Journal of the American Association of Nurse Practitioners最新文献_第5页

Feasibility and safety of a rapid-access transient ischemic attack clinic. 快速通道短暂性脑缺血发作门诊的可行性和安全性。

IF 1.2 4区医学

Journal of the American Association of Nurse Practitioners Pub Date : 2022-03-01 DOI: 10.1097/JXX.0000000000000622

Sarah Hermanson, Nirali Vora, C Craig Blackmore, Barbara Williams, Nancy Isenberg

{"title":"Feasibility and safety of a rapid-access transient ischemic attack clinic.","authors":"Sarah Hermanson, Nirali Vora, C Craig Blackmore, Barbara Williams, Nancy Isenberg","doi":"10.1097/JXX.0000000000000622","DOIUrl":"10.1097/JXX.0000000000000622","url":null,"abstract":"Background: In the United States, patients with transient ischemic attacks (TIAs) are commonly admitted to the hospital despite evidence that low-risk TIA patients achieve improved outcomes at lower costs at specialized rapid-access TIA clinics (RATCs).Local problem: All patients experiencing TIAs at a hospital system in the Pacific Northwest were being admitted to the hospital. This project aimed to implement an RATC to relocate care for low-risk TIA patients, showing feasibility and safety.Methods: Following implementation of the RATC, a retrospective chart review was performed. Outcomes included days to RATC; days to magnetic resonance imaging (MRI); final diagnosis; stroke-related admissions and deaths within 90 days of the RATC visit.Interventions: From 2016 to 2018, implementation of an RATC included patient triage tools; multidisciplinary collaboration between departments; a direct scheduling pathway; and emphasis on stroke prevention.Results: Ninety-nine patients were evaluated in the RATC, 69% (69/99) were referred from the emergency department. Sixty-six percent of patients were seen in the TIA clinic in 2 days or less, 19% at 3 days, and 15% at 4 days or more. Mean days to TIA clinic was 2.5 days (SD 2.4). Mean days (SD) to MRI was 2.1 days (SD 2.3). Forty-eight percent (48/99) had a final diagnosis of probable TIA, followed by 32% (32/99) who had other diagnoses; 15% (15/99) migraine variant; 4% (4/99) with stroke. Two percent (2/99) of patients had a stroke-related admission within 90 days, another 2% (2/99) died of non-stroke-related causes within 90 days of the RATC visit.Conclusions: Utilization of RATCs is feasible and safe. Nurse practitioners are integral in delivering this innovative, cost-effective model of care.","PeriodicalId":48812,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39078176","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}

引用次数: 4

Remote patient triage: Shifting toward safer telehealth practice. 远程病人分诊:转向更安全的远程医疗实践。

IF 1.2 4区医学

Journal of the American Association of Nurse Practitioners Pub Date : 2022-03-01 DOI: 10.1097/JXX.0000000000000655

Mahrokh M Kobeissi, Susan D Ruppert

{"title":"Remote patient triage: Shifting toward safer telehealth practice.","authors":"Mahrokh M Kobeissi, Susan D Ruppert","doi":"10.1097/JXX.0000000000000655","DOIUrl":"10.1097/JXX.0000000000000655","url":null,"abstract":"Abstract: Telehealth is a tool used to diagnose and treat patients at a distance. Telehealth quickly became essential during the COVID-19 pandemic as a result of stay-at-home orders. Regulatory waivers encouraged the use of telehealth as an alternative to the in-person encounter to limit the spread of disease. The pandemic incited a rapid growth in telehealth, and new legislation, new technologies, and providers new to virtual care changed the delivery of traditional telehealth. Postpandemic planning is necessary to support the safe integration of telehealth in the health care system. The purpose of this article is to discuss the current issues affecting telehealth and offer recommendations for safer virtual care. Critical considerations, beginning with an assessment of remote patient acuity, are needed to ensure the standard of care for telehealth is equivalent to the in-person setting. A triage protocol to screen patients seeking virtual services is required to prevent underestimation of severity of illness, sort patients to place of service, and determine if a need exists to escalate to an in-person evaluation or higher level of care. A standard approach to triage may minimize the risks to patient safety and support the appropriate use of telehealth technologies.","PeriodicalId":48812,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1d/be/jxx-34-444.PMC8893128.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39414157","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}

引用次数: 6

Brachial plexus injury and facial breakdown as a consequence of proning during COVID-19 treatment. 在COVID-19治疗期间因俯卧撑导致的臂丛损伤和面部破裂。

IF 1.2 4区医学

Journal of the American Association of Nurse Practitioners Pub Date : 2022-03-01 DOI: 10.1097/JXX.0000000000000654

