Beyond competence and retention: Developing a comprehensive evaluation framework for a rural primary care nurse practitioner residency program.

ABSTRACT: With the rise in nurse practitioner (NP) residency programs, evaluations have largely focused on retention and competency completion for residents. There is a need for expanded evaluation to ensure the sustainability of NP residency programs, to ensure timely adaptations to address resident satisfaction, and to solidify a long-term pathway of NPs well prepared for rural practice. We created a family nurse practitioner (FNP) residency program with a comprehensive evaluation framework to prepare residents for practice in rural settings. The evaluation framework was developed through collaborative engagement of an external evaluation team, program leadership, and clinical site representatives. The evaluation framework of the FNP residency program combined resident assessment and holistic program evaluation, using a rapid continuous quality improvement (QI) approach. The evaluation considered three distinct perspectives: the resident, the peer coach, and the clinical site. The rapid continuous QI approach allowed program leadership to respond swiftly to programmatic challenges, improve the residency program in response to residents' reported experiences, and emphasize sustainability for continued program impact, while assessing residents' learning and performance. The program's data-driven evaluation approach has demonstrated its success in meeting the goals of the Health Resources and Services Administration funding by increasing the number of primary care providers in rural settings. The program's expansion and continued success have further validated the efficacy of this evaluation framework in assessing, improving, and ensuring the sustainability of APRN residency programs. This article calls for the adoption of similar evaluation strategies in future residency programs to promote their long-term success and impact in rural health care settings.

An interprofessional education initiative: Introducing a local anesthesia dental course for nurse practitioner and physician assistant students.

PURPOSE/OBJECTIVE: To assess the impact of local anesthesia (LA) course for physician assistant (PA) and adult gerontology-acute care nurse practitioner (NP) program students on knowledge, attitudes, confidence, and intention to incorporate skills in clinical practice. METHODS: The course was conducted by dental faculty for forty-eight PA and seven NP students and consisted of two lecture hours on anatomy of the oral cavity, anesthesia and pain management, 2 hours of preclinic lab where participants practiced injection technique on mannikins, and a clinical practicum conducted by dental school faculty and residents where students observed dental treatment including administration of LA, and discussed symptom triage by NPs and PAs for patients with dental problems including orofacial pain, initial management including LA, and patient referral to dentists. An online survey was administered to all students before and after the course to assess changes in knowledge, attitudes, confidence, and intention to incorporate LA administration skills into clinical practice and elicit students' perception of program quality. Pre- to post-changes were analyzed by two-tailed t-tests and analysis of variance (ANOVA) with significance at 0.05. RESULTS: The response rate for pre- and post-course assessment was 96.4% and 87.3% respectively. Students' overall scale score for self-assessment of dental knowledge increased significantly from pre- (2.34) to post-assessment (4.19). An increase was seen in students' attitudes regarding management of dental emergencies (t = 2.181; p < 0.05). Furthermore, overall confidence of students related to managing patients with dental problems increased significantly (2.00 to 3.85) after taking the course. CONCLUSION: The LA course was well received by PA and NP students and resulted in increased knowledge and confidence in recognizing common oral health conditions, understanding dental pain management including administration of LA, and making referrals to dentists to optimize patient care.

Holistic Nurse Practitioner Care Including Promotion of Shared Decision-Making.

The purpose of this quantitative, descriptive, exploratory study was to gauge the degree to which nurse practitioners (NPs) incorporate holistic nursing values in their care, with a special focus on shared decision-making (SDM), using the Nurse Practitioner Holistic Caring Instrument (NPHCI), an investigator-developed scale. A single open-ended question inviting free-text comment was also included, soliciting participants' views on the holistic attributes of their care. A convenience sample of NPs (n = 573) was recruited from a southeastern U.S. state Board of Nursing's (BON) publicly available list of licensed NPs. Results suggest that NPs do indeed perceive their care to be holistic, and that they routinely incorporate elements of SDM in their care. Highest scores were accorded to listening, taking time to talk to patients, knowledge of physical condition, soliciting patient input in care decisions, considering how other areas of a patient's life may affect their medical condition, and attention to "what matters most" to the patient. Age, gender, level of education, practice specialty, and location were also associated with inclusion of holistic care. Free-text responses revealed that NPs value holistic care and desire to practice holistically, but identify "lack of time" to incorporate or practice holistic care as a barrier.

