Journal of Doctoral Nursing Practice最新文献

{"title":"Evidence-Based Approaches for Prescribing Psychotropic Medications in Individuals With Autism Spectrum Disorders.","authors":"Lisa Alberts","doi":"10.1891/JDNP-D-20-00001","DOIUrl":"https://doi.org/10.1891/JDNP-D-20-00001","url":null,"abstract":"<p><strong>Background: </strong>Treating children and adults with autism spectrum disorders (ASDs) is challenging, whether for mental health concerns, underlying healthcare conditions, or a variety of behavioral challenges, such as self-injury, aggression, or irritability.</p><p><strong>Objective: </strong>This article highlights evidence-based approaches to inform prescribing practices in treating children and adults with ASDs and mental health or behavioral challenges.</p><p><strong>Methods: </strong>Current and historical literature focusing on treating individuals with ASDs using psychotropic medications was analyzed.</p><p><strong>Results: </strong>Psychotropic medications may not be the best choice for treating individuals with ASDs and mental health or behavioral challenges. Inappropriate use of psychotropic medications in this population can cause significant side effects and lead to long-term health related issues.</p><p><strong>Conclusions: </strong>Prescribers should use evidence-based approaches when treating this population.</p><p><strong>Implications for nursing: </strong>Nurse practitioners are likely to encounter patients with ASDs in their practice. Understanding special considerations in prescribing for this population is highly relevant and important to improve health outcomes.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38724244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Consequences of Cannabis Use: A Review of Self-Reported Use and Experiences Among College Students.","authors":"Anna Castaneda Tabet,&nbsp;Delia G Meyer,&nbsp;Crystal Carrisalez,&nbsp;Jennifer Martinez,&nbsp;Richard Paul Diaz","doi":"10.1891/JDNP-D-19-00082","DOIUrl":"https://doi.org/10.1891/JDNP-D-19-00082","url":null,"abstract":"<p><strong>Background: </strong>Healthy People 2020 has introduced a new initiative focused on adolescent health, ages 10-17, and young adults, ages 18-25, due to health and social problems starting or peaking during these years. The initiative focuses on decreasing such problems including substance use. Cannabis is one of the most popular illegal substances used among young adults for recreation in the United States. Multiple consequences of cannabis use are well documented in the literature including the development of medical problems, developmental delays, and social issues. Furthermore, academic success is linked to overall health outcomes.</p><p><strong>Objective: </strong>The aim of this study was to explore cannabis use and knowledge of consequences among college students at a university in southwest Texas.</p><p><strong>Method: </strong>Secondary analysis of survey results from students at a small, private university. The Core Alcohol and Drug Survey, a self-report questionnaire, was utilized to measure alcohol and drug usage, attitudes, perceptions, and opinions regarding drug and alcohol usage. The survey was distributed to all 6,537 undergraduate students. The survey results were collected over a 3-month period and provided to the authors for interpretation.</p><p><strong>Results: </strong>Eighty-two survey responses were received. Analysis indicated that 24.7% of the students used marijuana in the past year, and 16% had used cannabis within 30 days of the survey. Of the respondents surveyed, 13.3% reported they used cannabis occasionally and 38.7% reported they used cannabis regularly. Furthermore, survey results indicated that 12.7% of respondents reported some of the consequences from cannabis use experienced within the past year included public misconduct, such as fighting, arguing, and vandalism. In addition, 13.9% reported having experienced serious personal problems due to cannabis use at least once during the past year including injuries, suicidal thoughts, and sexual assault. Reported attitudes and perceptions of cannabis use include 13.3% perceived great risk associated with cannabis use. Moreover, 62.3% of respondents believe that their friends would disapprove of cannabis use. A negative correlation was identified between cannabis use within the previous 30 days and low grades.</p><p><strong>Conclusion: </strong>The consequences of cannabis use are well documented in the literature, yet cannabis remains a popularly used illegal substance among college students. Despite experiencing known consequences of cannabis use, much of the sample reported regular use of the substance.</p><p><strong>Implications for practice: </strong>Results of the study may be used to improve education and interventions aimed at reducing cannabis use among college students. In addition, providers may use the information to provide patient education at routine visits.