A national survey of the impact of COVID-19 on personal, academic, and work environments of nursing students.

BACKGROUND: Nursing students are experiencing life changing events in their personal, academic, and work environments since the onset of the pandemic. PURPOSE: The purpose of this study was to describe and explore the effects of COVID-19 on personal, workforce, and academic experiences of nursing students (N = 620). METHOD: A 68-item survey with three areas of focus surrounding academic, workforce and personal experiences was distributed to multiple schools across the United States. The analysis compares student responses from the five regions of the US. FINDINGS: Significant differences were found in the pairwise comparisons. The analysis revealed the academic changes were generally viewed as negative. Fear/anxiety and political influences impacted the outcomes of the pandemic. DISCUSSION: Understanding the effects of the pandemic on the personal, work and academic experiences of nursing students will assist academia and healthcare in adapting existing policies to meet student needs in the various regions of the United States.

A national survey of nurse practitioners' patient satisfaction outcomes.

BACKGROUND: The research findings about nurse practitioner (NP) patient experiences (satisfaction) are limited to small sample sizes from local community clinics. No national studies with large sample sizes were found. PURPOSE: To analyze responses from the Consumer Assessment of Healthcare Providers and Systems survey and compare the patient experiences from four different provider categories. METHODS: Secondary data analysis was completed on survey responses from 53,885 patients. FINDINGS: In the sample, medical doctor providers were disproportionately represented in greater number than NPs, doctor of osteopathy, or physician assistant. Further analysis comparing patient experiences between providers revealed NP to be rated significantly higher than their colleagues. DISCUSSION: Recognizing the factors associated with patient satisfaction with their providers can lead to improvements in patient-provider interactions that can result in increased quality of care. CONCLUSION: Policy makers should find opportunities to employ NP in primary care settings and achieve greater patient satisfaction that can influence outcomes associated with patient-centered care initiatives.

Integrating Interprofessional Education and Cultural Competency Training to Address Health Disparities.

PROBLEM: Many U.S. medical schools have accreditation requirements for interprofessional education and training in cultural competency, yet few programs have developed programs to meet both of these requirements simultaneously. Furthermore, most training programs to address these requirements are broad in nature and do not focus on addressing health disparities. The lack of integration may reduce the students' ability to apply the knowledge learned. Innovative programs that combine these two learning objectives and focus on disenfranchised communities are needed to train the next generation of health professionals. INTERVENTION: A unique interprofessional education program was developed at the University of Arkansas for Medical Sciences Northwest. The program includes experiential learning, cultural exposure, and competence-building activities for interprofessional teams of medicine, nursing, and pharmacy students. The activities include (a) educational seminars, (b) clinical experiential learning in a student-led clinic, and (c) community-based service-learning through health assessments and survey research events. CONTEXT: The program focuses on interprofessional collaboration to address the health disparities experienced by the Marshallese community in northwest Arkansas. The Marshallese are Pacific Islanders who suffer from significant health disparities related to chronic and infectious diseases. OUTCOME: Comparison tests revealed statistically significant changes in participants' retrospectively reported pre/posttest scores for Subscales 1 and 2 of the Readiness for Interpersonal Learning Scale and for the Caffrey Cultural Competence in Healthcare Scale. However, no significant change was found for Subscale 3 of the Readiness for Interpersonal Learning Scale. Qualitative findings demonstrated a change in students' knowledge, attitudes, and behavior toward working with other professions and the underserved population. LESSONS LEARNED: The program had to be flexible enough to meet the educational requirements and class schedules of the different health professions' education programs. The target community spoke limited English, so providing interpretation services using bilingual Marshallese community health workers was integral to the program's success.

The Current State of U.S. Geropsychiatric Graduate Nursing Education: Results of the National Geropsychiatric Graduate Nursing Education Survey.

