Journal of the American Association of Nurse Practitioners最新文献

{"title":"Adherence unveiled: A concept analysis of medication adherence in adult patients with sickle cell disease.","authors":"Eva Okereke-Enechukwu","doi":"10.1097/JXX.0000000000001130","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001130","url":null,"abstract":"<p><strong>Background: </strong>Patients with sickle cell disease (SCD) require lifelong adherence to treatment protocols, significantly affecting their care quality. Despite effective disease-modifying drug therapies (DMDTs), adherence remains suboptimal, with 30%-60% of patients being nonadherent. Ensuring medication adherence is crucial to attain the intended outcomes of DMDTs in patients with SCD.</p><p><strong>Purpose: </strong>This article examines the concept of \"medication adherence\" in adult patients with SCD undergoing DMDTs, offering fresh insights, knowledge, and clarity regarding the concept.</p><p><strong>Methodology: </strong>Walker and Avant's methods for concept analysis were employed to establish attributes, antecedents, consequences, and empirical referents of adherence in adult patients with SCD on DMDTs. A thorough literature search of PubMed, Cochrane Library, and CINAHL was conducted, encompassing peer-reviewed articles published in English from 2009 to 2023, using keywords and Boolean operators pertinent to adherence and SCD.</p><p><strong>Results: </strong>Following the literature search, 55 articles were identified, with 29 excluded based on title and abstract. The eligibility process narrowed the count to 15 pertinent articles included in this concept analysis. Attributes, antecedents, and consequences were synthesized to formulate a definition well-founded in the literature.</p><p><strong>Conclusions: </strong>Adherence is crucial in health care and offers an opportunity for interventions to improve patient outcomes. Understanding adherence to treatment protocols is vital for health care providers and researchers, and it should be further integrated into research and practice to improve the quality of life for patients with SCD.</p><p><strong>Implications: </strong>Integrating SCD medication adherence into nursing education and continuing education has the potential to enhance clinical interventions, improve patient outcomes, and refine nursing practice.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730595","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":"Impact of the TeleECHO model: Rapid identification and treatment of syphilis.","authors":"Kelli Garber, Emily Hochwald, Grace Barthold, Frankie Speerhas, Tina Gustin","doi":"10.1097/JXX.0000000000001126","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001126","url":null,"abstract":"<p><strong>Abstract: </strong>Syphilis is a growing concern globally, affecting adult men and women as well as the fetus of infected mothers. Nationally, syphilis disproportionately affects Black and Hispanic women compared with White women, and younger women are reported to experience a disproportionate burden of syphilis with the highest disparities. Syphilis can be difficult to diagnose, particularly if the health care provider is not well-versed in risk factors and signs and symptoms of the disease. TeleECHO is a telementoring model that has been employed worldwide to educate providers on a wide array of health-related topics. The model unites clinical experts and community partners with learners in distant sites to extend knowledge and expertise to those providing frontline care. This case study depicts the successful identification and treatment of syphilis in an unhoused woman seeking care at a free and charitable clinic whose interprofessional staff and providers had recently attended a TeleECHO on syphilis. The impact of the TeleECHO knowledge sharing and the collaboration enabled by local community partnerships developed through the ECHO are highlighted while providing guidance on the diagnosis and treatment of syphilis.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663835","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":"Characteristics and outcomes of medication-assisted treatment care models for pregnant women with opioid use disorder: A scoping review.","authors":"Kyeung Mi Oh, K Pierre Eklou, Krista Beran, Nora H Elnahas, Rebecca Bates, Patagonita Kitsantas","doi":"10.1097/JXX.0000000000001123","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001123","url":null,"abstract":"<p><strong>Background: </strong>Pregnant women and their unborn children are often overlooked in the opioid crisis, despite increased rates of both maternal complications and neonatal opioid withdrawal syndrome. Although medications for opioid use disorder (MOUD) are considered the gold standard for pregnant women, many either do not have access to or are not offered MOUD as an option.</p><p><strong>Objectives: </strong>To describe the characteristics of MOUD care models and assess the effectiveness of MOUD Care Models on initiation, adherence, and engagement in treatment for pregnant women with OUD.</p><p><strong>Data sources: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol directed the process of this scoping review. A search for English, peer-reviewed, quantitative studies, published between 2012 and 2023 was conducted in eight scholarly databases. The Joanna Briggs Critical Appraisal tools were used to assess study quality.</p><p><strong>Conclusions: </strong>The integrated care models included medication management, psychotherapy support, behavioral health care, and medical care management, with added focus on prenatal and postpartum care. Synthesis revealed that treatment engagement, medication adherence, breastfeeding rates, and postdelivery MOUD referrals were higher in integrated care models compared with nonintegrated care models. Pregnant women with OUD in integrated care models have better outcomes compared with those in nonintegrated care models.</p><p><strong>Implications for practice: </strong>Improvements in care models are necessary to tackle provider shortages, stigma, and financial, geographic, and technological barriers. Addressing these issues will enhance nurse practitioners' ability to provide comprehensive and accessible care to this vulnerable population.