Journal of the American Association of Nurse Practitioners最新文献

{"title":"Demographic factors and rural residence history associated with smoking history.","authors":"","doi":"10.1097/JXX.0000000000001371","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001371","url":null,"abstract":"","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":"38 10","pages":"777-778"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111509","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":"Preclinical objective structured clinical examination for Family Nurse Practitioner students: Impact on clinical confidence and perceptions of curricular integration.","authors":"Jennifer Aldred, Joy Elwell, Lisa Rauch, Ivy M Alexander","doi":"10.1097/JXX.0000000000001320","DOIUrl":"10.1097/JXX.0000000000001320","url":null,"abstract":"<p><strong>Abstract: </strong>Family Nurse Practitioner (FNP) programs often lack structured preclinical competency verification, which delays identification of learning needs and creates patient safety risks. Although registered nurses demonstrate sophisticated clinical judgment within team-based practice, FNP practice demands autonomous diagnostic reasoning, generating differential diagnoses and formulating management plans. This shift requires intentional educational support through formative assessment. At one Western United States public university FNP program, students entered practicum without standardized preclinical evaluation. Faculty observed wide variation in preparedness, from overconfidence to hesitation. This single-cohort, mixed methods pilot educational program evaluation implemented a formative preclinical Objective Structured Clinical Examination for 12 FNP students to evaluate confidence in primary care assessment and diagnostic reasoning while exploring curriculum integration feasibility. Students rated confidence using the Simulation Effectiveness Tool-Modified; faculty used the Lasater Clinical Judgment Rubric. Structured debriefings and surveys captured qualitative data. Two 30-minute standardized patient encounters, an adult and pediatric wellness visits incorporating anemia recognition, followed International Nursing Association for Clinical Simulation and Learning standards. Prebriefing, encounters, documentation, and debriefing integrated Kolb's experiential learning and Tanner's clinical judgment frameworks. Students reported moderate confidence in primary care assessment ( M = 2.32) and diagnostic reasoning ( M = 2.26), with lower confidence in clinical decision making ( M = 1.70). Faculty ratings paralleled student self-assessments: highest in noticing ( M = 2.7), lowest in reflecting ( M = 2.0). Students ( M = 3.90) and faculty ( M = 4.89) rated the Objective Structured Clinical Examination as educationally valuable and appropriate; however, faculty expressed sustainability concerns ( M = 2.44). The preclinical Objective Structured Clinical Examination provided structured opportunity for diagnostic reasoning practice and identification of learning needs before practicum entry, demonstrating feasibility within competency-based FNP education.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":"828-836"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345667","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":"Take care of the people who take care of the people: How one organization improved clinician wellness.","authors":"Valerie Fuller, Karen Ketner","doi":"10.1097/JXX.0000000000001370","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001370","url":null,"abstract":"<p><strong>Abstract: </strong>In this segment, American Association of Nurse Practitioners treasurer Dr. Karen Ketner and I discuss the importance of clinician wellness.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":"38 10","pages":"741"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111485","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-directed continuing education leads to knowledge, confidence, and practice changes related to Alzheimer disease early diagnosis and disease-modifying treatments.","authors":"Patty Scalzo, Carolyn Clevenger, Raymond R Romano","doi":"10.1097/JXX.0000000000001276","DOIUrl":"10.1097/JXX.0000000000001276","url":null,"abstract":"<p><strong>Abstract: </strong>Alzheimer disease (AD) continues to be underdiagnosed and undertreated in primary care despite the high and growing prevalence. Lack of diagnosis becomes more pressing with the availability of disease-modifying therapies (DMTs) that can slow disease progression during a narrow window of time in the course of the disease. Nurse practitioners (NPs) are central to closing these practice gaps, but persistent deficiencies in knowledge and confidence highlight the need for focused continuing education (CE). A 1.6-hour CE activity was developed on the importance of early AD diagnosis, interpretation of DMT clinical trial data, and strategies to improve DMT access. Outcomes were assessed using pre- and post-activity surveys and a 60-day follow-up survey. A total of 6,541 learners completed the program, the majority of whom were practicing NPs providing direct patient care. Collectively, these providers reported caring for over 35,000 patients at risk for cognitive impairment each week. The CE program led to a remarkable 38% improvement in knowledge, with significant gains across all assessment items ( p < .001). The greatest gains were in recognizing the prolonged asymptomatic phase of AD (418% improvement) and identifying risk factors for the primary adverse effect of DMTs (50% improvement). Confidence in key domains improved significantly, with 75%-79% of follow-up respondents who see patients reporting sustained confidence gains. At 60 days, 59% had implemented at least one practice change. This CE program reached a large NP audience and improved knowledge, confidence, and reported practice behaviors related to AD early diagnosis and DMTs.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":"820-827"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775024","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":"Supportive kidney care in private practice nephrology: A quality improvement project.","authors":"Meera P Suthar, Michelle Webb, Tara A Albrecht, C Brent Shealy","doi":"10.1097/JXX.0000000000001271","DOIUrl":"10.1097/JXX.0000000000001271","url":null,"abstract":"<p><strong>Background: </strong>End-stage renal disease carries a high treatment burden, reduced quality of life, and limited survival in older adults. Patients with advanced kidney disease (stage 4-5 chronic kidney disease [CKD]) often initiate dialysis without fully understanding the prognosis or quality of life associated with different treatment options.</p><p><strong>Local problem: </strong>Supportive kidney care (SKC), or kidney palliative care, is not routinely provided in private nephrology practice. Early SKC can improve quality of life and support patients in living well with chronic illness.</p><p><strong>Methods and intervention: </strong>Using the Plan-Do-Study-Act quality improvement framework, an evidence-based practice change project was implemented. A structured, nurse practitioner-led SKC clinic was developed using a pre-post design to increase documented prognosis education and advance care planning (ACP) for patients with advanced CKD. The project ran from September 2023 to January 2024.</p><p><strong>Results: </strong>Fifty-seven patients attended the clinic during the intervention. After the initial visit, 98.2% had documented prognosis education and completed ACP. Treatment preferences were clarified: 46 patients chose active medical management without dialysis, 10 chose dialysis, and 1 remained undecided. Among those choosing medical management, no hospitalizations occurred during the implementation phase.</p><p><strong>Conclusions: </strong>Establishing a dedicated, nurse practitioner-led SKC clinic in private nephrology practice increased shared decision making and ensured goal-concordant care. This quality improvement project demonstrates that embedding SKC into private practice can empower patients and caregivers with prognosis education, ACP, and treatment aligned with their goals and values.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":"811-819"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499335","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":"Increasing the evaluation of Mycoplasma and Ureaplasma infections in primary care: A quality improvement project.","authors":"Elisabeth Marie Volpert, Brittney Corniel, Aubree Croghan, Melissa Humphreys, Claudiu Romulus Moisa, Jackie Smith","doi":"10.1097/JXX.0000000000001305","DOIUrl":"10.1097/JXX.0000000000001305","url":null,"abstract":"<p><strong>Background: </strong>Mycoplasma and Ureaplasma infections are frequently underdiagnosed and undertreated in primary care, contributing to adverse reproductive and genitourinary outcomes. Limited routine screening, diagnostic complexity, and variable provider awareness contribute to gaps in care.</p><p><strong>Local problem: </strong>In an academic primary care setting, patients presenting with genitourinary symptoms were infrequently evaluated for Mycoplasma and Ureaplasma.</p><p><strong>Methods: </strong>This quality improvement project was conducted in two academic family medicine clinics. Pre- and postintervention retrospective chart reviews assessed rates of testing and diagnosis among adult patients presenting with urethral or vaginal discharge, pelvic pain, and/or dysuria. Provider education and standardized evaluation and treatment algorithms were implemented.