseases states co-occur, including the risk of long-term complications, quality of life, mortality, and associated healthcare costs.

Objective: The purpose of this article is to review the relationship between type 2 diabetes mellitus and depression, as well as to provide recommendations on the integration of their management in primary care.

Methods: Utilizing PubMed and CINAHL, a literature review was completed to identify research pertaining to comorbid depression and diabetes. Reference lists of identified articles were also explored for relevance.

Results: There is evidence demonstrating the relationship between diabetes and depression, and a myriad of screening tools and treatment options that can be implemented within the primary care setting.

Conclusions: Based on current evidence, it is recommended that mood symptoms should be addressed as part of standard diabetes care in the primary care setting, and patients diagnosed with depression should be screened for diabetes.

Implications for nursing: Addressing both depression and diabetes are within the primary care scope of practice. The call to primary care providers to holistically, collaboratively, and simultaneously improve the outcomes of these comorbid conditions is now.

Background: Small bowel bacterial overgrowth (SBBO) is difficult to diagnose in pediatric patients with short bowel syndrome due to the invasive nature of the gold standard testing. Alternative testing methods also have barriers leaving providers to diagnose clinically. This has led to antibiotic overprescribing in this population. An algorithm for SBBO identification and standardized treatment is proposed.

Objective: Standardize SBBO identification and treatment in pediatric short bowel syndrome.

Methods: 1-year retrospective chart review and literature review.

Results: Final analysis of 146 admissions revealed diagnostic and antibiotic prescribing inconsistencies. In total, 28% (n = 41) received antibiotics for SBBO including those who continued home antibiotic (n = 27), those prescribed an antibiotic based on clinical suspicion (n = 12), and those prescribed an antibiotic based on duodenal aspirate (n = 2). In 10.2% (n = 15) patients, antibiotics were prescribed without clear clinical indication resulting in 342 antibiotic exposed days and $24,000 in prescription costs.

Conclusion: Clinical research is greatly needed as it relates to SBBO. In the meantime, the proposed algorithm guides providers through diagnosis and treatment decision-making. Thoughtful antibiotic prescribing is key to optimizing outcomes while minimizing adverse effects of antibiotics.

Implications for nursing: The algorithm empowers nursing to minimize antibiotic overuse through collaborative teamwork.