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2.
Orthop Nurs ; 39(4): 215-217, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32665477

RESUMO

The novel coronavirus (SARS-CoV-2) represents a rapidly evolving pandemic. Health systems are scrambling to mobilize and redeploy their medical staff in the fight against COVID-19. Orthopaedic nurse practitioners/physician assistants should be part of any redeployment strategy to address unmet needs during these unprecedented times. This article discusses redeployment considerations and strategies that utilize these providers appropriately while mitigating risks.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Infecções por Coronavirus/epidemiologia , Ortopedia/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Humanos , Profissionais de Enfermagem , Enfermagem Ortopédica , Assistentes Médicos , Estados Unidos/epidemiologia
4.
Nephrol Nurs J ; 47(3): 239-265, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32639125

RESUMO

Vitamin D deficiency is prevalent among patients with chronic kidney disease (CKD) and even more pronounced in patients with kidney failure who are undergoing peritoneal dialysis and hemodialysis. This project was a nurse practitioner-led quality improvement project conducted in an outpatient hemodialysis unit that focused on determining if educating providers and hemodialysis unit clinical staff on vitamin D guidelines increased the awareness and monitoring of patients on hemodialysis. The number of patients screened for vitamin D levels increased from 29% to 100%, and 70% of patients tested were deficient in vitamin D. While the follow-up monitoring yielded a result of only 32%, we recommend processes and structures for long-term sustainability, such as periodic re-education, reminders and prompts for conducting needed follow-up, continued outcome monitoring, and champions to support the ongoing processes and structures.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Medicina Baseada em Evidências/organização & administração , Corpo Clínico/educação , Diálise Renal , Insuficiência Renal Crônica/terapia , Deficiência de Vitamina D/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Programas de Rastreamento/estatística & dados numéricos , Profissionais de Enfermagem , Guias de Prática Clínica como Assunto , Melhoria de Qualidade/organização & administração , Insuficiência Renal Crônica/epidemiologia , Deficiência de Vitamina D/epidemiologia
5.
J Am Assoc Nurse Pract ; 32(6): 416-418, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-594928

RESUMO

Our health care landscape is rapidly changing. With the aging population and seemingly increasing outbreak of communicable diseases, it is expected that there will be a continued demand for inpatient/critical care providers. The current COVID-19 pandemic provides a glimpse of a health care system in severe provider shortage. Adult-gerontology acute nurse practitioners (GACNPs) can play a vital part in relieving that shortage. But with the increased role, there is an increased responsibility and need for expansion of AGACNP skill set. This includes the training and utilization of point-of-care ultrasound (POCUS). The case reports and data available from countries that have already combated COVID-19 outbreak show POCUS can play a key part in managing critically ill patients on isolation precautions. This article provides my perspective on POCUS training and competency achievement for AGACNPPs.


Assuntos
Competência Clínica/normas , Enfermagem Geriátrica/normas , Profissionais de Enfermagem/educação , Sistemas Automatizados de Assistência Junto ao Leito/normas , Ultrassonografia/normas , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Cuidados Críticos/normas , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle
6.
J Dent Hyg ; 94(3): 29-36, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32554413

RESUMO

Purpose: Preventive oral health behaviors are essential for children during early stages of development. The purpose of this study was to pilot an innovative, collaborative service-learning (ICSL) experience for dental hygiene (DH) and primary care nurse practitioner (NP) students to address pediatric oral health.Methods: A convenience sample of DH and NP students (n=12) participated in the development, planning and delivery of an ICSL activity focusing on pediatric oral health to 44 pre-school aged children. A learning management system was used for the communicating, planning and evaluating the ICSL activity. The interprofessional socialization of the participants was measured using the Interprofessional Socialization and Valuing Scale (ISVS-9A/9/B) survey prior to and following the ICSL experience. Descriptive statistics were used to analyze the data.Results: Twelve students agreed to participate in the ICSL experience (DH= 9 and NP=3) and completed the pre and post ISVS-9A/9B surveys. There was a positive change in interprofessional socialization scales (0.42) after the ICSL experience (p=0.066) for all participants. Marginal statistically significant differences were identified among the DH participants (p=0.058) in their pre and post interprofessional socialization scores.Conclusion: Within the limitations of this pilot study, the ICSL experience had a positive impact on NP and DH students' socialization to interprofessional collaboration. This low resource, service-learning educational project has potential for easy integration within dental hygiene and advanced practice nursing curricula.