Advanced Practice Registered Nurses (APRNs) must be prepared to care for the rapidly increasing numbers of older adults with mental health needs. All 363 graduate nursing programs in the United States were surveyed regarding the nature and extent of geropsychiatric nursing (GPN) content across program curricula and their perceptions of the influence that the APRN Consensus Model has exerted on preparing the next generation of APRNs to meet the growing needs of the older adult population. Of the 202 schools responding, 138 reported GPN content in one or more clinical programs, with the majority of content in non-PMHNP programs. Only 17 schools reported offering a GPN program, track, or minor. The majority of schools (n = 169) perceived that they were adequately well-prepared to meet the APRN Consensus Model's guidelines regarding inclusion of aging-related didactic and clinical educational experiences in all APRN education programs; nearly two thirds (n = 132) perceived a moderate to significant influence of the Consensus Model on institutional infusion of GPN into curricula. Compared with a similar survey 10 years ago, there was little change in the proportion of schools reporting GPN in clinical programs and few schools provide GPN programs, tracks, or minors. Implications for nursing education and practice are discussed.

Reimagining the Future of Clinical Nursing Education: A Cohort Partnership Model.

BACKGROUND: As the demand for registered nurses increases, innovative methods for stabilizing, improving, and ensuring the longevity of quality clinical nursing education should be considered. Traditionally, full-time nursing faculty teach nursing students in clinical settings. PROBLEM: Considering the impending nurse educator crisis, characterized by increasing demands on a dwindling nursing faculty, traditional approaches to clinical nursing education are no longer feasible. APPROACH: A new clinical cohort model (CCM), developed from an academic/health system partnership, is proposed as an innovative approach to future clinical nursing education. OUTCOMES: CCM implementation resulted in a significant reduction in the cost of educating nursing students. The health care system noted a 100% postgraduation 2-year retention rate among cohort students. Nursing students overwhelmingly expressed satisfaction, comfort, and new opportunities through participation in the CCM. CONCLUSIONS: This new CCM has significant benefits for schools of nursing, health care systems, and nursing students.

Advanced Practice Nurses' Meaningful use of electronic health records.

AIM: The aim of this study was to better understand electronic health records (EHRs) use among advanced practice nurses (APNs). BACKGROUND: EHRs are becoming an integral part of the U.S. health care system. Federal law was enacted with provisions that offer incentive payments to eligible professionals and hospitals who use EHRs. Little is known about APNs' EHR use. METHODS: A quantitative, non-experimental research design was used. Descriptive and multiple logistic regression analyses were performed. RESULTS: Two thirds of the APNs were EHR-user. Statistically significant differences between EHR-users and non-users were found in age categories, practice setting, practice size, and in tasks related to imagery report review and care coordination. EHR use was associated with higher odds of practicing in hospital, and employment longevity, but with decreased odds in the number of patients seen per day. CONCLUSIONS: With one third of the APNs being EHR non-users, more efforts are needed to help guide the adoption and diffusion of EHRs in practice.

Trends and opportunities in geropsychiatric nursing: enhancing practice through specialization and interprofessional education.

Forecasted changes in the demographics of the United States suggest there will be an unprecedented need for health care professionals with specific training in geropsychiatric care. An aging society, the dearth of geropsychiatric health care professionals, the shortage of educators, and the lack of interprofessional geropsychiatric education require new strategies for nursing education to address these issues. The vision of the Institute of Medicine serves as a foundation for transforming geropsychiatric nursing and interprofessional education to prepare the next generation of nurses and the geropsychiatric workforce to improve the mental health care of older adults. This article aims to describe the importance and implications of implementing the recently released Geropsychiatric Nursing Competency Enhancements and the Core Competencies for Interprofessional Collaborative Practice to improve the mental health care of older Americans. A secondary aim is to discuss how to overcome barriers in implementing interprofessional education in geropsychiatric nursing care.

Life history collages: effects on nursing home staff caring for residents with dementia.

This study evaluated the effects of person-centered life history collages on nursing staff knowledge about individual residents living with dementia and staff perceptions of individualized care practices. Thirty-six nursing staff participants (18 experimental and 18 control) who cared for 5 residents with dementia in two nursing homes were recruited. Intervention staff members were exposed to life history collages for 4 weeks. Pretest and posttest data were analyzed using multivariate analysis of covariance and analysis of covariance. While intervention group members' knowledge of residents' family, jobs/careers, and likes/dislikes/interests improved significantly at posttest, F(3, 26) = 6.80, p < 0.01, and at 3 weeks postintervention, F(3, 23) = 9.85, p < 0.001, perceptions of individualized care/person-centered care practices did not. Potential reasons for this lack of improvement are identified and discussed. Directions for future research are also provided.