Kelly Ayala, Jill Redding, Whitney Lynch, Theodore MacKinney

引用次数: 1

Traversing academic rank promotion for nurse practitioner faculty. 贯穿护士执业队伍的学术等级提升。

IF 1.2 4区医学

Journal of the American Association of Nurse Practitioners Pub Date : 2022-03-01 DOI: 10.1097/JXX.0000000000000685

Sharon L Stager, Brenda Douglass, Sheryl Mitchell, Barbara Wise, Susan W Buchholz

{"title":"Traversing academic rank promotion for nurse practitioner faculty.","authors":"Sharon L Stager, Brenda Douglass, Sheryl Mitchell, Barbara Wise, Susan W Buchholz","doi":"10.1097/JXX.0000000000000685","DOIUrl":"10.1097/JXX.0000000000000685","url":null,"abstract":"Abstract: The relatively rapid increase of nurse practitioner (NP) programs across the United States has necessitated schools and colleges of nursing to hire and support NP faculty through the promotion process to sustain their programs. Nurse practitioner faculty engaged in clinical practice often face barriers in obtaining rank promotion. The purpose of this article was to provide NP faculty an evidence-based pathway to support academic rank promotion. An additional aim was to recognize implicit biases and barriers, while offering guidance for overcoming challenges. Using Boyer (1990) and American Association of Colleges of Nursing (2018) as a foundation, this article outlines a pathway to synergistically highlight and weave clinical practice experiences within academic expectations of promotion. The categories of academic rank promotion identified and highlighted within this article include scholarship, teaching, practice, and service. The Stager & Douglass Pathway to Preparation for Traversing Academic Rank for Clinical Faculty provides steps for a well-developed plan and comprehensive dossier in supporting successful promotion. These steps include understanding institutional promotional guidelines, developing focused priorities, defining the clinical practice role in the progression of promotion, partnering with a mentor, gathering supportive materials early, and developing a comprehensive dossier, leading to a successful academic rank promotion process. Preparing the dossier early leverages time for the NP faculty to strategize with academic leaders and colleague mentors to develop focused priorities. In addition, identified biases and barriers may be mitigated to support successful academic rank promotion.","PeriodicalId":48812,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39903371","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}

引用次数: 2

Cultivating diversity in the advanced practice registered nurse workforce: An exemplar from an advanced practice registered nurse fellowship program. 培养高级执业注册护士队伍的多样性:高级执业注册护士奖学金项目的一个范例。

IF 1.2 4区医学

Journal of the American Association of Nurse Practitioners Pub Date : 2022-03-01 DOI: 10.1097/JXX.0000000000000679

Natalie Raghu, Mary McNamara, Emily Bettencourt, Charles Yingling

{"title":"Cultivating diversity in the advanced practice registered nurse workforce: An exemplar from an advanced practice registered nurse fellowship program.","authors":"Natalie Raghu, Mary McNamara, Emily Bettencourt, Charles Yingling","doi":"10.1097/JXX.0000000000000679","DOIUrl":"10.1097/JXX.0000000000000679","url":null,"abstract":"Abstract: Diversity in the nursing workforce is an important driver of patient satisfaction, adherence to care, and quality outcomes. Systemic barriers exist that prevent individuals from underrepresented minority groups entering and advancing in the nursing workforce. To advance the health of the community we serve and with grant support from the Health Resources and Services Administration, we developed a postgraduate advanced practice registered nurse (APRN) fellowship in community health. This program is a partnership between a federally qualified health center and a college of nursing. We developed a deliberate plan to recruit and admit diverse applicants who would continue to practice in our community at the conclusion of their fellowship year. Using targeted recruitment outreach, we identified new-graduate APRNs who were representative of the community we serve. Using holistic review methodology, we interviewed applicants with explicit efforts to mitigate the effects of bias towards race, ethnicity, gender, and academic affiliation. We embraced a quality-improvement ethos that enabled evolution and growth with each iteration of the program. Understanding that intention does not translate to outcomes, we undertook ongoing critique of our methods and engaged diverse resources to improve our processes. Over two admission cycles, our fellowship in community health for new graduate APRNs has demonstrated improvements in strategies to diversify the community health workforce. We will describe our process of nonjudgmental self-critique and a quality-improvement framework that can serve as a strategy to promote diversity, equity, and inclusion in the community health workforce.","PeriodicalId":48812,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39944989","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}

引用次数: 0

The impact of the COVID-19 pandemic on infant and toddler development. COVID-19大流行对婴幼儿发育的影响。