Assuntos
Profissionais de Enfermagem , Higiene Bucal , Atitude do Pessoal de Saúde , Criança , Pré-Escolar , Humanos , Relações Interprofissionais , Saúde Bucal , Projetos Piloto
8.
J Am Assoc Nurse Pract ; 32(6): 416-418, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32511190

RESUMO

Our health care landscape is rapidly changing. With the aging population and seemingly increasing outbreak of communicable diseases, it is expected that there will be a continued demand for inpatient/critical care providers. The current COVID-19 pandemic provides a glimpse of a health care system in severe provider shortage. Adult-gerontology acute nurse practitioners (GACNPs) can play a vital part in relieving that shortage. But with the increased role, there is an increased responsibility and need for expansion of AGACNP skill set. This includes the training and utilization of point-of-care ultrasound (POCUS). The case reports and data available from countries that have already combated COVID-19 outbreak show POCUS can play a key part in managing critically ill patients on isolation precautions. This article provides my perspective on POCUS training and competency achievement for AGACNPPs.


Assuntos
Competência Clínica/normas , Enfermagem Geriátrica/normas , Profissionais de Enfermagem/educação , Sistemas Automatizados de Assistência Junto ao Leito/normas , Ultrassonografia/normas , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Cuidados Críticos/normas , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle
9.
Emerg Microbes Infect ; 9(1): 1354-1355, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: covidwho-382080

RESUMO

We report a 35-year-old female nurse who possibly received the SARS-CoV-2 virus during the blood sampling of a 35-year-old male patient initially suspected as a dengue infection. The patient had mild thrombocytopenia and positive dengue IgG and IgM whereas the clinicians were not aware of the possibility of false-positive dengue serology revealed in the published case report from Singapore. The nurse put on a pair of gloves but did not wear a mask during the only encounter with this patient. This nosocomial transmission raised a safety concern among healthcare professionals in an area with a relatively low Covid-19 prevalence, especially when the clinical and laboratory characteristics could be confused with other viral infections.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/transmissão , Erros de Diagnóstico , Transmissão de Doença Infecciosa do Paciente para o Profissional , Pneumonia Viral/transmissão , Adulto , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Dengue/diagnóstico , Dengue/virologia , Vírus da Dengue/patogenicidade , Vírus da Dengue/fisiologia , Feminino , Humanos , Masculino , Profissionais de Enfermagem , Pandemias , Pneumonia Viral/diagnóstico , Tailândia
10.
Emerg Microbes Infect ; 9(1): 1354-1355, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32458742

RESUMO

We report a 35-year-old female nurse who possibly received the SARS-CoV-2 virus during the blood sampling of a 35-year-old male patient initially suspected as a dengue infection. The patient had mild thrombocytopenia and positive dengue IgG and IgM whereas the clinicians were not aware of the possibility of false-positive dengue serology revealed in the published case report from Singapore. The nurse put on a pair of gloves but did not wear a mask during the only encounter with this patient. This nosocomial transmission raised a safety concern among healthcare professionals in an area with a relatively low Covid-19 prevalence, especially when the clinical and laboratory characteristics could be confused with other viral infections.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/transmissão , Erros de Diagnóstico , Transmissão de Doença Infecciosa do Paciente para o Profissional , Pneumonia Viral/transmissão , Adulto , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Dengue/diagnóstico , Dengue/virologia , Vírus da Dengue/patogenicidade , Vírus da Dengue/fisiologia , Feminino , Humanos , Masculino , Profissionais de Enfermagem , Pandemias , Pneumonia Viral/diagnóstico , Tailândia
11.
Nat Med ; 26(6): 900-908, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32424212

RESUMO

Skin conditions affect 1.9 billion people. Because of a shortage of dermatologists, most cases are seen instead by general practitioners with lower diagnostic accuracy. We present a deep learning system (DLS) to provide a differential diagnosis of skin conditions using 16,114 de-identified cases (photographs and clinical data) from a teledermatology practice serving 17 sites. The DLS distinguishes between 26 common skin conditions, representing 80% of cases seen in primary care, while also providing a secondary prediction covering 419 skin conditions. On 963 validation cases, where a rotating panel of three board-certified dermatologists defined the reference standard, the DLS was non-inferior to six other dermatologists and superior to six primary care physicians (PCPs) and six nurse practitioners (NPs) (top-1 accuracy: 0.66 DLS, 0.63 dermatologists, 0.44 PCPs and 0.40 NPs). These results highlight the potential of the DLS to assist general practitioners in diagnosing skin conditions.


