Journal of the American Association of Nurse Practitioners最新文献

{"title":"The use of technology to improve wound care practice.","authors":"Anne Walsh","doi":"10.1097/JXX.0000000000001383","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001383","url":null,"abstract":"<p><strong>Background: </strong>As clinicians we may encounter patients with complicated wounds of varying etiologies.</p><p><strong>Local problem: </strong>Wound education is often lacking in nursing and medical curriculums. There is shortage of wound specialized clinicians to offer guidance. Furthermore, there is a shortage of palliative specialized clinicians to assist when the goals of wound care may need to shift to symptom management.</p><p><strong>Methods: </strong>The accredited Wound Care Pro app was developed as an educational resource for clinicians to meet this critical care need. It includes an overview of eight wound etiologies with descriptions, images, treatment options, case studies, and interventions to manage distressing symptoms, such as wound pain, odor, bleeding, and excessive exudate.</p><p><strong>Interventions: </strong>Technology was used to develop an educational tool for clinicians to have at their fingertips to help bridge the knowledge gap. The goals include empowering clinicians caring for patients with wounds to improve the healing potential when healing is the goal, to decrease the risk of complications, to improve symptom management, to decrease the wasteful use of costly wound supplies, and to decrease the risk of litigation from inappropriate wound care plans.</p><p><strong>Results: </strong>More than 11,000 clinicians have downloaded the application with positive feedback received, including how it has helped them get more appropriate, cost-effective wound care plans in place.</p><p><strong>Conclusion: </strong>Although there is a shortage of wound and palliative specialized clinicians to meet complex patient wound care needs, technology can help empower clinicians whether wound healing or palliation is the goal.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228099","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":"Supporting nurse practitioner autonomy: A policy proposal to advance hospice nurse practitioner scope.","authors":"Lauren Hochart, Tracie Gadler","doi":"10.1097/JXX.0000000000001381","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001381","url":null,"abstract":"<p><strong>Abstract: </strong>The nurse practitioner (NP) profession has achieved many advancements in its autonomy and scope of practice in the last 61 years since becoming a recognized advanced practice registered nursing role. However, some areas of health care still limit the NP's ability to practice autonomously although it is within their scope of practice. This is notable in the subspecialty of hospice care regarding certifying a terminal diagnosis as part of eligibility determination for a Medicare beneficiary to be able to receive covered hospice services. This health policy paper reviews current hospice regulations and provides evidence to support the benefits of advancing NP scope of practice and autonomy to include the ability to certify terminal diagnoses as defined in federal hospice care regulation 42 C.F.R. § 418.22. The goal of this health policy paper is successful change in federal legislation, allowing NPs to practice to the full extent of their scope and improving access to the provision of hospice care.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228123","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":"Curriculum to clinic: Integrating clinical readiness assessment.","authors":"Amy Haeger, Margaret Perlia Bavis, Bridget O'Brien","doi":"10.1097/JXX.0000000000001375","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001375","url":null,"abstract":"<p><strong>Abstract: </strong>The transition from didactic to clinical education in nurse practitioner (NP) programs demands robust strategies to ensure students are adequately prepared. Although competency-based education and simulation have gained prominence, a clear understanding of student readiness before clinical placement remains underexplored. This project aimed to assess perceptions of clinical training readiness among family nurse practitioner students, preceptors, and faculty to identify gaps and inform curriculum redesign. Evaluation of perceptions was carried out through a survey. Guided by the Domains of Competence put forth by the American Association of Colleges of Nursing (AACN), three distinct surveys were developed to collect data on perceived readiness to begin clinical rotations. A total of 43 participants responded, including 26 preceptors, 9 students, and 8 faculty members. Survey results indicate strong agreement among the three groups that students can perform a comprehensive medical history, but there is less consensus on their ability to conduct a physical examination, diagnose conditions, develop management plans, and interpret laboratory results. Professionalism was rated highly across all groups, and the majority agreed that students met overall expectations. Findings revealed the alignment of some competencies such as comprehensive medical histories, while exposing discrepancies in others. These insights highlight areas for continued work, recognizing that perceptions do not directly correspond to competence, underscoring the importance of early objective assessment to ensure student preparedness. Findings support the integration of formative, simulation-based assessments aligned with the AACN Essentials to bridge the gap between perceived and actual competence.