Content of medicine prescription and clinical practice training for haematology advanced practice nurses in China: A modified Delphi study.

AIM: To explore the scope and form of prescriptions for blood and hematopoietic drugs that future advanced practice nurses (APNs) in the Department of Haematology and to establish a medicine prescription training content in China. BACKGROUND: Because the increasing number of doctors cannot meet the increasing demand for medical care with the population growth, many countries have begun to explore the medical team structure and practice areas, among which nurse prescribing rights have been the most effective. However, China's higher nursing education system still lacks education and training on nurse prescription. DESIGN: On the basis of literature research and semi-structured interviews, a set of nursing prescription content, education, training and practice system suitable for Chinese nurses was jointly created. METHODS: Two rounds of expert consultation between 23 haematology nursing experts and clinical experts determined the training content of blood system drugs and medicine prescriptions. Additionally, on the basis of the 23 experts，13 experts engaged in clinical and education, teaching and training experts were involved. Two rounds of expert consultation with 36 experts identified a general clinical practice training program for advanced practice nurses in China. RESULTS: Regarding contents and forms of hematopoietic drugs, the study concluded that advanced practice nurses in haematology department can prescribe anti-anemia drugs, anti-coagulant drugs and anti-thrombotic drugs in 2 categories and 16 drugs. Of these, four kinds of drugs should be prescribed in the form of protocol prescription. One kind of drug should be prescribed in the form of extended prescription and 11 drugs should be prescribed in the form of independent/extended or agreed/extended prescription. Regarding training content, the study obtained the training content of nurses' medicine prescriptions in eight clinical circumstances and the medicine prescription training content for common diseases of the blood system. The required specifications and the medicine prescription decision skills of nurses were sorted out according to different prescription types. CONCLUSIONS: The degrees of expert authority were both higher in consultations. Moreover, the results after consultation were reliable. It was recommended that haematology APNs could prescribe anti-anaemic drugs and anti-coagulation and anti-thrombotic drugs. Furthermore, most drugs should be prescribed in the form of independent/extended or agreed/extended prescriptions. The establishment of a medicine prescription training content for haematology APNs is expected to provide a reference for clinical practice education and training for drug prescriptive authority applicants for blood and hematopoietic system nurses in China.

Advanced Nursing Practice and Advanced Practice Nursing roles within low and lower-middle-income countries.

INTRODUCTION: Population health initiatives rely on the availability and skills of an appropriate workforce to meet required goals. One global workforce initiative with demonstrated ability to expand health care services and improve access to care is the development of Advanced Nursing Practice and Advanced Practice Nursing roles. Given the sparse published information about these roles in Low and Lower-Middle-Income countries, this study seeks to describe their development and application in these countries. DESIGN: The researchers developed a descriptive cross-sectional multilingual survey for online distribution to nursing experts within the targeted countries. Survey questions addressed demographic information on the population served, Advanced Nursing Practice and Advanced Practice Nursing titles, the time frame and rationale for creating the title, and how the roles relate to the International Council of Nurses' Advanced Practice Nursing guidelines characteristics of education, practice, and regulation. RESULTS: Of the 167 responses received, only 24 participants met the inclusion criteria. This represented five low-income countries and nineteen lower-middle-income countries from four World Bank regions. Seventy-one roles were identified. Roles emerged predominantly over the last 20 years, focusing on care for underserved populations, with an almost even spread across primary and acute care settings. There were differences in education, practice, and regulation amongst the roles. Roles that required a master's education or higher with practice-related characteristics had a broader scope of practice, which is consistent with international guidelines. CONCLUSION: This paper describes how Advanced Nursing Practice and Advanced Practice Nursing roles from Low and Lower Middle-Income Countries have been implemented to address gaps in service and highlights disparities in education, practice and regulation compared to international guidelines. Maintaining and increasing support from organizations and universities internationally may be required to assist in developing and expanding educational programs for advanced nursing roles in these countries. CLINICAL RELEVANCE: Understanding how these advanced nursing roles are operationalized in relation to education, practice, and regulation in Low and Lower-Middle-Income countries can provide baseline information that will inform workforce development policies to address healthcare needs in similar jurisdictions.

