Journal of the American Academy of Nurse Practitioners最新文献

Purpose: To examine the Consensus Model for APRN Regulation as a proposed solution to simplify and unify regulation of advanced nursing practice with respect to licensure, certification, accreditation, and educational standards. Data sources: Policy statements and reports issued by national organizations of nursing professionals and discussion within the scholarly literature provided an overview of regulatory differences among the 50 U.S. states, their impacts on advanced practice registered nurse (APRN) practice, and discussion of the Consensus Model as a potential solution. Conclusions: Major organizations of nursing professionals have endorsed the Consensus Model, indicating the importance of this significant step toward standards and consistent quality in APRN education and practice. Diverse regulatory criteria, such as variable accreditation standards, disparate certification and licensing requirements, inconsistent population foci, and scopes of practice, represent barriers to optimized APRN function within today's complex healthcare system and, ultimately, reduced access to safe, quality care for patients. Implications for practice: The Consensus Model for APRN Regulation promises to unify APRN education, practice, and licensure, promoting greater mobility among nursing professionals. Elimination of inconsistencies in APRN licensure, education, certification, and accreditation requirements will promote greater value and mobility for the APRN within the healthcare system.

Purpose: To evaluate if wrist actigraphy, a measurement of movement, is an effective tool for assessing sleep/wake patterns and use in clinical practice in persons with asthma.

Data sources: Data from three individuals with asthma were utilized to develop three case scenarios. The case scenarios illustrated the use of actigraphy as the measurement tool for sleep patterns as they relate to individuals with varying degrees of asthma control.

Conclusions: The person with poorly controlled asthma had less total sleep time and lower sleep efficiency than the person with well-controlled asthma. The actigraph provided useful information on sleep patterns such as daytime napping, nighttime sleep, and sleep efficiency in persons with varying degrees of asthma control.

Implications for practice: Nighttime asthma symptoms are often hard for the nurse practitioner (NP) to assess as they are often subjectively reported by patients. The use of actigraph in the clinical setting can provide useful, objective information on the sleep/wake cycles of persons with asthma to aid the NP in providing optimal management of the disease.

Purpose: To provide a comprehensive review of the background, diagnosis, and primary care management of neuroblastoma (NBL) and to describe the pathophysiology, signs and symptoms, and diagnostic tests for the patient with NBL.

Data sources: Extensive review of the worldwide scientific literature on the condition, including primary care articles and studies performed.

Conclusions: NBL is one of the most common tumors of childhood and clinical presentation depends on the site of the primary tumor as well as the presence and location of any metastasis. Treatment includes a combination of surgery, chemotherapy, and radiation, as well as the newer immunotherapy.

Implications for practice: NBL is often identified in the primary care setting, and it is important to be able to recognize the presentation and correctly manage the disease. The clinical presentation of NBL, the vital facts needed to ensure that this diagnosis will not be overlooked, and follow-up in a primary care setting will be reviewed.

Purpose: To examine the effects of at-risk alcohol use on patterns of healthcare use and health outcomes.

Data sources: Using the National Health Interview Survey and the Medical Expenditures Panel Survey, a total sample of 4449 adults, mean age 45 (SD 15), were grouped according to responses to the question: "In the past year, on how many days did you have 5 or more drinks of any alcoholic beverage?"

Conclusions: Three categories of respondents were grouped as follows: not at-risk group = 0 days of 5+ drinks/day (n = 2991, 67%); the low at-risk group = 1-11 days of 5+ drinks/day (n = 796, 18%); and the high at-risk group = 12-365 days of 5+ drinks/day (n = 662, 15%). The level of risky alcohol use did not predict healthcare use or healthcare outcomes; high at-risk alcohol drinkers were less likely to use the healthcare system than other drinkers. When divided by rural versus urban living, rural high at-risk alcohol drinkers reported more emergency department visits and all rural living groups reported poorer physical and mental health than their urban counterparts.

Implications for practice: Risky alcohol use, defined as drinking above low-risk guidelines, affects 3 out of 10 adults, and risky drinking plays a role in over 60 chronic health conditions. Nurse practitioners encounter risky alcohol users in multiple practice settings. It may be difficult to identify the underlying alcohol issues, particularly in those living in rural settings; however, identification of at-risk drinkers is essential for prompt intervention in the potential progression from risky alcohol use to an alcohol use disorder.

Purpose: The purpose of this pilot study was to determine if pedometer placement sites in women, other than the waist, provide the same results.

Data sources: Three pedometers were given to 12 women to wear on a bra strap, waist, and shoe for a week and then rotated through each site. The participants recorded their daily step counts in a log, turned in weekly, and were instructed not to change their daily routine. Body mass index (BMI), placement preference, and waist and hip measures were collected at enrollment and the concluding sessions.