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38726122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression and Glycemic Control in the Primary Care Setting: An Overview for Primary Care Providers.","authors":"Elisa Laird,&nbsp;Meaghan Maydick,&nbsp;Brayden Kameg","doi":"10.1891/JDNP-D-19-00008","DOIUrl":"https://doi.org/10.1891/JDNP-D-19-00008","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes mellitus and depression are frequently comorbid health conditions. Outcomes are generally poorer when the two diseases states co-occur, including the risk of long-term complications, quality of life, mortality, and associated healthcare costs.</p><p><strong>Objective: </strong>The purpose of this article is to review the relationship between type 2 diabetes mellitus and depression, as well as to provide recommendations on the integration of their management in primary care.</p><p><strong>Methods: </strong>Utilizing PubMed and CINAHL, a literature review was completed to identify research pertaining to comorbid depression and diabetes. Reference lists of identified articles were also explored for relevance.</p><p><strong>Results: </strong>There is evidence demonstrating the relationship between diabetes and depression, and a myriad of screening tools and treatment options that can be implemented within the primary care setting.</p><p><strong>Conclusions: </strong>Based on current evidence, it is recommended that mood symptoms should be addressed as part of standard diabetes care in the primary care setting, and patients diagnosed with depression should be screened for diabetes.</p><p><strong>Implications for nursing: </strong>Addressing both depression and diabetes are within the primary care scope of practice. The call to primary care providers to holistically, collaboratively, and simultaneously improve the outcomes of these comorbid conditions is now.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38724242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic Stewardship Through Standardized Diagnosis and Treatment of Small Bowel Bacterial Overgrowth in Pediatric Patients With Short Bowel Syndrome Reduces Antibiotic Exposure and Improves Cost of Health Care.","authors":"Christie Heinzman,&nbsp;Conrad Cole","doi":"10.1891/JDNP-D-19-00080","DOIUrl":"https://doi.org/10.1891/JDNP-D-19-00080","url":null,"abstract":"<p><strong>Background: </strong>Small bowel bacterial overgrowth (SBBO) is difficult to diagnose in pediatric patients with short bowel syndrome due to the invasive nature of the gold standard testing. Alternative testing methods also have barriers leaving providers to diagnose clinically. This has led to antibiotic overprescribing in this population. An algorithm for SBBO identification and standardized treatment is proposed.</p><p><strong>Objective: </strong>Standardize SBBO identification and treatment in pediatric short bowel syndrome.</p><p><strong>Methods: </strong>1-year retrospective chart review and literature review.</p><p><strong>Results: </strong>Final analysis of 146 admissions revealed diagnostic and antibiotic prescribing inconsistencies. In total, 28% (<i>n</i> = 41) received antibiotics for SBBO including those who continued home antibiotic (<i>n</i> = 27), those prescribed an antibiotic based on clinical suspicion (<i>n</i> = 12), and those prescribed an antibiotic based on duodenal aspirate (<i>n</i> = 2). In 10.2% (<i>n</i> = 15) patients, antibiotics were prescribed without clear clinical indication resulting in 342 antibiotic exposed days and $24,000 in prescription costs.</p><p><strong>Conclusion: </strong>Clinical research is greatly needed as it relates to SBBO. In the meantime, the proposed algorithm guides providers through diagnosis and treatment decision-making. Thoughtful antibiotic prescribing is key to optimizing outcomes while minimizing adverse effects of antibiotics.</p><p><strong>Implications for nursing: </strong>The algorithm empowers nursing to minimize antibiotic overuse through collaborative teamwork.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38724240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Interprofessional Pain Diary in Transitional Care: A Feasibility Project.","authors":"Desirri L Arneson,&nbsp;Darla C Coss,&nbsp;Lisa P Rovick,&nbsp;Patricia Finch Guthrie","doi":"10.1891/JDNP-D-19-00075","DOIUrl":"https://doi.org/10.1891/JDNP-D-19-00075","url":null,"abstract":"<p><strong>Background: </strong>Understanding pain perceptions in older adults is important for pain management. An interprofessional team conducted a feasibility project to examine whether a pain diary designed for older adults in a transitional care unit offered a more holistic description of the pain experience.</p><p><strong>Objectives: </strong>The project was designed to: (a) Develop a pain diary, (b) Examine patient usability, (c) Determine feasibility of the diary in workflow, and (d) Examine outcomes of diary entries and satisfaction surveys.</p><p><strong>Methods: </strong>Three rapid change cycles assisted in developing and implementing the diary.</p><p><strong>Results: </strong>Five patients followed for 32 days during implementation wrote simple narratives and rated their pain (<i>M = 2-5.3)</i> on 11-point pain rating scales. Themes from narrative responses were <i>medicated relief and alternative methods, finding a balance between motion and activity, emotional burden of pain</i>, and the <i>importance of feeling supported by the health-care team</i>. Patients and staff completed satisfaction questionnaires indicating enhanced communication.