Nurse Practitioner Preceptor Plan: A Focus on Preceptor Rewards and Preferences.

ABSTRACT: Recruiting and retaining preceptors is a major challenge for nurse practitioner (NP) programs. The purpose of this project was to identify preceptor rewards that may foster NP preceptor recruitment and retention at one university. Seventy preceptors were surveyed regarding their reward preferences using rewards identified in the literature and among regional NP programs. The most preferred rewards included continuing education credits, professional growth opportunities, maintaining professional relationships with the university, and financial remuneration. To provide NP students with positive and effective clinical experiences, it is essential that NP program leaders understand preceptors' preferences and commit to preceptor support.

Preparing the clinicians of tomorrow: Weaving integrated care across doctor of nursing practice education.

In today's changing landscape of health care, integrated health care is essential for best patient outcomes. The number of people with psychiatric conditions in the United States today is staggering, but only half of these people will receive treatment for their condition. By effectively integrating psychiatric and primary health care patients can be connected to appropriate and necessary services that meet the Triple Aim of enhancing patient experience of care while achieving population health goals in a cost-effective manner. Incorporating integrated health care experiences in a DNP program can position future practice leaders to take on these challenges. Guided by DNP essentials and the National Organization of Nurse Practitioner Faculty competencies, integrated health care concepts were weaved across the DNP curriculum. Including robust academic experiences treating mental health conditions in primary care and integrated settings can increase the confidence and effectiveness of clinicians who identify, manage, and refer patients with mental health concerns. Increasing the number of doctorally prepared nurses who are educated in integrated health care helps improve clinical outcomes while transforming the health care landscape.

Factors Associated With Health Service Use Among Older Adults in a Mobile Veterans Program.

The current retrospective, longitudinal study applied Andersen's Behavioral Model of Health Services Use to examine how demographic characteristics (age), available resources (e.g., a caregiver, the Mobile Veterans Program [MVP]) and health needs (e.g., cognitive and physical functioning, depressive symptoms) affect hospitalization and institutionalization outcomes among older adults using the MVP. Fifty-four Veterans (age 55 to 95) participating in the MVP for up to 2 years were examined using hierarchical linear modeling (HLM) and growth curve model. In the final HLM model, each 1-point increase in depressive symptoms was associated with 76% (p ≤ 0.05) greater risk of institutionalization and 40% (p ≤ 0.01) greater risk of hospitalization. Each 1-point increase in cognitive functioning was associated with 24% (p ≤ 0.05) lower risk of institutionalization. The relationship between caregiver burden and hospitalization was attenuated by frequency of MVP visits. Services focused on reducing depressive symptoms may influence health service use and reduce caregiver burden in this population. [Journal of Gerontological Nursing, 46(5), 15-22.].

Community-Based Older Adults' Acceptance of and Willingness Toward Waist Circumference Measurement.

Older adults have higher rates of central obesity and greater risk for central obesity-related diseases compared to younger adults. Waist circumference measurement is a reliable indicator of preventable, central obesity-related disease risk. Despite its value, it is rarely measured in primary care settings due to providers' perceived patient discomfort with waist measurement. The current study examined community-based older adults' (N = 99) experience with, acceptance of, and willingness toward waist measurement. Ninety-two percent of participants reported never having waist measurement in primary care settings. Despite lack of waist measurement experience, 62.6% reported feeling "very" comfortable and 82.8% were "very willing" to have waist measurement. High acceptance of and willingness toward waist measurement in the absence of experience supports acceptability of waist measurement among older adults. Thus, providers are encouraged to use waist measurement to screen older adults for central obesity and associated disease risk. [Journal of Gerontological Nursing, 45(5), 11-15.].

Diet quality and cognitive function in an urban sample: findings from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study.

OBJECTIVE: Poor diet quality contributes to morbidity, including poor brain health outcomes such as cognitive decline and dementia. African Americans and individuals living in poverty may be at greater risk for cognitive decrements from poor diet quality. DESIGN: Cross-sectional. SETTING: Baltimore, MD, USA. SUBJECTS: Participants were 2090 African Americans and Whites (57 % female, mean age=47·9 years) who completed two 24 h dietary recalls. We examined cognitive performance and potential interactions of diet quality with race and poverty status using baseline data from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Healthy Eating Index-2010 (HEI-2010) scores were calculated and interpreted using federal guidelines. A neurocognitive test battery was administered to evaluate cognitive function over several domains. RESULTS: Linear regression analyses showed that lower HEI-2010 scores were associated with poorer verbal learning and memory (P<0·05) after adjustment for covariates. Diet quality within the sample was poor. Significant interactions of HEI-2010 and poverty status (all P<0·05) indicated that higher diet quality was associated with higher performance on tests of attention and cognitive flexibility, visuospatial ability and perceptual speed among those below the poverty line. No significant race interactions emerged. Higher diet quality was associated with better performance on two measures of verbal learning and memory, irrespective of race and poverty status. CONCLUSIONS: Findings suggest that diet quality and cognitive function are likely related at the population level. Future research is needed to determine whether the association is clinically significant.

Changes in Physical and Cognitive Function Predict Sedentary Behavior in Older Adults With Mild Cognitive Impairment.

The current longitudinal study examined the influence of cognitive and lower extremity function on sedentary behavior continuously over 6 months in community-dwelling older adults with mild cognitive impairment (MCI). Multilevel models examined Montreal Cognitive Assessment (MoCA) change scores and the Short Physical Performance Battery (SPPB) on percent time in sedentary behavior among 17 older adults with MCI (50 to 74 observations for analysis). Sedentary behavior was measured daily and averaged monthly using wrist-worn actigraphy. Each 1-unit decrease in MoCA score was associated with an increase of 2 percentage points in sedentary behavior (p ≤ 0.01). In addition, each 1-unit decrease in chair stand score (lower extremity strength) was associated with an increase of 5 percentage points in sedentary behavior (p ≤ 0.01). Older adults experiencing cognitive decline and concurrent changes in lower extremity strength had the sharpest increase in sedentary behavior. Findings suggest lower body strengthening interventions may reduce sedentary behavior time and subsequently preserve physical functioning in this vulnerable population. [Research in Gerontological Nursing, 14(6), 285-291.].