Journal of the American Association of Nurse Practitioners最新文献

Abstract: The convergence of the opioid epidemic and COVID-19 pandemic created an urgent need in our communities to combat a rising tide of "deaths of despair." Responding to the call to care for persons with a substance use disorder is a service to both community and to self. Working in addictions provides the nurse practitioner renewed opportunity to experience life and career affirming humility, resilience, and gratitude through the joys of recovery.

Background: As transcatheter aortic valve replacement (TAVR) becomes a preferred treatment option for patients with aortic valve stenosis, and demand for TAVR increases, it is imperative that length of stay (LOS) is reduced while maintaining safety and effectiveness.

Local problem: As TAVR procedures have become less invasive and more streamlined, current protocols have not been updated to reflect today's postprocedure requirements.

Methods: The next-day discharge (NDD) protocol was established using available literature. A convenience sample was evaluated for NDD protocol inclusion during aortic multidisciplinary team conference using predetermined inclusion and exclusion criteria. Length of stay for NDD protocol participants was compared with LOS from a retrospective convenience sample of patients undergoing TAVR in the time frame mirroring NDD protocol initiation of the year prior.

Interventions: Patients meeting inclusion criteria were enrolled in the NDD protocol with a goal of discharge to home on postprocedural day 1 by 2:00 p.m. The NDD protocol included preprocedure expectation setting, prescheduled same-day postprocedure imaging, and discharge priority on postprocedure day 1.

Results: There is a significant difference in LOS between the NDD eligible retrospective and prospective groups. The prospective group has a significantly lower LOS than the retrospective group (M = 1.6 vs 2.1, respectively; p = .0454).

Conclusions: An NDD protocol can help reduce LOS after TAVR in appropriately selected patients. Further protocol revision will be required to optimize LOS outcomes.

Background: Colorectal cancer (CRC) is the third most common diagnosed cancer among non-Hispanic Black people in the United States. Alarmingly, this population is also 40% more likely to succumb to the disease. Black men get diagnosed younger, present with late-stage disease, and have poor 5-year survival rates. In total, 42% of the racial disparity is due to differences in screening.

Local problem: In Rochester, New York, there are eight zip codes where less than 47% of the population completed CRC screening and six zip codes where men have 15% to 49% above expected cases of CRC.

Methods: This qualitative improvement project took place in a barbershop in a zip code with subpar screening rates and higher-than-expected cases of CRC. Black men, 45-75 years of age, not current with CRC screening guidelines were recruited to participate after they received barber services. CRC screening was considered complete once a colonoscopy was scheduled.

Interventions: Colorectal cancer education was provided by a nurse practitioner to barbers, who then provided education to their eligible patrons. After the education, patrons who decided to undergo screening were connected to a local gastroenterology group where a colonoscopy was scheduled.

Results: Thirteen participants agreed to participate in the project. Nine participants scheduled CRC screening, and seven completed the colonoscopy evaluation.

Conclusions: Barbers and nurse practitioners are an ideal partnership when seeking to disrupt the CRC health care disparity. Members of the Black community who may not routinely participate in preventive care can be innovatively educated to improve their health status.

Background: Effectively managing pain is a unique challenge for the U.S. military. Chronic pain has a tremendous detrimental impact on mission readiness throughout the Armed Forces. Examining the effects of chronic pain on readiness is critical to understanding and addressing these challenges.

Purpose: The purpose of this study was to examine the associations of chronic pain and sleep disruption in the context of work performance among active duty military service members.

Methodological orientation: The study design was a cross-sectional observational study that examined associations between patients with chronic pain and sleep disruption, in the context of work performance.

Results: One hundred forty-five participants completed the study. Age, depression, sleep, and pain severity were consistently strong predictors of work performance.

Conclusions: Patients performed better with age, whereas those with depression, sleep disruption, and increased pain severity performed poorly.

Implications for practice: Research focused on the differences in work performance among age groups may provide a better understanding of coping strategies. Focused depression research can lead to a greater understanding of how mental health affects pain, sleep, and work. The findings of this study open the door to explore multiple approaches that could lead to treatments and preventions for military members living with chronic pain.

Abstract: The COVID-19 pandemic has led to a rapidly shifting health care environment, with frequent changes to best practices, which can lead to knowledge and practice gaps among health care providers, including nurse practitioners (NPs). The purpose of this paper was to describe a continuing education (CE) program developed to address COVID-19 knowledge gaps and to report on the changes in knowledge, competence, and confidence following program completion. The CE program was a 2.5 to 2.67 contact hour webinar delivered in July 2020, October 2020, and February 2021. Content included COVID-19 prevention, diagnosis, and management and was updated before the second and third webinars. Changes in content and webinar audience participation in the question and answer portion were reflected in the CE credit awarded. Preactivity and postactivity knowledge, competence, and confidence levels were assessed among activity completers. Changes between the preactivity and postactivity evaluation were compared. A total of 2,901 learners were included in the analysis, of whom 91.6% were NPs. Overall, baseline knowledge of COVID-19 transmission, diagnosis, and treatment was low. Substantial improvements in knowledge, competence, and confidence were reported from baseline to postactivity evaluation, with increases of 47-73% overall. Furthermore, learner confidence in identifying patients at risk for severe COVID-19 and counseling patients on prevention and transmission significantly increased. Despite plans to implement strategies to improve COVID-19 management, several barriers to uptake were identified. The rapid development of a COVID-19 CE program resulted in substantial gains in NP knowledge related to prevention, diagnosis, and management, with possible implications for nearly 68,000 patient encounters per month.