Journal of the American Association of Nurse Practitioners最新文献

{"title":"Hepatic encephalopathy in patients with cirrhosis: Key clinical considerations for the nurse practitioner and physician assistant.","authors":"Christina Hanson, Elizabeth K Goacher","doi":"10.1097/JXX.0000000000001105","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001105","url":null,"abstract":"<p><strong>Background: </strong>Hepatic encephalopathy (HE) is a common neurocognitive cirrhosis-related complication with a broad range of symptoms. Timely recognition and treatment of HE, including identifying precipitating factors, when possible, is critical for improving outcomes in patients with cirrhosis. Lactulose and rifaximin therapies, as appropriate, are recommended for patients with cirrhosis and a history of HE episode(s) to reduce risk of HE recurrence.</p><p><strong>Objectives: </strong>To provide clinical considerations for nurse practitioners and physician assistants (PAs) on the diagnosis and management of patients with cirrhosis.</p><p><strong>Data sources: </strong>A PubMed search of English-language articles published between January 1, 2008, and March 13, 2024, was performed to identify publications on the diagnosis and treatment of HE.</p><p><strong>Results: </strong>Important topics to address when discussing care with patients with cirrhosis and their caregivers include concomitant medication use, recent infection history, comorbid conditions (e.g., diabetes), fall and frailty risks, and sleep quality. In addition, ensuring treatment adherence is important for reducing the risk of future HE episodes and HE-related hospitalizations. Engaging and empowering caregivers helps reinforce the need for patient adherence to treatment and facilitates earlier identification of HE symptoms.</p><p><strong>Conclusions: </strong>Early recognition of HE, treatment, and reduction in risk of recurrence are imperative to minimize patient morbidity and mortality.</p><p><strong>Implications for practice: </strong>Nurse practitioners and PAs play an important role in supporting patients with cirrhosis who are at risk for developing HE, as well as their caregivers. Understanding and recognizing precipitating factors and clinical symptoms of HE and treating and preventing HE recurrence can improve patient outcomes.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of the challenges facing nurse practitioners in providing care to children.","authors":"Ashleigh F Bowman, Kristin Hittle Gigli","doi":"10.1097/JXX.0000000000001114","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001114","url":null,"abstract":"<p><strong>Background: </strong>Pediatric nurse practitioners (NPs) play an essential role in achieving optimal child health. However, few studies have examined barriers to implementing pediatric NP roles.</p><p><strong>Purpose: </strong>The purpose of this study was to identify challenges in pediatric NPs' practice that limit their ability to provide care.</p><p><strong>Methodology: </strong>The authors conducted a secondary, qualitative analysis of survey data collected by the National Association of Pediatric Nurse Practitioners. The authors analyzed data from one open-ended question, \"What is the biggest challenge to the pediatric-focused NP role?\" An inductive thematic analysis resulted in discovery of 18 themes.</p><p><strong>Results: </strong>A total of 980 pediatric NPs responded, most (67.9%) were primary care pediatric NPs, and 15.2% were acute care pediatric NPs. Challenges aligned with four megathemes: who we are, what we can do, what we need, and what our patients need.</p><p><strong>Conclusions: </strong>Pediatric NPs identified barriers to role recognition that align with improving professional identity.</p><p><strong>Implications: </strong>Future research should address barriers to role recognition that can increase the ability of pediatric NPs to provide child health care.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recognizing and responding to human trafficking in clinical care environments: A pediatric primary care case study.","authors":"Jessica L Peck, Kelcey Y King, Katherine P Hettenhaus, Kelley B Rigby, Tami McMichael","doi":"10.1097/JXX.0000000000001110","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001110","url":null,"abstract":"<p><strong>Abstract: </strong>Human trafficking is a proliferating abuse within the United States in which persons who are victimized frequently interface with clinical environments across the care continuum with a variety of presentations for health needs. However, in the absence of uniform standards for evidence-based training among the health professions, recognition and response in these scenarios remains low. This case study presents a young adolescent female accessing primary care with a chief complaint of commercial sexual exploitation. The Core Competencies for Human Trafficking Response in Health Systems is used as a guiding lens for practical applications in clinical practice in provision of pediatric primary care. Health care providers in a direct service role should be prepared to respond with evidence-based, trauma-informed, culturally responsive procedures and protocols used within their scope of practice.