Integration of a nurse practitioner and physician associate leadership structure within an academic cancer center.

BACKGROUND: Nurse practitioners and physician associates are an essential part of the multidisciplinary cancer care team with expanding and evolving roles within cancer specialties. LOCAL PROBLEM: As these clinicians flourish, a parallel need for leadership rises to optimize scope of practice, mentor, and retain this crucial workforce. The purpose of this quality improvement project was to development a nurse practitioner and physician associate leadership structure within an academic cancer center. METHODS: Development of this nurse practitioner and physician associate leadership structure was guided by transformational leadership theory. In collaboration with nursing, business, and physician leadership, a quad structure was supported. INTERVENTIONS: Implementation of a leadership structure included the establishment of eight team leaders and two managers. These leaders identified multiple opportunities for improvement including improved communications, offload of nonbillable work, development of incentive programs, provision of equipment, specialty practice alignment, hematology/oncology fellowship, and professional development. RESULTS: Overall, a nurse practitioner and physician associate leadership structure allowed for representation across the cancer center. Such inclusion supported multiple quality improvement projects developed in partnership with nursing, business, and physician leaders. Cumulatively, these interventions yielded efficient workflows and expansion of services. Consistent with reported evidence, these efforts contributed to nurse practitioner and physician associate retention as well as improved job satisfaction. CONCLUSIONS: Advanced practice leadership is essential to recruiting, developing, supporting, and retaining nurse practitioner and physician assistant colleagues in cancer care.

Navigating the pathway to advanced practice: A grounded theory of nurse practitioner role transition in a fellowship.

BACKGROUND: Greater attention to the transitional period for advanced practice nurses has urged health care organizations and employers to implement fellowships. Currently, the theoretical process of nurse practitioner (NP) role transition from the essential perspectives of NP fellows does not exist. PURPOSE: The purpose of this study was to construct a middle-range theory grounded in reality of an NP fellowship environment that explains how NPs transition to their new role. METHODOLOGY: Following Charmaz's constructivist methodology, 11 NPs who transitioned to practice in a fellowship were interviewed. RESULTS: "Navigating the Pathway to Advanced Practice: A Grounded Theory of Nurse Practitioner Role Transition in a Fellowship" emerged from the data and is composed of through five phases: (1) mapping a path, (2) stepping onto the trailhead, (3) navigating the trailway, (4) gaining traction, and (5) summiting. CONCLUSIONS: The resulting middle-range theory is the first in the nursing literature that conceptualizes meaning about NP role transition in a fellowship. This process occurs in the contextual factor of a realm of support that includes growth, value, lifelong learning, and readiness. Throughout this process, NPs build competence and confidence that advances them to summit, or transition, to their NP role at the completion of an NP fellowship. IMPLICATIONS: This discovery will fill the research gap pertaining to best practice interventions in support of NPs during role transition in fellowships. Understanding how NPs transition to their new advanced practice roles may inform organizations on how to structure fellowships that support learning, encourage confidence, and enhance competence.

Implementing an Oncology Nurse Practitioner Fellowship: Reflections and Lessons Learned.

As oncology nurse practitioner (NP) fellowships expand across the United States, institutions note improved transitions to specialty practice and better patient outcomes. These fellowships may further serve as a strategy to a.

Changes in Telehealth Experienced by Advanced Practice RNs During COVID-19: US Survey Results.

The sudden, expanded need for telehealth during the COVID-19 pandemic added to the challenges advanced practice RNs face in the United States. The purposes of this article are to summarize advanced practice RNs' responses about the use of telehealth before and during the pandemic and to analyze free-text comments about how the use of telehealth changed during the pandemic. A 20-item survey was distributed using convenience sampling to advanced practice RNs from June 1 to September 23, 2020. Analyses of descriptive and open text responses related to telehealth were conducted. Most of the respondents did not use telehealth prior to the pandemic (n = 5441 [73%]), but during the pandemic, half used telehealth at least daily (n = 3682 [49%]). The most common barriers related to telehealth were about the difficulty some populations had in accessing the necessary technology. The most common favorable comments cited by respondents were related to some patients' improved access to care. Telehealth use is unlikely to return to prepandemic levels. As a result, considerations of telehealth-related recommendations provided for advanced practice RN education, policy, and practice are encouraged for the purpose of increasing healthcare access.

Nurse Practitioner Transition to Practice: Recommendations and Strategies for Designing and Implementing Fellowships.

Fellowships prepare new graduate nurse practitioners (NPs) to become skilled providers with advanced knowledge and clinical competency to practice nursing in a specialized area. The literature lacks guidance about comprehensive approaches for the development, implementation, evaluation, and accreditation of NP fellowships. The purpose of this article was to describe recommendations and useful strategies for professional development nurse educators to deliver optimal learning and training for NPs transitioning into practice.