Rapid Curricular Innovations During COVID-19 Clinical Suspension: Maintaining Student Engagement with Simulation Experiences.

Health care education programs were faced with the need to quickly adapt to a new reality during the coronavirus disease 2019 pandemic. Students were temporarily suspended from campus and clinical sites, requiring prompt changes in structure to their didactic and clinical learning. This article describes the rapid adjustments that one midwifery and women's health nurse practitioner education program created using both synchronous and asynchronous simulation experiences to promote student learning and ongoing engagement. Flexibility and reflexivity were needed by faculty and students alike in the face of the multiple changes wrought by the pandemic. Curricular changes were made simultaneously in many courses. Objective structured clinical examinations simulate telehealth experiences that assess knowledge, clinical reasoning, and professional behaviors via a scripted scenario and an actor patient. On-call simulations mimic telephone triage and provide students the opportunity to build listening, assessment, and management skills for prenatal and intrapartum scenarios. Students are provided equipment and virtual instruction in an intrauterine device insertion session, which promotes skill acquisition and self-confidence. Trigger films are used to visualize real-life or scripted clinical encounters, leading to discussion and decision-making, particularly in the affective domain. Bilateral learning tools, similar to case studies, provide students an opportunity to demonstrate their knowledge and critical thinking with a mechanism for faculty feedback. Web-based virtual clinical encounter learning tools using patient avatars prompt additional student learning. Suturing skills introduced in live remote group sessions are augmented with video-guided individual practice. This article describes each of these adapted and innovative simulation methods and shares lessons learned during their development and implementation.

Estratégias de ensino na abordagem dos cuidados paliativos com profissionais de enfermagem: revisão integrativa / Teaching strategies in addressing palliative care with nursing professionals: integrative review / Estrategias de enseñanza para abordar los cuidados paliativos con profesionales de enfermería: revisión integradora

Objetivo: Identificar, nas produções científicas, as estratégias de ensino utilizadas na abordagem dos cuidados paliativos com profissionais de enfermagem. Método: Revisão integrativa realizada em cinco bases de dados. Resultados: Foram analisados 12 artigos, todos internacionais. Várias estratégias de ensino foram utilizadas como: oficinas, simulação, discussão em grupos, dramatizações, aula expositiva. A metodologia ativa foi a mais utilizada, com a associação de várias estratégias de ensino, sendo o estudo de caso a mais frequente. Conclusão: A associação da teoria com a simulação da prática clínica é uma boa estratégia de ensino. Maior ênfase tem que ser dada na capacitação dos profissionais de enfermagem através de atividades de educação permanente em cuidados paliativos visando fornecer uma assistência segura e qualificada para o paciente e sua família

Objective: To identify, in scientific productions, the teaching strategies used to approach palliative care with nursing professionals. Method: Integrative review made in five databases. Results: 12 articles were analyzed, all international. Several teaching strategies were used as: workshops, simulation, group discussion, role plays, lecture. The active methodology was the most used, with the association of several teaching strategies, being the case study the most frequent. Conclusion: The association of theory with the simulation of clinical practice is a good teaching strategy. Greater emphasis has to be placed on training nursing professionals through continuing education activities in palliative care to provide safe and qualified care for the patient and their family

Objetivo: Identificar, en producciones científicas, las estrategias de enseñanza utilizadas para abordar los cuidados paliativos con profesionales de enfermería. Método: Revisión integradora realizada en cinco bases de datos. Resultados: Se analizaron 12 artículos, todos internacionales. Se utilizaron varias estrategias de enseñanza como: talleres, simulación, discusión grupal, juegos de roles, conferencias. La metodología activa fue la más utilizada, con la asociación de varias estrategias de enseñanza, siendo el estudio de caso el más frecuente. Conclusión: La asociación de la teoría con la simulación de la práctica clínica es una buena estrategia de enseñanza. Se debe hacer mayor hincapié en la capacitación de profesionales de enfermería a través de actividades de educación continua en cuidados paliativos para proporcionar atención segura y calificada para el paciente y su familia

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.

Effect of Balint training in gastroenterology intern nurse practitioners: A systematic review protocol.

