Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 19.128
Filtrar
2.
Crit Care Nurs Clin North Am ; 34(4): 491-500, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36336438

RESUMO

The need for a workforce able to address the health care needs of older adults has been well established. Individuals with kidney disease experience an extensive number of transitions of care across health care settings related to the kidney disease process and the number of health care providers involved in their care. Kidney disease is multifactorial, and the prevention of progression of disease and poor outcomes are key to improving the health of individuals with kidney disease. Nurses and nurse practitioners can improve the outcomes for individuals with complex comorbid conditions and kidney disease especially during the transitions of care.


Assuntos
Nefropatias , Nefrologia , Profissionais de Enfermagem , Humanos , Idoso , Atenção à Saúde , Pessoal de Saúde
3.
Adv Chronic Kidney Dis ; 29(6): 534-538, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36371118

RESUMO

There is no consistent educational model to introduce the physician assistant and/or nurse practitioner to nephrology. The job descriptions of the nephrology physician assistant/nurse practitioner may be similar, but the training, state and federal licensing, background, and recertification are different for the 2 professions adding a level of complexity to the training of the physician assistant/nurse practitioner new to nephrology. On-the-job training is the most common modality, but formats, content, mentors, and practices vary from organization to organization and even within organizations. The advantage of on-the-job training is its flexibility while the disadvantage is its nonspecific outcomes. As nephrology practices vary widely and range from single provider private practices to multiprovider academic practices, it is difficult if not impossible to develop a generic orientation model. This article outlines the history and present state of postgraduate educational offerings for the physician assistant/nurse practitioner and provides insight into components of an ideal training program.


Assuntos
Nefrologia , Profissionais de Enfermagem , Assistentes Médicos , Humanos , Assistentes Médicos/educação , Profissionais de Enfermagem/educação
4.
J Prim Care Community Health ; 13: 21501319221136938, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36373693

RESUMO

INTRODUCTION: In 2007, the first formal postgraduate nurse practitioner (NP) residency program was launched at Community Health Center, Inc., a large Federally Qualified Health Center in Connecticut, and focused on primary care and community health. There are numerous post-graduate nurse practitioner training programs across the nation, and many more are under development. Although the literature describes the impact of postgraduate residency training programs on new NPs' early practice transition, to date, no studies have examined the long-term impact of postgraduate NP training programs on alumni's career choices, practice, and satisfaction. This study sought to understand the impact over time of Community Health Center Inc.'s postgraduate NP residency program on the subsequent career paths of alumni who completed the program between 2008 and 2019. Additionally, it explored alumni's current reflections on the impact of their postgraduate residency training on their transition to the post-residency year and beyond, as well as their professional development and career choices. Moreover, it sought to identify any previously undocumented elements of impact for further exploration in subsequent studies. METHODS: This was a retrospective cohort study that used an electronic survey and interviews. All 90 of the alumni who had completed Community Health Center Inc.'s residency between 2008 and 2019 were invited to participate. RESULTS: The survey's response rate was 72%. Most (74%) of the participating alumni indicated they were still practicing as primary care providers. Of these, 57% were practicing at FQHCs. Nine subthemes were identified from the interviews, with an overarching theme that the program was foundational to a successful career in community-based primary care and that the impact of the program continues to evolve. CONCLUSION: Community Health Center Inc.'s postgraduate NP residency program had a long-standing impact on alumni's commitment to continuing in primary care practice, as well as their engagement in leadership activities to ensure quality care.


Assuntos
Internato e Residência , Profissionais de Enfermagem , Humanos , Estudos Retrospectivos , Centros Comunitários de Saúde , Liderança
5.
J Dr Nurs Pract ; 15(3): 150-156, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36351766

RESUMO

Problem: The Advance Practice Registered Nurses (APRNs) employed by the Veterans Health Administration (VHA) lack race-based trauma training for Veterans that have experienced psychological, physiological, and emotional trauma. The VHA is responsible for the health of this culturally diverse patient population with complex health conditions. APRNs without prior military experience may have trouble obtaining an accurate history and physical exam due to their inexperience with the military's cross-cultural environment. This quality improvement pilot project aimed to incorporate race-based trauma training into a new adult geriatric acute care nurse practitioner's (AGACNP) fellowship curriculum. The study question is: In acute geriatric acute care nurse practitiioner's, what are the effects of race-based trauma training on competency and confidence in providing care to Veterans when hospitalized? Methods: A prospective descriptive design utilized a purposeful sample of senior adult-geriatric nurse practitioner (AGNP) students, due to the unforeseen circumstances of not hiring AGACNPs s for this pilot, for the first 6-weeks of a new acute care fellowship pilot program. Outcome measures included evaluating skills in identifying racial differences and confidence in applying culturally sensitive care. Results: Participant (N = 3) self-reported confidence increased by .33 (20%) in providing culturally competent and race-based trauma care, and an improvement in identifying race-based differences by .33 (17%) at completion of the pilot. Implications: Results indicated improvement in confidence and competence when providing race-based trauma care within 6 weeks. Continued training and evaluation throughout the 12-month fellowship are recommended.