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148680","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":"Pilot study of the Xpert hepatitis C virus VL fingerstick assay in the intended use setting.","authors":"Katy Keylis, Manzhen Chen, Annabelle St Pierre, Robert Kozak, Tamara Barnett, Faranak Canani, Scott Sugden, Mia Biondi","doi":"10.1097/JXX.0000000000001376","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001376","url":null,"abstract":"<p><strong>Background: </strong>Integrating hepatitis C virus (HCV) point-of-care (POC) RNA testing into community settings is essential to achieving World Health Organization elimination targets. However, the preparation required for end users to operate the Xpert HCV VL Fingerstick assay remains unclear.</p><p><strong>Purpose: </strong>To determine whether end users can independently review the Instructions for Use (IFU) and accurately perform testing without additional training.</p><p><strong>Methodology: </strong>A single-arm ease-of-use study was conducted in Ontario, Canada with nurses practicing incommunity settings serving priority HCV populations. Eligible participants included registered practical nurses, registered nurses, and nurse practitioners without prior experience using the assay. Participants reviewed the IFU, completed a knowledge questionnaire, performed the assay under observation, completed an ease-of-use questionnaire, and were invited to interviews. Feasibility outcomes were analyzed descriptively.</p><p><strong>Results: </strong>Nine participants (seven registered nurses and two nurse practitioners) were enrolled. The mean knowledge score was 99%, exceeding the prespecified benchmark (≥78%). Test interpretations were correct in 100% of cases using spiked samples, and no critical user errors were observed. Minor challenges occurred during noncritical tasks, reflected in some Likert-scale responses, although the overall workflow was rated as simple.</p><p><strong>Conclusions: </strong>Community-based nurses successfully conducted POC HCV RNA testing using only the IFU, demonstrating feasibility for implementation.</p><p><strong>Implications: </strong>Minimal training requirements may facilitate scale-up of HCV POC testing in nursing-led community settings, particularly for underserved populations. Reduced training could lower costs and logistical barriers while supporting decentralized, low-barrier diagnosis. Quality-assurance processes and optional competency-based training may further promote consistent performance and broader implementation.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148064","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 next frontier in advanced practice nursing: Infectious diseases nurse practitioner certification.","authors":"Sara Rogers, Sagie De Guzman, Vanessa Riley, SuKyung Kim, Mary Lou Manning","doi":"10.1097/JXX.0000000000001378","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001378","url":null,"abstract":"<p><strong>Abstract: </strong>The increasing complexity of infectious diseases (ID) care, including antimicrobial stewardship, emerging pathogens, outpatient parenteral antimicrobial therapy, and expanding immunocompromised populations, has significantly broadened the role of nurse practitioners (NPs) in IDs practice. Concurrent challenges, including antimicrobial resistance, recurrent pandemics, evolving immunization guidelines, and vaccine hesitancy, further underscore the need for specialized expertise. This article proposes formal recognition of IDs as a NP subspecialty and outlines a framework for a postgraduate certification for Infectious Diseases Nurse Practitioners. The proposed competencies are grounded in the National Organization of Nurse Practitioner Faculties' NP Role Core Competencies and align with the 2021 American Association of Colleges of Nursing Essentials for Advanced Nursing Education. The framework also incorporates a One Health perspective, recognizing the interconnected influences of human, animal, and environmental health on ID management. Establishing a structured pathway for advanced training and certification may strengthen the NP workforce and enhance the delivery of comprehensive, evidence-based ID care.