An academic-health department partnership to expand adolescent access to care and FNP student clinical experiences.

More than 90,000 qualified applicants were rejected from nursing schools in 2021 due in part to the national shortage of nurse practitioner (NP) preceptors and clinical placements. One model that has the potential to address this shortage by enhancing and expanding NP clinical training sites is the academic-practice partnership. In this article, the authors describe the development of a novel academic-practice partnership between a college of nursing and a health department and report the outcomes of a partnership activity that provided wellness visits for adolescents. Through this partnership, the graduate nursing program increased adolescent-focused clinical experiences for family nurse practitioner students by 87.6 h; added one adolescent clinical site for nine NP students; and delivered a total of 34 school and sports physicals, 81 immunizations, and 65 screening tests for adolescent-aged clients. Through this feasible, mutually beneficial, and innovative academic-practice partnership, the graduate nursing program and health department successfully expanded clinical placement experiences for NP students and improved access to wellness care for adolescents. The partnership model can be utilized to not only expand clinical opportunities for NP students but also improve access to care and health outcomes for our local communities.

Integrating the 4Ps in masters-level nursing education.

BACKGROUND: The curriculum for our generalist masters in nursing program required a heavy credit load of science courses shared with the nurse practitioner programs. The bundle of required courses far exceeded the masters in nursing program completion outcomes, increasing tuition costs and prolonging the program of study for students who were not seeking advanced practice credentials. PURPOSE: The purpose of this project was to streamline the curriculum and better align course content with MS program expected learning outcomes, student learning needs, and recent accreditation requirements. PROCESS: Course expected learning outcomes were drafted and mapped to program expected learning outcomes and AACN The Essentials: Core Competencies for Professional Nursing Education (2021) concepts and sub-competencies. A two-course series totaling 5 credits was developed to integrate the 4Ps (pathophysiology, pharmacology, physical/health assessment, and health promotion) into an online master's level nursing curriculum while decreasing the total number of credits. OUTCOMES: A total of 67 students successfully completed the online courses during the first semester. Minor revisions based on student feedback were made after the first implementation. CONCLUSIONS: Integrating the 4Ps into a series of two courses is a feasible option for streamlining a generalist masters in nursing curriculum.

Outcomes of postgraduate fellowships and residencies for nurse practitioners: An integrative review.

BACKGROUND: In 2011, the Institute of Medicine published a report on the future of nursing, which recommended nurse practitioner postgraduate training in the form of fellowships or residencies. Since then, the number of postgraduate programs has grown, but data is still scarce regarding their efficacy and benefits. AIM: The goal of this integrative review is to synthesize available literature regarding the outcomes of nurse practitioner postgraduate fellowships and/or residencies on clinical competence and perceived readiness to practice. METHODS: CINAHL, PubMed, and citation searching were used to search relevant subject headings, MeSH headings, and keywords related to fellowships and residencies for nurse practitioners, resulting in 11 articles being included based on inclusion and exclusion criteria. Synthesis was completed using the Garrard Matrix method to identify common themes among the studies. RESULTS: Eight quasi-experimental and three cross-sectional studies were included in this review. Programs included multiple areas of focus, including primary care, critical care, and pediatric acute care. Common themes among the studies were an increased level of preparedness, reduced turnover, and greater job satisfaction. CONCLUSIONS: The major theme found among the studies was an increased confidence and preparedness to practice. Minor themes include increased job satisfaction and decreased intent to quit.

Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review.