BACKGROUND: This study aims to assess the effect of Balint training (BT) in gastroenterology intern nurse practitioners (GINP) systematically. METHODS: This study will search EMBASE, MEDLINE, PsycINFO, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and China National Knowledge Infrastructure from inception to the September 30, 2019 with no language limitation. In addition, we will also search grey records, such as conference abstracts and dissertations. Study quality will be checked using Cochran risk of bias tool. Statistical analysis will be performed using RevMan 5.3 software. RESULTS: This study will systematically evaluate the effect of BT in GINP and will provide evidence to judge whether BT is effective for GINP clinically. CONCLUSION: The results of this study may provide helpful evidence of BT in GINP in the clinical training.

Holistic Nursing Values in Nurse Practitioner Education.

Much has been written about the inclusion of holistic nursing values and practices in undergraduate nursing education, but their inclusion and influence in advanced practice nursing education has not been fully explored. Nurse practitioners (NPs) are nurses, so it is assumed that the nursing perspective provides a framework for NP education and practice, and that NP education represents the blending of a holistic nursing approach with medical diagnosis and treatment. Nurse practitioners are taking increasing responsibility for filling the gap in primary healthcare availability in the U.S., and in the current political and economic healthcare climate, NPs are in a position to promote primary care models that honor comprehensive, patient-centered, and relationship-based care. As a result, it becomes essential to quantify the inclusion of these values in NP educational programs and coursework, as instilling core values for practice begins in educational environments. This quantitative, descriptive study explored the inclusion of holistic nursing values by NP faculty, using the Nurse Practitioner Holistic Caring Instrument (NPHCI). The NPHCI exhibited quite high reliability and validity in the sample, including confirmation of its three subscales. Survey results suggest that NP faculty actively incorporate holistic nursing values in educational coursework, and that age, length of time teaching in NP programs, highest educational degree, and academics as the primary area of practice were important indicators of the inclusion of holistic nursing values in NP program curricula. Findings add to knowledge of NP education, but further study is warranted.

The doctorate of nursing practice and entry into midwifery practice: Issues for consideration and debate.

The American College of Nurse-Midwives represents two cadres of midwifery professionals: certified nurse-midwives who are educated in both midwifery and nursing, and certified midwives who are educated in the discipline of midwifery. Certified nurse-midwives are designated by nursing professional organizations as advanced practice nurses. The United States nursing profession is advancing toward adoption of the Doctor of Nursing Practice degree, as the entry into practice credential for advanced practice nursing. There is no evidence to date to demonstrate differences in clinical practice outcomes between certified nurse-midwives and certified midwives. A secondary analysis of data from a series of compensation and benefits surveys did not demonstrate differences in salaries between respondents who held a practice-focused doctoral degree compared to a master's degree. The requirement of the practice-focused nursing doctoral degree for entry into midwifery practice for certified nurse-midwives would require additional evidence to support both a professional and a business case for such a change in policy. It would also require consideration of the professional and business impact that such a policy would have on certified midwives who do not hold the nursing credential. Equivalent entry into practice pathways would need to be developed.

Implementation of alcohol and drug screening, brief intervention, and referral to treatment: Nurse practitioner learner perspectives on a mobile app.

BACKGROUND AND PURPOSE: Screening, brief Intervention, and referral to treatment (SBIRT) is a widely trained evidence-based strategy to identify and address alcohol and drug use problems. The purpose of this qualitative study was to explore the experience of family nurse practitioner (FNP) learners in the implementation of SBIRT and the perceived clinical utility of an SBIRT mobile app. METHODS: Twenty-two FNP learners completed didactic SBIRT training and orientation to an SBIRT mobile app. At the conclusion of the study, participant focus groups explored overall SBIRT delivery (N = 19) and SBIRT mobile app utilization (N = 14). Focus group data were analyzed within a Theory of Planned Behavior framework. RESULTS: Participants indicated that the mobile app was useful in the ongoing development of SBIRT knowledge, skill confidence, and motivation. Learners identified the clinical context as a major factor in facilitating the delivery of SBIRT overall. Participants who did not deliver SBIRT indicated that the most significant barriers to SBIRT implementation were lack of support from clinical preceptors and health systems. CONCLUSIONS: Findings suggest that a mobile app is an acceptable and feasible tool to improve the delivery of SBIRT. However, collaboration with preceptors and clinical training organizations is essential to optimize clinical translation.