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127991","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":"Genomics in psychiatric Nurse Practitioner practice: Moving from emerging trend to essential competency.","authors":"Laurie M Connors","doi":"10.1097/JXX.0000000000001327","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001327","url":null,"abstract":"<p><strong>Abstract: </strong>Genomics is increasingly influencing psychiatric practice as evidence links genetic variation with neurodevelopmental disorders, treatment response, and complex psychiatric presentations. Psychiatric nurse practitioners are well positioned to incorporate genomics into patient assessment and management; however, familiarity with testing options and clinical indications remains limited. This column reviews key genomic considerations for psychiatric practice, including pharmacogenomics, chromosomal microarray analysis, and exome or genome sequencing. Clinical \"red flags,\" such as developmental delay, dysmorphic features, early-onset psychosis, epilepsy, and strong family patterns of neuropsychiatric disease, can guide decisions on when to refer for further genetic evaluation. Integrating genomics enhances diagnostic clarity, supports precision prescribing, and informs risk assessment, ultimately improving patient outcomes. Strengthening nurse practitioner genomic literacy is essential to advancing person-centered mental health care and ensuring that emerging genomic tools are applied responsibly, ethically, and effectively in practice.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":"38 10","pages":"746-750"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111451","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":"Conceptualizing nurse practitioner role ambiguity: A dual-perspective for contemporary nurse practitioner practice.","authors":"Meagan L Guise, Franklin Hicks","doi":"10.1097/JXX.0000000000001290","DOIUrl":"10.1097/JXX.0000000000001290","url":null,"abstract":"<p><strong>Background: </strong>The sustained well-being of the nurse practitioner (NP) workforce is threatened by pervasive role ambiguity. This ambiguity is frequently cited as a barrier to successful professional integration and practice. Although existing literature acknowledges this issue, it lacks a formal definition within the context of NP practice. This omission prevents targeted evaluation of its true impacts and the development of effective interventions.</p><p><strong>Purpose: </strong>The purpose of this article is to present a concept analysis of role ambiguity within the NP context.</p><p><strong>Methodology: </strong>Rodgers' evolutionary concept analysis was used. A targeted integrative literature review was conducted across PubMed, CINAHL, and Scopus. This process resulted in 29 articles selected for thematic analysis.</p><p><strong>Results: </strong>The analysis revealed NP role ambiguity manifests as both an internal professional identity conflict and an externally imposed issue driven by systemic barriers. The derived working definition is a state of confusion or lack of clarity regarding the practice authority, scope of practice, abilities, and educational preparation of NPs experienced not only by NPs themselves but also by health care consumers, other health care staff, administrators, and the public ultimately leading to decreased job satisfaction, difficulties in professional identity formation, and the marginalization of NPs. Key attributes include conflict over scope of practice and the discrepancy between the anticipated and actual NP role. Antecedents span legal, organizational, and financial barriers, with consequences such as underutilization and burnout.</p><p><strong>Conclusions: </strong>These findings require recognizing NP role ambiguity as an externally imposed systemic challenge that generates internal conflict.</p><p><strong>Implications: </strong>Nurse practitioners should leverage this clarified definition to advocate for broader professional recognition and guide the implementation of external strategies, such as targeted education campaigns and policy advocacy, to support professional sustainability.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":"760-768"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148258547","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":"Advocacy in action: A real-world example of nurse practitioners collaborating for formulary change.","authors":"Emily Smith, Tarik Khan","doi":"10.1097/JXX.0000000000001335","DOIUrl":"10.1097/JXX.0000000000001335","url":null,"abstract":"<p><strong>Abstract: </strong>Nurse practitioners (NPs) play a critical role in identifying and addressing policy barriers that affect patient care. We present a real-world example of nurse practitioner-led advocacy to improve access to hormone replacement therapy after cancer treatment. Collaboration among a practicing nurse practitioner, a nurse practitioner-legislator, and state Medicaid leadership resulted in changes to Pennsylvania's Preferred Drug List, eliminating the need for prior authorizations and improving access to estrogen replacement therapy. This experience demonstrates how NP advocacy can influence health policy and patient outcomes.