Journal of the American Academy of Nurse Practitioners最新文献

Purpose: To describe the work of the U.S. Preventive Services Task Force and to encourage nurse practitioners (NPs) to use its evidence-based recommendations for clinical preventive services.

Sources: Evidence reports, recommendation statements, and journal articles published under the auspices of the U.S. Preventive Services Task Force since its establishment in 1984.

Conclusions: A core competency for NPs working in primary care is knowledge about and provision of appropriate preventive services for their patients. The U.S. Preventive Services Task Force, an independent panel of experts in prevention and primary care, is an important resource for NPs.

Implications for practice: NPs can use Task Force recommendations to guide their screening, counseling, and preventive medication decisions. They can also educate patients about the missed prevention opportunities related to underuse of effective services and the potential harms of overuse of inappropriate preventive services.

Purpose: To review international statistics on the morbidity and mortality of diarrhea, pathophysiology, global incidence, and implications for the clinical practice of nurse practitioners (NPs).

Data sources: Selective review of literature.

Conclusions: Because of ever-increasing international travel, immigration, and rising awareness of global health issues, NPs must be current on the prevention, diagnosis, and treatment of diarrhea.

Implications for practice: Increased awareness of diarrhea as a significant international health issue mandates that NPs counsel clients who travel to high-risk areas about preventive measures to avoid exposure or manage symptoms while traveling. Guidelines for evidence-based treatments of diarrheal illness are widely available and should be followed.

Purpose: To review the current literature regarding the mental health needs of refugee children resettled in the United States and provide recommendations for clinicians working with refugee children and their families.

Data sources: An extensive review of journal articles published from research conducted in first-world countries such as the United States, the United Kingdom, Australia, the Netherlands, and Canada.

Conclusions: Review of the current literature suggests that while some refugee children will suffer poor mental health outcomes, such as post-traumatic stress disorder, depression, and anxiety, others may not. Several groups of researchers concluded that refugee children are actually a high functioning group. Many coping and protective factors as well as risk factors for poor outcomes have been identified by the research.

Implications for practice: Because many refugee children will experience adverse psychosocial outcomes during the resettlement period, it is essential that the mental health screenings be performed during each primary care visit. Nurse practitioners have the unique opportunity to make a difference in the lives of refugee children because they play a pivotal role in the assessment, screening, and referral of children for mental health services.

Purpose: The purposes of this review were to provide an updated report of intervention studies designed to enhance mobility in older adults and discuss the strengths and limitations of existing intervention studies and their implications for practice.

Data sources: Medline, CINAHL, and PsychInfo were searched to identify original research articles reporting interventions for promoting mobility in community-dwelling older adults.

Conclusion: Effective interventions for enhancing mobility in older adults include walking, aerobic exercise, and resistance training focusing on strength, balance, and flexibility. Group-based interventions show significant beneficial effects in increasing mobility. To obtain significant effects of physical activity interventions, the patient should participate in the exercise programs for at least 12 weeks. Strengths of existing clinical trials for promoting mobility in older adults include testing of various types of physical activity and training interventions and the use of an experimental design with a control group. The major challenges of creating mobility enhancement recommendations for older adults include detailing a mobility enhancement program will delay disability, creating a specific program dose for different populations by gender and ethnicity, and developing culturally appropriate mobility enhancement programs to improve adherence over time.

Implications for practice: Prescribing regular physical activity including aerobic exercise and resistance training in a primary care setting can be a beneficial approach to minimize progression of impaired mobility in older adults. The typical dose of the physical activity prescription is 20-60 min of aerobic activity three times weekly. Adherence to mobility enhancement recommendations by older patients can be followed up by in-person interview or use of mobility monitoring tools such as exercise diary or log.

Purpose: The purpose of this pilot study was to evaluate the impact of jazz dance class instruction on balance, cognition, and mood (specifically depression) in 13 healthy, community-dwelling, English-speaking older women with a mean age of 68.

Data sources: Data were collected using self-report questionnaires (Folstein Mini Mental Status Examination [MMSE] and Geriatric Depression Scale [GDS]), and the sensory organization test (SOT) for balance measurements (using the NeuroCom Smart Balance Master) was performed at three time periods in the study: time 1: between week 1 and week 2 of jazz class (baseline), time 2: between week 8 and week 9 of jazz class (midpoint), and time 3: after week 15 of jazz class (final measurement).

Conclusions: Differences in mean MMSE and GDS scores over time were not significant; however, SOT scores showed an increasing trend (p < .001). Data analysis using analysis of variance with repeated measures showed that balance measures improved throughout the duration of the study (F(2,10)= 19.68, p < .001). Post hoc analyses using paired t tests with a Bonferroni correction indicated that significant increases in balance occurred from time 1 to time 2 and from time 2 to time 3. These preliminary pilot study findings suggest that jazz dance does not impact cognition or mood but may improve balance in older women. This finding may have significant implications for fall prevention in the postmenopausal population.

Implications for practice: Because falls are a leading cause of morbidity and mortality in older adults of both genders, research is needed to evaluate both the impact of jazz dance on balance in older men and jazz dance as a fall prevention strategy in aging adults. Additionally, longitudinal research with a larger sample size is needed to test the effectiveness of jazz dance as a strategy for improving balance, cognition, and mood.