Training in aspiration abortion care: An observational cohort study of achieving procedural competence.

BACKGROUND: Studies in multiple countries have found that the provision of aspiration abortion care by trained nurses, midwives, and other front-line health care workers is safe and acceptable to women. In the United States, most state abortion laws restrict the provision of abortion to physicians; nurse practitioners, nurse-midwives, and physician assistants, can legally perform medication abortion in only twelve states and aspiration abortion in five. Expansion of abortion care by these providers, consistent with their scopes of practice, could help alleviate the increasing difficulty of accessing abortion care in many states. OBJECTIVES: This study used a competency-based training model to teach advanced practice clinicians to perform vacuum aspiration for the abortion care. Previous research reporting on the training of providers other than physicians primarily focused on numbers of procedures performed, without assessment of skill competency or clinician confidence. DESIGN: In this prospective, observational cohort study, advanced practice clinician trainees were recruited from 23 clinical sites across six partner organizations. Trainees participated in a standardized, competency-based didactic and clinical training program in uterine aspiration for first-trimester abortion. SETTINGS: Trainee clinicians needed to be employed by one of the six partner organizations and have an intention to remain in clinical practice following training. PARTICIPANTS: California-licensed advanced practice clinicians were eligible to participate in the training if they had at least 12 months of clinical experience, including at least three months of medication abortion provision, and certification in Basic Life Support. METHODS: A standardized, competency-based training program consisting of both didactic and clinical training in uterine aspiration for first-trimester abortion was completed by 46 advanced practice clinician participants. Outcomes related to procedural safety and to the learning process were measured between August 2007 and December 2013, and compared to those of resident physician trainees. RESULTS: Essentially identical odds of complications occurring from advanced practice clinician-performed procedures were not significantly different than the odds of complications occurring from resident-performed procedures (OR: 0.99; CI: 0.46-2.02; p > 0.05) after controlling for patient sociodemographic and medical history. The number of training days to foundational competence ranged from six to 10, and the number of procedures to competence for those who completed training ranged from 40 to 56 (median = 42.5). CONCLUSIONS: A standardized, competency-based trainingprogram can prepare advanced practice clinicians to safely provide first-trimester aspiration abortions. Access to safe abortion care can be enhanced by increasing the number of providers from cadres of clinicians other than physicians.

Fellowship Programs: Reflections of an Advanced Practice Nurse Fellow.

Newly graduated advanced practice nurses (APNs) often accept positions equipped only with brief, limited training and are expected to primarily learn on the job. APN fellowship programs, such as the oncology fellowship program at Sylvester Comprehensive Cancer Center (SCCC) in Florida, may be a solution to this problem; they provide in-depth training to APNs, offer support through open communication with preceptors, grant APNs opportunities to develop skills and confidence, and allow APNs the time to earn the trust of others at the institution and take on additional responsibilities. This article discusses such programs and focuses on the author's experiences as a fellow at SCCC.

Health Care Provider Perceptions of the Safety of IUDs for Women with HIV.

CONTEXT: Women who are living with HIV use IUDs at a lower rate than the general population, and it is unclear whether health care providers' misconceptions about IUD safety contribute to this disparity. METHODS: A 2013-2014 nationwide survey of 1,998 U.S. family planning providers assessed perceptions of IUD safety for women with HIV or other medical conditions. Multivariable logistic regression was used to examine associations between provider characteristics and whether individuals believed IUDs were safe for HIV-positive women. Data from public-sector providers and office-based physicians were analyzed separately. RESULTS: Seven in 10 providers considered IUDs safe for women with HIV, and there were no differences by provider type. Among public-sector providers, some of the characteristics associated with believing that IUDs were unsafe for seropositive women were working at a clinic without Title X funding (odds ratio, 1.5), not being trained in IUD insertion (2.1) and not using the U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) for clinical guidance (1.8). Office-based physicians who did not use the guidelines also had an increased likelihood of believing that IUDs were unsafe for women with HIV (2.9), and physicians who had completed training 25 or more years ago were more likely than those who had done so less than five years ago to consider IUDs unsafe (3.3). CONCLUSIONS: Greater use of evidence-based contraceptive guidance such as the U.S. MEC may help inform provider perceptions of IUD safety and hence contribute to increased contraceptive choice for women with HIV.