Nurse practitioners' time on nonbillable activities.

BACKGROUND AND PURPOSE: During the provision of patient care delivery, all providers, including nurse practitioners (NPs), spend some time in activities that are not reimbursable. Understanding these nonbillable activities is crucial to the economic viability and success of existing and projected practice models. This study explored and compared seven nonbillable activities occurring in the practices of NPs in various settings. METHODS: Using a nonexperimental, descriptive design, 509 NPs were surveyed about nonbillable activities encountered in daily practice. Binomial regression analyses and incidence rate ratios were used to interpret relationships between each variable and nonbillable time. CONCLUSIONS: Although not every variable had significance, there were significant differences found in the amount of time spent in certain nonbillable activities depending on workplace setting, number of support staff, and primary care provider role. IMPLICATIONS FOR PRACTICE: The uncertainty of health care reform, including reimbursement, provider shortage, and the expanding roles of NPs, requires a closer look at both billable and nonbillable care activities. Understanding how nonbillable time affects work efficiency, costs, and the value of NPs will allow NPs to influence future health care reimbursement policies and delivery care models.

Diabetes and Hypertension in Marshallese Adults: Results from Faith-Based Health Screenings.

BACKGROUND: The Pacific Islander population in the USA is growing rapidly. However, research on Pacific Islanders in the USA is limited, or sometimes misleading due to aggregation with Asian Americans. This project seeks to add to the dearth of health literature by conducting a health assessment of Marshallese in northwest Arkansas. METHODS: Using a community-based participatory research approach, nine health screening events were conducted at local Marshallese churches. Participants completed the Behavioral Risk Factors Surveillance Survey core questionnaire and diabetes module if applicable. Biometric data, including Hemoglobin A1c, blood pressure, and body mass index, were gathered by an interprofessional team. RESULTS: Four hundred one participants completed health screenings. High proportions of diabetes, obesity, and hypertension were found. A high percentage of participants were uninsured, and multiple barriers to health care were found within the sample. DISCUSSION: This project represents one of the first broad health assessments of Pacific Islanders in the USA. Proportions of diabetes, hypertension, obesity, and uninsured found in the sample are much higher than national proportions.

Integrating Geropsychiatric Nursing and Interprofessional Collaborative Practice Competencies Into Adult-Gerontology Clinical Nurse Specialist Education.

Specific changes to the national clinical nurse specialist (CNS) certification are necessitating a move away the psychiatric/mental health (P/MH) CNS population focus. However, a rapidly increasing older adult population with P/MH comorbidities such as depression and anxiety means that the adult-gerontology CNS (AGCNS) will likely be coordinating much of the complex care needs of this vulnerable population. Therefore, strategies are needed to ensure AGCNSs are competent in advanced practice P/MH nursing. In addition, at this critical time in the redesign of healthcare, the Institute of Medicine has made interprofessional practice center stage for healthcare professional education. Therefore, the purpose of this manuscript is to propose aligning the current AGCNS population-focused competencies with the CNS geropsychiatric nursing competency enhancements and interprofessional collaborative practice education competencies. Examples of the proposed alignment and educational application strategies are presented. When AGCNS educational curricula encompass P/MH nursing at an advanced level from an interprofessional perspective, future AGCNSs will continue to be positioned to make significant contributions to the design of care systems and monitor and trend important outcomes, while ensuring safe and efficient, high-quality healthcare for older adults with P/MH comorbidities.

Hartford Gerontological Nursing Leaders: From Funding Initiative to National Organization.

In 2000, the John A. Hartford Foundation established the Building Academic Geriatric Nursing Capacity Program initiative, acknowledging nursing's key role in the care of the growing population of older adults. This program has supported 249 nurse scientists with pre- and postdoctoral awards. As a result of the program's success, several Building Academic Geriatric Nursing Capacity Program awardees formed an alumni organization to continue to advance the quality care of older adults. This group of Building Academic Geriatric Nursing Capacity Program awardees joined others receiving support from the John A. Hartford Foundation nursing initiatives to grow a formal organization, the Hartford Gerontological Nursing Leaders (HGNL). The purpose of this article is to present the development, accomplishments, and challenges of the HGNL, informing other professional nursing organizations that are experiencing similar accomplishments and challenges. This article also demonstrates the power of a funding initiative to grow an organization dedicated to impact gerontological health and health care through research, practice, education, and policy.