Using Objective Structured Clinical Examination as a Teaching Tool in a Hybrid Advanced Health Assessment Course.

BACKGROUND: Advanced health assessment is a required course in advanced practice RN (APRN) education, essential to providing the foundation for differential diagnosis (DD) skills and the ability to formulate a plan of care. PROBLEM: Feedback from clinical preceptors revealed that our doctor of nursing practice (DNP) students struggled to make a DD. APPROACH: This educational quality improvement project collected data from 7 cohorts of DNP students in either the Family Nurse Practitioner or Adult Gerontology Nurse Practitioner program to evaluate their readiness for clinical practicums and to inform necessary curriculum revisions. OUTCOMES: Data revealed that students' ability to identify 3 DDs correctly during the summative health assessment objective structured clinical examination was inconsistent. Qualitative data revealed students lacked understanding on how to use results from the physical assessment to formulate a DD. CONCLUSION: The findings of this project corroborate those from the literature that suggest we should teach APRN students DD skills explicitly.

Transitioning an Advanced Practice Fellowship Curriculum to eLearning During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 global pandemic brought mandatory shelter-in-place orders, disrupting traditional face-to-face teaching methods for advanced practice fellowship programs nationally, creating a challenge for fellowship program directors to preserve curriculum using nontraditional methods. METHOD: Using a variety of both web-based and app-based virtual platforms, a nationally accredited fellowship program converted traditional in-seat learning modalities to elearning platforms using both synchronous and asynchronous education. RESULTS: Preliminary data indicate that knowledge acquisition and perceived fellow satisfaction are preserved despite the abrupt change to program delivery. Programmatic modifications were submitted to the American Nurse Credentialing Center for compliance and deemed as creative, innovative, and collaborative. CONCLUSION: Curriculum for advanced practice fellowship programs can be favorably converted to elearning using virtual platforms during a crisis. Through prompt reevaluation and restructuring, virtual platforms can replace in-seat didactic lectures, patient case studies, mentoring, and even simulation, while ensuring program continuation and compliance with accreditation standards. [J Nurs Educ. 2020;59(9):514-517.].

Results and implications from a gender minority health education module for advance practice nursing students.

Nursing literature has recognized deficits in lesbian, gay, bisexual, transgender, queer-specific care. Of particular concern is lack of knowledge about gender minorities. Lack of knowledge remains despite this populations' increased health disparities. This pilot study investigates pre- and post-knowledge of medical guidelines, disparities, policies, and attitudes specific to gender minorities among advanced practice nursing students attending a gender minority health module. All participants in this pilot study completed a questionnaire on content and a transphobia scale to evaluate its effect on attitudes. Students were also surveyed on previous experience with gender minority patients. Students indicated sex and gender identity as female, with a mean age of 33.5 years. Twenty-seven percent of the students reported experience with gender minority patients. Wilcoxon signed rank test indicated statistically significant improvement in knowledge and improved scores on transphobia. This study demonstrated a module on the health of gender minorities is an effective method for increasing student knowledge of gender minority health care.

Moving towards universal health coverage: advanced practice nurse competencies. / Avançando na direção de cobertura universal de saúde: competências de enfermeiros de práticas avançadas.

OBJECTIVE: this paper aims to describe the first phase of a project whose general goal was to develop a consensus-based set of advanced practice nurse competencies applicable to Latin American countries and, based on these competencies, produce an advanced practice nurse curricular prototype adapted to Latin American countries. The project was framed in a competency-based approach to advanced practice nursing education. The specific aims of the first phase of the project described in this paper were: 1) to identify a set of potential advanced practice nurse competencies that would serve as the template for Core Advanced Practice Nurse Competencies in Latin American countries and 2) to establish consensus for Core Advanced Practice Nurse Competencies in Latin American countries. METHOD: advanced practice nurse competencies were derived from a comprehensive review of published competencies and informed the development of a survey designed to assess the relevance of advanced practice nurse competencies in Latin American countries. The survey was distributed to nurse leaders and nurse educators. Data were analyzed using descriptive statistics. RESULTS: consensus for Core Competencies was established. CONCLUSION: the Core Advanced Practice Nurse Competencies presented can provide a structured framework to build educational programs aligned to the needs of the regional environment.

