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1.
Res Sq ; 2024 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-38559202

RESUMO

Background: Nurse practitioners (NPs) increasingly deliver primary care in the United States. Yet, poor working conditions strain NP care. We examined whether racial/ethnic health disparities in ED visits among older adults with asthma are moderated by primary care NP work environments. Methods: Survey data on NP work environments in six states were collected from 1,244 NPs in 2018-2019. 2018 Medicare claims data from 46,658 patients with asthma was merged with survey data to assess the associations of all-cause and ambulatory care sensitive conditions (ACSC) ED visits with NP work environment and race/ethnicity using logistic regression. Results: NP work environment moderated the association of race (Black patients versus White patients) with all-cause (odds ratio [OR]: 0.91; p-value = 0.045) and ACSC (OR: 0.90; p-value = 0.033) ED visits. Conclusions: Disparities in ED visits between Black and White patients with asthma decrease when these patients receive care in care clinics with favorable NP work environments.

2.
Artigo em Inglês | MEDLINE | ID: mdl-38284964

RESUMO

INTRODUCTION: The pediatric nurse practitioner (PNP) workforce was designed to improve child health equity. We aimed to systematically review the evidence on facilitators and barriers to PNP practice. METHOD: We included empirical studies on PNP practice in the United States and excluded studies with non-identifiable PNP data. We applied Joanna Briggs Institute tools to appraise studies and applied critical interpretive synthesis principles to synthesize. RESULTS: The final sample is 26 studies, mostly published before 2013 and observational. Prescriptive privileges, training program availability, organizational climate, and telehealth are facilitators. Mandated physician supervision, reduced pediatric curricula, geographically disparate training programs, and poor data infrastructure are barriers. The sample is limited by a moderate to high risk of bias. DISCUSSION: Evidence suggests modifiable factors impact PNP practice and could have important implications for child health equity. We offer a theoretical model to guide robust research studying the PNP workforce and health equity.

3.
J Subst Use Addict Treat ; 157: 209285, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38159910

RESUMO

INTRODUCTION: The prevalence of substance use disorders (SUDs) is growing among older adults, and older adults in rural areas face disparities in access to SUD care. Rural older adults with SUDs commonly have comorbid chronic conditions that puts them at risk for frequent acute healthcare utilization. In rural areas, primary care for patients with SUDs are increasingly provided by nurse practitioners (NPs), and quality primary care services may decrease ED visits in this population. Yet, NP-delivered primary care for rural older adults with SUDs may be limited by work environment barriers, which include lack of support, autonomy, and visibility. This study assessed the relationship between the NP work environment and ED utilization among rural older adults with SUDs. METHODS: This was a secondary analysis of cross-sectional data from a large survey of NPs in six U.S. states merged with Medicare claims. The study measured the NP work environment by the four subscales of the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), which measure 1) independent practice and support, 2) NP-physician relations, 3) NP-administration, and 4) professional visibility. Multilevel logistic regression models, adjusted for practice and patient covariates, assess the relationship between the NP work environment and all-cause ED use. RESULTS: The sample included 1152 older adults with SUDs who received care at 126 rural NP primary care practices. NP independent practice and support at the practice was associated with 49 % lower odds of all-cause ED visits among older adults with SUDs. There were no relationships between the other NP-PCOCQ subscales and all-cause ED visits. CONCLUSIONS: Organizational support for NP independent practice is associated with lower odds of all-cause ED utilization among rural older adults with SUDs. Practice administrators should ensure that NPs have access to support and resources to enhance their ability to care for rural older adults with SUDs. Ultimately, these practice changes could reduce ED utilization and health disparities in this population.


Assuntos
Profissionais de Enfermagem , Transtornos Relacionados ao Uso de Substâncias , Idoso , Humanos , Estados Unidos/epidemiologia , Estudos Transversais , Atenção Primária à Saúde , Medicare , Inquéritos e Questionários , Condições de Trabalho , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
4.
Med Care Res Rev ; 80(6): 563-581, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37438917

RESUMO

Multiple chronic conditions (MCCs) are more common and costly than any individual health condition in the United States. The growing workforce of nurse practitioners (NPs) plays an active role in providing primary care to this patient population. This study identifies the effect of NP primary care models, compared with models without NP involvement, on cost, quality, and service utilization by patients with MCCs. We conducted a literature search of six databases and performed critical appraisal. Fifteen studies met inclusion criteria (years: 2003-2021). Overall, most studies showed reduced or similar costs, equivalent or better quality, and similar or lower rates of emergency department use and hospitalization associated with NP primary care models for patients with MCCs, compared with models without NP involvement. No studies found them associated with worse outcomes. Thus, NP primary care models, compared with models without NP involvement, have similar or positive impacts on MCC patient outcomes.