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Voices from the frontline: Perspectives from certified nurse practitioners, clinical nurse specialists and physician assistants at an Academic Medical Center.","authors":"Katherine N Dickerman, Cara A Chao, Nicole M Rondinelli, Hareklia L Brackett, Martina M Schulte, Kasey R Bowden, Marisha A Burden, Hillary J Chrastil, Katherine T Morrison, Kristin M Jensen, Stacey A Seggelke","doi":"10.1097/JXX.0000000000001111","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001111","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has exacerbated already existing stressors within health care. In August 2020, a campus-wide COVID-19 well-being survey indicated high levels of burnout, stress, and mental health concerns among certified nurse practitioners (CNPs), clinical nurse specialists (CNSs), and physician assistants (PAs) within our Department of Medicine.</p><p><strong>Purpose: </strong>In response to this survey, an interdisciplinary task force was formed by CNPs, CNSs, and PAs across departmental specialty divisions to conduct focus groups to gain a deeper understanding of workplace experience both prepandemic and during the COVID-19 pandemic.</p><p><strong>Methodology: </strong>As part of a quality-improvement project, 14 focus groups involving 34 CNPs, CNSs, and PAs within our department were conducted to better understand their experiences before and during the COVID-19 pandemic. A rapid qualitative analysis was used to identify themes and subthemes. In this article, we explore these themes and review potential solutions solicited from the focus groups.</p><p><strong>Results: </strong>The following themes were identified: (1) the importance of being valued; (2) the need for career development opportunities; and (3) the significance of professional fulfillment.</p><p><strong>Conclusions: </strong>Each of these themes existed before, but was exacerbated by, the ongoing COVID-19 pandemic. The manifestation of these stressors is unique to the CNPs, CNSs, and PAs experience, although the larger themes may overlap with physician colleagues.</p><p><strong>Implications: </strong>To improve the professional experience and well-being of CNPs, CNSs, and PAs at our institution, it will be critical for leadership to acknowledge these differences and develop specific initiatives to address these concerns.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A model of care redesign within rheumatology: A mixed methods approach integrating nurse practitioners and physician assistants.","authors":"Lisa Carnago, Kristin Holbrook, David Leverenz, Allison Dimsdale","doi":"10.1097/JXX.0000000000001112","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001112","url":null,"abstract":"<p><strong>Background: </strong>Increasing patient demand and clinician burnout in rheumatology practices have highlighted the need for more efficient models of care (MOC). Interprofessional collaboration is essential for improving patient outcomes and clinician satisfaction.</p><p><strong>Local problem: </strong>Our current MOC lacks standardization and formal integration of Nurse Practitioners (NPs) and Physician Assistants (PAs), resulting in reduced clinician satisfaction and limited patient access. To optimize care quality, clinician satisfaction, and patient access, we sought to develop an interprofessional MOC tailored to an academic rheumatology practice.</p><p><strong>Methods: </strong>We used a mixed methods sequential-exploratory design within a quality improvement (QI) framework to create a blueprint for MOC redesign.</p><p><strong>Intervention: </strong>Intervention development proceeded in four phases: needs assessment, data collection, socializing key ideas, and team design and planning.</p><p><strong>Results: </strong>In the needs assessment phase, divisional leadership was interviewed to identify shared goals for an optimized MOC. Data collection included surveys distributed to 12 physicians and 8 NPs/PAs, addressing 11 key domains related to current and future MOC needs. In phase 3, we communicated key findings to divisional leadership, clinicians, and staff. Phase 4 involved iterative team building and MOC design. Survey results revealed low satisfaction with the current MOC and a strong preference for parallel practice, standardization, and formal NP/Physician Assistant integration. Several barriers to MOC implementation were also identified.</p><p><strong>Conclusion: </strong>Redesigning the MOC in rheumatology requires aligning clinician, leadership, and organizational priorities. A mixed methods QI approach effectively uncovers clinical needs and potential barriers, supporting the successful implementation of a new MOC.