Twenty-eight years of experience measuring autonomy using the Dempster Practice Behavior Scale.

BACKGROUND: Autonomy in practice is an important attribute of all professions and a cornerstone of advanced nursing practice. The Dempster Practice Behavior Scale was conceptualized, constructed, and psychometrically tested to make available a generalizable, empirically sound, and useful tool capable of measuring previously unrecognized dimensions of autonomy in practice. Nurse practitioner (NP) practice continues to evolve as new models of care emerge, requiring more autonomy in the NP role. PURPOSE: The purpose was to describe the development and psychometric testing of the Dempster Practice Behavior Scale (DPBS), review the extant research on its use in research on nursing and other professions, and determine where future research is needed on the concept of autonomy in professional practice with a focus on advanced practice registered nurses (APRNs). METHODS: Research articles, theses, dissertations using the DPBS as an instrument to measure practice autonomy were reviewed. RESULTS: Twenty-one unique publications were examined for reports of psychometric properties in various populations. For the APRN population (total N = 1,669 in 10 studies), psychometrics for the DPBS support the reliability of the instrument for research. The remaining 11 studies included 2,285 participants who were not APRNs. IMPLICATIONS FOR PRACTICE: Questions remain about the relationships between autonomy and external factors such as regulatory environment, practice setting, models of care, years of experience, and practice mix.

Professional organization membership: Advancing the nurse practitioner role.

With a paucity of literature on professional organization membership by nurse practitioners (NPs), the authors base the discussion of the personal benefits associated with membership on literature focusing on clinicians other than NPs and their personal experiences as members of multiple organizations. Membership is described as related to NP socialization, engagement, networking, mentorship, advocacy, policy, leadership development, research dissemination, professional development, and volunteerism. In addition to encouraging active participation in one or more professional organizations, the need for research into factors influencing the degree to which NPs participate in organizations and the associated benefits is identified.

Nurse Practitioner Research Agenda Roundtable, October 2015.

This is a report of the 2015 nurse practitioner (NP) Research Agenda Roundtable hosted by the Fellows of the American Association of Nurse Practitioners. A consensus was reached on four major categories where the need for research is greatest: 1) policy and regulation, 2) practice models, 3) education, and 4) workforce. Specific gaps in the existing body of research on NPs as essential elements of the broader health care environment were identified.

Effective professional networking.

The reasons for nurse practitioners to develop a professional network are boundless and are likely to change over time. Networking opens doors and creates relationships that support new opportunities, personal development, collaborative research, policy activism, evidence-based practice, and more. Successful professional networking involves shared, mutually beneficial interactions between individuals and/or individuals and groups, regardless of whether it occurs face to face or electronically. This article combines nuggets from the literature with guidance based on the authors' combined experience in networking activities at the local, national, and international levels.

Screening, diagnosis, and clinical care for depression.

Depression is an extremely common condition, which usually responds well to prescribed treatment. Many patients have undiagnosed depression or related illnesses. There are a variety of screening tools that can be applied in practice settings. It is recommended that adult patients be screened for depression in practice sites able to coordinate the actual diagnosis and treatment of depression. This column reviews two sets of recommendations specific to the screening, diagnosis, and treatment of depression.

National Kidney Foundation Guidelines for chronic kidney disease: evaluation, classification, and stratification.

Chronic kidney disease is becoming more prevalent in the United States. The National Kidney Foundation has recently published a new set of guidelines to assist clinicians in providing earlier detection and treatment of kidney disease to minimize the progression to end-stage renal disease. As approximately 11% of the adult population has some degree of kidney disease, this new CPG should be applicable in many settings.

2001-2002 AANP national nurse practitioner practice site survey.

Between October 2001 and February 2002, AANP implemented the National NP Practice Site Survey. The purpose of the survey was to describe the general U.S. NP workforce, including the percentage of NPs working in primary care and their settings. Data were collected from over 39,000 NPs of all specialties. Based on the survey, a description of the U.S. NP Workforce was developed. For instance, according to the survey, the average NP is female (95%) and 47 years old. She has been in practice for 8.6 years, is a family NP (35%), and is involved in direct patient practice. This report includes detail on the respondents' clinical specialization, age, years of practice, and type of practice.

Diagnosis and treatment of heel pain.

The American College of Foot and Ankle Surgeons (ACFAC) clinical practice guideline (CPG) summarizes the literature on the assessment and diagnosis of heel pain. The framework classifies heel pain depending on whether the cause is mechanical, neurological, arthritic, traumatic, or from another origin. Treatment strategies are included for the most common form of heel pain that are caused by mechanical problems.

Clinical practice guidelines. USPSTF recommendations.

