The Lived Experience of COVID-19.

This qualitative study examined the essence of living with coronavirus disease 2019 (COVID-19). We used a phenomenological research design and interviewed 14 individuals ages 18 and older during the first wave of the COVID-19 pandemic. Data analysis using Colaizzi's method for analysis revealed 2 overarching themes-physical experiences and psychologic/emotional experiences-and 8 subthemes that identify concerns that affect quality of life. The findings provide insights for nurses and health care providers on the experiences of living with COVID-19.

Engaging in meaningful discussion: What nurse practitioners need to know about retirement and end-of-life planning.

ABSTRACT: Nurse practitioners (NPs) should be knowledgeable about entering into meaningful conversations with clients about their retirement and end-of-life planning. Through knowledge of advanced care planning, NPs should be prepared to serve as a resource as clients develop life plans. Nurse practitioners should assess their practice for documenting client wishes that align with the 1990 Patient Self-Determination Act and advocate for changes in electronic record-keeping systems.

Business documents of the advanced practice registered nurse: Curriculum vitae, resume, and biosketches.

Advanced practice nurses (APNs) now have great opportunities to serve in leadership positions for organizations, institutions of higher education, community and public agencies, and more. The need exists for APNs to have a full set of professional business documents readily available. Such common documents would extend beyond the professional business card and professional photograph to include the curriculum vitae, the resume, and the National Institutes of Health Biographical Sketch (biosketch) and a professional biosketch. Advanced practice nurses should understand the differences between the documents as each document helps to share the professional identity.

The value of faculty during student on-site evaluations.

The American Academy of Nurse Practitioners Certification Board recognizes the value of nurse practitioner faculty in evaluating students at the clinical site. The Board of Commissioners recently approved the awarding of clinical hours to nurse practitioner faculty for clinical site visits. This article outlines the rationale and procedure for conducting and documenting student visits that can be applied to recertification.

Managing peripheral edema in patients with arterial hypertension.

Calcium channel blockers (CCBs) play a vital role in the management of hypertension. Peripheral edema is the most common side effect reported with CCB monotherapy, especially with high-dose dihydropyridine CCBs. CCB-related peripheral edema is a dose-limiting effect that is usually medically benign but can compromise patient adherence. CCB-related peripheral edema may cause considerable discomfort and patient concern. Patients presenting with peripheral edema should undergo assessment for drug and nondrug causes. Rather than lowering the CCB dose or switching to another monotherapy, combination therapy (e.g, CCB plus a renin-angiotensin-aldosterone system inhibitor) can enhance blood pressure control, generally with lower doses of individual agents, and lessen the risk of adverse events. As recommended by consensus guidelines, addition of a renin-angiotensin-aldosterone system inhibitor as part of combination therapy may accelerate the time to goal blood pressure as well as help alleviate peripheral edema in affected patients. Successful management of CCB-related peripheral edema with lifestyle changes and rational combination therapy is likely to improve blood pressure control and patient outcomes.

Optimizing management of hypertension with combination therapy: considerations for the nurse practitioner.

Hypertension is an important contributor to the risk of cardiovascular disease and death, yet success in achieving blood pressure (BP) control has been limited. Most patients will require 2 or more medications to control their BP. Nurse practitioners play a vital role in treating patients with hypertension and can help overcome barriers to reaching BP goals. Measures to improve therapeutic adherence include educating the patient and simplifying the medication regimen. Use of single-pill combination therapy, which reduces the pill burden, can contribute to improved medication persistence and compliance. Rational combination therapy combines medications with complementary mechanisms of action, such as a calcium channel blocker (CCB) and a renin-angiotensin-aldosterone system (RAAS) inhibitor; it is often more efficacious than monotherapy and allows the use of lower doses of the individual components, which usually results in improved tolerability. Current guidelines support the first-line use of combination therapy in many patients. Initiating therapy with a RAAS inhibitor-based combination can reduce BP and cardiovascular risk and may be more effective for some patients than traditional combinations such as a beta-blocker with a diuretic. Adverse events associated with any medication can compromise its therapeutic usefulness. Peripheral edema is a common and dose-dependent adverse event seen with dihydropyridine CCBs, which can cause marked patient distress, reduce adherence to therapy, and result in dose reduction or even discontinuation of therapy. In most cases, CCB-induced peripheral edema can be managed successfully, and CCB therapy need not be abandoned. Management strategies include nonpharmacologic and pharmacologic measures. Several clinical trials have shown a lower incidence of peripheral edema in patients receiving combination therapy with a CCB and a RAAS blocker compared with CCB monotherapy.