Improving lesbian, gay, bisexual, transgender, and queer/questioning health: Using a standardized patient experience to educate advanced practice nursing students.

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) persons account for 3.5% of the population. Nursing programs in the United States provide a median of 2.13 hours of formal content regarding LGBTQ health, which contributes to iatrogenic barriers to care. Patient experiences related to inadequate provider preparation include misguided treatment strategies, impedance of communication, and abuse. A pilot educational project was developed to provide advanced practice nursing (APRN) students meaningful clinical interactions with LGBTQ-identifying standardized patients (SPs) to better prepare them to care for LGBTQ patients with cultural humility. This project was determined to be Exempt by the Institutional Review Board at the University of Michigan. Implemented in an advanced health assessment course with 99 APRN students, components of the project included course readings, lecture content, laboratory activities, an SP experience, and both large and small debriefing sessions. The SP experience itself was a 15-minute clinical encounter with a patient presenting with "abdominal pain," with an emphasis on history-taking, communication, and cultural humility. Qualitative data analysis was performed using the constant comparison method to interpret the results from student evaluations and other written feedback. This pilot project has promise to inform future educational offerings and set the standard for LGBTQ health content and application for APRN students. Further research is needed to evaluate the quality of LGBTQ content in APRN curricula to improve the ability of APRN students to provide care to LGBTQ patients.

Development and Validation of the Achieving Effective & Safe Opioid Prescribing-Advanced Practice Registered Nurse (AESOP-APRN) Survey: A Pilot Study.

BACKGROUND: Advanced practice registered nurses (APRNs) are essential partners in the management of pain, both in primary care and in pain specialty practices. One of the more controversial treatment practices surrounds the use of opioid analgesic medication for the relief of pain in persons with chronic pain. Although several guidelines have been developed, the extent and impact of APRN knowledge, attitudes, and values about pain management and opioid prescribing practices are not known. In addition, regulatory mandates may encumber APRN scope of pain management practice. AIMS: This manuscript describes the development and pilot testing of the Achieving Effective & Safe Opioid Prescribing-APRN (AESOP-APRN) Survey conceptualized to address these topics. DESIGN: Instrument development. PARTICIPANTS/SUBJECTS: Advanced practice registered nurses. METHODS: Phase I addressed development, content validity determination, and survey refinement. APRN-focused discussion groups, expert review, and analysis of content were conducted. In phase II, pilot testing was conducted to determine reliability. RESULTS: APRNs are aware of regulatory restrictions to practice and potential implications on patient outcomes. The Initial Content Validity Index suggested refinement of survey questions. After content revision, final ratings were acceptable. A sample of APRNs (N = 23) completed the survey. Cronbach's α range (.65-.91) suggests acceptable internal consistency for a new survey. CONCLUSIONS: Even at this initial phase, the newly developed AESOP-APRN Survey accurately represents the underlying thematic concepts of interest; however further psychometric analyses are required, and instrument refinement is possible. Additional study should include analysis of members from a variety of health care disciplines, as was the intention of the development of the Core Competencies for Pain Management from which many items were derived.

Meeting Health Care Needs in Rural Alabama: The Power of Partnerships.

Recruiting and retaining rural primary care providers is challenging. The Graduate Nursing Education Primary Care Scholars (GNEPCS) is a partnership between a philanthropic organization and a school of nursing to recruit, educate, train, and retain primary care advanced practice registered nurses (APRNs) for practice in rural Alabama with a focus on improving the state's health outcomes. In its initial four years, the GNEPCS partnership has been successful in identifying 60 registered nurses interested in becoming rural primary care APRNs. These students have received mentoring, individualized content on rural health, preceptorships with rural providers, and opportunities for professional and leadership development. Pilot philanthropic funding has allowed us to develop sustainable curricula, attract additional complementary federal funds, and create a critical mass of practice-ready APRNs who are improving primary care access for some of the state's most rural and underserved populations.

