Chloe Michaelis, Elizabeth Hundt, William Lombardi, Jill Howie Esquivel
{"title":"Transitions in care: Piloting a neurocritical care clinic with nurse practitioners and physician associates.","authors":"Chloe Michaelis, Elizabeth Hundt, William Lombardi, Jill Howie Esquivel","doi":"10.1097/JXX.0000000000000950","DOIUrl":"10.1097/JXX.0000000000000950","url":null,"abstract":"<p><strong>Abstract: </strong>The transition period from hospital to home is a vulnerable time for rehospitalization and adverse events for patients. Follow-up clinic visits within 7-14 days of discharge is an effective strategy for reducing hospital readmissions. Neurocritical care patients have a unique set of needs to safely transition to home. We evaluated the feasibility of a Neuroscience Rapid Follow-Up Clinic with nurse practitioners (NPs) and physician associates (PAs) to meet transitional care gaps in neurocritical care patients and prevent rehospitalization. Clinic procedures and documentation templates were customized for the pilot clinic. Five NPs and one PA underwent a brief training course for the ambulatory care setting. Eligible patients were tracked throughout the hospitalization and the team made follow-up appointments. The pilot clinic took place from October 2022 to January 2023. Nine patients were seen in the clinic approximately 8 days after discharge. The clinic attendance rate was 90%. Among the clinic attendees, 66% received referrals to a primary care provider or other services, one third received medication changes or refills and all received patient-specific education. There were no rehospitalizations among the clinic patients. Implementation of this pilot clinic was possible with the current departmental resources. This innovative model of care has the potential to reduce hospital readmissions.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41136881","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":"Diabetic myonecrosis: An easily overlooked cause of limb pain in diabetic patients.","authors":"Jennifer Wells, Stephen C Sorsby","doi":"10.1097/JXX.0000000000000962","DOIUrl":"10.1097/JXX.0000000000000962","url":null,"abstract":"<p><strong>Abstract: </strong>Diabetic myonecrosis (DMN) is an underdiagnosed cause of spontaneous extremity pain and swelling in patients with diabetes. Failure to consider this diagnosis in patients with recent onset of extremity pain may lead to inappropriate testing and to treatment that worsens symptoms and delays healing. The following is a case report of recurrent diabetic myonecrosis in a 36-year-old woman that highlights several typical features of this uncommon disorder. We discuss the differential diagnosis and how to rapidly identify DMN, as well as best practices for the treatment of the disorder. We approach most types of muscular pain issues with stretching and exercise, but this approach can result in increased pain and delayed resolution in patients with DMN. Nurse practitioners and other providers should consider DMN when faced with a patient with diabetes and spontaneous extremity pain and understand how to efficiently diagnose this disorder and rule out other causes.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50161978","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}
Laura A Ivey, Patrick Flavin, Katy Vogelaar, Jessica L Peck
{"title":"A case for the health welfare of Texans-A nurse practitioner state regulation policy analysis.","authors":"Laura A Ivey, Patrick Flavin, Katy Vogelaar, Jessica L Peck","doi":"10.1097/JXX.0000000000000967","DOIUrl":"10.1097/JXX.0000000000000967","url":null,"abstract":"<p><strong>Abstract: </strong>Restrictive nurse practitioner (NP) practice regulation at the state level continues to obstruct patient access to quality affordable care because primary care provider shortages heighten across the nation. Evidence-based research supports NPs as cost-effective providers without conceding quality of care. A patchwork of highly variable state policies subjectively determines the degree of collaborative oversight required for NPs to practice in each state. An objective review of policies influencing NP capacity to deliver care promotes evidence-informed policy adaptation. A policy analysis was completed using Bardach and Patashnik's framework to evaluate policy options for NP practice regulation in Texas. Full practice authority (FPA) policy effect was quantitively evaluated through difference-in-differences regression models using selected measures of all 50 states and the District of Columbia. Health welfare outcomes were calculated using emergency department utilization, average household health expenditures, poor physical health days, and NP-specific adverse action reports (AAR). Overall, FPA policy did not have a statistically significant effect on state-clustered emergency department utilization, average household health expenditures, or poor physical health days. Full practice authority was associated with decreased NP AAR. The analysis supports FPA as a viable policy option for states such as Texas and counters claims FPA policy adoption results in detrimental sequalae in the health of the population.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71424567","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}
Sylvana Brickley, Shimika Barrolle, Alice Pentland