A Scoping Review of Measures Utilized to Assess Patient Satisfaction with Acupuncture Treatments Within Randomized Controlled Trials.

Objective: Patient satisfaction is an increasing priority for health care facilities in ensuring reimbursement for services, high-quality access to care, and transparent communication. Cumulatively, these metrics guide patient-centered care and facilitate optimal service delivery. The purpose of this scoping review was to evaluate measures of patient satisfaction with acupuncture treatments. Materials and Methods: This scoping review was guided by the Arksey and O'Malley methodological framework. Analysis was performed based on the multidimensional hierarchical model of perceived service-quality conceptual framework. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement was used to organize included publications and to display search processes in a flow diagram. An academic reference librarian conducted a literature search, using electronic databases that included PubMed,® Cumulative Index to Nursing and Allied Health Literature, EMBASE,® and Web of Science. Results: A total of 384 publications were initially identified and screened; 26 met the eligibility criteria and were included in the synthesis. Discrepancies in the use of patient-satisfaction measures among studies were found in only 1 study demonstrating holistic assessment. Conclusions: There is a need for consistent measurement of patient satisfaction with acupuncture treatments. Future studies may evaluate development of a satisfaction tool to measure patient satisfaction with acupuncture treatments comprehensively.

Utilizing Patient Reported Outcomes and Quality of Life Measures in the Management of Obesity.

BACKGROUND: Patient-reported outcome measures (PROMs) assess health-related quality of life (HRQOL). These tools can facilitate assessment of weight-related successes and challenges. OBJECTIVE: Implement surveys to better understand individual experiences with obesity and explore factors that may be associated with HRQOL. METHODS: Patients completed Obesity and Weight Loss Quality of Life Instrument (OWLQOL) and Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 surveys. Three scores were calculated from survey results: global physical health (GPH), global mental health (GMH), and OWLQOL. The association between these scores and body mass index (BMI) was examined using multiple linear regression analyses. RESULTS: 114 surveys were analyzed. GPH and OWLQOL scores were negatively associated with BMI. OWLQOL scores were higher in those who lost more than 10% body weight compared to those who lost less weight. OWLQOL scores for return patients were significantly higher than those for new patients. CONCLUSIONS: Various factors may affect HRQOL. Higher BMI may adversely affect HRQOL, but weight loss greater than 10% and an ongoing clinical relationship may have a positive effect.Implications for NursingThese surveys can promote quality care, providing relevant information to enhance the clinical visit and offering another means to evaluate interventions over time.

Results of a National Survey: Ongoing Barriers to APRN Practice in the United States.

Limited information is available on the barriers to practice for advanced practice registered nurses (APRNs) among states with full, restricted, and reduced practice. The purpose of this study is to identify practice barriers in relationship to United States (U.S.) state practice authority, APRN type, area of practice (rural, suburban, urban), and nature of practice (outpatient, inpatient, and both). An electronic survey of a convenience sample of APRNs was conducted to assess barriers to practice. Identified barriers were examined based on state practice environment, APRN role, practice setting, and location. Data were analyzed using thematic analysis for qualitative data and descriptive analysis for quantitative data. Over 7,000 APRNs representing all 50 states participated. Themes that were identified and reported by respondents, included licensure and administrative barriers, therapy restrictions, physician signature requirements, a lack of collegiality, prescribing barriers, uneven reimbursement, physician only procedures, and telehealth issues. Barriers were identified in all states, regardless of the type of practice authority. All four APRN role types identified practice barriers, some of which were more frequent for some roles than others. Restrictions for home health approval and the requirement for a physician signature for durable medical supply orders were identified by over 40% of respondents practicing in rural areas. Barriers to APRN practice continue to restrict aspects of patient care and patient access to care, even in states with full practice authority. Continued efforts to reduce barriers to APRN practice are needed to ensure patient access to care, especially in rural areas.

Exploration of Vaccination Attitudes Among Parents and Caregivers in a Rural Appalachian Health Clinic.

At a rural Appalachian health clinic in Kentucky, 20% of patients under 18 years were not up to date with the CDC-recommended immunization schedule. Reasons parents or caregivers chose to delay or refuse their child's immunizations were explored using the Caregiver Vaccination Attitude Scale. High levels of trust in the healthcare provider and self-reported vaccine knowledge highlight opportunities for rural healthcare providers to apply evidence-based communication strategies to address vaccine hesitancy and promote the safety and health of the entire community.

Cannabidiol: Knowledge, Beliefs, and Experiences of Patients With Cancer.