Conclusions: Women's adiposity distribution patterns and clothing provide potential barriers to pedometer use at the waist. Daily walking is an affordable option for physical activity counseling by nurse practitioners (NPs). The bra and shoe placements were not found to be equitable alternative sites compared with waist placement of pedometers. However, 75% of participants had improvement in BMI and waist-to-hip measures with no lifestyle intervention. The participants preferred a placement perceived as comfortable and consistent.

Implications for practice: The results inform NPs that women need to consistently wear pedometers in a daily walking program, which can lead to beneficial changes in BMI. NPs should encourage walking as a form of daily physical activity, which may be monitored by a pedometer worn consistently.

Purpose: To explain the Genetic Information Nondiscrimination Act (GINA), what it covers, and what it does not cover to aid primary care practitioners in advising their patients.

Data sources: Governmental agencies, congressional records, and various nongovernmental agencies, press releases, and journal articles.

Conclusions: The GINA will protect patients from employment and insurance information in multiple ways. However, loopholes exist which will need to be addressed at the next review of the Act in 6 years.

Implications for practice: In order to provide accurate information regarding genetic testing, clinicians need to be familiar with key factors about GINA regarding law, practice, impact on patients and their rights in terms of genetic testing.

Purpose: The purpose of this literature review is to describe the severity of and susceptibility for negative outcomes in patients with implantable cardioverter defibrillators (ICDs) who lack advanced directives.

Data sources: A comprehensive review of literature was conducted with articles selected from CINAHL, Pubmed, Ovid, Medline, evidence-based medicine, evidence-based nursing, and the Web of Science from 1990 to the present. Key words such as ICD, randomized controlled trials, case studies, advanced directives, end-of-life, living will, health care proxy, and durable power of attorney were used to identify specific studies.

Conclusions: Advanced directives are becoming an essential part of care for the ICD population. The recommendations in the literature suggest that clinicians should initiate end-of-life discussions with their patients when they are healthy. The patients' preferences should be discussed often in patient care in case they would like changes made to their advance directive as their condition changes.

Implications for practice: Implementation of advanced directives in patients' medical care will need to be encouraged in the event of illness. Advanced practice nurses can provide clear explanations of patients' treatment choices in outpatient and inpatient settings.

Purpose: Cervical cancer is the second leading cause of cancer deaths among women worldwide. Human papillomavirus (HPV) has been shown to be the precursor of cervical cancer in over 99% of these cases. Although preventative measures have greatly reduced the burden of HPV-induced cervical cancer, these measures cannot be utilized by women who are unaware of the existence of HPV and its relationship to their health. Women over the age of 40 are being newly diagnosed with HPV, profoundly impacting their lives and their sense of well-being. This article highlights the necessity for clinicians to assess knowledge, health beliefs, and preventative measures regarding HPV and cervical cancer in women over the age of 40.

Data sources: Review of scientific literature of knowledge, health beliefs, and preventative measures in women regarding HPV and cervical cancer and clinical practice guidelines.

Conclusions: Although women aged 40 and above are not specifically considered high risk for HPV infection, many women are testing positive in this age group and are facing the impact of an HPV diagnosis that implicates a sexually transmitted disease and is known to be a precursor to cervical cancer.

Implications for practice: Suggested questions to use for all patients are presented as it is crucial for healthcare providers to understand the healthcare needs of this age group in order to appropriately direct resources and to save the lives of women from this preventable disease.

Purpose: To add three further dimensions of evidence for the care of women with genital piercings (GPs).

Data sources: Following a literature review, a cross-sectional study replicated previous work, using a web-based survey. This triad of evidence provides (a) descriptive quantitative data (N = 240) about women with GPs, (b) qualitative data about women with GPs, as well as (c) clinical observations from 60 healthcare providers (HCPs) who have cared for women with GPs.

Conclusions: Three important findings about women with GPs were validated: (a) GPs were deliberate actions, sought for personal and sexual expression; (b) women with GPs treat piercings as a normal, meaningful part of their lives which produce sexual enhancement and expression; and (c) they continue to seek information about GP care from nonhealth providers. New data indicate that they have experienced depression (47%), abuse (physical 18%; emotional, 27%; sexual, 14%), and forced sexual activity (35%) in their lives. Several unsubstantiated assumptions about women with GPs are challenged with these data.

Implications for practice: GPs should not delay important health care. Health-protective, as well as health promotion, behaviors are important to reduce risks. Nurse practitioners (NPs) can become effective and resourceful advocates in three specific areas of care: (a) responsiveness to women with GPs, (b) collaborative decision making for the removal of jewelry, and (c) promotion of applicable patient education.