BACKGROUND: Advanced practice providers (APPs), including physician assistants/associates (PAs), nurse practitioners (NPs) and other non-physician roles, have been developed largely to meet changing healthcare demand and increasing workforce shortages. First introduced in primary care in the US, APPs are prevalent in secondary care across different specialty areas in different countries around the world. In this scoping review, we aimed to summarise the factors influencing the development, recruitment, integration, retention and career development of APP roles in hospital health care teams. METHODS: We conducted a scoping review and searched Ovid MEDLINE, Ovid Embase, Ovid Global Health, Ovid PsycINFO and EBSCOhost CINAHL to obtain relevant articles published between Jan 2000 and Apr 2023 that focused on workforce management of APP roles in secondary care. Articles were screened by two reviewers independently. Data from included articles were charted and coded iteratively to summarise factors influencing APP development, recruitment, integration, retention and career development across different health system structural levels (macro-, meso- and micro-level). RESULTS: We identified and analysed 273 articles that originated mostly from high-income countries, e.g. the US (n = 115) and the UK (n = 52), and primarily focused on NP (n = 183) and PA (n = 41). At the macro-level, broader workforce supply, national/regional workforce policies such as work-hour restrictions on physicians, APP scope of practice regulations, and views of external collaborators, stakeholders and public representation of APPs influenced organisations' decisions on developing and managing APP roles. At the meso-level, organisational and departmental characteristics, organisational planning, strategy and policy, availability of resources, local experiences and evidence as well as views and perceptions of local organisational leaders, champions and other departments influenced all stages of APP role management. Lastly at the micro-level, individual APPs' backgrounds and characteristics, clinical team members' perceptions, understanding and relationship with APP roles, and patient perceptions and preferences also influenced how APPs are developed, integrated and retained. CONCLUSIONS: We summarised a wide range of factors influencing APP role development and management in secondary care teams. We highlighted the importance for organisations to develop context-specific workforce solutions and strategies with long-term investment, significant resource input and transparent processes to tackle evolving healthcare challenges.

Implementation of Full Practice Authority for Nurse Practitioners in Massachusetts: Impact of Organizational Climate on Practice Change.

OBJECTIVE: The aim of this study was to examine the relationship between nurse practitioner (NP) organizational climate and the implementation of full practice authority (FPA) for NPs. BACKGROUND: In 2021, Massachusetts passed FPA for NPs. Most NPs did not experience changes to their practice. It is unknown whether NP organizational climate impacts implementation of FPA. METHODS: A Web-based survey was distributed to NPs in Massachusetts. RESULTS: Response rate was 50.3% (N = 147). Practice remained unchanged for most. Organizations with more favorable climates experienced more rapid implementation of FPA, resulting in improved efficiency (P = 0.049) and timeliness (P = 0.007) of care. Nurse practitioners outside hospital systems were more likely to report favorable organizational climates and positive change to their practice after FPA. CONCLUSIONS: Organizations that facilitate implementation of FPA are likely to experience improvement in efficiency and timeliness of patient care. Nursing leadership, especially within hospital-based organizations, can help achieve these benefits by improving the organizational climate for NPs.

Validação de vídeos educativos sobre manejo da dor e prevenção da adição por opioides / Validation of educational video on pain management and prevention of oopioid addiction / Validación de vídeo educativo sobre manejo del dolor y prevención de la adicción a opioides

Objetivo:validar vídeos educativospara os profissionais de Enfermagem sobre avaliação e manejo da dor em adultos, assim como risco de adição por opioides. Método:estudo metodológico, realizado nos anos de 2020 e 2021, agregando as técnicas de designinstrucional e validação de conteúdo por especialistas e usuários, com avaliação por meio do Índice de Validade de Conteúdo Total, considerando válido valor igual ou superior a 0,78. Resultados:o vídeo 1 foi 'Avaliação da dor' e o vídeo 2 'Tratamento da dor e prevenção da adição a opioides', com índices dos especialistas de 0,89 e 0,97, e dos usuários de 0,95 e 0,98, respectivamente. Conclusão:os vídeos educativos produzidos e validados neste estudo são uma estratégia para a qualificação dos profissionais da enfermagem, propiciando conhecimento e aprimorando as habilidades técnicas, buscando melhoria na qualidade assistencial

Objective:to validate educational videos for Nursing professionals on the assessment and management of pain in adults, as well as the risk of opioid addiction. Method:methodological study, carried out in 2020 and 2021, combining instructional design and content validation techniques by experts and users, with evaluation using the Total Content Validity Index, considering a valid value equal to or greater than 0.78. Results:video 1 was 'Pain assessment' and video 2 'Pain treatment and prevention of opioid addiction', with experts' index of 0.89 and 0.97, and users' index of 0.95 and 0.98, respectively. Conclusion:the educational videos produced and validated in this study are a strategy for qualifying nursing professionals, providing knowledge and improving technical skills, seeking to improve the quality of care.