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623488","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 multistate analysis of nurse practitioner delegation regulations.","authors":"John D Gonzalez, Kristin H Gigli","doi":"10.1097/JXX.0000000000001121","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001121","url":null,"abstract":"<p><strong>Background: </strong>Nurse practitioners (NPs) are essential to meeting the demand for primary care and improving quality. Variation in primary care work environment has implications for outcomes. One opportunity to better support NP practice includes increasing NP access to support staff. However, given statutory regulation of NP's ability to delegate to unlicensed personnel, there may be limited effect of these interventions.</p><p><strong>Purpose: </strong>To describe state regulations on NP delegation to unlicensed personnel and consider implications of NP delegation regulations on opportunities to improve NP work environment.</p><p><strong>Methodology: </strong>We conducted a cross-sectional, six state policy surveillance of state nursing regulations related to NP delegation to unlicensed personnel. Using an iterative data identification process, we review of documents from six state boards of nursing. Analysis included nominal and textual data.</p><p><strong>Results: </strong>Five states prohibited NPs from delegating medication administration to unlicensed personnel. One state permitted delegation of mediation administration to unlicensed personnel but only in community settings.</p><p><strong>Conclusions: </strong>Delegation limitations prevent NPs from practicing to the full extent of their education. Nurse practitioners must be aware of the delegation regulations when working with unlicensed personnel to prevent disciplinary actions. Nurse practitioner-specific delegation regulations can facilitate greater use of unlicensed personnel in NP-led primary care.</p><p><strong>Implications: </strong>Boards of Nursing should consider NP delegation regulations that promote public safety, minimize unintended consequences, and increase access to NP-led primary care.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623487","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":"The association between Doctor of Nursing Practice Nurse Practitioner staffing and hospital outcomes.","authors":"Meaghan H Roberts, Marcy Ainslie, Shannon Idzik, Mary Beth Bigley, Louis Fogg, Kara Elena Schrader, Susan W Buchholz","doi":"10.1097/JXX.0000000000001120","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001120","url":null,"abstract":"<p><strong>Background: </strong>The National Organization of Nurse Practitioner Faculties advocates for the doctoral level as the entry-to-practice standard for NPs. Understanding the impact of Doctor of Nursing Practice NPs (DNP-NPs) on health care systems is vital for shaping policy, regulations, and practice.</p><p><strong>Purpose: </strong>This study quantitatively assesses the relationship between DNP-NP staffing levels and hospital quality and cost outcomes using major datasets.</p><p><strong>Methodology: </strong>Data from the 2022 Iowa and Kentucky State Boards of Nursing (BON) and the Centers for Medicaid & Medicare Services (CMS) were used. The BON databases identified DNP-NPs matched to CMS data, with hospital affiliation determined by Hospital CMS Certification Number codes. Doctor of Nursing Practice NP counts were scaled by hospital size, with DNP-NPs per 100 beds as the treatment variable. Outcome variables and hospital characteristics were analyzed by DNP-NP quintiles.</p><p><strong>Results: </strong>Hospitals in the lowest quintile of DNP-NP staffing had a significantly higher mean readmission rate of 14.84% (SE = 0.245), which was 0.39% points higher (p = .005) than the adjusted mean of 14.45% (SE = 0.214) for other hospitals. No systematic relationship was found between DNP-NP staffing and readmission rates across the remaining distribution, and no correlation was detected between DNP-NP staffing and other hospital quality or cost efficiency measures.</p><p><strong>Conclusion: </strong>The study underscores the need for improving data infrastructure to further research the relationship between DNP-NP staffing and hospital quality outcomes and address hospital staffing questions.</p><p><strong>Implications: </strong>Recommendations are provided for enhanced data sources on NP education and practice to inform health care workforce research, staffing, policies, and regulations.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623489","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":"Improving cervical cancer screening rates at a Federally Qualified Health Center.","authors":"Lauren A McCann, Marjorie Kozlowski, Michelle Martinez","doi":"10.1097/JXX.0000000000001118","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001118","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer is the fourth most common cancer in women. Early detection with screening methods can help to prevent mortality.</p><p><strong>Local problem: </strong>Cervical cancer screening is below national standards at a Midwest Federally Qualified Health Center and may compromise future funding. A manual chart review of cervical cancer screening was compared with an electronic health record-generated report and found results from outside facilities accounted for 27% of the metric's underperformance. This quality improvement project aimed to improve the Uniform Data System performance for cervical cancer screening at a specific health center from 46.3% to 79.2% by July 2024.</p><p><strong>Methods: </strong>Implementation, guided by the Improvement Model and Lewin's Change Theory, included (1) analysis of cervical cancer screening underperformance, (2) sharing data with key stakeholders, and (3) creating tip sheets for chart reconciliation.</p><p><strong>Interventions: </strong>Interventions consisted of (1) auditing and reconciling charts from Epic's generated reports, (2) modifying the frequency of or discontinuing Pap smears, (3) updating surgical history to reflect hysterectomy type, and (4) sending scheduling outreach messages.</p><p><strong>Results: </strong>As of March 2024, cervical cancer screening 2023 percentages increased by ≥9% for each quarter and by 8.7% for year-to-date at the Midwest health center. The quality metric's quarter 1 and 2, 2024 data increased by 4% and 3% as of July 2024.