Using Objective Structured Clinical Examination as a Teaching Tool in a Hybrid Advanced Health Assessment Course.

BACKGROUND: Advanced health assessment is a required course in advanced practice RN (APRN) education, essential to providing the foundation for differential diagnosis (DD) skills and the ability to formulate a plan of care. PROBLEM: Feedback from clinical preceptors revealed that our doctor of nursing practice (DNP) students struggled to make a DD. APPROACH: This educational quality improvement project collected data from 7 cohorts of DNP students in either the Family Nurse Practitioner or Adult Gerontology Nurse Practitioner program to evaluate their readiness for clinical practicums and to inform necessary curriculum revisions. OUTCOMES: Data revealed that students' ability to identify 3 DDs correctly during the summative health assessment objective structured clinical examination was inconsistent. Qualitative data revealed students lacked understanding on how to use results from the physical assessment to formulate a DD. CONCLUSION: The findings of this project corroborate those from the literature that suggest we should teach APRN students DD skills explicitly.

A Nurse-Led Evidence-Based Practice Protocol to Reduce Postoperative Nausea and Vomiting in the Bariatric Surgery Patient.

PURPOSE: To create and implement a standard care bundle to reduce postoperative nausea and vomiting (PONV) in the bariatric surgery patient. DESIGN: Evidence-based quality improvement project. METHODS: A pre- and postintervention chart review identified high-risk indicators for PONV in patients with longer lengths of stay (LOS), which led to the development of targeted care bundle components. FINDINGS: A clinically significant difference was observed in predicted PONV for Apfel scores 3 and 4 in patients receiving the full bundle compared with those receiving a partial bundle. Decreased LOS after implementation of the antiemetic care bundle was found. Health care provider compliance with bundle administration was low (57%). CONCLUSIONS: Clinically significant PONV scores were low after implementation of the antiemetic bundle for high-risk patients. The nurse-led creation and implementation of an antiemetic care bundle may have contributed to decreased LOS, reduced PONV, and reduced provider variability in care management.

Meeting preceptor expectations to facilitate optimal nurse practitioner student clinical rotations.

Preceptors are essential to nurse practitioner (NP) students' transition from being a student to competent entry-level NP graduate. The literature is replete with data pertaining to the benefits of and barriers to preceptors engaging in the clinical education of NP students, and little has changed in the last two decades in this regard. Therefore, faculty solicited preceptor input to enhance curriculum revision and clinical training preparation. This qualitative inquiry project derived data from interviews with 13 preceptors in a variety of clinical settings. Interviews were audio-recorded, transcribed verbatim, and analyzed using a content analysis method. Recruiting, training, and retaining qualified, willing preceptors are of paramount importance to NP programs. This article describes preceptor expectations of NP students' knowledge, skills, and attitudes for optimal clinical rotation experiences. The results have important implications for innovative NP educational models, developing trust in NP education programs and promoting competency development of the NP student using entrustable professional activities.

Impact of a Plant-Based Diet and Support on Mitigating Type 2 Diabetes Mellitus in Latinos Living in Medically Underserved Areas.

PURPOSE: To determine the impact that a high-fiber, low-fat diet, derived from mostly plant-based sources, when coupled with support has upon self-management of type 2 diabetes mellitus in Latinos from medically underserved areas (MUAs). DESIGN: Experimental randomized controlled community pilot study. SETTING: Three community clinics in MUAs located within San Bernardino County, California. PARTICIPANTS: Thirty-two randomly assigned Latinos with A1C greater than 6.4: 15 control and 17 experimental. INTERVENTION: Participants completed a 5-week education program. Researchers provided follow-up support for 17 randomly assigned experimental group participants through focus groups held at participating clinics-1, 3, and 6 months posteducation. MEASURES: Changes in fat and fiber consumption were measured using a modified Dietary Screener for Mexican Americans. Self-management was measured through the Self-Efficacy for Exercise Scale and Diabetes Quality of Life Measure. ANALYSIS: Baseline characteristics for both groups were analyzed using independent t tests and χ2 tests. A 2-way repeated-measures analysis of variance was used to analyze biometric data between baseline and 6 months for both groups. RESULTS: Mean A1C levels decreased from baseline to 6 months for both groups: control, µ1 = 9.57, µ2 = 9.49; experimental, µ1 = 8.53, µ2 = 7.31. CONCLUSION: The experimental group demonstrated a statistically significant reduction in mean A1C levels ( P = .002) when compared to the control group.

Factors that influence diabetes self-management in Hispanics living in low socioeconomic neighborhoods in San Bernardino, California.

The growing incidence of diabetes among Hispanics is a serious public health concern. To identify factors that influence diabetes self-management in Hispanics, qualitative data gathered through five focus group interviews was examined using grounded theory methods. Four major themes emerged which were perceived by participants as enhancing or limiting factors: (1) access to resources, (2) struggle with diet, (3) self-efficacy, and (4) social support. The family's role as a determinant of diabetes self-management emerged as the underlying sub-theme to all four themes and underscores its importance among Hispanics living with diabetes. Results suggest that for the family to be an enhancing factor, health care providers need to educate, empower, and include the family in diabetes management and prevention. Programs which aim to improve the practice of self-management should incorporate the sociocultural and socioeconomic context in which Hispanics with diabetes live.