The Southern states: NPs made an impact in rural and healthcare shortage areas.

PURPOSE: To investigate the distribution of nurse practitioners (NPs) in the U.S. Southern region with a focus on rural and underserved areas. Described in this study are the NP characteristics and their workforce distribution relative to rural and health professional shortage areas (HPSAs). METHOD: A questionnaire was administered to NPs in 12 Southern states. Other data sources included (a) the Health Resources and Services Administration, which identified HPSAs; and (b) data from the U.S. Census Bureau, to distinguish urban and rural areas. CONCLUSIONS: Approximately 72% of NPs worked in HPSAs and less than half of the NPs worked in the rural area. Family NPs were more likely to practice in rural and HPSAs. Employment in primary care was more likely to occur in rural and HPSAs. Racial diversity was almost nonexistent within the NP population. IMPLICATION FOR PRACTICE: This research does demonstrate that NPs are practicing in rural and underserved areas as conceived decades ago, but there is still a great demand and gap to fill. To optimize their effectiveness, NPs need to practice to the full extent of their education. Additionally, more research and strategies to help diversify the workforce is needed.

Community-Driven Research Agenda to Reduce Health Disparities.

This paper describes how a new regional campus of an academic health center engaged in a community-based participatory research (CBPR) process to set a community-driven research agenda to address health disparities. The campus is situated among growing Marshallese and Hispanic populations that face significant health disparities. In 2013, with support from the Translational Research Institute, the University of Arkansas for Medical Sciences Northwest began building its research capacity in the region with the goal of developing a community-driven research agenda for the campus. While many researchers engage in some form of community-engaged research, using a CBPR process to set the research agenda for an entire campus is unique. Utilizing multiple levels of engagement, three research areas were chosen by the community: (1) chronic disease management and prevention; (2) obesity and physical activity; and (3) access to culturally appropriate healthcare. In only 18 months, the CBPR collaboration had dramatic results. Ten grants and five scholarly articles were collaboratively written and 25 community publications and presentations were disseminated. Nine research projects and health programs were initiated. In addition, many interprofessional educational and service learning objectives were aligned with the community-driven agenda resulting in practical action to address the needs identified.

Minimal changes and missed opportunities: a decade look at nurse practitioners in the lower Mississippi River Delta states.

The U.S. southern region has one of most socioeconomically deprived and poorest health care outcomes in the county. The aims of this study were to determine changes of nurse practitioners (NPs) and their practice in lower Mississippi River Delta over the past decade and to examine differences of NPs' employment in health professional storage areas (HPSAs) and rural areas. A nonexperimental quantitative survey technique was used in the years 2000 and 2010. Other data sources included Health Resources and Services Administration that identified HPSA and the U.S. Census Bureau used to distinguish urban and rural areas. NPs are younger, and more are graduates of master's and doctorate degrees, but they are not reflective of the race they serve. Approximately, 25% of NPs worked in HPSA, and 50% worked in the rural area both in 2000 and in 2010. This proportion has remained blatantly steady during the past decade. Employment in rural health centers and family practice as a specialty declined; however, self-employment was on the rise. Nursing schools and health care institutions should be collaborating to develop plans and implementation strategies to recruit and retain NPs in the Mississippi River Delta rural and HPSAs.

Levels of personhood: a model for dementia care.

"Personhood" is a concept that may be seen as insignificant to health care delivery, yet it has strong relevance to people suffering from dementia in nursing home settings. When the dementia disease process negatively affects residents' cognition, memory, and the ability to communicate effectively, nursing home caregivers may approach care in a paternalistic manner, similar to a parent's authority over a child. Based on attributes of personhood identified in the literature, 3 levels of personhood are defined, discussed, and related to the naturally occurring dementia disease progression. Challenges to, and benefits of, the promotion of personhood in current nursing home dementia care are discussed. The author proposes a Personhood Model for Dementia Care that is based on the 3 identified levels of personhood. The model provides a structure for organizing existing person-centered interventions and strategies in dementia care. In addition, the proposed model provides a framework for understanding and testing the potential value and significance of future person-centered interventions as they are developed and implemented.