Journal of the American Association of Nurse Practitioners最新文献

{"title":"Ethical considerations and decision making in opioid prescribing for chronic pain: A case study in rheumatology practice.","authors":"Lisa Carnago, Mitchell R Knisely, Janet Malek","doi":"10.1097/JXX.0000000000001002","DOIUrl":"10.1097/JXX.0000000000001002","url":null,"abstract":"<p><strong>Abstract: </strong>Dilemmas regarding opioid prescribing for chronic pain frequently occur within health care settings. The ethical principles of autonomy, beneficence, nonmaleficence, and justice, as well as the principles of care ethics, can assist in addressing these opioid-related dilemmas. The purpose of this clinical case study is to provide a case study highlighting an opioid prescribing dilemma and then identify opioid-related transition considerations; address ethical questions that nurse practitioners (NPs) may encounter in clinical practice when providing care for individuals living with chronic pain who may need or use a prescribed opioid medication; and draw on the ethical principles and care ethics to provide guidance for NPs who face these challenging issues.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139707060","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 mixed-methods pilot examination of Montana, North Dakota nurse practitioner telepresence behaviors through web-camera eye-tracking and qualitative descriptive interviews.","authors":"Elizabeth A Johnson, Kimberly A Strauch","doi":"10.1097/JXX.0000000000000974","DOIUrl":"10.1097/JXX.0000000000000974","url":null,"abstract":"<p><strong>Background: </strong>The use of telehealth for mental health-related encounters has increased exponentially since the COVID-19 pandemic. However, little is known how nurse practitioners (NPs) in rural areas establish connection and presence with patients through telehealth.</p><p><strong>Purpose: </strong>To leverage web-camera eye-tracking technology coupled with qualitative interviews to better understand rural NPs' perceptions, beliefs, experiences, and visual cues of connection and presence during mental health-related telehealth encounters.</p><p><strong>Methods: </strong>This mixed-methods study employed web-camera eye-tracking technology to measure eye contact, facial/body movements with microexpressions, and auditory expressions during a simulated mental health-related telehealth visit. A qualitative descriptive methodology was used to conduct semistructured interviews with participants regarding utilization of telehealth in rural mental health care delivery. Sticky software, R, and STATA were used for the quantitative eye-tracking and demographic data analyses. Qualitative findings were analyzed using inductive thematic analysis.</p><p><strong>Results: </strong>Ten NPs participated in the eye-tracking aspect of the study; among them, three completed semistructured interviews. Eye-tracking areas of interest were significant for the number of fixations ( p = .005); number of visits ( p < .001); time until notice ( p < .001); and time viewed ( p < .001). The category Workflow had the greatest number of thematic units ( n = 21) derived from semistructured interviews.</p><p><strong>Conclusions: </strong>Although an accessible means of obtaining data, web-camera eye tracking poses challenges with data usability. This prompts further attention to research, optimizing the telehealth milieu to lessen patient and provider frustrations with technological or environmental issues.</p><p><strong>Implications: </strong>Nurse practitioners provide a key voice in the design and deployment of telehealth platforms congruent with the comprehensive assessment and presence of remote care delivery.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71424569","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":"Gaining experience in the provider role: Exploration of a novel simulation intervention to prepare nurse practitioner students to detect and manage skin cancer.","authors":"Kelly Powers, Katherine D Shue-McGuffin","doi":"10.1097/JXX.0000000000000999","DOIUrl":"10.1097/JXX.0000000000000999","url":null,"abstract":"<p><strong>Background: </strong>The high prevalence and negative outcomes associated with skin cancer demand effective strategies to prepare nurse practitioner students to detect cancerous lesions and manage patient care. However, few studies have examined dermatologic simulations to prepare nurse practitioner students to detect and manage skin cancer.</p><p><strong>Purpose: </strong>An exploratory-descriptive qualitative approach was used to examine nurse practitioner students' experiences with simulations involving standardized patients wearing three-dimensional (3-D) prosthetic skin lesions, perceptions of ability to apply the simulations to clinical practice, and preferences for learning dermatologic care.</p><p><strong>Methodology: </strong>A convenience sample of 39 nurse practitioner students participated in simulations with standardized patients wearing 3-D skin lesions. Focus groups were conducted following simulation participation, and thematic analysis was performed by two researchers.</p><p><strong>Results: </strong>Four themes emerged: Simulation provides a safe place to practice , Dermatology should be an integral part of education , Realism makes a difference , and Improved confidence and preparation for practice .