Assuntos
Múltiplas Afecções Crônicas , Profissionais de Enfermagem , Humanos , Estados Unidos , Hospitalização , Serviço Hospitalar de Emergência , Atenção Primária à Saúde
5.
Nurs Outlook ; 71(4): 101995, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37343483

RESUMO

BACKGROUND: The nurse practitioner (NP) workforce is key to meeting the demand for mental health services in primary care settings. PURPOSE: The purpose of this study is to synthesize the evidence focused on the effectiveness of NP care for patients with mental health conditions in primary care settings, particularly focused on primary care NPs and psychiatric mental health NPs and patients with anxiety, depression, and substance use disorders. METHODS: Studies published since 2014 in the United States studying NP care of patients with anxiety, depression, or substance use disorders in primary care settings were included. FINDINGS: Seventeen studies were included. Four high-quality studies showed that NP evidence-based care and prescribing were comparable to that of physicians. Seven low-quality studies suggest that NP-led collaborative care is associated with reduced symptoms. DISCUSSION: More high-quality evidence is needed to determine the effectiveness of NP care for patients with mental health conditions in primary care settings.


Assuntos
Serviços de Saúde Mental , Profissionais de Enfermagem , Transtornos Relacionados ao Uso de Substâncias , Humanos , Estados Unidos , Saúde Mental , Atenção Primária à Saúde
6.
Nurs Outlook ; 71(3): 101951, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36947974

RESUMO

BACKGROUND: Many professional nursing organizations have proposed that the Doctor of Nursing Practice (DNP) is the most appropriate entry-level degree for nurse practitioners (NPs). There have been no studies to date examining the impact of DNP preparation on quality of care or patient outcomes. PURPOSE: To examine differences in emergency department utilization and hospitalizations among patients with chronic conditions cared for by Master of Science in Nursing (MSN)- and DNP-prepared primary care NPs. METHODS: We use survey data from over 1,000 primary care NPs in 6 states linked to Medicare claims data. Using regression models, we controlled for various patient, NP, and practice characteristics that might confound the relationship. RESULS: We find that patient outcomes are not statistically different between patients attributed to MSN- and DNP-prepared primary care NPs. DISCUSSION: These findings suggest that there remains little evidence that DNP education has led to significant improvements in patient outcomes. CONCLUSIONS: Further empirical analysis related to the clinical outcomes other than health care utilization of the DNP degree is warranted. Future studies might consider examining (a) NPs in settings other than primary care, (b) practice-wide or system-wide outcomes, (c) other measures of care quality, and (d) impact of DNP program content.


Assuntos
Educação de Pós-Graduação em Enfermagem , Profissionais de Enfermagem , Idoso , Humanos , Estados Unidos , Medicare , Profissionais de Enfermagem/educação , Atenção Primária à Saúde , Doença Crônica
7.
Res Nurs Health ; 46(2): 263-273, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36611290

RESUMO

Primary care providers (PCPs) are well-positioned to provide care for opioid use disorder (OUD), yet very few address OUD regularly. One contributing factor may be PCPs' lack of confidence in their ability to effectively treat OUD. Evidence demonstrates that clinician confidence in home care and hospital settings is associated with improved care delivery and patient outcomes. However, a conceptual definition of PCP confidence in addressing OUD has yet to be established. The aim of this concept analysis is to enhance conceptual understanding of PCP confidence in addressing OUD and inform future measurement strategies. Following Walker and Avant's method of concept analysis, PubMed, PsycINFO, and Google Scholar were searched in October 2021. Manuscripts were included if they referenced confidence in relation to PCPs who provide care to adult patients with OUD. Studies conducted outside the US and not published in English were excluded. The search resulted in 18 studies which were synthesized to conceptualize PCP confidence in addressing OUD. Defining attributes include self-efficacy, experience, and readiness to address OUD. These attributes may be influenced by organizational culture, training, support, and resources. Consequences of PCP confidence addressing OUD may include improved patient outcomes, improved delivery of and access to OUD care, and PCP attitude changes. This concept analysis-which grounds the concept of PCP confidence in addressing OUD in the theoretical and empirical literature-lays the framework for future measurement of the concept. This represents a critical first step towards developing strategies to enhance PCP confidence in addressing OUD.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Adulto , Humanos , Transtornos Relacionados ao Uso de Opioides/terapia , Atenção à Saúde , Hospitais , Atenção Primária à Saúde
8.
J Ambul Care Manage ; 45(4): 289-298, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36006387

