Benefits of a Pediatric Clinic Simulation Using Standardized Patients in Family Nurse Practitioner Education.

ABSTRACT: The purpose of this study was to examine the effect of a pediatric clinic simulation with standardized patients on anxiety, self-efficacy, and performance in family nurse practitioner students. A pediatric clinic simulation was developed in which family nurse practitioner students encountered standardized patients presenting for a well-child visit or exhibiting a common chief complaint. Anxiety and self-efficacy were assessed pre/post the simulation intervention, along with faculty-observed student performance. The clinic simulation resulted in increased self-efficacy, lower anxiety, and improved performance (p < .01). High-fidelity simulation of a pediatric clinic was found to foster development of clinical competency, lower student anxiety, and improve self-efficacy.

Applying the Beers and STOPP Criteria to Care of the Critically Ill Older Adult.

Potentially inappropriate medications impact pharmacotherapy for the older adult in critical care settings. Critical care teams must be aware of the Beers and Screening Tool of Older Person's Prescriptions criteria as resources to identify medications that may cause adverse drug events in the elderly. Although criteria should not replace clinical judgment, awareness of these guidelines may direct critical care teams to minimize dosing and duration of potentially inappropriate medications to improve outcomes in the intensive care unit.

Using Virtual Reality Simulation for Screening Brief Intervention and Referral to Treatment.

BACKGROUND: This study examined the effects of virtual reality on students' confidence and knowledge in Screening, Brief Intervention, and Referral to Treatment (SBIRT), and understanding of substance use disorders (SUDs) in mental health and primary care settings. METHOD: Using a pre- and postdesign, questionnaires were distributed before, immediately after, and 3 months after the simulation. RESULTS: Data analysis revealed significant increases in SBIRT characteristics, screening tools, and alcohol consumption guidelines from pre- to postsimulation (p < .05) among the participants (n = 380). Confidence levels improved significantly (p < .001), with no notable difference between post-simulation and follow-up surveys. CONCLUSION: Simulation training with structured prebriefing and debriefing sessions facilitated the application of learned skills during the simulation, boosting students' self-efficacy and readiness. [J Nurs Educ. 2024;63(7):453-459.].

Patient-Centered Care Through Nurse Practitioner-Led Integrated Behavioral Health: A Case Study.

Integrated behavioral health can improve primary care and mental health outcomes. Access to behavioral health and primary care services in Texas is in crisis because of high uninsurance rates, regulatory restrictions, and lack of workforce. To address gaps in access to care, a partnership formed among a large local mental health authority in central Texas, a federally designated rural health clinic, and the Texas A&M University School of Nursing to create an interprofessional team-based health care delivery model led by nurse practitioners in rural and medically underserved areas of central Texas. Academic-practice partners identified 5 clinics for an integrated behavioral health care delivery model. From July 1, 2020, through December 31, 2021, a total of 3183 patient visits were completed. Patients were predominantly female (n = 1719, 54%) and Hispanic (n = 1750, 55%); 1050 (33%) were living at or below the federal poverty level; and 1400 (44%) were uninsured. The purpose of this case study was to describe the first year of implementation of the integrated health care delivery model, barriers to implementation, challenges to sustainability, and successes. We analyzed data from multiple sources, including meeting minutes and agendas, grant reports, direct observations of clinic flow, and interviews with clinic staff, and identified common qualitative themes (eg, challenges to integration, sustainability of integration, outcome successes). Results revealed implementation challenges with the electronic health record, service integration, low staffing levels during a global pandemic, and effective communication. We also examined 2 patient cases to illustrate the success of integrated behavioral health and highlighted lessons learned from the implementation process, including the need for a robust electronic health record and organizational flexibility.

Efficacy and safety of an albiglutide liquid formulation compared with the lyophilized formulation: A 26-week randomized, double-blind, repeat-dose study in patients with type 2 diabetes mellitus.