</p><p><strong>Conclusions: </strong>Simulations with standardized patients wearing 3-D skin lesion prosthetics provided students the opportunity to assess, diagnose, and manage the care of patients with cancerous skin lesions. Participants valued the realistic practice with dermatologic care and reported improved confidence and preparation for practice.</p><p><strong>Implications: </strong>Faculty can use simulations to provide experiential learning about the provider role in general and as it pertains to skin cancer care. Attention to realism is important to aid in building students' confidence and preparation for practice.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139642351","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":"Maximization of scope of practice and satisfaction among geriatric nurse practitioners in Israel.","authors":"Anat Romem, Beth G Zalcman, Ronit Pinchas-Mizrachi","doi":"10.1097/JXX.0000000000000952","DOIUrl":"https://doi.org/10.1097/JXX.0000000000000952","url":null,"abstract":"<p><strong>Background: </strong>There is an increasing demand for comprehensive geriatric care. Nurse practitioners (NPs), who undergo specialized training, are situated to provide such care. In Israel, the role of a geriatric nurse practitioner was introduced in the health care system 10 years ago. However, little is known about the rate of professional satisfaction and realization of full potential among these nurses.</p><p><strong>Purpose: </strong>The aims of this study are (1) to describe the geriatric NP workforce in Israel, (2) to measure the current geriatric scope of practice, and (3) to measure the geriatric NP satisfaction from their working environment.</p><p><strong>Methodology: </strong>For this cross-sectional study, a survey, comprising three sections relating to demographics, professional qualifications and scope of practice, and career satisfaction, was sent to 53 geriatric nurse practitioners in Israel who currently work as geriatric nurse practitioners.</p><p><strong>Results: </strong>Forty-seven nurses participated in the survey. Almost 64% reported that they are satisfied with their position, and 72% reported that they are able to fulfill their full scope of practice. The mean score for scope of practice was 68.31 out of a possible score of 100.</p><p><strong>Conclusions: </strong>A number of qualifications were correlated with satisfaction at work, indicating that nurses tend to be more satisfied at work when they are able to fulfill their potential.</p><p><strong>Implications: </strong>Ensuring nurse practitioners' ability to realize their full potential should be a goal of the health care system. Interventions should be in place to encourage nurses to perform tasks related to their work, for which they are trained.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855455","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":"Transforming diabetes care with continuous glucose monitoring: Rationale for expanded eligibility criteria.","authors":"Barbara R Hirsch","doi":"10.1097/jxx.0000000000000993","DOIUrl":"https://doi.org/10.1097/jxx.0000000000000993","url":null,"abstract":"Randomized trials and large retrospective database studies have shown that individuals treated with noninsulin therapies experience the same glycemic benefits from continuous glucose monitoring (CGM) use as those treated with more intensive treatment regimens. However, many policy makers and payers are reluctant to provide CGM coverage for these patients. Although the recent American Diabetes Association guidelines have taken an important first step in recommending that CGM should be offered to all adults treated with basal insulin who are capable of using it, clinicians should consider the acute and long-term consequences of persistent hyperglycemia in all of their patients with diabetes. This article describes how the use of the FreeStyle Libre 2 CGM System (Abbott Diabetes Care, Alameda, CA) improved glycemic outcomes and facilitates personalized diabetes care in two type 2 diabetes patients treated with noninsulin therapies.","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140798937","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":"Ethical considerations for nurse practitioners conducting research in populations with opioid use disorder.","authors":"Barbara J. St. Marie, Esther I Bernhofer","doi":"10.1097/JXX.0000000000001020","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001020","url":null,"abstract":"ABSTRACT\u0000People with opioid use disorder (OUD) are a vulnerable population who face unique risks of harm when participating in research. Despite a long-standing dialogue, written research codes of ethics, and institutional review board oversight for the conduct of ethical research in vulnerable populations, protections for study populations with OUD is rarely mentioned. Nurse practitioners who conduct research using participants with OUD, especially when recruiting their own patients (i.e., dual role), must be aware of the unique ethical considerations necessary to protect their patients and participants from increased risks. This article explores vulnerabilities and influences that can affect participant recruitment and consent, imbalances in the distribution of risk and benefits to participants participating in research, and the concerns of coercions, undue influence, and unjustifiable pressure contributing to vulnerabilities. Strategies to reduce the risks of influences that are of concern in the vulnerable population of research participants with