RESUMO

The nurse practitioner (NP) workforce in community health centers (CHCs) increases access to primary care for underserved populations. Working with medically complex patients, high workloads, and low resources in the CHC setting, CHC NPs may be susceptible to poor workforce outcomes. This study uses NP survey data collected from 6 US states to describe and assess the relationship between CHC NP practice environment and burnout, job satisfaction, and turnover intention. CHC NPs rated their practice environments favorably, and more than 89% of CHC NPs reported satisfaction with their job. Better rating of NPs' relationship with CHC administration was associated with improved job satisfaction and decreased turnover intention.


Assuntos
Profissionais de Enfermagem , Centros Comunitários de Saúde , Estudos Transversais , Humanos , Satisfação no Emprego , Reorganização de Recursos Humanos , Inquéritos e Questionários , Recursos Humanos
10.
J Sch Nurs ; : 10598405221116017, 2022 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-35880266

RESUMO

Rural adolescents with asthma are a disparate group. Self-management is essential to asthma control. We describe asthma knowledge, self-efficacy, and self-management behaviors among 198 rural adolescents with poorly controlled asthma, exploring demographic differences; we also test the application of Social Cognitive Theory to asthma self-management examining if self-efficacy mediates associations between knowledge and self-management. Asthma knowledge and self-management were relatively poor in our sample, particularly among male and White adolescents; greater knowledge was significantly associated with better symptom prevention and management. Self-efficacy partially mediated the association between knowledge and symptom prevention, but not acute symptom management, suggesting that knowledge may not improve symptom prevention behaviors without confidence to implement such behaviors and that factors beyond knowledge and self-efficacy likely play a role in asthma self-management in this population. Addressing asthma knowledge and self-efficacy could improve self-management and, ultimately, enhance asthma control among rural adolescents with poorly controlled asthma.

11.
Respir Med ; 200: 106897, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35714575

RESUMO

BACKGROUND: Adolescent asthma is highly prevalent and frequently uncontrolled despite control being achievable with good self-management. Anxiety, depression, and stress are associated with worse asthma outcomes, and may impact self-management; no previous review has examined this relationship. AIM: This scoping review assessed the nature of the current literature on mental health and asthma self-management among adolescents ages 11 to 24 and synthesized their relationships. METHODS: Guided by the PRISMA-ScR guidelines, we systematically searched the literature using MEDLINE, Embase, CINAHL, PsycInfo, and Scopus in September 2020 and updated it in June 2021. Included studies examined associations between anxiety, depression, and/or stress and asthma self-management in adolescents ages 11-24. We did not restrict study design, location, or date. RESULTS: Out of 1559 records identified, 14 met inclusion criteria. Types of self-management included trigger control, healthcare adherence, and overall symptom prevention and management. Anxiety symptoms were associated with poorer asthma self-management in four studies, but better in three. Depressive symptoms were associated with poorer asthma self-management in five studies, but better in two. Stress was associated with poorer self-management in one study. Mental health symptoms were nearly universally associated with poorer trigger control, but associations with healthcare adherence and overall symptom prevention and management varied. CONCLUSION: Mental health symptoms may facilitate or hinder asthma self-management depending on the types of mental health and self-management. Further research is needed to better understand this relationship and inform future interventions. Providers might assess mental health as a potential barrier to adolescent asthma self-management.


Assuntos
Asma , Autogestão , Adolescente , Adulto , Ansiedade/epidemiologia , Asma/epidemiologia , Asma/psicologia , Asma/terapia , Criança , Comportamentos Relacionados com a Saúde , Humanos , Saúde Mental , Adulto Jovem
12.
Nurs Outlook ; 70(3): 401-416, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35183357

RESUMO

BACKGROUND: The growing nurse practitioner (NP) workforce plays a critical role in primary care delivery in the United States. However, better recruitment and retention of the robust NP workforce in underserved areas are needed; evidence to inform such effort is limited. PURPOSE: This scoping review aimed to examine the findings, scope, and knowledge gaps of available literature on factors associated with NP recruitment and retention in underserved areas. METHODS: This review was guided by Joanna Briggs' Scoping Review Methodology and PRISMA-SCR reporting standards. Literature search for peer-reviewed and gray literature was conducted in six databases. FINDINGS: A total of 22 studies met inclusion criteria. Factors associated with NP recruitment and retention in underserved areas were mapped into five themes, including factors related to: the individual NP, NP education programs/financial aid, organizations employing NPs, the communities NPs work in, and autonomous practice. Majority of the included studies were published before 2010; few used rigorous study designs and analysis methods; and few exclusively studied NPs and unique challenges facing the NP workforce. DISCUSSION: Available studies demonstrate that NP recruitment and retention can be addressed by various stakeholders (e.g., educators, policy makers); however, up-to-date, methodologically rigorous, and NP-focused studies are needed.