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurse practitioner and physician associate mentorship: Improving retention and employment experiences.","authors":"Boyon Yun, Adam C Gilbert, Hsin-Fang Li, James M Scanlan, Andrea L Coleman","doi":"10.1097/JXX.0000000000001093","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001093","url":null,"abstract":"<p><strong>Background: </strong>Clinician turnover is costly for health care organizations.</p><p><strong>Local problem: </strong>A retention strategy for newly hired nurse practitioners (NPs) and physician associates (PAs) was needed at our organization.</p><p><strong>Methods: </strong>A quality improvement project was conducted to determine whether a mentorship program could improve retention and employment experiences of newly hired NPs and PAs.</p><p><strong>Interventions: </strong>A one-to-one mentorship program was implemented for newly hired NPs and PAs. (a) Retention and productivity data were compared for mentee participants vs. nonparticipants. (b) Mentee and mentor participants completed two program evaluation surveys to examine the program's impact on their employment experiences.</p><p><strong>Results: </strong>Sixty-eight mentee-mentor pairs completed their mentoring relationship during the first 3 years of the program. Retention was higher among mentee participants vs. nonparticipants during their first (96% vs. 85%, p = .0332) and second year of employment (83% vs. 65%, p = .0480). Productivity during the first year was similar for mentee participants and nonparticipants (38th percentile vs. 37th percentile, p = .84). Most participants (≥69%) believed the program improved onboarding, personal and professional growth, work environment, and NP and PA community connection.</p><p><strong>Conclusions: </strong>The mentorship program improved first- and second-year retention of newly hired NPs and PAs and employment experiences of program participants. By our estimates, the program helped retain 15 NPs and PAs who would have otherwise left the organization, yielding potential organizational savings of $1.29M-$1.72M. A mentorship program can be an effective retention strategy for reducing health care turnover and related costs.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationships among health promotion behaviors, patient engagement, and the nurse practitioner-patient partnership.","authors":"Irene DeCelie, Bonnie Sturm","doi":"10.1097/JXX.0000000000001039","DOIUrl":"10.1097/JXX.0000000000001039","url":null,"abstract":"<p><strong>Background: </strong>Individuals adopting health promotion behaviors benefit from improved health and reduced risk of chronic diseases. Patient engagement and a strong provider-patient partnership may play a role in health promotion.</p><p><strong>Purpose: </strong>This study examined the relationships between patient engagement, the nurse practitioner-patient partnership and health promotion behaviors among adults in a primary care setting.</p><p><strong>Methodology: </strong>A descriptive correlational study using convenience sampling to recruit 85 participants from a nurse practitioner primary care practice. Participants completed questionnaires measuring health promotion behaviors (Health Promoting Lifestyle Profile II), the quality of the nurse practitioner-patient partnership (Patient Reactions Assessment), and a person's capacity to engage in their health care (Person Engagement Index).</p><p><strong>Results: </strong>Moderate to strong correlations were found among the main study variables. Multiple regression analysis found a person's capacity to engage in health care significantly predicted health promotion behaviors ( R2 = 0.362, p < .001) and explained 36.2% of the variance in health promotion behaviors.</p><p><strong>Conclusions: </strong>Patient engagement is a significant predictor of health promotion behaviors. The interactive care model can serve as a framework for nurse practitioners to build partnerships and facilitate patient engagement. Nurse practitioners can serve as a coach, navigator, collaborator, and trusted health care partner with their patients.</p><p><strong>Implications: </strong>Nurse practitioners in primary care may need to restructure the health care encounter to allow for adequate time to communicate, listen, educate, and enlist patients in the shared decision-making process. Nurse practitioners can provide the support patients need to engage in their health care as they accept greater responsibility for their health.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":"8-18"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"I never thought of it as payment\": Qualitative evaluation of workshops with advanced practice registered nurses on pharmaceutical industry payment reporting.","authors":"Quinn Grundy, Nancy Rudner, Tracy Klein, Elissa Ladd, Dana Hart, Meghan MacIsaac, Lisa Bero","doi":"10.1097/JXX.0000000000001077","DOIUrl":"10.1097/JXX.0000000000001077","url":null,"abstract":"<p><strong>Background: </strong>With the expansion of professional autonomy and prescriptive authority of advanced practice registered nurses (APRNs), interactions with industry are under greater scrutiny. As of July 1, 2021, pharmaceutical and medical device companies must publicly report all payments to APRNs through the Centers for Medicare and Medicaid Services' Open Payments website.