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.

Precepting nurse practitioner students: A new view-Results of two national surveys of nurse practitioner preceptors.

PURPOSE: The aim of two national studies was to identify characteristics of nurse practitioners (NPs) who precept and the benefits, incentives, and barriers associated with the NP preceptor role. METHODS: Stratified randomized sampling was used to invite a representative number of NPs from each state to participate in a 2015 survey and a follow-up survey in 2016. These descriptive, exploratory studies distributed electronic questionnaires to 5000 randomly selected NPs in the 2015 survey and 40,000 NPs in the 2016 survey. Responses from 10.9% (n = 548) and 9.9% (n = 3970), respectively, were analyzed. CONCLUSIONS: The findings show strong support among our NP colleagues to assist with educating future NPs. Several benefits, barriers, and motivators among stakeholders were identified that need to be considered when working with preceptors. IMPLICATIONS FOR PRACTICE: This study provides a basis for understanding the current climate in education when working with clinical preceptors. Many areas become apparent where NP education could enhance the experience for both the student and the preceptor. Educational settings need to consider preceptor time, issues with online learning, and the rise of specialty practices. Offering incentives linked to the most valued, positive aspects of the role and methods to overcome barriers should be explored.

Curriculum vitae: An important tool for the nurse practitioner.

Advanced practice nurses (APNs) should maintain a curriculum vitae (CV) that comprehensively reflects the individual's work and professional accomplishments. This article guides APNs through best practices for development of a CV. Tips are offered to help guide the content, format, and maintenance of the CV.

Medication adherence part two: predictors of nonadherence and adherence.

PURPOSE: This is the second of a three-part series on medication adherence in which the authors describe the continuum of adherence to nonadherence of medication usage. DATA SOURCES: Research articles through MEDLINE and PubMed. CONCLUSIONS: Understanding the magnitude and scope of the problem of medication nonadherence is the first step in reaching better adherence rates (described in Part One of this series). The second step is to recognize the complexities of the reasons for medication adherence/nonadherence (described here). Reasons for nonadherence include beliefs related to the benefits of medication for physical and mental disorders, complexities of systems of health care and treatment plans, and lifestyle and demographic characteristics of patients. The final step is to evaluate each patient for medication adherence, tailoring the plan of care according to patient and system specific barriers (described in Part Three of this series). IMPLICATIONS FOR PRACTICE: Nurse practitioners must recognize a critical element of thorough care is to assess medication adherence at each patient visit, countering patient and system barriers as indicated. Nurse practitioners also need to adjust assessment and prescribing practices according to the evidence for best practices to improve medication adherence.

Medication adherence Part three: Strategies for improving adherence.

PURPOSE: This is the third of a three part series on Medication Adherence in which the authors describe the continuum of adherence to nonadherence of medication usage. DATA SOURCES: Research articles through Medline and PubMed. CONCLUSIONS: Understanding the magnitude and scope of the problem of medication nonadherence is the first step in reaching better adherence rates. The second step is to evaluate the risk factors for each patient for medication adherence/nonadherence. Steps are then taken to prevent nonadherence. IMPLICATIONS FOR PRACTICE: The implications for nurse practitioners include using time with patients to assist them in adherence, building a trusting relationship with patients, and developing protocols for assessing and preventing nonadherence.

Medication adherence part one: understanding and assessing the problem.

PURPOSE: This is the first of a three-part series on medication adherence in which the authors describe the continuum of adherence to nonadherence of medication usage. DATA SOURCES: Research articles through MEDLINE and PubMed. CONCLUSIONS: Understanding the magnitude and scope of the problem of medication nonadherence is the first step in reaching better adherence rates. The second step is to evaluate the risk factors for each patient for medication adherence/nonadherence. The third step is to assess for adherence. The process will continue with a consistent systematic process to evaluate continual adherence. IMPLICATIONS FOR PRACTICE: The implications for nurse practitioners include using time with patients to assist them in adherence, building a trusting relationship with patients, and developing protocols for assessing and preventing nonadherence.