Assuntos
Área Carente de Assistência Médica , Profissionais de Enfermagem , Humanos , Atenção Primária à Saúde , Estados Unidos , Recursos Humanos
13.
Ann Allergy Asthma Immunol ; 127(6): 661-666.e1, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34547441

RESUMO

BACKGROUND: Rural adolescents are vulnerable to asthma; good self-care can reduce morbidity. The subtypes of anxiety (eg, asthma-related, generalized) may have differential associations with asthma self-care. Low self-efficacy, a determinant of behavior, is associated with increased anxiety. Little is known regarding these relationships in rural adolescents. OBJECTIVE: To evaluate whether anxiety symptoms are associated with asthma symptom prevention and management among rural adolescents and whether self-efficacy mediates these relationships. METHODS: We used baseline data from 197 rural adolescents (mean age = 16 years; 69% girls; 62% Black) who were part of a trial that tested the effectiveness of a school-based asthma intervention. Adolescents completed the Youth Asthma-Related Anxiety Scale, Screen for Child Anxiety and Emotional Disorders, Asthma Management Self-efficacy Index, and Asthma Prevention and Management Indices. Linear regression was performed to test whether: (1) asthma-related and generalized anxiety had curvilinear relationships with self-care; (2) social and separation anxiety had linear relationships with self-care; and (3) self-efficacy mediated relationships. RESULTS: Asthma-related anxiety had a significant curvilinear relationship with prevention (P = 0.001) and a linear association with management (P = .01). Generalized anxiety had a significant curvilinear association with management (P = .03), whereas social anxiety had a significant linear relationship with prevention (P = .04). Self-efficacy partially or fully mediated these relationships. CONCLUSION: Anxiety symptoms were associated with asthma self-care among this sample of rural adolescents, with differing roles for prevention and management. Self-efficacy may be a mechanism to improve asthma self-care among rural adolescents with anxiety. With a lack of self-efficacy, asthma-related, generalized, or social anxiety may motivate adolescents to take steps to care for their asthma.


Assuntos
Ansiedade , Asma , Autocuidado , Autoeficácia , Adolescente , Ansiedade/epidemiologia , Asma/epidemiologia , Asma/psicologia , Feminino , Humanos , Masculino , População Rural
14.
J Occup Rehabil ; 29(1): 205-211, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29781055

RESUMO

Purpose Ability to return to work (RTW) after stroke has been shown to have positive psychosocial benefits on survivors. Although one-fifth of aneurysmal subarachnoid hemorrhage (aSAH) survivors suffer from poor psychosocial outcomes, the relationship between such outcomes and RTW post-stroke is not clear. This project explores the relationship between age, gender, race, marital status, anxiety and depression and RTW 3 and 12 months post-aSAH. Methods Demographic and clinical variables were collected from the electronic medical record at the time of aSAH admission. Anxiety and depression were assessed at 3 and 12 months post-aSAH using the State Trait Anxiety Inventory (STAI) and Beck's Depression Inventory-II (BDI-II) in 121 subjects. RTW for previously employed patients was dichotomized into yes/no at their 3 or 12 month follow-up appointment. Results Older age was significantly associated with failure to RTW at 3 and 12 months post-aSAH (p = 0.003 and 0.011, respectively). Female gender showed a trending but nonsignificant relationship with RTW at 12 months (p = 0.081). High scores of depression, State anxiety, and Trait anxiety all had significant associations with failure to RTW 12 months post-aSAH (0.007 ≤ p ≤ 0.048). At 3 months, there was a significant interaction between older age and high State or Trait anxiety with failure to RTW 12 months post-aSAH (p = 0.025, 0.042 respectively). Conclusions Patients who are older and suffer from poor psychological outcomes are at an increased risk of failing to RTW 1-year post-aSAH. Our interactive results give us information about which patients should be streamlined for therapy to target their psychosocial needs.