IF 1.2 4区医学

Journal of the American Association of Nurse Practitioners Pub Date : 2022-03-01 DOI: 10.1097/JXX.0000000000000653

Annie Imboden, Bernadette K Sobczak, Valerie Griffin

{"title":"The impact of the COVID-19 pandemic on infant and toddler development.","authors":"Annie Imboden, Bernadette K Sobczak, Valerie Griffin","doi":"10.1097/JXX.0000000000000653","DOIUrl":"10.1097/JXX.0000000000000653","url":null,"abstract":"Background: The COVID-19 pandemic has created new cultural norms with pervasive societal implications. Families have experienced a heightened amount of physical, psychological, emotional, and financial stress. Infants and children living with stress have the potential for delayed developmental milestones, difficulty with emotional regulation, and social or behavioral issues.Purpose: This study aims to determine if the pandemic has affected developmental outcomes in infants and toddlers.Methodology: Prepandemic and postpandemic developmental (ASQ-3) scores were obtained from charts of 1,024 patients (6, 12, 18, 24, and 36 months) from two pediatric practices.Results: There were no significant differences in prepandemic and postpandemic ASQ-3 scores for the overall sample. Age-group analysis showed statistically significant differences in domain scores. Postpandemic problem-solving scores decreased among 6-month-olds while increasing among 24-month-olds. Categorization by score interpretation categories showed a slight decrease in postpandemic scores in the communication domain among 6- and 12-month-olds.Conclusions: The pandemic has the potential to affect childhood development. However, the results of this study are reassuring, showing only slight differences in developmental scores prepandemic versus postpandemic. More studies are needed to establish causation and possible trends in future developmental trajectories.Implications: An increased focus on communication screening and promotion of language and communication skills in young children postpandemic is needed. Education about the importance of parent-child engagement, nurturing relationships, opportunities for free-play and exploration, and caregiver support and stress reduction will continue to be of paramount importance.","PeriodicalId":48812,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39414158","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}

引用次数: 15

Virtual visits and the use of continuous glucose monitoring for diabetes care in the era of COVID-19. COVID-19时代糖尿病护理中的虚拟就诊和连续血糖监测

IF 1.2 4区医学

Journal of the American Association of Nurse Practitioners Pub Date : 2022-03-01 DOI: 10.1097/JXX.0000000000000659

Patricia Underwood, Jennifer Hibben, Jolynn Gibson, Monica DiNardo

{"title":"Virtual visits and the use of continuous glucose monitoring for diabetes care in the era of COVID-19.","authors":"Patricia Underwood, Jennifer Hibben, Jolynn Gibson, Monica DiNardo","doi":"10.1097/JXX.0000000000000659","DOIUrl":"10.1097/JXX.0000000000000659","url":null,"abstract":"Abstract: The coronavirus disease 2019 (COVID-19) pandemic has led to an increase in virtual care utilization for patients with diabetes mellitus (DM). Virtual DM care requires both providers and patients to become familiar with new technology that supports home health monitoring. Continuous glucose monitoring (CGM) is a DM technology that provides 24-hr glucose monitoring and is associated with improved clinical outcomes, including decreased rates of hypoglycemia and lower hemoglobin A1c (A1c). Continuous glucose monitoring use has increased due to ease of use and its ability to allow patients to share data with providers during virtual visits. Although the clinical benefits of CGM use are clear, many providers are overwhelmed by the various options available and large influx of data received. The purpose of this clinical case review is to provide an overview of CGM use in the virtual care setting. Various types of CGMs will be defined and an overview of the patient characteristics shown to benefit most from CGM use will be provided. Further, recommendations for improving clinic workflow when using CGM will be outlined, including strategies to handle the influx of large datasets, outlining the role of the nurse practitioner (NP) and other providers in the clinic, and organizing data for efficient and improved clinical decision making. Continuous glucose monitoring use is hallmarked to revolutionize DM care for many patients, particularly during and after the COVID-19 pandemic. It is important that clinicians understand the nuances of CGM use and organize their virtual clinics to efficiently manage CGM users, leading to improved clinical decisions and patient outcomes.","PeriodicalId":48812,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8893130/pdf/jxx-34-586.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39725542","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}

引用次数: 2

Occupational Heat Stress: An Overview for Nurse Practitioners. 职业热应激:护士从业人员概述

IF 1.2 4区医学

Journal of the American Association of Nurse Practitioners Pub Date : 2022-03-01 DOI: 10.1097/JXX.0000000000000665

Kathryn Sabo, R Starodub, Sara Smoller, Lisa Quinn, Debra Kelly, Karen Flaherty, Patrice K Nicholas

