A Contemporary Paradigm: Integrating Spirituality in Advance Care Planning.

In the 25 years since advance care planning first drew the attention of the national healthcare and legal systems, gains in the rate of advance care directive completion have been negligible despite the effort of researchers, ethicists, and lawmakers. With the benefit of sophisticated healthcare technology, patients are living longer. Despite the benefits of increased longevity, it is widely acknowledged that enough has not been done to adequately address end-of-life care decisions at the crossroads between medical futility and quality of life. To arrive at a solution, researchers have focused on patient self-reflection, provider attitudes, health literacy, communication and the logistics of surrogacy, setting, payment, and documentation. However, a survey of the literature reveals one conspicuously absent theme. It is a phenomenon one would expect in the context of end-of-life discussion and decision making, that of spiritual inquiry. This article explores the history leading up and past approaches to advance care planning and then suggests the use of a theoretical model and a body of work concerning spiritual care as a new tack in the ongoing development of advance care planning.

Promoting treatment for hepatitis C in people who inject drugs: A review of the barriers and opportunities.

BACKGROUND: People who inject drugs (PWIDs) comprise a significant amount of the population who are also positive for hepatitis C virus (HCV) around the world. Even though there is evidence that patients who currently inject drugs do not display altered treatment adherence or medication effectiveness, health care providers are still hesitant to treat this patient population based on perceived threats and barriers. OBJECTIVES: This literature review informs of the perceived barriers associated with PWID in receiving HCV treatment and supports recommendations to address these barriers. DATA SOURCES: For this review, eight scholarly articles rated levels I A through II B using John Hopkins Evidence-Based Practicing ratings consisting of randomized controlled trials, systematic reviews, and meta-analyses were selected. Both qualitative and quantitative data contributed to identifying perceived barriers and suggested course of action that should be taken to increase HCV treatment uptake among PWID. CONCLUSIONS: The three main perceived barriers are evidence of barriers to treatment in the PWID populations and include increased risk of reinfection, low adherence to treatment, and decreased response to treatment. Removal of these barriers by increasing education about HCV disease and treatment options to both patients and health care workers and changing current policy in health care settings to provide enhanced access to HCV treatment for PWID can promote an opportunity for successful treatment of these patients. IMPLICATIONS FOR PRACTICE: There is a significant need for HCV treatment among PWID. Opportunities for successful treatment exist and should be adopted.

Standardizing mammogram screening in primary care: Integrating an evidence-based approach.

BACKGROUND: Mammogram screening for surveillance and detection of breast cancer has been long recognized as a preventive health measure in primary care for women. However, a clear consensus on when to start screening individual women, based on age and risk factors, lacks guidance. Reputable organizations uphold varying breast cancer screening (BCS) guidelines for women potentiating the risk for fragmented and inconsistent practices among health care providers (HCPs). OBJECTIVES: This review aims to evaluate the current literature on the possible risks, benefits, and limitations associated with BCS for women between 40 and 49 years and to discuss the need for a more individualized, evidence-based approach to BCS. DATA SOURCES: A comprehensive systematic review of eight articles, along with five clinical practice guidelines published within the past 10 years that address advantages and disadvantages of receiving mammography for women in their fourth decade was completed. CONCLUSIONS: There is insufficient evidence to promote adherence to any single clinical practice guideline for the benefit of all patients. Further high-level research is needed, as well as the assessment of individual risk factors influencing breast cancer development and screening outcomes. IMPLICATIONS FOR PRACTICE: There is a significant need for further education for HCPs and the development of tools that incorporate a BCS shared decision-making process. Current practice lacks the ability to easily screen individual patients with a method that identifies the appropriate age to screen and addresses the benefits, risks, and limitations of mammography.

Initiation of HIV pre-exposure prophylaxis in adolescents and young adults: Barriers and opportunities.

BACKGROUND: Adolescents and young adults (AYA) ages 13 to 24 years comprise a quarter of the new HIV diagnoses in the United States. Lack of access to HIV-preventive biomedical tools such as pre-exposure prophylaxis (PrEP) reduces opportunities to prevent HIV infection in this population. Initiating PrEP in AYA significantly reduces the negative health outcomes of HIV, but many providers are still reluctant to initiate PrEP in their AYA patients based on perceived threats and barriers. OBJECTIVES: This review aims to highlight the barriers and opportunities for initiating PrEP services in AYA and provides recommendations for PrEP services in this population. DATA SOURCES: Ten scholarly articles rated levels IIA through IIIB were identified using the Johns Hopkins Evidence-Based Practice ratings. These included quasi-experimental and nonexperimental publications. Both quantitative and qualitative data contributed to identifying perceived barriers, opportunities, and recommendations for increased PrEP access and prescription in AYA. CONCLUSIONS: Pre-exposure prophylaxis is a vital component of a robust HIV prevention program. Themes that emerged hindering optimal PrEP utilization in AYA included provider-related barriers (e.g., knowledge deficit, lack of familiarity with PrEP guidelines, and protocols), patient-related barriers (e.g., lack of awareness, confidentiality issue, and HIV stigma), and structure-related barriers (e.g., lack of AYA-friendly clinics and insurance coverage). IMPLICATIONS FOR PRACTICE: Providers in any setting should be able identify at-risk AYA and prescribe PrEP accordingly. Nurse practitioners should make PrEP accessible to AYA by addressing the barriers to PrEP utilization, prescribing, and continuity of care. Nurse practitioner curriculum, training, and continuing education should include PrEP for AYA.

Can a smartphone app help manage wounds in primary care?

BACKGROUND AND PURPOSE: Although wound care guidelines are available for primary care providers, barriers to assessment and treatment remain. This article examines current evidence supporting wound management, wound guidelines, and provider comfort with wound management in primary care and discusses the need for improved training, education, and the development of a simplified approach to wound management in primary care. METHODS: This review of evidence examines knowledge of wound care, wound curriculum, and the current availability of guidelines for health care providers at the frontlines. CONCLUSION: Few primary care curriculums and institutions require wound care education. Access to guidelines, pathways, and educational resources is limited, which negatively effects primary care provider's knowledge and comfort level in treating wounds in current clinical practice. IMPLICATION FOR PRACTICE: Educating the general practitioner on evidence-based wound management and providing adequate resources remain a priority. Increasing awareness of available electronic wound care applications (apps) can improve a timely wound care assessment, diagnosis, and initiation of treatment.

Barriers to implementation of long-acting reversible contraception: A systematic review.

BACKGROUND AND PURPOSE: Long-acting reversible contraception (LARC) is one of the most effective forms of contraception available. The utilization of LARC remains low despite being recommended by major health organizations such as Centers for Disease Control and Prevention, American Congress of Obstetricians and Gynecologists, American Academy of Pediatrics, American Academy of Family Physicians, and the National Committee for Quality Assurance. Health care professionals play an essential role in the potential increased use of LARC. This review aims to highlight key barriers to the utilization of LARC and discuss interventions to address this issue. METHODS: A systematic review of 14 peer-reviewed articles focused on LARC utilization rates that help identify barriers to the utilization of LARC in current education and practice. Articles were evaluated for strength of research design using the Johns Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal tool. CONCLUSIONS: Three categories affecting LARC utilization emerged: deficits in provider education/competency, lack of hands-on training, and barriers to practice. IMPLICATIONS FOR PRACTICE: The importance of including LARC training and education in the advanced practice nursing curriculum and providing opportunities for continuing education with LARC is demonstrated.