Defining Nurse Practitioner Core Entrustable Professional Activities: Essential Step Toward Competency-Based Education.

BACKGROUND: Gaps between educational preparation and clinical practice readiness have led to innovative approaches to competence assessment. Entrustable professional activities (EPAs) show promise as a competence assessment framework in graduate nursing education. PURPOSE: This study sought to develop and validate a set of EPAs that reflect the core activities performed by all nurse practitioners (NPs). METHODS: Eight EPAs were developed. A Delphi approach was used to validate the EPAs by NP practice experts located across the United States and representing most NP populations. RESULTS: Consensus was reached after 2 Delphi rounds. CONCLUSIONS: The EPAs developed and validated in this study map multiple advanced-level NP competencies to workplace expectations and provide a shared framework for competency-based workplace assessment among NP preceptors from varied health care professions.

Telehealth Simulation: Effect on Nurse Learner Knowledge, Confidence, and Attitudes.

ABSTRACT: Limited research explores the effectiveness of educational interventions in meeting telehealth technology competencies. A combined didactic and simulation intervention was implemented with 66 prelicensure and 15 nurse practitioner students. Telehealth knowledge, confidence, and attitudes were evaluated using the Telemedicine Objective Structured Clinical Exam survey. Results were analyzed using descriptive and inferential strategies, and responses to an open-ended question were content analyzed. Survey scores significantly increased from pre- to post-intervention. Learners recognized the value of telehealth and the educational intervention. This effective and well-received intervention can be used by schools of nursing to facilitate student attainment of telehealth competencies.

Improving management of ventilator associated tracheitis in a level IV NICU.

BACKGROUND: There are no published guidelines regarding the diagnosis and treatment of ventilator-associated tracheitis (VAT) in the neonatal intensive care unit (NICU). VAT is likely over-diagnosed and over-treated, increasing antibiotic burden and cost. LOCAL PROBLEM: Diagnosis and treatment of VAT were entirely NICU provider dependent. METHODS: Retrospective pre- and post-intervention chart reviews were performed. INTERVENTIONS: A VAT diagnosis and treatment algorithm was created for use in the care of intubated patients without tracheostomies. 3 plan-do-study-act (PDSA) cycles were used to implement change. RESULTS: Intubated patients treated for VAT with <25 PMNs on Gram stain decreased from 79% to 35% following the quality improvement (QI) initiative. Treatment of VAT with >7 days of antibiotic therapy decreased from 42% to 10%. CONCLUSION: Implementing a QI initiative to improve the diagnosis and treatment of VAT in the NICU decreased the percent of patients treated inappropriately for VAT.

Case-based learning: Facilitating nurse practitioner clinical learning with virtual patient cases.

ABSTRACT: Through unfolding patient case studies, case-based learning has the potential to facilitate nurse practitioner (NP) student application of didactic knowledge to clinical practice, thus narrowing the theory-practice gap. The purpose of this study was to investigate NP student experience using virtual patient cases to supplement clinical learning. Bloom's cognitive taxonomy served as the framework. Seven students enrolled in the final semester of a distance family NP program completed 45 virtual patient cases over an 8-week period. Case topics covered a variety of primary care problems. Usability of the virtual learning platform was measured by the System Usability Scale. Clinical learning value was measured by the Student Satisfaction and Self-Confidence in Learning Scale. Students rated their perceived ability to manage common primary care problems at the start and end of the 8-week period. Students found the virtual learning platform highly usable and were satisfied and self-confident with their learning. Student perceived ability to manage common primary care problems increased for all virtual case topics from start to end of course. This study provides further evidence that well-designed virtual patient cases have the potential to effectively supplement NP student clinical learning. These results are important as NP faculty look for alternative forms of clinical learning to supplement direct care clinical experiences.

Evaluating Nurse Practitioner Student Competencies: Application of Entrustable Professional Activities.

BACKGROUND: A knowledge gap exists regarding the best methods for assessment of nurse practitioner (NP) student clinical competence. Entrustable professional activities (EPAs) translate competencies into practice and provide a potential framework for NP clinical competency assessment. This study piloted the use of an EPA-based method of assessing NP student clinical competence via simulated clinical experiences. METHOD: Six EPAs were mapped to NP core competencies. Faculty designed clinical scenarios to assess student clinical performance using EPA-based rubrics. Online family nurse practitioner students rotated through simulated clinical scenarios during an on-campus residency. Faculty assigned a utility score to each EPA activity description. RESULTS: Student EPA scores paralleled time-based program requirements. Faculty found over 70% of EPA activity descriptions to be useful or requiring minor editing in assessing students. CONCLUSION: This study is an important step toward the creation of a standardized, competency-based process for NP clinical performance assessment. [J Nurs Educ. 2020;59(12):714-720.].

SBIRT Education for Nurse Practitioner Students: Integration Into an MSN Program.

BACKGROUND: Substance use disorders are a major public health problem. As primary care providers, nurse practitioners (NPs) must be proficient at screening, identifying, and intervening for at-risk patients. Screening, brief intervention, and referral to treatment (SBIRT) is a well-established, evidence-based model for teaching behavioral health skills to health care providers. It is vital that Master of Science in Nursing (MSN)-NP programs incorporate SBIRT into their curricula. METHOD: SBIRT content was mapped to 10 courses across an MSN-NP program. Methods of integration included readings, lectures, case studies, role-plays, tutorials, symposia, and test questions, as well as tracking the use of SBIRT during clinical preceptorships. RESULTS: A total of 139 online and on-campus MSN-NP students were trained. Data demonstrate students successfully implemented SBIRT in precepted clinical settings. CONCLUSION: This approach provides a framework for integrating SBIRT training into MSN-NP curricula. [J Nurs Educ. 2017;56(12):725-732.].

Care coordination between convenient care clinics and healthcare homes.

PURPOSE: Patient care coordination is foundational to high-quality health care and is a national priority. Since its inception, convenient health care has been criticized for its potential to decrease patient care coordination. The purpose of this study is to investigate care coordination between convenient care clinics and healthcare homes. DATA SOURCES: The care coordination practices of Minute Clinic, which represents over 40% of the convenient care industry, were studied. Patient identification of healthcare homes and consent to transmit visit records were abstracted from the health records of 1,014,249 patients dated July 1 to December 31, 2012. The completeness of record content and timeliness of record transmission were assessed by means of interviewing Minute Clinic's Director of Quality and reviewing patient electronic health records. CONCLUSIONS: Minute Clinic attempts to coordinate care with healthcare homes, but opportunities for improved care coordination exist. IMPLICATIONS FOR PRACTICE: Increased vigilance on the part of providers, patients, and healthcare systems is needed to mitigate barriers to care coordination. Future research is needed to examine care coordination from multiple convenient care operators and explore how to increase care coordination with healthcare homes.

Clinical Inquiry: Do any topical agents help prevent or reduce stretch marks?

No topical agent has been proven to prevent or reduce stretch marks. Randomized controlled trials show that cocoa butter doesn't prevent stretch marks ; neither does olive oil.