Assuntos
Aprendizado Profundo , Diagnóstico Diferencial , Dermatopatias/diagnóstico , Acne Vulgar/diagnóstico , Adulto , Afro-Americanos , Nativos do Alasca , Americanos Asiáticos , Carcinoma Basocelular/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Dermatite Seborreica/diagnóstico , Dermatologistas , Eczema/diagnóstico , Grupo com Ancestrais do Continente Europeu , Feminino , Foliculite/diagnóstico , Hispano-Americanos , Humanos , Índios Norte-Americanos , Ceratose Seborreica/diagnóstico , Masculino , Melanoma/diagnóstico , Pessoa de Meia-Idade , Profissionais de Enfermagem , Grupo com Ancestrais Oceânicos , Fotografação , Médicos de Atenção Primária , Psoríase/diagnóstico , Neoplasias Cutâneas/diagnóstico , Telemedicina , Verrugas/diagnóstico
12.
J Nurs Adm ; 50(6): 343-348, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32433114

RESUMO

This article describes a team approach to developing an evidence-based mentoring program for nurses at a major academic medical center. The center's nursing leadership empowered nurses to design and implement a program that supports staff engagement and professional development. This structured, collaborative process resulted in an innovative mentoring program that is aligned with the organizational culture and practices.


Assuntos
Liderança , Tutoria , Enfermeiras Administradoras , Profissionais de Enfermagem , Recursos Humanos de Enfermagem no Hospital , Desenvolvimento de Programas , Desenvolvimento de Pessoal , Mobilidade Ocupacional , Humanos , Cultura Organizacional
13.
Nurs Clin North Am ; 55(2): 163-174, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32389251

RESUMO

Nurse practitioners (NPs) play an increasingly greater role in the delivery of orthopedic patient care. NPs practice in a wide variety of orthopedic settings having a significant positive impact on orthopedic care delivery. Few formal educational outlets exist for training NPs for orthopedic care. Many new orthopedic NPs rely on continuing education and an apprenticeship model of learning "on the job" with their surgeon counterparts. This article describes the preparation, role, and impact that today's NPs have on orthopedic care delivery.


Assuntos
Prática Avançada de Enfermagem , Doenças Musculoesqueléticas/enfermagem , Profissionais de Enfermagem , Humanos , Profissionais de Enfermagem/educação , Papel do Profissional de Enfermagem , Pesquisa em Avaliação de Enfermagem , Ortopedia/organização & administração
14.
Rev Infirm ; 69(258): 43-44, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-32327062

RESUMO

Catherine is an advanced nurse practitioner working in a large general practice in the north of England. She works alongside her medical colleagues and receives and treats patients with undifferentiated complaints. Margaret, a 64 year-old woman, is presenting today with vague symptoms. She is reluctant to come and get help and is fearful of what the consequences might be.


Assuntos
Profissionais de Enfermagem/psicologia , Relações Enfermeiro-Paciente , Assistência Centrada no Paciente/organização & administração , Prática Avançada de Enfermagem , Inglaterra , Feminino , Medicina Geral , Humanos , Pessoa de Meia-Idade
15.
Womens Health Issues ; 30(3): 167-175, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32334910