opioid disorder are suggested. The goal of this article was to raise awareness of the unique potential risks of harm when using people with OUD as research participants and to explore strategies to minimize potential risks of various levels of influence in this vulnerable population.","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140662082","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 quality improvement project to improve treatment of severe hypertriglyceridemia in veterans.","authors":"Caroline R Wool, Kathy Shaw, David R Saxon","doi":"10.1097/JXX.0000000000001017","DOIUrl":"https://doi.org/10.1097/JXX.0000000000001017","url":null,"abstract":"BACKGROUND\u0000Severe hypertriglyceridemia (sHTG) is associated with an increased risk of acute pancreatitis. Prompt recognition and treatment of sHTG is key for prevention of acute pancreatitis and its associated life-threatening complications.\u0000\u0000\u0000LOCAL PROBLEM\u0000Patients with sHTG at a primary care clinic within the Veterans Affairs Eastern Colorado Health Care System were receiving suboptimal treatment that did not align with evidence-based guidelines.\u0000\u0000\u0000METHODS\u0000We initiated a quality improvement (QI) project to improve the management of sHTG in an outpatient primary care clinic. Veterans with a triglyceride level between 500 and 1,500 mg/dl were included in the project.\u0000\u0000\u0000INTERVENTIONS\u0000Project interventions included provider education, patient education, and targeted electronic consultations (e-consults) with treatment recommendations. The primary outcome was to decrease the percentage of patients with triglycerides ≥500 mg/dl by 25%. The secondary outcome was to decrease the mean triglyceride level of the patient population by 15%.\u0000\u0000\u0000RESULTS\u0000Education on evaluation and treatment of sHTG was given to 100% (n = 21) of primary care clinicians. Overall, 72.8% (95% CI [62.6-81.6%]) of patients (n = 67) received appropriate written education materials, and 72.8% (95% CI [62.6-81.6%]) of patients (n = 67) received a targeted e-consult. The percentage of patients with sHTG decreased by 47%. Average triglyceride level decreased from 651 to 483 mg/dl (25.8% decrease).\u0000\u0000\u0000CONCLUSION\u0000A multipronged QI project consisting of provider education, patient education, and targeted e-consults resulted in decreased triglyceride levels and improved access to specialist expertise. Clinical implications include decreased prevalence of sHTG and risk of acute pancreatitis among patients in the project.","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140668769","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":"Reflecting on diagnosis: The Metacognitive Diagnostic Reasoning Model©.","authors":"Sarah L Beebe, Angela M McNelis, Majeda El-Banna, Kristina Thomas Dreifuerst","doi":"10.1097/jxx.0000000000001018","DOIUrl":"https://doi.org/10.1097/jxx.0000000000001018","url":null,"abstract":"Diagnostic reasoning is a complex cognitive process that requires intuitive, heuristic processing from knowledge and experience, as well as deliberate and reflective thinking. Evidence on interventions to improve diagnostic reasoning is inconsistent, in part because different terms and models are used to guide research.","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140629556","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":"Advanced practice nurse pharmacogenomics capacity and utilization.","authors":"Cathy R Fulton, Anna L M Macagno, Stephanie L Dickinson, Kathleen Calzone","doi":"10.1097/jxx.0000000000001007","DOIUrl":"https://doi.org/10.1097/jxx.0000000000001007","url":null,"abstract":"Guided by Clinical Pharmacogenomic Implementation Consortium (CPIC) guidelines for &gt;140 medications, pharmacogenomic tests inform medication selection and dosing to optimize efficacy while minimizing toxicities.","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140602392","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":"American Association of Nurse Practitioners Research Agenda, 2023-2028.","authors":"Robin Arends, Tammy Austin-Ketch, Asefeh Faraz Covelli, Leslie Davis, Donna Hallas, Karen Kalmakis, Holly Kirkland-Kyhn, Karen Devereaux Melillo, Monica O'Reilly-Jacob, Abby Parish, Kristen Rawlett, Richard Ricciardi, Christine Tracy, Chris Winkelman, Christina Whitehouse","doi":"10.1097/jxx.0000000000001011","DOIUrl":"https://doi.org/10.1097/jxx.0000000000001011","url":null,"abstract":"This report highlights the 2023-2028 American Association of Nurse Practitioners Research Agenda (AANP-RA), which focuses on the research goals of AANP as an organization and is based on its mission and strategic plan. The purpose of the AANP Research Agenda is to outline research priorities that advance the AANP Strategic Plan and concurrently address gaps in nursing science. American Association of Nurse Practitioners supports research studies that are rigorously designed and conducted using quantitative, qualitative, and mixed-methods approaches, as well as implementation science with the potential to positively impact both NP practice and patient health outcomes. The AANP-RA strategy is guided by the PEARL acronym: examining NP Practice, Education, policy Advocacy, Research, and Leadership. A discussion of each area is presented along with suggested topics.","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140602301","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}