</p><p><strong>Purpose: </strong>To gauge APRNs' familiarity with, and perceptions of the Open Payments database and discuss whether and how APRNs should respond.</p><p><strong>Methodology: </strong>Virtual workshops consisting of a didactic presentation and interactive exercises with APRNs recruited through professional networks, associations, and conferences. Transcripts were analyzed using a qualitative interpretive approach, grounded in an everyday ethics theoretical framework.</p><p><strong>Results: </strong>Thirty-six APRN clinicians, students, and faculty participated in nine workshops. Seeing sponsored meals reported in Open Payments as \"payments\" prompted participants to see familiar interactions in a new way. Participants valued the enhanced transparency as a way to identify risks of bias but were concerned that reporting might undermine public trust in APRNs. Emphasizing awareness as a precursor to action, participants desired greater preparation for ensuring independence in practice.</p><p><strong>Conclusions: </strong>The importance of tackling the ethical issues associated with industry interactions is heightened within the context of an existing climate of distrust within health care. However, many participants were concerned about the effects of transparency on public trust rather than how APRNs individually or collectively can be more trustworthy.</p><p><strong>Implications: </strong>Open Payments can serve as a useful tool to catalyze broader conversations about ethics, integrity in decision making, and health policy advocacy.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":"51-60"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolution of a quality improvement curriculum in a family nurse practitioner residency program.","authors":"Kiera Yamada, Paula Susanne Price, Bronwyn Gorgone, Bethany Robertson","doi":"10.1097/JXX.0000000000001096","DOIUrl":"10.1097/JXX.0000000000001096","url":null,"abstract":"<p><strong>Abstract: </strong>There is a wide variation in the curricular emphasis and implementation nationally across programs for teaching quality improvement (QI) in family nurse practitioner (FNP) programs. This variation among curriculum plans often leaves NP graduates unsure as to how to identify and effect change within their organizations. This manuscript describes the development of an initial QI curriculum and subsequent enhancements over a 3-year time frame and outlines the curriculum development process, implementation, and program outcomes within an FNP residency program. This report also focuses on the importance of reinforcing the role of QI within the personal identity of the FNP, ensuring quality care to patients.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":"44-50"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the Nurse Practitioner Knowledge and Attitudes of Patient Obesity Scale: A pilot study.","authors":"Donna Willenbrock, Sage Rose","doi":"10.1097/JXX.0000000000001097","DOIUrl":"10.1097/JXX.0000000000001097","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a chronic, complex, relapsing disease requiring medical intervention that has reached epidemic proportions globally. Most patients are still experiencing bias and stigma related to their disease-even by health care providers. Our goal in this pilot study is twofold: to develop a scale to accurately measure nurse practitioner knowledge and attitude regarding the disease of obesity to determine whether bias exists and to potentially identify gaps in knowledge that can be targeted with future educational interventions.</p><p><strong>Purpose: </strong>To determine whether nurse practitioners in the Northeast have less stigmatized knowledge and attitudes regarding obesity.</p><p><strong>Methodology: </strong>A survey was created by the primary investigator as the \"Nurse Practitioner Knowledge and Attitudes of Patient Obesity Scale\" and distributed through email to New York State Nurse Practitioner Association members. Questions explored knowledge related to treatment of the patient living with obesity and nurse practitioner attitudes toward the disease.</p><p><strong>Results: </strong>The sample ( N = 45) was homogenous, which did not allow for generalization. Preliminary results show that a large percentage of respondents were aware of the definition of obesity as a disease and treatment guidelines. The scale met reliability and validity criteria and showed that Nurse Practitioners (NPs) with continuing education had more positive views.</p><p><strong>Conclusions: </strong>More research is needed to understand nurse practitioner knowledge and attitudes regarding the disease of obesity and the benefit of continuing education in reducing bias and stigma.</p><p><strong>Implications: </strong>This may serve to improve NP obesity continuing education.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":"21-28"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}