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":"739-740"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604440","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":"Association between age-adjusted Charlson Comorbidity Index and risk of nonhome discharge in sepsis survivors: A retrospective analysis based on the Medical Information Mart for Intensive Care IV database.","authors":"Jiafang Zhang, Qianying Mo, Jiahui Liu, Yiheng Zhang, Zeyu Cai, Xiangyang Duan, Tianrui Jin, Yinuo Zhu, Jun Lyu, Xiaoshen Zhang","doi":"10.1097/JXX.0000000000001374","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001374","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is a common complication in intensive care units, and the discharge disposition of survivors has clinical significance. The Charlson Comorbidity Index (CCI) predicts long-term outcomes based on comorbidity burden.</p><p><strong>Purpose: </strong>To investigate the association between age-adjusted CCI (ACCI) and nonhome discharge among sepsis survivors.</p><p><strong>Methodology: </strong>A retrospective cohort study was conducted using the Medical Information Mart for Intensive Care IV database. Adult sepsis survivors (Sepsis-3.0 criteria) were included. Patients who died during hospitalization or had missing data were excluded. The primary outcome was nonhome discharge (i.e., discharge to skilled nursing facilities, long-term care, or rehabilitation). Multivariable logistic regression, subgroup, and sensitivity analyses were performed.</p><p><strong>Results: </strong>Among 23,683 sepsis survivors, 44.9% were discharged home, and 55.1% had nonhome discharge. In the nonhome discharge group, 65% had a CCI score ≥5, compared with 40.4% in the home discharge group. Multivariable logistic regression showed that each 1-point increase in ACCI was associated with higher odds of nonhome discharge (odds ratio = 1.15, 95% confidence interval: 1.14-1.16, p < .001). This association remained robust across sensitivity analyses.</p><p><strong>Conclusions: </strong>An ACCI means people with sepsis are more likely to be discharged to a location other than home.</p><p><strong>Implications: </strong>The ACCI can help nurses figure out which patients with sepsis are at risk. This can help plan for their care after they leave the hospital, and it can also help make sure that the right resources are used for the patients.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111437","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":"Attitudes, perceptions, and beliefs related to full practice authority for advanced practice registered nurses.","authors":"Mark D Miller, Jennifer C Barut","doi":"10.1097/JXX.0000000000001315","DOIUrl":"10.1097/JXX.0000000000001315","url":null,"abstract":"<p><strong>Background: </strong>Advanced practice registered nurses (APRNs) play a critical role in addressing health care access, yet regulatory barriers in states without full practice authority (FPA) limit their capacity to provide care. Tennessee remains a restricted-practice state, and limited data exist on Tennessee APRNs' attitudes and perceptions regarding FPA.</p><p><strong>Purpose: </strong>The purpose of this Doctor of Nursing Practice project was to examine the attitudes, perceptions, and beliefs of APRNs in Tennessee related to FPA and to identify factors influencing their perspectives.</p><p><strong>Methodology: </strong>A cross-sectional, web-based survey was distributed via email to all APRNs listed in the Tennessee state licensure database from October 1 through December 31, 2023. The survey included a total of 26 structured questions with Likert-type responses and open-ended questions. Descriptive statistics and thematic analysis were used to analyze quantitative and qualitative data, respectively. The Vanderbilt Institutional Review Board exempted the study.</p><p><strong>Results: </strong>A total of 1,484 APRNs responded (9% response rate), with 1,281 complete responses. Most respondents were nurse practitioners ( n = 1,285; 86.6%). More than two thirds ( n = 978; 67.4%) indicated a preference for FPA, with rural APRNs showing significantly higher support (76.5%) compared with suburban (63.3%) and urban (63.5%) APRNs. Although 81.5% of respondents reported a strong understanding of FPA, qualitative analysis of 7,630 open-ended responses revealed that approximately 25% of those reporting a high level of understanding held misconceptions about FPA's scope and implications.</p><p><strong>Conclusions: </strong>Tennessee APRNs broadly support FPA, particularly those in rural settings, yet significant misconceptions persist. These findings highlight the need for targeted educational initiatives and informed advocacy to advance FPA policy in Tennessee and other restricted-practice states.</p><p><strong>Implications: </strong>Targeted education is needed to address APRN knowledge gaps and bolster advocacy. Advancing FPA will require coordinated education, legislative action, and public awareness to improve health care access and workforce utilization.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":"837-846"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679099","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}