{"title":"Implementation of a postgraduate dermatology fellowship program for nurse practitioners.","authors":"Sylvana Brickley, Shimika Barrolle, Alice Pentland","doi":"10.1097/JXX.0000000000000963","DOIUrl":"10.1097/JXX.0000000000000963","url":null,"abstract":"<p><strong>Abstract: </strong>Transition to practice programs (also referred to as fellowship, residency, or postgraduate training programs) for nurse practitioners (NPs) are becoming more popular, especially in specialties such as dermatology. A nationwide shortage of dermatology clinicians, which had led to long appointment wait times and inadequate patient access to care, has led to more NPs practicing dermatology to help meet the demand for care. New graduate NPs may struggle in their transition to practice, and fellowship programs have been shown to support NPs as they transition from novice to expert. In this article, the University of Rochester Medical Center shares its experience in developing, implementing, and managing a postgraduate dermatology fellowship program for NPs.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10898538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71424570","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":"What the X? Understanding changes in buprenorphine prescribing regulation.","authors":"Chandra Speight","doi":"10.1097/JXX.0000000000000942","DOIUrl":"10.1097/JXX.0000000000000942","url":null,"abstract":"<p><strong>Abstract: </strong>Opioid use disorder remains an epidemic in the United States. Buprenorphine is a Food and Drug Administration-approved medication for opioid use disorder that is associated with decreased opioid-related mortality and morbidity. Until recently, providers had to have a specialized wavier, a Drug Enforcement Agency (DEA) X, to prescribe buprenorphine for opioid use disorder. The 2023 Consolidated Appropriations Act, signed into law by President Biden, removed X waiver requirements and implements new training requirements for all new and renewing DEA registrants. This brief report outlines the history of buprenorphine prescribing regulation, reviews the recent regulatory changes and their implications for nurse practitioner buprenorphine prescribing, and concludes by considering the importance of promoting buprenorphine access.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10104751","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 effective depression care in an outpatient psychiatric clinic.","authors":"Thomas Moore, Sharanna Johnson","doi":"10.1097/JXX.0000000000000975","DOIUrl":"10.1097/JXX.0000000000000975","url":null,"abstract":"<p><strong>Background: </strong>With more than 20 million adults experiencing a major depressive episode in 2020, depression is one of the most widespread and costly illnesses in the United States.</p><p><strong>Local problem: </strong>An audit of medical records at an outpatient psychiatric clinic revealed that none of the patients (0/56) were receiving standardized depression screening at follow-up appointments.</p><p><strong>Methods: </strong>An 8-week rapid cycle Plan-Do-Study-Act model for change was used to spearhead a quality improvement (QI) project for effective depression care. The QI project comprised ongoing data collection through chart audit every 3 days, which drove tests of change (TOC). Team engagement surveys were also assessed for change in team engagement scores.</p><p><strong>Interventions: </strong>The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, and an effective care log (ECL) measured effective depression care. Every 2 weeks, a TOC was implemented, which guided further iterative changes throughout the project.</p><p><strong>Results: </strong>Effective depression care increased to 74% over the course of the project, surpassing the initial aim of 50%. Completion rates of the PHQ-9 (76%) and ECL (91%) increased. Team engagement (27.1) also increased over the course of the project.</p><p><strong>Conclusions: </strong>This project improved effective depression care. The success was largely due to the iterative TOCs, ECL, and team engagement.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71424572","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}
Stephanie O Ibemere, Susan G Silva, Mary Lou Affronti, Rita Masese, Paula Tanabe
{"title":"Nurse practitioner satisfaction with in-person versus telehealth chronic care delivery.","authors":"Stephanie O Ibemere, Susan G Silva, Mary Lou Affronti, Rita Masese, Paula Tanabe","doi":"10.1097/JXX.0000000000000964","DOIUrl":"10.1097/JXX.0000000000000964","url":null,"abstract":"<p><strong>Background: </strong>The widespread use of telehealth and regulatory changes that enhanced nurse practitioner (NP) practice authority because of the SARS-CoV-2 pandemic offers an opportunity to assess postpandemic NP satisfaction with telehealth care delivery and perceptions of its feasibility compared with in-person visits.</p><p><strong>Purpose: </strong>Outpatient chronic care delivery satisfaction and preference were compared among NPs who provide care to adults through in-person and/or telehealth visits and examined NP demographic and clinical characteristics associated with overall satisfaction by care delivery type.</p><p><strong>Methodology: </strong>Data were collected using a cross-sectional, descriptive design through online dissemination of The Care Delivery Satisfaction Survey to a nationally representative sample of 586 NPs.</p><p><strong>Results: </strong>Compared with NPs using both visit types to deliver care, NPs delivering care in-person only had significantly lower satisfaction scores for interpersonal manner ( p = .0076) and communication ( p = .0108). NPs using telehealth only had significantly higher overall satisfaction and satisfaction subscale scores (all p < .01) compared with NPs using both visit types. Overall, 77% of NPs using both visit types preferred in-person delivery.