Purpose: To describe nurse practitioner (NP) practice patterns for exercise counseling for adults.

Data sources: Using a cross-sectional design, participants completed a self-administered questionnaire that ascertained barriers and facilitators encountered when providing exercise counseling. Participants included 398 NPs, who averaged 11 years in practice (SD = 7.9) and worked in a variety of practice areas.

Conclusions: In a given week, about half (48%) of the NPs counseled more than 50% of their patients for exercise. The majority of participants (84%) agreed that exercise counseling is as valuable an intervention as prescribed medication. More than half (59%) of the participants exercised regularly. Barriers and facilitators to exercise counseling were predominantly a patient's lack of interest and the length of the patient visit. Specific strategies were identified for older adults and individuals residing in rural areas who may require more tailored exercise counseling. Participants demonstrated strong values about exercise counseling and observed that exercise had clear benefits for their patients. NP respondents offered recommendations focused on safety and adherence that can be used to improve exercise counseling.

Clinical implications: Exercise is a crucial component of preventative health care. Studies have shown that healthcare provider recommendations can be effective in helping patients increase their exercise and activity.

Purpose: The purpose of this research was to compare changes in perceived physical, mental, and social function measured by the Short Form-36 (SF36vr2) in a group of older adults who were trained by peer mentors (PMs) versus a similar group trained by qualified kinesiology student mentors (SMs).

Data sources: We conducted a two-arm repeated measures longitudinal intervention and collected data for 87 PM and 44 SM participants. Pre- and post-training subscale scores were computed for all eight subscales and the two summary physical and mental component scores. The percentage differences in the 10 scores were used as the response variables.

Conclusions: After a 14-week physical fitness intervention, perceived physical, mental, and social functioning improved significantly (p < .05) for the PM group, but not for the SM group (p > .06). Thus, older adults who participated in a physical fitness program with peer support perceived (a) overall improvement in physical and mental well-being; (b) better social functioning, (c) enhanced ability to carry out physical and emotional roles, (d) improved general health, and (e) increased level of vitality. Thus, we conclude that peer-mentored exercise programs for older adults are superior to programs mentored by young professionals and may lead to increased adherence.

Implications for practice: Nurse practitioners routinely prescribe exercise while educating older adults about the benefits of an active lifestyle; however, older adults often remain sedentary and exhibit poor adherence to exercise. One potential solution is to use peer support. Two factors that can improve adherence are availability of structured exercise programs for the older adult and peer mentoring.

Purpose: To provide a review of physical activity measures and subjective and objective methods of its measurement. Considerations for the use of these measurements in research and practice will be discussed.

Data sources: The PubMed, CINAHL, and Health and Psychosocial Instruments databases, and the Centers for Disease Control Web site were searched using the search term "Physical Activity Measurement."

Conclusions: Physical activity is a lifestyle factor that is a key focus in chronic disease-related research, prevention, and interventions. Healthy People 2010 set goals of decreasing the prevalence of preventable diseases by encouraging healthier lifestyle patterns. Shifts toward more sedentary lifestyles have resulted in increases in life-limiting disease states, including obesity, diabetes, heart disease, cancer, and osteoporosis. Physical activity measurements have been used widely in research studies but are less commonly used in primary care. Measuring individuals' physical activity levels as part of the health assessment will enhance the provider's ability to engage in health promotion and suggest health protection interventions. The strengths, weaknesses, and potential applications to practice of physical activity measures are summarized in an effort to familiarize nurse practitioners (NPs) with commonly used tools and encourage integration of physical activity assessment into their current practice.

Implications for practice: NPs are in an ideal position to promote health by encouraging appropriate amounts of physical activity. Screening, health promotion, and disease prevention are part of the core competencies of NP practice established by the National Organization of Nurse Practitioner Faculties. Increased knowledge of physical activity measures will enhance the NP's ability to evaluate relevant physical activity research for use in evidence-based practice. Incorporation of simple yet appropriate physical activity measurements into practice will expand the NP's ability to identify and thus address sedentary lifestyles in their clientele.

Purpose: To explore the relationships between the physical fitness and the demographic characteristics, general health and well-being, social support, and physical activity in a group of community-dwelling older adults. This study also assessed the feasibility of obtaining physical fitness measures in the primary care setting.

Data sources: Thirty-four persons older than 60 years completed self-report measures and the Senior Fitness Test (SFT), a battery of fitness measures normed for older adults. Self-report measures included demographics, general health and well-being (SF-36), social support (Social Support for Physical Activity Scale), and physical activity levels (Physical Activity Scale for the Elderly).

Conclusions: Physically active older adults had significantly better upper and lower body strength, aerobic endurance, and dynamic balance. Older adults who reported better general health and had fewer chronic conditions scored better on the physical fitness tests. The SFT took 10-15 min to complete in the primary care setting.

Implications for practice: Physical fitness measures give primary care providers objective information to develop a physical activity program for their patients. A physical activity program that includes recommendations for aerobic endurance, strength, flexibility, and/or balance that is based on objective findings may be a useful tool to promote better health and physical fitness in older adults.