</p><p><strong>Conclusions: </strong>Although the target goal was not reached in the designated time frame, the percentage increase proves that implementation of a chart reconciliation workflow can improve rates for cervical cancer screening at a Federally Qualified Health Center.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567481","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":"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":"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":"173-181"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","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":"Improving oral health screening and dental referrals for patients with diabetes in a community health clinic.","authors":"Joy McGowen, Kathy Shaw","doi":"10.1097/JXX.0000000000001047","DOIUrl":"10.1097/JXX.0000000000001047","url":null,"abstract":"<p><strong>Background: </strong>Oral health screening and access to dental care in adults with diabetes lead to improved health outcomes and quality of life. Patients with barriers to accessing health services have a greater risk of poor medical and dental outcomes. People with diabetes are more likely to have periodontal disease and less likely to visit a dentist.</p><p><strong>Local problem: </strong>Oral screening and dental referrals were not being done at a community health clinic in Plano, Texas.</p><p><strong>Methods: </strong>The aim of this 6-month quality-improvement project was to increase oral health screenings in adults with diabetes from 0% to 80%; subaim was to increase access to dental services by increasing referrals from 0% to 50%. Adults with diabetes without insurance or dental care in the past 12 months were eligible for the project ( n = 263). Outcome measures were tracked using a longitudinal chart.</p><p><strong>Interventions: </strong>Eligible patients were screened and referred to a dental office with an income-based financial assistance program using Plan-Do-Study-Act methodology. Staff education, referral order set, and follow-up calls were additional processes implemented.</p><p><strong>Results: </strong>Fifty-two percent of eligible patients were screened, 35.9% were referred to dental services, and 17.7% of those referred established care with dental clinic.</p><p><strong>Conclusions: </strong>Interventions were successful in improving access to dental care, although target goal was not met. Creating systems that facilitate interdisciplinary care improved health equity and standards of health in chronic disease.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":"182-188"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748458","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":"Icodec ONWARDS: A review of the first once-weekly diabetes treatment for nurse practitioners and physician assistants.","authors":"Davida Kruger, Melissa Magwire, Scott Urquhart","doi":"10.1097/JXX.0000000000001065","DOIUrl":"10.1097/JXX.0000000000001065","url":null,"abstract":"<p><strong>Background: </strong>Diabetes management is challenged by the complexity of treatment regimens and the need for frequent injections, affecting patient adherence and quality of life. Insulin icodec, a once-weekly basal insulin analog, represents a significant innovation, potentially simplifying diabetes care and improving outcomes.</p><p><strong>Objectives: </strong>This review aims to evaluate the safety, efficacy, and clinical implications of insulin icodec for individuals with type 1 and type 2 diabetes, highlighting its potential to affect current treatment paradigms.</p><p><strong>Data sources: </strong>A review was conducted comparing once-weekly insulin icodec with daily basal insulin analogs using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to ensure transparent reporting of systematic reviews. A search was performed in the following databases: PubMed, Google Scholar, Embase, and ClinicalTrials.gov , focusing on efficacy and safety outcomes.</p><p><strong>Conclusions: </strong>Insulin icodec has demonstrated effective glycemic management and a safety profile comparable to daily basal insulins. Its extended half-life and steady-state glucose-lowering effect have the potential to reduce the burden of daily injections and improve patient adherence.</p><p><strong>Implications for practice: </strong>The introduction of once-weekly insulin icodec represents an advancement in diabetes care. For front-line clinicians, this innovation aligns with the need for more straightforward medication regimens. Coupled with continuous glucose monitoring systems, it enables a more personalized and efficient approach to diabetes management, with the potential to improve patient satisfaction and clinical outcomes. This underscores the impact of integrating such advancements into practice, highlighting the role of nurse practitioners and physician assistants in adopting these innovations to optimize patient care.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":"160-172"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11855992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468614","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":"A case study of hypophosphatasia: An underdiagnosed bone disorder characterized by low alkaline phosphatase.","authors":"Leslie Moro","doi":"10.1097/JXX.0000000000001099","DOIUrl":"10.1097/JXX.0000000000001099","url":null,"abstract":"<p><strong>Abstract: </strong>Hypophosphatasia (HPP) is a rare genetic metabolic bone disorder that is underdiagnosed. Although there are many forms of this disease, based on age of onset, symptoms, and severity, HPP is characterized by low serum alkaline phosphatase levels, bone fractures, and dental complications. Diagnosis of HPP is made from clinical, laboratory, and radiologic findings. Genetic testing for an ALPL gene variant responsible for causing HPP confirms a molecular diagnosis. Distinguishing HPP from other more common bone disorders, such as osteoporosis, is important as the treatment for these diseases differs greatly. Although there is no known cure for HPP, treatment should be holistic and multidisciplinary.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":"189-195"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729153","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}