Outcomes of Hematuria Evaluation by Advanced Practice Providers and Urologists.

OBJECTIVE: To examine the quality and costs of care for patients evaluated for hematuria by urologic advanced practice providers (APPs) and urologists. The roles of APPs in urology are growing, but their clinical and financial outcomes compared to urologists are not well understood. METHODS: We conducted a retrospective cohort study of commercially insured patients using data from 2014 to 2020. We included adult beneficiaries with a diagnosis code for hematuria and an initial outpatient evaluation and management visit with a urologic APP or urologist. We assessed receipt of cystoscopy procedure, imaging study, bladder biopsy procedure, and bladder cancer diagnosis within 6 months of the initial visit. Secondary outcomes included the time until each of these outcomes occurred and the out-of-pocket spending and total payments. RESULTS: We identified 59,923 patients who were initially evaluated for hematuria. Visits with urologic nurse practitioners rather than urologists were associated with significantly lower odds of receiving cystoscopy procedures (odds ratio [OR] 0.93, 95% confidence interval [95% CI] 0.54-0.72, P < .001), imaging studies (OR 0.79, 95% CI 0.69-0.91, P < .001), and bladder biopsy procedures (OR 0.61, 95% CI 0.41-0.92, P = .02). Visits with urologic physician assistants were associated with 11% greater out-of-pocket payments (incident risk ratio 1.11, CI 1.01-1.22, P = .02) and 14% greater total payments (incident risk ratio 1.14, CI 1.04-1.25, P = .004). CONCLUSION: There are clinical and financial differences in hematuria care delivered by urologic APPs and urologists. The incorporation of APPs into urologic care warrants further study, and specialty-specific training for APPs should be considered.

Self-management in Heart Failure: The Importance of Self-regulation but not Complexity of Condition.

Heart failure (HF) is a growing public health problem. Self-management (SM) of HF is an important component of chronic disease management. Guided by the Individual and Family Self-Management Theory (IFSMT), we examined the associations among complexity of condition, self-regulation, and self-efficacy mediation of SM behaviors in a population of HF outpatients. A cross-sectional design was used. Seventy-three outpatients with HF were enrolled. Simple and multiple linear regressions were run for each outcome variable. Only self-regulation was significantly associated with SM behavior. Complexity of condition was not significantly associated with SM behavior. There was no mediation by self-efficacy. Future nursing interventions should explore self-regulation in HF to provide a clearer understanding of the processes used to change health behavior. SM may be particularly useful in HF with preserved ejection fraction (EF), where there is no proven pharmacological treatment.

Student experiences in an academic support program to diversify the nursing workforce.

BACKGROUND: The current demographic of the Nursing workforce in the United States suggests a need to increase the percentage of minority nurses in practice. Diversifying the nursing workforce may change patient perceptions and improve the quality of care received by underserved patients. A college of nursing created the Nursing Endeavor Program to support first generation, low income, and/or underrepresented students from the point of acceptance in the nursing program to graduation. Nursing Endeavor students are guaranteed acceptance into the nursing major upon successful completion of these preliminary nursing courses. Despite application of some Jeffreys interventions, only 50% of Nursing Endeavor students enrolled in the preliminary nursing courses qualified to enter the major and graduated. One hundred percent of all Nursing Endeavor students who successfully transitioned into the final two years of the major had graduated. Therefore, this study focused on the efficacy of NEP interventions to support students in the first two years. OBJECTIVES: The aim of this study was to analyze student perspectives of the efficacy of interventions in the Nurse Endeavor Program designed to facilitate successful completion of the first two years of preliminary courses in the nursing major, which equates to a successful transition to student nurse. DESIGN: This study used a Qualitative Phenomenographic research design. SETTINGS: Individual interviews were conducted in the Principal Investigator's office in a Midwestern United States Research Universities' College of Nursing. PARTICIPANTS: Eleven students who continued in the Nursing Endeavor Program to graduation, and eight former Nursing Endeavor students who withdrew from the nursing major during preliminary nursing courses. METHODS: Meleis transitions theory guided the study design. Institutional Review Board approval for study 17.272, and participant consent were obtained. Face-to-face interviews were conducted in the Principal Investigator's office and were transcribed verbatim. Phenomenographic methods were used for narrative analysis. RESULTS: Students reported nine interventions facilitated transition from preliminary nursing courses to the nursing major. Students reported three factors hindered transition: academic rigor, isolation, and living at home. Attendance at professional events was not mentioned. CONCLUSIONS: Students credited Jeffreys' interventions for successful transitions. Additional factors influencing transition identified by students merit further study.