Assuntos
Ansiedade/psicologia , Depressão/psicologia , Retorno ao Trabalho/estatística & dados numéricos , Hemorragia Subaracnóidea/psicologia , Adulto , Fatores Etários , Ansiedade/complicações , Ansiedade/diagnóstico , Depressão/complicações , Depressão/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Retorno ao Trabalho/psicologia , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/reabilitação
15.
Biol Res Nurs ; 20(2): 177-182, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29258400

RESUMO

Survivors of aneurysmal subarachnoid hemorrhage (aSAH) often experience unfavorable functional outcomes that result in a reduced ability to independently perform activities of daily living. The apolipoprotein E gene ( APOE) encodes for a protein known to facilitate lipid transport and aid in neuronal repair within the central nervous system and to moderate the inflammatory response, making functional variations in this gene likely candidate biomarkers to predict outcomes following aSAH. In the present work, we examined the relationship between APOE genotype and the ability to perform activities of daily living as measured by the Barthel Index (BI) score at 3 months ( n = 298) and 12 months ( n = 288) following aSAH. APOE genotypes were determined using polymerase chain reaction followed by restriction digestion and gel electrophoresis and treated as binary variables depending on the presence or absence of alleles E4 and E2. Multiple logistic regression was used to determine whether APOE genotype accounted for variability in BI score after controlling for age, sex, and severity of clinical condition as measured by the Hunt and Hess classification. No significant association was found between the presence of allele E4 and BI score at 3 ( p = .20) or 12 months ( p = .29) or between the presence of allele E2 and BI score at 3 ( p = .23) or 12 months ( p = .86) after controlling for covariates. The results of this study do not support a relationship between APOE genotype and the ability to perform activities of daily living after aSAH.


Assuntos
Atividades Cotidianas , Aneurisma Roto/genética , Aneurisma Roto/fisiopatologia , Apolipoproteínas E/genética , Hemorragia Subaracnóidea/genética , Idoso , Alelos , Feminino , Genótipo , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , Hemorragia Subaracnóidea/fisiopatologia
16.
J Neurosci Nurs ; 49(3): 179-184, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28471926

RESUMO

OBJECTIVE: The aim of this study was to describe literature regarding the impact of psychosocial comorbidities on working capacity after aneurysmal subarachnoid hemorrhage (aSAH). DESIGN/METHODS: This study is a review of the literature using PubMed, CINAHL, PyschINFO, and Google Scholar. RESULTS: Patients with aSAH affected by depression, anxiety, cognitive impairment, or posttraumatic stress disorder are less likely to return to work, although there are mixed results. These may be due to inconsistent inclusion, adjustment of demographic and clinical variables shown to be associated with return to work, and differences in instrumentation and sample size. CONCLUSIONS: Working capacity after aSAH is likely affected by poor psychosocial outcomes, but future research should consider the standardization of demographic and clinical data, use standardized measurement tools, and consider the interrelatedness between psychosocial comorbidities.


Assuntos
Comorbidade , Retorno ao Trabalho , Hemorragia Subaracnóidea/complicações , Transtornos Cognitivos/etiologia , Humanos , Recuperação de Função Fisiológica , Transtornos de Estresse Pós-Traumáticos/etiologia , Hemorragia Subaracnóidea/psicologia
17.
Oncol Nurs Forum ; 42(2): 156-64, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25806882

RESUMO

PURPOSE/OBJECTIVES: To explore the literature to examine the physical, social, psychological, financial, usability, and feasibility outcomes of Web-based interventions on caregivers of people with cancer and to identify potential trends in this body of evidence. DATA SOURCES: PubMed, CINAHL®, PsycINFO®, and Inspec. DATA SYNTHESIS: Six articles met inclusion criteria. Across studies, most caregivers were middle-aged female spouses with some college attendance who felt "somewhat comfortable" using the Internet. Caregiver interventions used single- and multicomponent services and reduced negative mood. CONCLUSIONS: Web-based caregiver interventions can be beneficial in offering information and support and may positively influence the social and psychological outcomes in this population. IMPLICATIONS FOR NURSING: Many studies described caregiver Internet usage and interventional perceptions and needs, but few have examined the impact of web-based interventions on caregivers. More research is needed to produce high-quality evidence in this population.


Assuntos
Cuidadores/psicologia , Internet , Neoplasias , Adaptação Psicológica , Adulto , Afeto , Idoso , Cuidadores/estatística & dados numéricos , Alfabetização Digital , Escolaridade , Família , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Papel (figurativo) , Apoio Social , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia
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