引用次数: 0

Evaluation and quality improvement of Doctor of Nursing Practice-Family Nurse Practitioner scholarly projects. 护理实践博士-家庭护理师学术项目评价与质量改进。

IF 1.2 4区医学

Journal of the American Association of Nurse Practitioners Pub Date : 2022-03-01 DOI: 10.1097/JXX.0000000000000668

Erin C Donovan, Janice A Holvoet, Kathleen N Hall

{"title":"Evaluation and quality improvement of Doctor of Nursing Practice-Family Nurse Practitioner scholarly projects.","authors":"Erin C Donovan, Janice A Holvoet, Kathleen N Hall","doi":"10.1097/JXX.0000000000000668","DOIUrl":"10.1097/JXX.0000000000000668","url":null,"abstract":"Background: The Commission on Collegiate Nursing Education's accreditation standards require nursing programs to demonstrate that students acquire doctoral-level knowledge and competencies beyond that expected at the baccalaureate and/or masters levels. The purpose of this article was to describe a quality improvement (QI) project for Doctor of Nursing Practice-Family Nurse Practitioner (NP) scholarly projects.Local problem: Nurse practitioner faculty inquired about whether students' scholarly projects were of the quality and rigor expected at the doctoral, rather than masters, level.Methods: This project was conducted as a QI initiative and was designated as such by the institutional review board. Methods were based on Deming Plan-Do-Study-Act QI process model.Interventions: Two doctorally prepared nursing faculty evaluated nine doctoral scholarly projects using the Roush DNP-PCAT instrument. This instrument evaluates 16 components, and key elements within each component, for completeness. The DNP-PCAT tool was evaluated for interrater reliability and content validity in an earlier study.Results: Strengths and weaknesses were identified using quantitative and qualitative data analyses. Floor effects were seen in strategic planning, ethical concerns, data collection, results, discussion, and limitations. Qualitative findings identified weaknesses across all 16 components. Findings were similar to the results reported in a prior study. Results were reviewed and action plans were developed to improve the rigor of scholarly projects.Conclusions: The nursing faculty plan to incorporate routine evaluation of scholarly projects into their program evaluation. Other NP programs may benefit from instituting a similar process.","PeriodicalId":48812,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39541135","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}

引用次数: 0

Evaluation of a nurse practitioner-led transitional care program: The effects on 30-day Medicare readmission rates and patient satisfaction scores. 评估护士执业主导的过渡护理计划:对30天医疗保险再入院率和患者满意度得分的影响。

IF 1.2 4区医学

Journal of the American Association of Nurse Practitioners Pub Date : 2022-03-01 DOI: 10.1097/JXX.0000000000000690

Patrick J Sherlock

{"title":"Evaluation of a nurse practitioner-led transitional care program: The effects on 30-day Medicare readmission rates and patient satisfaction scores.","authors":"Patrick J Sherlock","doi":"10.1097/JXX.0000000000000690","DOIUrl":"10.1097/JXX.0000000000000690","url":null,"abstract":"Background: Data suggest that nurse practitioner (NP)-led transitional care models can reduce 30-day readmission rates. It remains unclear if transitional care has any impact on Press Ganey's Hospital Consumer Assessment of Health Provider and Systems (HCAHPS) patient satisfaction scores.Local problem: A transitional care encounter program (TCEP) was designed and implemented by an NP at an internal medicine private practice in response to an increase in Medicare 30-day readmission rates and lower HCAHPS results. A program evaluation was carried out to determine any impact on 30-day readmissions and HCAHPS.Methods: The evaluator used CDC's Framework for Program Evaluation in Public Health for program evaluation. Quantitative retrospective data collection of Medicare 30-day readmission rates was obtained and compared preimplementation/postimplementation. HCAHPS results were collected from the data analytics department at Methodist Health System and compared preimplementation/postimplementation.Interventions: All Medicare patients followed by the private practice discharged from hospital to home had a TCEP visit within 7 days of discharge. The NP extensively reviewed the hospital records, medication reconciliation, education about current medications, diagnoses, and treatment plan with the patient.Results: Readmission rates and HCAHPS are tracked by physician name at discharge. The TCEP resulted in a 2.1% reduction in Medicare 30-day readmission rate. Physician A pre-/post-HCAHPS score was 74% increased to 81.3%. Physician B pre-/post-HCAHPS score was 75.8% increased to 78.6%.Conclusion: The TCEP model became an integral part of the clinic's daily operations. Transitional care has potential for decreasing Medicare 30-day readmission rate and improving HCAHPS.","PeriodicalId":48812,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39876880","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}

引用次数: 2