Objetivo:validar videos educativos para profesionales de Enfermería sobre la evaluación y manejo del dolor en adultos, así como el riesgo de adicción a opioides.Método: estudio metodológico, realizado en 2020 y 2021, combinando técnicas de diseño instruccional y validación de contenidos por expertos y usuarios, con evaluación mediante el Índice de Validez Total de Contenido, considerando un valor válido igual o mayor a 0,78.Resultados: el video 1 fue 'Evaluación del dolor' y el video 2 'Tratamiento del dolor y prevención de la adicción a opioides', con índices de expertos de 0,89 y 0,97, y de usuarios de 0,95 y 0,98, respectivamente.Conclusión: los videos educativos producidos y validados en este estudio son una estrategia para capacitar a los profesionales de enfermería, brindando conocimientos y mejorando habilidades técnicas, buscando mejorar la calidad de la atención

Habilidades e competências da equipe de enfermagem na técnica de mensuração da pressão arterial / Nursing team skills and competencies in blood pressure measurement technique / Habilidades y competencias del equipo de enfermería en la técnica de medición de presión arterial

Objetivo: verificar as competências e habilidades da equipe de enfermagem na mensuração da pressão arterial. Método: estudo observacional e quantitativo. A amostra foi de 34 profissionais de enfermagem (17 enfermeiros e 17 técnicos de enfermagem) de um hospital de pequeno porte no segundo semestre de 2021. Os dados foram coletados através de um checklistvalidado, aplicando adequado e inadequado de acordo com a execução da técnica, os dados foram tabulados no programa Microsoft Excel. Resultados: quanto aosenfermeiros, nenhum mediu a circunferência do braço, selecionou manguito adequado ou estimou a pressão sistólica e apenas 6,8% palparam a artéria braquial. Quanto aos técnicos de enfermagem, nenhum mediu a circunferência do braço ou estimou a pressão sistólica, apenas 5,8% selecionaram o manguito adequado e 17,6% palparam a artéria braquial. Conclusões: os profissionais de enfermagem tiveram dificuldades na execução da técnica de mensuração da pressão arterial, denotando a necessidade de educação permanente.

Objective: to verify the skills and abilities of the nursing team in measuring blood pressure. Method: observational and quantitative study. The sample consisted of 34 nursing professionals (17 nurses and 17 nursing technicians) from a small hospital in the second half of 2021. Data were collected using a validated checklist, with appropriate and inadequate classifications based on the execution of the technique. The data were then tabulated in the Microsoft Excel program.Results: regarding the nurses, none measured the arm circumference, selected an appropriate cuff, or estimated the systolic pressure, and only 6.8% palpated the brachial artery. As for the nursing technicians, none of them measured the arm circumference or estimated the systolic pressure, only 5.8% selected the appropriate cuff, and 17.6% palpated the brachial artery. Conclusions: nursing professionals encountered difficulties in performing the blood pressure measurement technique, indicating the need for ongoing education.

Objetivo:verificar las habilidades y habilidades del equipo de enfermería en la medición de la presión arterial. Método:estudio observacional y cuantitativo. La muestra fue de 34 profesionales de enfermería (17 enfermeros y 17 técnicos de enfermería) de un pequeño hospital en el segundo semestre de 2021. Los datos se recolectaron mediante una lista de verificación validada, aplicando apropiado e inadecuado según al ejecutar la técnica, los datos fueron tabulados. Resultados:ninguno enfermero midió la circunferencia del brazo, seleccionó un manguito adecuado, ni estimó la presión sistólica y sólo el 6,8% palpó la arteria humeral. En cuanto a los técnicos de enfermería, ninguno midió la circunferencia del brazo ni estimó la presión sistólica, sólo el 5,8% seleccionóel manguito adecuado y el 17,6% palpó la arteria braquial. Conclusiones:los profesionales de enfermería tuvieron dificultades en la realización de la medición de presión arterial, denotando la necesidad de educación continua.

Therapeutic management of atopic dermatitis.

ABSTRACT: Atopic dermatitis (AD), a chronic inflammatory, pruritic skin disorder, is seen primarily in the pediatric population but can be found among all age groups. The symptoms of AD can cause embarrassment in patients and can interrupt daily activities and productivity, potentially resulting in avoidance of social situations. In addition to nonpharmacologic management, mainstay pharmacologic treatments for AD are topical medications including corticosteroids, calcineurin inhibitors, phosphodiesterase-4 inhibitors, and topical Janus kinase (JAK) inhibitors. Promising new drugs-oral JAK inhibitors and monoclonal antibodies-have emerged as new treatment options for moderate-to-severe AD.