RESUMO

OBJECTIVES: We examined advanced practice clinicians' (APCs: nurse practitioners [NPs], certified nurse midwives [CNMs], physician assistants) interest in training to provide medication and aspiration abortion in Colorado, where abortion provision by APCs is legal. METHODS: We surveyed a stratified random sample of APCs, oversampling women's health (CNMs/women's health nurse practitioners [WHNPs]) and rural APCs. We examined prevalence and predictors of interest in abortion training using weighted χ2 tests. RESULTS: Of 512 participants (21% response), the weighted sample is 50% NPs, 41% physician assistants, and 9% CNMs/WHNPs; 55% provide primary care. Only 12% are aware they can legally provide abortion. A minority of participants disagree that medication abortion (15%) or aspiration abortion (25%) should be in APC scope of practice. Almost one-third (29%) are interested in medication abortion training and 16% are possibly interested; interest is highest among CNMs/WHNPs (52%) (p < .01). Interest in aspiration abortion training is 15% with another 11% who are possibly interested; interest is highest among CNMs/WHNPs (34%) (p < .01). There are no significant differences in abortion training interest by rural practice location or by receipt of abortion education in graduate school. Participants not interested in medication and aspiration abortion training cited abortion being outside their specialty practice scope (44% and 38%, respectively) and religious or personal objections (42% and 34%). Among clinicians interested in medication abortion training, 33% believe their clinical facility is likely to allow them to provide this service, compared with 16% for aspiration abortion. CONCLUSIONS: Interest in abortion training among Colorado APCs is substantial. However, facility barriers to abortion provision must be addressed to increase abortion access with APCs.


Assuntos
Aborto Induzido/educação , Conhecimentos, Atitudes e Prática em Saúde , Enfermeiras Obstétricas/educação , Profissionais de Enfermagem/educação , Assistentes Médicos/educação , Colorado , Feminino , Humanos , Masculino , Gravidez , População Rural , Inquéritos e Questionários
16.
Med Care ; 58(8): 681-688, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32265355

RESUMO

OBJECTIVE: The objective of this study was to compare health care utilization and costs among diabetes patients with physician, nurse practitioner (NP), or physician assistant (PA) primary care providers (PCPs). RESEARCH DESIGN AND METHODS: Cohort study using Veterans Affairs (VA) electronic health record data to examine the relationship between PCP type and utilization and costs over 1 year in 368,481 adult, diabetes patients. Relationship between PCP type and utilization and costs in 2013 was examined with extensive adjustment for patient and facility characteristics. Emergency department and outpatient analyses used negative binomial models; hospitalizations used logistic regression. Costs were analyzed using generalized linear models. RESULTS: PCPs were physicians, NPs, and PAs for 74.9% (n=276,009), 18.2% (n=67,120), and 6.9% (n=25,352) of patients respectively. Patients of NPs and PAs have lower odds of inpatient admission [odds ratio for NP vs. physician 0.90, 95% confidence interval (CI)=0.87-0.93; PA vs. physician 0.92, 95% CI=0.87-0.97], and lower emergency department use (0.67 visits on average for physicians, 95% CI=0.65-0.68; 0.60 for NPs, 95% CI=0.58-0.63; 0.59 for PAs, 95% CI=0.56-0.63). This translates into NPs and PAs having ~$500-$700 less health care costs per patient per year (P<0.0001). CONCLUSIONS: Expanded use of NPs and PAs in the PCP role for some patients may be associated with notable cost savings. In our cohort, substituting care patterns and creating similar clinical situations in which they practice, NPs and PAs may have reduced costs of care by up to 150-190 million dollars in 2013.


Assuntos
Diabetes Mellitus/economia , Pessoal de Saúde/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Diabetes Mellitus/psicologia , Feminino , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem/economia , Profissionais de Enfermagem/normas , Profissionais de Enfermagem/estatística & dados numéricos , Assistentes Médicos/economia , Assistentes Médicos/normas , Assistentes Médicos/estatística & dados numéricos , Médicos/economia , Médicos/normas , Médicos/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Estados Unidos , United States Department of Veterans Affairs/economia , United States Department of Veterans Affairs/organização & administração , United States Department of Veterans Affairs/estatística & dados numéricos
17.
Nurse Pract ; 45(5): 16-23, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32271260

RESUMO

The prevalence of pediatric hypertension is growing. Hypertension during childhood remains a major risk factor for adverse cardiovascular events later in life. NPs should be aware of current guidelines on screening, diagnosis, and treatment of hypertension in children to improve care for this patient population.


Assuntos
Hipertensão/enfermagem , Enfermagem Pediátrica , Guias de Prática Clínica como Assunto , Adolescente , Criança , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Programas de Rastreamento/enfermagem , Profissionais de Enfermagem , Diagnóstico de Enfermagem
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