Diagnosis and management of diverticular disease in primary care.

ABSTRACT: Each year, more than 1 million ambulatory patient visits occur for diverticular disease, with nearly 75% of these patients seen in outpatient clinics. Although diverticulitis historically had been considered a disease of the older adult, it has become increasingly prevalent among the younger population. Likewise, in the past, antibiotics were considered first-line treatment for uncomplicated diverticulitis (Hinchey classification 0 and Ia); however, two large clinical trials compared treatment with antibiotics versus without antibiotics in uncomplicated cases of the disease and found no significant difference in patient outcomes. Based on these findings, first-line management now constitutes clear-liquid diet along with bowel rest for resolution of symptoms in these patients. Proper management with lifestyle modifications can help prevent complications and improve outcomes for patients with this condition; patient education is therefore critical.

An international comparison of student nurse practitioner diagnostic reasoning skills.

BACKGROUND: Nurse practitioners (NPs) play a pivotal role in health care provision. Diagnostic reasoning is an important core skill of advanced practice. PURPOSE: The purpose of this study was to compare diagnostic reasoning skills of NP students. It also identified the variability in clinical teaching components of a sample of international NP curricula. METHODS: An international group of NP students completed an online survey using a validated diagnostic reasoning scale during the first year of their NP program. Program faculty surveyed provided data on core curricula. RESULTS: The NP students' ( n = 152) mean diagnostic thinking inventory (DTI) score was 142, flexibility in thinking subscale score mean of 73 with a knowledge structure in memory of 69. The programs surveyed required bioscience courses. Most programs provided opportunities for students to practice diagnostic thinking using individual precepted clinical hours (range 500-950) and objective structured clinical examinations. CONCLUSION: The lower scores of this group of NP students were similar to other NP students and first-year medical residents. Higher mean scores in the DTI reflect expertise and are developed over time. Courses providing a foundation of biomedical knowledge were identified in each program, with opportunities for the NP students to practice diagnostic thinking using objective structured clinical examinations and clinical practice hours. IMPLICATIONS: The use of the diagnostic reasoning inventory is a useful tool for evaluating student NP's diagnostic reasoning during their NP program. Nurse practitioner programs should consider the provision of dedicated clinical hours, including supervised clinical practice experiences and objective structured clinical examinations to improve diagnostic reasoning.

Job satisfaction and empowerment of self-employed nurse practitioners: A mixed methods study.

BACKGROUND AND PURPOSE: Self-employed nurse practitioners (NPs) have been part of the American health care landscape since the 1970s, owning practices throughout the United States. The purpose of this study was to explore and measure the 2 characteristics of job satisfaction and empowerment in self-employed NPs practicing within the 50 states and District of Columbia and to explore factors that influence these characteristics. METHODS: A convergent parallel design, mixed methods study, using a survey and semistructured interviews, was completed. The survey included the Misener Job Satisfaction Survey and Conditions of Work Effectiveness Questionnaire II. CONCLUSIONS: Self-employed NPs are satisfied and empowered. The more empowered, the higher their level of job satisfaction. Over 40% practiced with full practice authority in a rural location, and 50% had over 10 years of experience as both an RN and NP. Their experience in private practice was explored further in the interviews. IMPLICATIONS FOR PRACTICE: This study identifies barriers to job satisfaction and empowerment in self-employed NPs, including physician oversight and lack of business management education. Continuing work to remove restricted and reduced state regulatory environments and to provide education on business management may increase the number of NPs in private practice, expanding access to health care in the United States.

Phase I: The development and content analysis of the Pediatric Sedation Agitation Scale.

No "gold standard" currently exists for the objective assessment of sedation depth in critically ill pediatric patients requiring mechanical ventilation. The risks for these patients due to both over-sedation and under-sedation include poorer outcomes, reduced patient and family satisfaction, and increased costs to the institutions. Available tools were unsatisfactory for the authors' patient population and practice model. The purpose of this study was to assess the content validity of the Pediatric Sedation-Agitation Scale (P-SAS), which was adapted from the Riker Sedation-Agitation Scale (SAS). Analysis by a panel of 30 health care professionals with expertise in pediatric acute care supported the content validity of the P-SAS.

Caring for the victim of child abuse in the pediatric intensive care unit.

Children are the future of the world and deserve their chance to succeed, cheered on by the caretakers and adults who surround them. Nurses in the pediatric intensive care unit do not need to be forensic specialists to effectively identify children who are at risk of abuse, but they should be forensically educated in an effort to increase awareness and serve as a patient advocate. Nurses have the opportunity and legal responsibility to stop the "cycle of violence" one life at a time when working with families living in an abusive environment. This article discusses several aspects of child abuse and the role of the critical care nurses.