An update on COPD prevention, diagnosis, and management: The 2024 GOLD Report.

ABSTRACT: Chronic obstructive pulmonary disease (COPD) is one of the top three causes of death throughout the world. Because of the preventable and treatable nature of the disease along with its prevalence, COPD represents a major public health challenge. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report provides a review of the most current evidence for prevention of COPD as well as the assessment, diagnosis, and treatment of people with the disease. The purpose of this article is to provide a summary of the 2024 revised GOLD Report and current best practices in accordance with the evidence.

Animal and human bites: Navigating evaluation and care.

ABSTRACT: Patients who have experienced animal or human bites may present for care in a number of settings with a variety of injuries requiring different approaches to treatment and management. Because animal and human bites range in severity and can result in a host of sequelae, their evaluation and management can be complex. In caring for patients with an animal or human bite, NPs must consider the many factors relevant to such an injury.

Advanced nurse practitioner well-being: A 4-year cohort mixed methods study.

AIMS: To examine changes in advanced nurse practitioner (ANP) well-being, satisfaction and motivation over a four-year period. DESIGN: Longitudinal Cohort study. METHODS: Surveys were carried out each year from 2019 to 2022 with the same cohort of ANPs in the United Kingdom (UK). The survey consisted of demographics, questions on contemporary issues in advanced practice, National Health Service (NHS) staff survey questions and validated questionnaires. A core set of questions were asked every year with some changes in response to the COVID-19 pandemic. RESULTS: Response rate ranged from 40% to 59% and appeared to be affected by COVID-19. Staff satisfaction with pay and the well-being score were stable throughout. Other questions on well-being, job satisfaction and motivation saw statistically significant reductions after 4 years. Open-ended questions about ongoing well-being concerns show participants are concerned about exhaustion levels caused by workload, staffing issues, abuse from patients and colleagues' mental health. CONCLUSION: The findings highlight a decline in ANP well-being, job satisfaction and motivation post-COVID-19. Reasons for this, explored in the qualitative data, show that ANPs have faced extremely difficult working conditions. Urgent action is required to prevent a workforce retention crisis as many nursing staff are close to retirement and may not be motivated to remain in post. IMPACT: This study has followed ANPs through the most challenging years the NHS has ever seen. Job satisfaction, motivation and enjoyment of the job all significantly reduced over time. In many areas, the ANP role has been used to fill medical workforce gaps, and this will become harder to do if ANPs are dissatisfied, disaffected and struggling with stress and burnout. Addressing these issues should be a priority for policymakers and managers. PATIENT OR PUBLIC CONTRIBUTION: None as this study focussed on staff. Staff stakeholders involved in the design and conduct of the study.

Hypertension management in chronic kidney disease: A guide for NPs.

ABSTRACT: This article offers a guide for NPs for managing hypertension (HTN) in adults in the setting of chronic kidney disease (CKD). It outlines evidence-based strategies, including lifestyle modifications, pharmacologic interventions, and patient education measures, that can be used in patients with CKD to optimize BP control. Special considerations, such as comorbid mental health conditions and individualized treatment plans, are also addressed. NPs play a pivotal role in improving outcomes by fostering patient engagement and adherence. By embracing this holistic approach, NPs are poised to enhance the quality of care and well-being of patients with CKD and HTN.

Enhancing sleep quality for adult patients: Interventions and insights.

ABSTRACT: Sleep is critical to a person's physiological and psychological functioning. Approximately 30% to 40% of the general population experiences insomnia, and among patients with mental health conditions, the prevalence of insomnia and other sleep disturbances rises to about 70%. Insomnia is associated with many adverse health issues, including lower immunity, weight gain, elevated BP, and increased mortality, and it is often undiagnosed and either untreated or self-treated. Providers can work together with patients to enact measures-such as implementation of enhanced sleep hygiene, engagement in cognitive behavioral therapy, and treatment of any underlying causes-that can markedly improve patient sleep quality. This article provides an overview of evidence-based best practices and whole-person strategies that NPs can adopt to address poor sleep quality in adult patients, and it serves as a primer for primary care NPs on common presentations of several sleep disorders.