Attitude, source of knowledge, and supporting factors on evidence-based nursing among cardiovascular nurses: A cross-sectional descriptive study in Turkey.

RATIONALE, AIMS, AND OBJECTIVES: Cardiovascular nursing has been a rapidly growing specialty since the 1960s. Assessing cardiovascular nurses' EBN (evidence-based nursing) attitudes and beliefs and the factors supporting EBN is important to assist the training programmes in fostering EBN practice in a clinical environment. Few investigations have been conducted on EBN knowledge, attitudes, beliefs, and implementation among cardiovascular nurses. The present study aims to investigate cardiovascular nurses' attitudes towards EBN, sources of knowledge, and the factors supporting EBN in Turkey. METHODS: A cross-sectional survey with a descriptive and comparative design was conducted with 62 cardiovascular nurses working at two hospitals in Turkey. Data were collected by using the Evidence-Based Nursing Attitude Questionnaire, a sociodemographic questionnaire concerning demographic information and including questions about nurses' sources of knowledge, supporting factors to implement EBN, research experience, use of clinical guidelines, and barriers to applying EBN. Data were analysed with descriptive and inferential statistics. RESULTS: The research revealed that cardiovascular nurses have positive attitudes, feelings, beliefs, and intention of conduct towards EBN. Cardiac surgery nurses reported significantly higher positive feelings, beliefs, intention of conduct, and attitude towards EBN than cardiology nurses. Nursing experience and information acquired through nursing school were the most frequently used sources of knowledge rather than research results (35.5%) in their clinical practice. Half of the respondents (47%) were familiar with EBN. Cardiovascular nurses who had graduate degrees, reviewed nursing research and were familiar with EBN had significant positive attitudes towards EBN. Nurses needed enough time and resources, a background in clinical practice, and support from the hospital administration to implement EBN. CONCLUSIONS: An education intervention should be provided about EBN knowledge and skills for cardiovascular nurses. Mentor nurses should be trained and assigned in cardiovascular clinics to implement EBN.

The University of Wisconsin-Milwaukee Flexible Option for Bachelor of Science in Nursing Degree Completion.

The 2010 "Future of Nursing: Leading Change, Advancing Health" report from the Institute of Medicine recommended that 80% of registered nurses (RNs) obtain a bachelor of science in nursing (BSN) degree by 2020. Hospitals with BSN nurses have reduced morbidity and mortality. In 2014, the University of Wisconsin-Milwaukee and the University of Wisconsin-Extension launched the University of Wisconsin Flexible Option BSN (UW Flex BSN) as an additional model for BSN degree completion, adding to the in-person and online delivery models already being offered.In this article, the authors examine the decision to launch the UW Flex BSN program as a competency-based, time-variable approach to RN-to-BSN degree completion. They discuss the factors contributing to its success (including proactive, wraparound support for students through the use of academic success coaches and regular and substantive interaction with faculty), design and program elements and decisions, and continuing challenges that have yet to be resolved.UW Flex BSN is one version of direct-assessment, competency-based education, and it represents the first of its kind in a public institution for postlicensure BSN degree completion. The program meets all Higher Learning Commission standards and requirements and is grounded in the American Association of Colleges of Nursing Baccalaureate Essentials and program quality standards. The UW Flex BSN for degree completion is a successful example of a competency-based, time-variable education model that has been applied in a practice discipline.

Pain management in military trauma.

The wounded warrior requires immediate care, and at times, evacuation from injury. Care may be self-regulated, or may require more advanced care under the direction of medics or advanced practitioners, including physicians and surgeons. While survivability is the immediate priority, pain management has become a military initiative, recognizing that poor management of acute pain may lead to the development of chronic pain and post-traumatic stress disorder. This article reviews current initiatives used in current conflict situations, as well as those in continued care following initial stabilization.

Predictors of chronic pain in traumatically injured hospitalized adult patients.

It is unclear what causes chronic pain in traumatically injured hospitalized adults. A total of 101 patients admitted to a level 1 trauma center completed interviews during their inpatient stay and at 4 months, and data on biologic, psychologic, and sociologic variables were collected. Statistical analysis used hierarchical logistical regression,χ, and independent-samples t tests. Prevalence of chronic pain at 4 months was 79.2%. Those with chronic pain at 4 months had more posttraumatic stress disorder, anxiety, and depression. High initial pain score was the only significant predictor of chronic pain. Initial pain intensity predicts chronic pain.