</p><p><strong>Conclusions/implications: </strong>NPs delivering telehealth care only were more satisfied with chronic care delivery than NPs using both delivery types. NPs using both types were more satisfied with interpersonal manner and communication compared with NPs delivering in-person care only. Most NPs using both types preferred in-person care delivery. Given increased telehealth use, health systems, academic institutions, and insurance companies can use these study findings to inform policy on telehealth resources and infrastructure.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92154853","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":"What the X? Understanding changes in buprenorphine prescribing regulation.","authors":"","doi":"10.1097/JXX.0000000000001008","DOIUrl":"10.1097/JXX.0000000000001008","url":null,"abstract":"","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140028312","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}
Nyema T Eades-Brown, Anne O Oguntoye, Dalal Aldossary, Miriam O Ezenwa, Laurie Duckworth, Duane Dede, Versie Johnson-Mallard, Yingwei Yao, Agatha Gallo, Diana J Wilkie
{"title":"Adherence to a reproductive health intervention for young adults with sickle cell.","authors":"Nyema T Eades-Brown, Anne O Oguntoye, Dalal Aldossary, Miriam O Ezenwa, Laurie Duckworth, Duane Dede, Versie Johnson-Mallard, Yingwei Yao, Agatha Gallo, Diana J Wilkie","doi":"10.1097/JXX.0000000000000997","DOIUrl":"10.1097/JXX.0000000000000997","url":null,"abstract":"<p><strong>Background: </strong>The CHOICES intervention is tailored specifically for young adults with sickle cell disease (SCD) or sickle cell trait (SCT). The face-to-face (F2F) delivery format is feasible with efficacy for improving knowledge about reproductive health for those with SCD or SCT.</p><p><strong>Purpose: </strong>The purpose of the study was to compare the participant adherence to a remote online CHOICES intervention study (N = 107) and a F2F CHOICES intervention study (N = 234).</p><p><strong>Methodology: </strong>In both studies, participants with SCD or SCT were randomized into experimental or usual care control groups. Descriptive statistics were collected for all participants by group in both studies. Adherence was measured by retention at each data collection time point. Independent t-tests were conducted to compare mean participant adherence of the F2F and online studies postbaseline (6, 12, 18, and 24 months).</p><p><strong>Results: </strong>There was a significant difference in mean adherence postbaseline between the studies (p = .005). The results suggest that more research is necessary for proper online participant retention.</p><p><strong>Conclusion: </strong>Advance practice nurses that are well informed on CHOICES can transmit the availability of this evidence-based intervention to this special population. Special referral for the CHOICES intervention, which is tailored specifically for young adults with SCD or SCT, may increase adherence to the intervention if it comes from trusted health care providers.</p><p><strong>Implications: </strong>Nurse practitioners are educators in primary and acute care settings. Encounters with reproductive age populations with SCD or SCT can occur in both settings.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11339234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139972349","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":"Evidence-based simulation: Fostering competency through structured and multisource feedback.","authors":"Leah Burt, Sarah Fitz, Bob Kiser","doi":"10.1097/JXX.0000000000001004","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001004","url":null,"abstract":"<p><strong>Abstract: </strong>Preclinical simulation is an evidence-based method for nurse practitioner (NP) students to improve clinical communication and disease management competency. During simulation, students may receive feedback from multiple sources, including standardized patients (SPs), faculty, peers, and themselves. Although evidence supports simulation with multisource feedback, its impact on clinical knowledge and communication has yet to be evaluated among NP students. We designed, implemented, and evaluated a preclinical simulation program with structured multisource feedback integrated into a disease management course within a Doctor of Nursing Practice curriculum. Differences in communication self-efficacy and disease management knowledge before and after participation, as well as perceptions of learning and importance of varying feedback sources, were evaluated using a single group pre-post mixed-methods design. On average, clinical communication self-efficacy was significantly higher, and disease management knowledge scores were significantly higher after participation. Learners rated feedback sources as important or very important and described varying feedback sources as complementary. Feedback from SPs, peers, learners themselves, and faculty was complementary and important to learning. This preclinical simulation program with purposeful integration of multisource feedback provides an evidence-based foundation for scaffolding multidomain competency development into curriculums to meet updated standards of advanced nursing education.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139912873","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}