</p><p><strong>Conclusions: </strong>The diary was feasible for patients and staff to use and has potential as an effective interprofessional tool for pain management.</p><p><strong>Implications for nursing: </strong>The pain diary provides the interprofessional team an opportunity to understand the patient experience and provide holistic care.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38724241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Students' Perceptions of the Value of Learning the Skill Sets of a DNP-Prepared Nurse: An Exploratory Study.","authors":"Meigan Robb,&nbsp;Diane F Hunker","doi":"10.1891/JDNP-D-20-00002","DOIUrl":"https://doi.org/10.1891/JDNP-D-20-00002","url":null,"abstract":"<p><strong>Background: </strong>Students enter doctor of nursing practice (DNP) programs with varying interests and professional experiences. Little is known about how this impacts learning.</p><p><strong>Objective: </strong>To explore if differences existed in students' perceptions of task values related to learning the skill sets of a DNP-prepared nurse.</p><p><strong>Methods: </strong>Students were sent a link to a 17-item electronic survey consisting of demographic questions and nine statements based on competencies as outlined in <i>The Essentials of Doctoral Education for Advanced Nursing Practice</i> (American Association of Colleges of Nursing [AACN], 2006). Students ranked the statements in order of perceived value of performing after program completion.</p><p><strong>Results: </strong>Mean rankings of task values demonstrated the advanced practice registered nurse (APRN) group (<i>n</i> = 32) identified the most valuable skill as \"suggest an evidence-based change in professional practice based on the findings of published research articles and professional practice experience.\" The non-APRN group (<i>n</i> = 10) reported \"work collaboratively with other non-nursing healthcare professionals to improve patient and population health outcomes.\"</p><p><strong>Conclusions: </strong>Students' perceptions of the value of learning the skill sets vary amongst APRNs and non-APRNs, and are shaped by past professional experiences and future role demands.</p><p><strong>Implications for nursing: </strong>Findings provide faculty with knowledge that can be used to tailor teaching and engagement strategies.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38724245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Increasing Sun Protection Counseling and Skin Cancer Screening.","authors":"Bonnie L Nickasch,&nbsp;Tori Sauer,&nbsp;Michelle Lehr","doi":"10.1891/JDNP-D-19-00012","DOIUrl":"https://doi.org/10.1891/JDNP-D-19-00012","url":null,"abstract":"<p><strong>Background: </strong>Skin cancer is the most common cancer in the United States. Skin cancer is a broad term that includes squamous cell carcinoma, basal cell carcinoma, and melanoma. Melanoma is the most concerning of the three types of skin cancer and is the focus of this project. The projected number of individuals impacted by a new diagnosis of melanoma in 2020 is a staggering 100,350 coupled with an estimated 6,850 patients dying from melanoma each year. In Wisconsin, it is estimated there will be 2,190 new cases of melanoma, and 150 deaths in 2020. Expanding patient's knowledge about the risk and benefits of skin cancer screenings, techniques, and characteristics will enhance understanding of the significance of skin cancer.</p><p><strong>Objectives: </strong>The purpose of this study was to assess current skin cancer knowledge and raise awareness by providing education regarding skin cancer risks and statistics among manufacturing employees in Wisconsin.</p><p><strong>Methods: </strong>A quality improvement procedure took place as employees of a Midwestern global manufacturer were educated about self-skin screens, skin cancer risks, and the importance of sun protective behaviors. Pre- and post-education surveys were distributed and obtained.</p><p><strong>Results: </strong>A total of 16 individuals participated in the study, and the results were clinically significant. Providing education about skin cancer risks and sun protection behaviors improved employee's knowledge base by 50%.</p><p><strong>Conclusions: </strong>Although individuals identified skin cancer as an area of high concern, few reported knowing how to prevent skin cancer and the risks for skin cancer before being provided the related education. Therefore, it is evident, even with this small group that simple skin cancer counseling offers great benefit in helping increase knowledge among those educated about skin cancer risk factors and sun protective behaviors.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38726125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing Sleep Apnea Screening Prior to Conscious Sedation Procedures in a Rural Hospital: A Quality Improvement Project.","authors":"Erin Booms,&nbsp;Beverly W Dabney,&nbsp;Denise Cooper","doi":"10.1891/JDNP-D-19-00078","DOIUrl":"https://doi.org/10.1891/JDNP-D-19-00078","url":null,"abstract":"<p><strong>Background: </strong>Screening patients for obstructive sleep apnea (OSA) risk factors is an effective method for helping reduce adverse outcomes in conscious sedation. Patients receiving conscious sedation for endoscopy were not being screened for OSA at a rural hospital.