Journal of the American Academy of Nurse Practitioners最新文献

Purpose: To describe the evolving and expanding role of nurse practitioners (NPs) in providing diabetes medical nutrition therapy (MNT) as the United States faces epidemics of diabetes and obesity.

Data sources: Scientific literature and reports from the public health, diabetes, and nutrition fields.

Conclusions: Although clinically effective for both prevention and treatment of diabetes, MNT is often underutilized. The majority of people with diabetes are cared for by primary care providers; the role of NPs as primary care providers is evolving and expanding. NPs are recognized as leaders who creatively adapt to the rapidly changing health care delivery system.

Implications for practice: NPs can serve as role models by presenting accurate, basic nutrition messages, referring patients to registered dietitians for MNT, reinforcing nutrition and the importance of lifestyle change as primary treatments for their disease, and following up on their patients' progress with nutrition interventions.

Gastrointestinal (GI) bleeding is a commonly encountered primary care clinical challenge. The AGA Medical Position Statement: Evaluation and Management of Occult and Obscure Gastrointestinal Bleeding, reviewed in this month's clinical practice guideline column, summarizes recommendations for the initial diagnostic approach and management for occult bleeding, as well as the subsequent diagnostic and management approach for obscure bleeding. The recommendations have applicability in primary care as nurse practitioners (NPs) assess the cause of occult bleeding and consult with specialists when obscure bleeding occurs.

Purpose: To present the current state of the science of pathophysiology, assessment and treatment of carpal tunnel syndrome, including the use of pyridoxine (B6).

Data sources: Selected research articles, texts, Websites, personal communications with experts, and the authors' own clinical experience.

Conclusions: Much is yet to be learned about carpal tunnel syndrome. While the basic treatment of NSAIDs and nighttime splints seems universally accepted, much controversy remains. The use of vitamin B6 as a treatment is one such controversy requiring further investigation.

Implications for practice: Current treatment for carpal tunnel syndrome should include NSAIDs, nighttime splinting, ergonomic workstation review, and vitamin B6 200 mg per day.

Purpose: To describe the routine health maintenance needs of individuals with Down syndrome who have specialized health needs associated with the multi-system impact of the diagnosis.

Data sources: Review of scientific literature including peer-reviewed articles, books, and online resources.

Conclusion: In addition to the routine health maintenance needs of all persons, those with Down syndrome have specialized needs. Failure to address these specific health maintenance concerns may lead to misdiagnoses and failure to reach the highest level of function possible.

Implications for practice: Patients with Down syndrome who have legitimate, treatable diagnoses may be misdiagnosed as having behavior problems or dementia. Failure to identify abnormalities such as cardiac problems or sleep apnea may shorten life and interfere with ability to live life to the fullest.

Purpose: To evaluate the use and effectiveness of a protocol developed for emergency nurses and other medical personnel to use with survivors of sexual assault. The Ohio Department of Health (ODH) Protocol for the Treatment of Adult Sexual Assault Survivors was developed by a multi-disciplinary team in 1991-92 as a written guide to provide comprehensive, standardized, non-judgmental, and equitable treatment for survivors. In 1993, this 118-page manual was sent to all Ohio hospitals. In 1994, a follow-up video and training guide were also delivered. In 1997, Victims Rights Advocacy, a non-profit agency in Ohio, and the Center for Social Work Research at The University of Texas at Austin collaboratively conducted an evaluation of the utilization and effectiveness of this protocol at Ohio hospitals.

Data sources: Emergency departments at Ohio hospitals were asked to complete a mailed survey regarding their policies and procedures for treating sexual assault patients. Telephone calls were made to the hospitals that did not return a survey, and site visits were conducted at 20 hospitals in diverse areas of Ohio.

Conclusions: Overall, respondents concurred that hospitals can benefit from using a standardized protocol, such as the ODH Protocol, for treating victims of sexual assault. Survey participants also indicated that training is needed on several topics, especially testifying in court, cultural awareness, and the needs of special populations, such as male, gay, lesbian, and bisexual survivors. In addition, findings indicate that survivors need more follow-up services, and written information about these services should be provided to them.

Implications for practice: Nurse practitioners can improve the treatment of sexual assault survivors in their communities through a variety of actions, such as gathering information about available protocols and training opportunities for personnel, and becoming familiar with resources that can help victims.

Purpose: To determine the most frequently taught procedures and how important it is to teach these procedures in Family Nurse Practitioner (FNP) programs in the United States according to FNP program directors.

Data sources: Each of the 178 directors of FNP programs in the United States was mailed a survey to complete anonymously. The survey, designed for this study, listed 78 procedures. Directors were asked to indicate whether or not the procedure is taught in their FNP program and how important they think it is that FNP programs in the United States should teach that procedure. A total of 114 (64%) responded.

Conclusions: A total of 10 of the 78 procedures were taught in 50% or more of the FNP programs. These procedures were: obtaining Papanicolau smears, testing visual acuity, audiometry, tympanometry, splinting of extremities, interpreting 12-Lead electrocardiograms, interpreting blood gases, local infiltration of anesthetics, single layer wound closure, and fluorescein staining of the eyes. The directors believed that six of these were very important to teach in FNP programs.

Implications for practice: The findings of this study can be used to plan course content related to procedures in new FNP programs or to revise course content in existing programs. The study results are helpful to individuals who develop continuing education courses to target skills that NPs may find valuable or may need for their current employment setting but were not taught in their educational programs.