BACKGROUND: Cannabidiol (CBD) is purported to work for a variety of therapeutic indications. Interest in CBD products has significantly increased as patients with cancer seek ways to improve symptom control and quality of life. OBJECTIVES: The purpose of this study was to explore patients' knowledge of and experience with CBD. METHODS: A panel of oncology nurse practitioners, an oncologist, and oncology pharmacy specialists developed a survey to capture information about patient knowledge and use of CBD. The initial survey was pilot tested and further refined, resulting in the final item survey. The final survey was administered to 100 participants undergoing or having completed cancer treatment and being followed in a supportive oncology care clinic at a large academic medical center. FINDINGS: Most patients learned about CBD through a family member or friend. The majority of patients had never tried CBD. The most common reported indications were pain, anxiety, and nausea. Of those who had not tried CBD, the most common reasons included lack of knowledge about CBD and providers not recommending CBD.

Optimizing the student learning environment: A framework to select faculty for teaching courses.

Nurse educators must provide high quality student education and demonstrate foundational competencies to fulfill the academic role. Reports on nursing and health care underscore the importance of nurse educators' clinical expertise and educational preparation in teaching; yet, a framework to framework faculty selection and preparation to teach courses does not exist. The purpose of this article is to describe an innovative Faculty-Course Selection Framework (FCSF) for nursing education and discuss two practical examples of application in one school of nursing. The FCSF describes student, organizational, and faculty elements for consideration in determining faculty-course assignment. The fundamental units of the framework include workload needs, credentials, skills, content interest, individual attributes, and commitment. The FCSF equips nursing program administrators and directors to cultivate a highly functioning faculty team that can achieve pedagogical, subject, social, and organizational competence to practice the nurse educator role skillfully and artistically and optimize the student learning environment.

Leveraging School Nurse Expertise to Meet Children's Health and Nutrition Needs in Afterschool Programs.

The National Association of School Nurses' position statement clarifies the role of school nurses in afterschool activities is to assess, plan, and evaluate the health needs of students in programs that extend beyond the regular school day. School nurses leverage their expertise as trusted and caring providers to deliver health promotion education in the school setting. They can partner with afterschool programs to assess students' healthy eating and physical activity. The purpose of this article is to describe an exemplar assessment of Healthy Eating and Physical Activity in one afterschool program and discuss approaches to address preventable factors associated with childhood obesity.

Cannabidiol: The Need for More Information About Its Potential Benefits and Side Effects.

Consumer demand for cannabidiol (CBD) oil has increased, with growing sales from dispensaries because of the alleged medicinal benefits. Although studies examining the specific therapeutic effects of CBD are increasing, clinical data do not support the popular uses of CBD for Parkinson disease, schizophrenia, cancer palliation and treatment, chronic pain and spasticity, depression, anxiety disorder, insomnia, and inflammation.

Appreciative Advising Pilot Study: An Innovative Approach to Advising Doctor of Nursing Practice Students.

BACKGROUND: Traditional advising may not meet the needs of doctor of nursing practice (DNP) students. Founded on the principles of appreciative inquiry, appreciative advising serves as a promising alternative model. PURPOSE: The purpose of this pilot study was to determine feasibility of a DNP appreciative advising model to advise students through the rigors of DNP education and improve student and faculty satisfaction. METHODS: Faculty were oriented to the model and provided comprehensive guidebooks. Survey data were collected at 4 time points. Quantitative survey data were analyzed using descriptive statistics. Qualitative responses were analyzed using qualitative content analysis. RESULTS: Twenty-six students and 7 faculty who participated reported satisfaction with the model and commented that the model allowed for early identification of needs and was helpful and worthwhile. CONCLUSION: The model may hold promise as a solution to assist students in adjusting to DNP education and deserves further exploration as an advising approach.

Mindfulness in a Graduate Nursing Curriculum: A Randomized Controlled Study.

This study evaluated a mindfulness-based stress reduction intervention for graduate nursing students. Forty-four participants engaged in 20 weekly, 1.5-hour sessions of mindfulness training. There were no statistically significant effects on participants' stress levels or quality of life, yet there was a statistically significant increase in overall mindfulness (P < .05).

Pain Management: Strategies for Screening and Monitoring Patients Receiving Chronic Opioid Therapy
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The current state of pain management within the oncology setting, effectiveness of opioids for the relief of pain, and limited alternatives for chronic pain management have produced reliance on opioid medications with an inherent risk for aberrant behavior. Although standardization is lacking among prescribers who manage cancer-related pain, advanced practice RNs must act according to the available evidence that suggests assessing and monitoring for abuse and misuse. 
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