Advanced Holistic Nursing Practice Narratives: A View of Caring Praxis.

Advanced holistic nurses (AHNs), emerging as leaders in health care transformation, are described as caregivers, but caring and caring-within-practice are often difficult for AHNs to explicate. Nursing research that describes caring in advanced practice is limited. Only one study has been reported that focused on describing practice for advanced practice nurses. This article presents a secondary analysis of narratives from a larger qualitative study of holistic pediatric nursing practice. From that study, narratives provided by six holistic advanced practice nurse participants, working in a variety of settings, were extracted and analyzed to illuminate caring-within-practice. Participants were asked to write a reflective narrative on a patient exemplar of caring and use John's model for structured reflection to provide a deeper reflection on their narrative of caring. Researchers analyzed the extracted narratives to identify common themes of caring-within-practice. Seven themes emerged depicting AHNs caring-within-practice: normalizing the environment, creating sacred space, being rooted in compassion, the art of being present, establishing trust-caring, coaching the family as caregiver, and inspiration for the future. This article provides excerpts from the narratives that support the themes, discusses the findings, and presents implications of the study.

The Impact of Oral-Systemic Health on Advancing Interprofessional Education Outcomes.

The aim of this study was to evaluate the effectiveness of an interprofessional education (IPE) clinical simulation and case study experience, using oral-systemic health as the clinical population health example, for nurse practitioner/midwifery, dental, and medical students' self-reported attainment of interprofessional competencies. A pretest-posttest evaluation method was employed, using data from the Interprofessional Collaborative Competency Attainment Scale (ICCAS) completed by two large cohorts of nurse practitioner/midwifery, dental, and medical students at one U.S. university. Data from faculty facilitators were collected to assess their perceptions of the value of exposing students to interprofessional clinical simulation experiences focused on oral-systemic health. The results showed that self-reported interprofessional competencies measured by the ICCAS improved significantly from pre- to posttest for all three student types in 2013 (p<0.001) and 2014 (p<0.001). Faculty facilitators reported that the IPE clinical simulation experiences were valuable and positively influenced interprofessional communication, collaboration, patient communication, and student understanding of patient care roles. These results suggest that the Teaching Oral-Systemic Health Program Interprofessional Oral-Systemic Health Clinical Simulation and Case Study Experience was effective as a standardized, replicable curriculum unit using oral-systemic health as a population health exemplar to teach and assess interprofessional competencies with nurse practitioner/midwifery, dental, and medical students.

Integrating Nurse Practitioners Into Intensive Care Units.

As demand for nurse practitioners in all types of intensive care units continues to increase, ensuring successful integration of these nurses into adult and pediatric general and specialty intensive care units poses several challenges. Adding nurse practitioners requires strategic planning to define critical aspects of the care delivery model before the practitioners are hired, develop a comprehensive program for integrating and training these nurses, and create a plan for implementing the program. Key strategies to ensure successful integration include defining and implementing the role of nurse practitioners, providing options for orientation, and supporting and training novice nurse practitioners. Understanding the importance of appropriate role utilization, the depth of knowledge and skill expected of nurse practitioners working in intensive care units, the need for a comprehensive training program, and a commitment to continued professional development beyond orientation are necessary to fully realize the contributions of these nurses in critical care.

Classroom to clinic: incorporating adolescent spiritual/faith assessment into nurse practitioner education & practice.

Although nursing is well grounded in the conceptualization of person as body-mind-spirit, there is little evidence that advanced practice nurses routinely address the spirit in giving patient care, especially with adolescents in the outpatient setting. The neglect of spiritual aspects of care may be related to lack of a framework, or education/incorporation into nurse practitioner preparation. This article describes one method of integrating adolescent spiritual/faith assessment into a nurse practitioner clinical course. Readings, assignments, and a grading rubric are offered.

Interprofessional education between dentistry and nursing: the NYU experience.

In 2005, New York University Colleges of Dentistry and Nursing formed an organizational partnership to create a unique model of interprofessional education, research, service and practice. This paper describes the first eight years of experience, from the early reaction of the public to the partnership, to examples of success and past and current challenges.