</p><p><strong>Objective: </strong>The purpose of this quality improvement project was to implement a nurse education program to improve OSA screening of endoscopy patients, using an evidence-based screening tool, and to increase nurse OSA knowledge and patient education.</p><p><strong>Methods: </strong>This study was conducted in the outpatient perioperative section of a small rural hospital in northern Michigan. Data were obtained from pre/post chart review and nurse knowledge assessment. Twenty-eight nurses participated in an educational session that included OSA education and instructions on using the STOP-Bang questionnaire for OSA screening.</p><p><strong>Results: </strong>Nurse OSA knowledge increased from 75% preeducation program to 89% posteducation program. Use of the STOP-Bang Questionnaire for patients presenting for outpatient endoscopy procedures requiring conscious sedation and patient OSA education increased from 43.5% to 81.2% pre- to posteducation program.</p><p><strong>Conclusions: </strong>This study's educational session was successful in promoting use of the STOP-Bang questionnaire among perioperative nurses and increasing education for patients screened positive for OSA.</p><p><strong>Implications for nursing: </strong>Training nurses to use a brief OSA screening tool effectively improved the OSA screening of patients presenting for outpatient conscious sedation involving endoscopy.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38726124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilizing a Five-Step, Direct-Call Reminder System to Increase Vaccination Compliance in a Federally Qualified Health Center: A Quality Improvement Process.","authors":"LaToya L Royal,&nbsp;Gwendolyn L Hooper","doi":"10.1891/JDNP-D-19-00070","DOIUrl":"https://doi.org/10.1891/JDNP-D-19-00070","url":null,"abstract":"<p><strong>Background: </strong>Childhood vaccines prevent more than 10 million illnesses and 33,000 deaths in the United States each year. Noncompliance rates for children 2 and under are higher in underserved and resource poor communities.</p><p><strong>Objective: </strong>The aim of this project was to develop and implement a five-step, direct-call reminder system to increase vaccination rates among children ages 2 and under presenting to a federally qualified health center (FQHC).</p><p><strong>Methods: </strong>This project examined whether direct phone contact with parents can increase office visits to discuss vaccine status over a 6-week period following implementation of a five-step, direct-call reminder system.</p><p><strong>Results: </strong>47 parents/guardians were contacted from a list of 455 patients. Thirty-six percent of parents contacted scheduled and kept appointments.</p><p><strong>Conclusions: </strong>This study found that the vaccines rates of a FQHC practice initiative are directly affected by methods of contact and knowledge of the vaccine schedule. Reaching out and discussing vaccine schedules with parents can increase vaccination rates. Yet, many of them have limited methods of contact.</p><p><strong>Implications for nursing: </strong>A five-step, direct-call reminder system has a positive impact on vaccination compliance. Vaccination compliance is complicated, and approaches should be multifaceted.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38726123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation and Evaluation of a Transformational Leadership Education Session for Nurse Leaders and Nurse Educators.","authors":"Ashley Singh","doi":"10.1891/JDNP-D-19-00054","DOIUrl":"https://doi.org/10.1891/JDNP-D-19-00054","url":null,"abstract":"<p><strong>Background: </strong>Transformational leadership is one of the most utilized models of leadership across the disciplines. It can positively impact the leader-follower relationship, performance of the leader, and productivity of the organization.</p><p><strong>Objective: </strong>The purpose of the project was to assess the impact of an educational session on the recognition and execution of transformational leadership characteristics for nurse leaders and nurse educators.</p><p><strong>Methods: </strong>An interactive transformational leadership education session aimed to affect the recognition and execution of nurse leaders' and nurse educators' transformational leadership characteristics.</p><p><strong>Results: </strong>A Wilcoxon Signed Rank Test yielded a statistically significant increase in idealized influence (behavior), and an increase in intellectual stimulation and inspirational motivation.</p><p><strong>Conclusions: </strong>This project creates the infrastructure for future ongoing initiatives focusing on the beneficial impact of transformational leadership development for nurse leaders and educators.</p><p><strong>Implications for nursing: </strong>A supportive environment for transformational leadership development may take the institution to the next level regarding engagement, productivity, and performance, all of which are vital to organizational success.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38280585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}