Evaluation of an Interprofessional Oral Health Assessment Activity in Advanced Practice Nursing Education.

The curriculum for nurse practitioner (NP) students often overlooks the assessment of the oral cavity. In recognition of this, the HEENT (head, eyes, ears, nose, and throat) assessment was expanded to HEENOT (head, ears, eyes, nose, oral, and throat) through integration of an interprofessional educational (IPE) activity developed for University of Colorado NP and dental students. The aim of this study was to assess NP students' perceptions of an IPE activity in which dental faculty and students taught NP students how to conduct an oral exam, recognize oral health pathology, and apply fluoride varnish. Afterwards, the NP students completed an evaluation survey focusing on their thoughts, comfort level, organization, and understanding of the activity. This IPE activity was repeated over four semesters from 2014 to 2017, and significant differences among the semesters were compared. All NP students in the four semesters participated in the activity and the survey: semester one N=25, semester two N=31, semester three N=43, and semester four N=25. In all semesters, NP students reported feeling more confident conducting oral health exams after completion of the IPE activity. Semester four students agreed more with the idea of interprofessional collaboration (OR: 0.103) and receiving educational information not learned elsewhere in the curriculum (OR: 0.134) compared to semester one students. Higher odds for the session being well organized and conducted in a suitable time were found for semester four compared to semester two (OR: 0.217). These comparisons reflect improvement in teaching methodologies over the four semesters and an overall increased confidence for NP students in performing an oral health assessment.

Evaluation of a Low-Cost, High-Fidelity Animal Model to Train Graduate Advanced Practice Nursing Students in the Performance of Ultrasound-Guided Central Line Catheter Insertion.

INTRODUCTION: Ultrasound-guided central venous catheter insertion (UGCVC) is a commonly performed procedure taught through simulation. The aims of the study were to examine the utilization of an animal model and compare it with two currently used Blue Phantom central line models to determine whether an animal model provides good or better simulated conditions for the performance of UGCVC insertion. METHODS: Using a randomized cross-over study, 46 advanced practice nursing students were assessed using a task-specific performance tool in their performance of UGCVC insertion on both the animal model and the Blue Phantom models. The number of insertion attempts and time to performance was recorded. A preprocedure survey was used to ascertain their presimulation workshop experience, followed by a postprocedure survey. A cost comparison was completed as a secondary outcome. RESULTS: A comparison was conducted on the performance scores and the postsurvey results between the animal model and the Blue Phantom models. The number of venous access attempts was not significantly different when comparing the three models. A cost comparison showed the total cost of each animal model was US $15.66 as compared with the approximate cost for the Blue Phantom IJ model of US $1500.00 and the Gen I model of US $2700.00. CONCLUSIONS: Current Blue Phantom models lack the ability to fully perform all the necessary steps critical to the performance of UGCVC insertion. At a total cost of US $15.66 per model, this study showed that training with an alternative economical model was comparable with more expensive mannequin simulators. The results of this study may serve to guide clinicians and educators who are seeking alternative simulation models to provide skill acquisition.

Integrating Population Health Content into FNP Program Curriculum.

In the current healthcare environment, the healthcare industry has become increasingly focused on population health concerns. While advanced practice registered nurses (APRNs) are well prepared to contribute to population health by delivering holistic healthcare to individuals, families, groups, communities, and populations, they are not engaged in initiatives to improve population health commensurate with their numbers, education, training, experience, and role as primary care providers and essential healthcare team leaders and members. This article discusses the rationale for integrating population health into APRN curricula, one program's approach to doing so, and preliminary lessons learned from this effort. The three main lessons learned include population health content should be integrated across the curriculum for all APRN cohorts, supplementary population health content should be considered, and opportunities for integrating didactic population health content should be included across the FNP curriculum.