</p><p><strong>Interventions: </strong>An educational session was delivered and supported with emailed materials. Standardized algorithms outlining indications for testing and recommended treatments were integrated into clinical workflow.</p><p><strong>Results: </strong>During the study period, 519 patients presented with genitourinary symptoms. Recurrent symptoms consistent with Mycoplasma or Ureaplasma infection were identified in 205 patients (39.5%); however, 133 (64.9%) were not screened. Among the 72 patients (35.1%) who underwent diagnostic testing, 46 (63.9%) tested positive. Overall, 45 patients were diagnosed with Mycoplasma or Ureaplasma infections, including Mycoplasma hominis (26.7%), Ureaplasma parvum (31.1%), Ureaplasma urealyticum (20.0%), and Mycoplasma genitalium (20.0%). Most patients received guideline-concordant antimicrobial therapy, primarily doxycycline, azithromycin, or levofloxacin, with referral for specialty evaluation in cases of persistent infection. These primary care-based interventions reduced underdiagnosis and improved reproductive and genitourinary health outcomes.</p><p><strong>Conclusion: </strong>Targeted provider education and streamlined diagnostic protocols improved evaluation and screening for Mycoplasma and Ureaplasma in primary care.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":"805-810"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148226246","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":"An essential responsibility for fellows: Explaining the financial realities of education.","authors":"Rodney W Hicks, Susan D Ruppert, Judith A Berg, Mary Ellen Roberts","doi":"10.1097/JXX.0000000000001358","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001358","url":null,"abstract":"<p><strong>Abstract: </strong>Recent proposed changes to what constitutes a professional and their impact on federal student loans are in flux, and the public has concerns over the cost of higher education. The Fellows of the American Association of Nurse Practitioners have a professional responsibility to help educate policymakers and the public about the cost of attendance. Missing from national discussions are the not-so-visible expenses that contribute to the education of professionals. These expenses are necessary to maintain the world's most highly educated health care workforce.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":"38 10","pages":"742-745"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111497","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":"Assessing an asynchronous 6-week video-based storytelling program to empower diabetic foot care: A patient-centered pilot study.","authors":"Hsiao-Hui Ju, Jeffery Alford, Dina White, Nikhil Padhye, Daphne C Hernandez","doi":"10.1097/JXX.0000000000001278","DOIUrl":"10.1097/JXX.0000000000001278","url":null,"abstract":"<p><strong>Background: </strong>People with diabetes with an A1C level above 8% are at greater risk of developing serious diabetic foot disease.</p><p><strong>Purpose: </strong>To create and pilot an asynchronous educational storytelling video program as a mechanism to engage individuals at risk for developing diabetic foot disease to improve foot care knowledge and practices.</p><p><strong>Methods: </strong>A multidisciplinary team developed six engaging storytelling videos on diabetes foot care. Knowledge of foot care was assessed before and after each video, and foot care behaviors were measured using the Summary of Diabetes Self-Care Activities (SDSCA) foot scale at baseline, 6-week, and 12-week follow-up.</p><p><strong>Results: </strong>A high level of engagement was observed with an 80% (24/30) program completion rate and a 73% (22/30) study retention rate. There were significant improvements in their foot care knowledge and self-care practices among participants that completed the program. In addition, participants provided positive feedback regarding the design and delivery of the intervention.</p><p><strong>Conclusion: </strong>Video storytelling may be a promising intervention to increase awareness of foot health and promote foot self-care behaviors in people with diabetes and elevated A1C levels.</p><p><strong>Implication: </strong>By incorporating video storytelling interventions, nurse practitioners can engage patients with diabetes and elevated A1C levels in foot care education to prevent diabetes-related foot complications.