The set of USPSTF recommendations provides a valuable resource for clinicians in varied practice settings. Although the 2nd edition of recommendations addressed over 200 topics, only six statements have been released as part of the 3rd edition thus far. Others, not reviewed in this article include: screening for newborn hearing, screening for bacterial vaginosis during pregnancy, and screening for lipid disorders. The recommendations are conservative and, like all clinical practice guidelines, should be considered in light of one's philosophy of practice. The recommendations meet many of the criteria addressed in the initial column of this series. The factors considered by the panel members are identified, including accuracy of available screening methodologies, cost factors, and benefit/risk determinations. The evidence on which recommendations are based is rated. Exceptions to the recommendations are identified. For instance, the authors of the paper on skin cancer screenings indicate that they did not consider studies based on persons with familial skin cancers. Although no recommendation is made for or against skin cancer screenings, ways in which the skin can be assessed during physical examinations performed for other reasons are identified. The importance of individual patient preference is included. The USPSTF panel is multi-disciplinary and includes [table: see text] (http://www.guideline.gov). The statement on aspirin therapy was published in the Annals of Internal Medicine and is available, along with a second article discussing the evidence in more depth (Hayden, Pignone, Phillips, & Mulrow, 2002), at: http://www.annals.org. Print versions are available through the Agency for Healthcare Research and Quality (AHRQ) Publications Clearinghouse (1-800-358-9295). Readers are encouraged to obtain full copies of the recommendations that are applicable to their practice as they become available and to assess their potential application in practice.

Clinical practice guidelines. Managing oral anticoagulant therapy.

Clinical practice guidelines (CPG) provide recommendations based on the summary of large volumes of literature and expert opinion. They are not absolute care directives, but are intended to facilitate individualized decision making related to patient care situations. Each month this column reviews a CPG of direct relevance to clinical practice. Readers are urged to contact the author, Mary Jo Goolsby (mjgoolsby@aanp.org) with requests for reviews of specific clinical guidelines or submissions of manuscripts addressing major guidelines that readers have found helpful in their practice. The Clinical Practice Guideline column is designed to inform practitioners of the wide range of accessible and current recommendations on a myriad of clinical topics. The guideline reviewed this month is actually one part of a large report stemming from the Sixth American College of Chest Physicians (ACCP) Consensus Conference on Antithrombotic Therapy. The management of oral anticoagulant therapy is but one portion of the overall report, complemented and supported by other components, including a preceding chapter that summarizes the mechanisms of action, clinical effectiveness, and therapeutic range of oral agents. This CPG focuses on following issues: (a) initiating and maintaining dosage, (b) managing non-therapeutic dosages, (c) managing the agents during invasive procedures, and (d) recognizing and responding to adverse events. Special situations are discussed, including management of patients who are elderly or pregnant, and comparisons of the management in different models of care. There is in-depth discussion of the literature, accompanied by a summary of recommendations.

National Guideline Clearinghouse guideline syntheses and comparisons.

As the number of clinical practice guidelines relevant to clinical practice continues to grow, nurse practitioners may find it confusing to choose from two or more guidelines on the same or similar topics. The National Guideline Clearinghouse provides two resources to assist clinicians in comparing multiple guidelines on similar topics: guideline syntheses and guideline comparisons. This column describes the features of these two resources, using examples from guidelines on acute pharyngitis.

Screening, diagnosis, and monitoring of hepatic injury.

Although prophylactic vaccines and a better screened blood supply have contributed to a decreased incidence of viral hepatitis, liver injury remains a common problem. It is important that nurse practitioners know which patients are at risk for hepatic injury, when and how to screen for hepatic injury, and how to monitor patients diagnosed with hepatic damage. The National Academy of Clinical Biochemistry guidelines related to hepatic injury provide a framework for the screening, diagnosis, and monitoring of hepatic injury resulting from a variety of causes.

Migraine headaches.

Migraine headaches are the source of significant disability for many individuals and their management can present a considerable clinical challenge. The American Academy of Family Physicians (AAFP) and American College of Physicians--American Society of Internal Medicine (ACP-ASIM) "Pharmacologic Management of Acute Attacks of Migraine and Prevention of Migraine Headaches," provides a succinct, evidence-based resource for primary care nurse practitioners. In addition to reviewing this clinical practice guideline, this column describes related supporting documents.

Evaluation and management of occult and obscure gastrointestinal bleeding.

Gastrointestinal (GI) bleeding is a commonly encountered primary care clinical challenge. The AGA Medical Position Statement: Evaluation and Management of Occult and Obscure Gastrointestinal Bleeding, reviewed in this month's clinical practice guideline column, summarizes recommendations for the initial diagnostic approach and management for occult bleeding, as well as the subsequent diagnostic and management approach for obscure bleeding. The recommendations have applicability in primary care as nurse practitioners (NPs) assess the cause of occult bleeding and consult with specialists when obscure bleeding occurs.

Policy on acute toxic ingestion or dermal or inhalation exposure.

Many nurse practitioners (NPs) practice in emergency and urgent-care settings, and far more practice in remote settings. NPs in each of these settings should be familiar with the assessment, stabilization, and treatment of patients who seek treatment for suspected intentional or accidental poisoning. This month's clinical practice guideline (CPG) column reviews the "Clinical Policy for the Initial Approach to Patients Presenting With Acute Toxic Ingestion or Dermal or Inhalation Exposure."