Nurse Practitioner Fellowship: Developing a Program to Address Gaps in Practice

Formal training is an important mechanism to assist the new generation of nurse practitioners (NPs) entering the complex field of oncology. The growing number of patients with cancer and the expansion of treatment options demand structured oncology training to support the transition of novice advanced practice nurses to the field. Oncology NP fellowships are a potential solution for those seeking training centered on the management of patients with cancer. This article discusses the process of implementing an NP fellowship program at an academic cancer center, including benefits and barriers.

Self-Assessment Scores Improve After Simulation-Based Palliative Care Communication Skill Workshops.

BACKGROUND: We conducted a randomized trial of a simulation-based multisession workshop to improve palliative care communication skills (Codetalk). Standardized patient assessments demonstrated improved communication skills for trainees receiving the intervention; however, patient and family assessments failed to demonstrate improvement. This article reports findings from trainees' self-assessments. AIM: To examine whether Codetalk resulted in improved self-assessed communication competence by trainees. DESIGN: Trainees were recruited from the University of Washington and the Medical University of South Carolina. Internal medicine residents, medicine subspecialty fellows, nurse practitioner students, or community-based advanced practice nurses were randomized to Codetalk, a simulation-based workshop, or usual education. The outcome measure was self-assessed competence discussing palliative care needs with patients and was assessed at the start and end of the academic year. We used robust linear regression models to predict self-assessed competency, both as a latent construct and as individual indicators, including randomization status and baseline self-assessed competency. RESULTS: We randomized 472 trainees to the intervention (n = 232) or usual education (n = 240). The intervention was associated with an improvement in trainee's overall self-assessment of competence in communication skills ( P < .001). The intervention was also associated with an improvement in trainee self-assessments of 3 of the 4 skill-specific indicators-expressing empathy, discussing spiritual issues, and eliciting goals of care. CONCLUSION: Simulation-based communication training was associated with improved self-assessed competency in overall and specific communication skills in this randomized trial. Further research is needed to fully understand the importance and limitations of self-assessed competence in relation to other outcomes of improved communication skill.

Current Status of Fellowship Programs for Advanced Practice Registered Nurses in the Nurse Practitioner Role.

Students completing an advanced practice RN program for practice as a nurse practitioner may seek options for further advancement. Although postgraduate clinical fellowship programs exist, information about such programs is not readily available. This article offers a resource for faculty to assist graduate students in finding advanced practice RN nurse practitioner fellowship programs in the United States.

Advocacy Through Education.

Nurses are one of the largest groups of policy stakeholders in the health-care workforce, yet their influence on policy is not necessarily commensurate with their numbers. Since 2011, grassroots action coalitions have emerged to advance the profession's impact on health-care policy. In one state, a partnership among professional nursing organizations, policy stakeholders, and academics resulted in educational presentations focused on political advocacy knowledge and skills. The goal of this project was to bring awareness to nurses and nursing students about their potential contributions to the political and advocacy processes that shape health policy. The purpose of this study was to determine the effectiveness of focused educational presentations in correcting misconceptions, increasing awareness, and providing clarification of the roles of advanced practice registered nurses, and identifying related policy implications. This quasi-experiment used a retrospective pre-post intervention self-evaluation tool administered immediately following an educational presentation. The sample ( N = 137) consisted of baccalaureate nursing students and licensed nurses. The results showed ( p < .001) that education could have a significant improvement in political advocacy participation.

Educational Changes to Support Advanced Practice Nursing Education.

Educational factors limit the number of advanced practice registered nurse (APRN) graduates to meet the growing workforce demands. Healthcare dynamics are necessitating a shift in how nursing education envisions, creates, and implements clinical learning opportunities. The current clinical education model in APRN programs continues to be the same as it was 45 years ago when the student numbers were much smaller. New approaches in graduate nursing education are needed to address the shortage of APRNs in primary and acute care areas. Determining competency based on the number of clinical hours can be inefficient, ineffective, and costly and limits the ability to increase capacity. Little research exists in graduate nursing education to support the effectiveness and efficiency of current hours of clinical required for nurse practitioner students. Simulation and academic-practice partnership models can offer innovative approaches to nurse practitioner education for clinical training, with the goal of producing graduates who can provide safe, quality care within the complex practice-based environment of the nation's evolving healthcare system.