AIMS: Compare the efficacy and safety of albiglutide from a ready-to-use, single-dose, auto-injector system with the lyophilized product in patients with type 2 diabetes mellitus (T2DM). METHODS: In this phase 3 study, 308 patients between 18 and 80 years with T2DM and experiencing inadequate glycemic control on their current regimen of diet/exercise alone or in combination with metformin were randomized 1:1 to weekly injections for 26 weeks with an active albiglutide auto-injector and placebo lyophilized dual-chamber cartridge (DCC) pen injector (n = 154) or active albiglutide lyophilized DCC pen injector and placebo liquid auto-injector (n = 154). Participants received liquid or lyophilized albiglutide 30 mg for 4 weeks, and then 50 mg for the remaining 22 weeks. Change in HbA1c and fasting plasma glucose (FPG), pharmacokinetics, and safety were assessed. RESULTS: In the albiglutide liquid and lyophilized drug product groups, 55.6% (85/153) and 45.5% of patients (70/154) had a baseline HbA1c ≥ 8.0%, respectively. The model-adjusted least squares (LS) mean change in HbA1c from baseline at week 26 was -1.1% (95% CI: -1.3, -1.0) and -1.2% (95% CI: -1.3, -1.0; noninferiority P = 0.0002) in the albiglutide liquid and lyophilized product groups, respectively. Similarly, the model-adjusted LS mean change in FPG from baseline at week 26 in the albiglutide liquid and lyophilized product groups was -2.2 (95% CI: -2.6, -1.8) mmol/L and -1.9 (95% CI: -2.3, -1.5) mmol/L, respectively. No new safety concerns were identified. CONCLUSION: Change from baseline in HbA1c for albiglutide liquid was noninferior to lyophilized drug product in patients with T2DM.

The impact of interprofessional education on family nurse practitioner students' and family medicine residents' knowledge and confidence in screening for breast and cervical cancer.

BACKGROUND AND PURPOSE: This study determined the impact of an interprofessional education (IPE) simulation on family nurse practitioner (FNP) students' and family medicine residents' (FMRs) self-reported confidence in counseling women reluctant to engage in cancer screening or evaluation and assessed knowledge of breast and cervical cancer risk factors. METHOD: A multi-item knowledge survey on breast and cervical cancer risk factors was administered to 76 FNP students and FMRs followed by an IPE simulation with a pre-/postsurvey of self-reported confidence in counseling a woman reluctant to have breast and cervical cancer screening and evaluation. DISCUSSION: Data demonstrated knowledge deficits in breast and cervical cancer risk factors in both disciplines with the average risk factor knowledge score of 8.5/12 for breast cancer and 7.8/12 for cervical cancer. Following IPE simulation, confidence in counseling women reluctant to have breast or cervical cancer screening improved across both disciplines (p < .05) and debrief feedback findings suggest improved attitudes toward collegiality, communication, and understanding of other interprofessional roles among both disciplines. CONCLUSION: Knowledge gaps exist among both FNP students and FMRs in breast and cervical cancer risk factors. This study suggests IPE simulation is effective in building individual provider confidence and team collegiality.

Improving Outcomes for Infants with Single Ventricle Physiology through Standardized Feeding during the Interstage.

Congenital heart disease is identified as the most common birth defect with single ventricle physiology carrying the highest mortality. Staged surgical palliation is required for treatment, with mortality historically as high as 22% in the four- to six-month period from the first- to second-stage surgical palliation, known as the interstage. A standardized postoperative feeding approach was implemented through an evidence-based protocol, parent engagement, and interprofessional team rounds. Five infants with single ventricle physiology preprotocol were compared with five infants who received the standardized feeding approach. Mann-Whitney U tests were conducted to evaluate the hypotheses that infants in the intervention condition would consume more calories and have a positive change in weight-to-age z-score (WAZ) and shorter length of stay (LOS) following the first and second surgeries compared to infants in the control condition. After the protocol, the change in WAZ during the interstage increased by virtually one standard deviation from 0.05 to 0.91. Median LOS dropped 32% after the first surgery and 43% after the second surgery. Since first- and second-stage palliative surgeries occur within the same year of life, this represents savings of $500,000 to $800,000 per year in a 10-infant model. The standardized feeding approach improved growth in single ventricle infants while concurrently lowering hospital costs.