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":"751-759"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148031541","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":"Responsive cardiovascular screening: A grounded theory of nurse practitioner practices in primary care.","authors":"Catherine Nadeau, Mary Colvin, Virginia Hackett, Kenya Snowden, Juan M Gonzalez, Claudette Chin","doi":"10.1097/JXX.0000000000001331","DOIUrl":"10.1097/JXX.0000000000001331","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) remains the leading cause of death among women in the United States. Despite well-documented sex- and gender-specific risk factors, women remain underrepresented in CVD research and continue to experience gaps in prevention and early detection. Nurse practitioners (NPs) deliver a substantial proportion of primary care (PC) in the United States, positioning them at the forefront of cardiovascular prevention and risk reduction. Despite this, gaps persist in understanding how NPs approach cardiovascular screening for women at risk.</p><p><strong>Purpose: </strong>The purpose of this study was to explore the critical factors that influence how NPs in PC screen women at risk for CVD and to construct a theoretical understanding of the processes underlying these NP-led screening practices.</p><p><strong>Methodology: </strong>A qualitative study using Charmaz's constructivist grounded theory approach was conducted with 17 PC NPs via semi-structured interviews. Constant comparative analysis guided data collection and interpretation, with credibility ensured through memoing, peer debriefing, and an audit trail to support methodological rigor.</p><p><strong>Results: </strong>Four interrelated categories emerged: (1) complexities of sex and gender in women's cardiovascular health, (2) adaptive patient-centered cardiovascular care, (3) professional knowledge integration, and (4) organizational and social determinants influencing screening practices. Together, these categories informed the theory of responsive cardiovascular screening, describing how NPs dynamically balance evidence, patient context, and system factors in CVD risk assessment.</p><p><strong>Conclusions: </strong>Nurse practitioners employ responsive cardiovascular screening practices, reflecting a dynamic, context-sensitive process.</p><p><strong>Implications: </strong>This framework offers actionable guidance to strengthen sex-specific cardiovascular screening and promote equitable preventive care for women.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":"779-789"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549520","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":"Mentorship and early career retention in pediatric nurse practitioners: Findings from a nationwide survey.","authors":"Rachel Swerdlin, Christina Calamaro, Scott Gillespie, Susan Brasher","doi":"10.1097/JXX.0000000000001292","DOIUrl":"10.1097/JXX.0000000000001292","url":null,"abstract":"<p><strong>Background: </strong>The demand for advanced practice registered nurses is surging in response to evolving health care needs and workforce shortages, particularly in pediatrics. These shortages underscore the importance of retaining pediatric nurse practitioners (PNPs). Lack of mentorship can pose challenges in transition to practice for PNPs, and there is limited research on the implications of mentorship.</p><p><strong>Purpose: </strong>To evaluate the relationship between having a mentor and the duration PNPs remain in their first professional role, describe the prevalence of mentorship among PNPs, and explore key characteristics of those mentoring relationships.</p><p><strong>Methodology: </strong>This study used convergent mixed-method design. A 28-question survey created by the authors sent to certified PNPs. Primary quantitative analysis used univariable/multivariable logistic regression models with mentorship status as the primary exposure and descriptive analysis of other variables. Analysis of open-ended questions analyzed with qualitative descriptive method with coding by two independent coders.</p><p><strong>Results: </strong>Results indicate that having a mentor in their first position was significantly associated with greater odds of remaining in that role (odds ratio [OR] = 1.44, 95% confidence interval [CI]: 1.06-1.96). Among 599 PNPs no longer in their first position, mentorship in the first role was associated with increased odds of remaining in the position for over 2 years (OR = 2.59, 95% CI: 1.84-3.63). Qualitative analysis identified three main themes relating to PNPs and mentoring including \"time to transition,\" \"guidance and support,\" and \"shaping the future.\"</p><p><strong>Conclusion: </strong>This study highlights the importance of mentorship when transitioning to practice for PNPs and its potential long-term effect on retention.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":" ","pages":"790-800"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148157035","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}