Assuntos
Serviços Médicos de Emergência , Profissionais de Enfermagem , Veteranos , Adulto , Humanos , Idoso , Projetos Piloto , Profissionais de Enfermagem/educação , Currículo
6.
J Nurs Educ ; 61(11): 624-632, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36343192

RESUMO

BACKGROUND: In most nursing schools, Holocaust and genocide studies are not part of the curriculum. However, studying past horrors involving health care professionals is essential for forming a clear moral compass to navigate future nursing practice. This article analyzes a unique Holocaust and genocide curriculum for graduate nurse practitioner students and its effects on participants. METHOD: The students wrote reflective accounts, which were analyzed using qualitative content analysis. RESULTS: The studies had a profound effect on the students, who adopted a critical perspective and became more sensitive to wrongdoing and social suffering, more involved in current ethical and social issues, and more willing to engage in social advocacy. The course strengthened the moral responsibility of the students, transforming them into critical intellectuals. CONCLUSION: Holocaust and genocide studies enhance nurses' humanistic approach and help them confront dogma, challenge social denial, and resist oppression, discrimination, and structural racism. [J Nurs Educ. 2022;61(11):624-632.].


Assuntos
Educação em Enfermagem , Genocídio , Holocausto , Profissionais de Enfermagem , Estudantes de Enfermagem , Humanos , Profissionais de Enfermagem/educação , Currículo
7.
J Am Assoc Nurse Pract ; 34(8): 978-990, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-36330551

RESUMO

BACKGROUND: Transitioning to advanced practice, novice nurse practitioners need to take on new roles, learn new practice areas, and develop new skills. This process requires breaking old practices and work habits and facing new challenges. PURPOSE: To explore the nature of nurse practitioners' work experiences during the first year of transition from registered nurse to nurse practitioner. METHODS: This qualitative study was based on Husserl's phenomenological methodology. A purposive sample of 16 first-year nurse practitioners was recruited. Data were collected through in-depth interviews and analyzed by thematic content analysis. The approaches of Lincoln & Guba were applied to improve the validity of the study. RESULTS: Results showed that the first-year experience of transitioning from registered nurse to nurse practitioner fell into two overarching themes: challenge and adjustment. The challenge consists of five subthemes: "facing the expectation-reality gap," "managing others' expectations," "striving to acquire professional skills," "handling situational variability," and "bearing emotional burdens" subthemes. The adjustment includes five subthemes: "finding resources," "gaining experiences," "building relationships," "relieving stress," and "overcoming obstacles." IMPLICATIONS FOR PRACTICE: Novice nurse practitioners face many challenges as they adjust to a new role during their first year on the job. New nurse practitioners develop coping strategies to help themselves adjust to their work. They also gradually gain new resources and experiences to help them stay positive in stressful situations and restore work-life balance. The challenges of transitioning from a registered nurse to a nurse practitioner cannot be overlooked. Novice nurse practitioners need appropriate support measures to adapt to advanced practice roles.


Assuntos
Profissionais de Enfermagem , Humanos , Profissionais de Enfermagem/psicologia , Pesquisa Qualitativa
8.
J Am Assoc Nurse Pract ; 34(8): 1022-1032, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-36330553

RESUMO

BACKGROUND: It is increasingly imperative that organizational leaders continually assess nurse practitioners' (NPs) and physician assistants' (PAs) productivity, turnover, and vacancies. Optimizing the feasibility, impact, strategic placement, and monitoring increases patient access, improves wait times and affordability, and increases revenue. LOCAL PROBLEM: A healthcare system needed a systematic, data-driven approach aimed at optimizing productivity and placement of NPs and PAs in outpatient primary care sites. METHOD: Results from this project are reported using the Revised Standards for Quality Improvement Reporting Excellence framework. After formation of a QI team, a gap analysis, and action plans were developed and implemented. INTERVENTION/RESULTS: Priority areas requiring action included the development of an integrated position justification algorithm and tracking form addressing NPs' and PAs' placement, establishing consistent patient contact hours, setting workload expectations, and consistently communicating these via an organization-specific situation background, assessment, and recommendation communication tool. CONCLUSION: Health care leaders should leverage the talents of NPs and PAs meeting organizational benchmarks and goals as well as the needs of patients. Nurse practitioner and PA leaders should focus on benchmarking performance and analyzing barriers to optimization. These efforts are most beneficial when multidisciplinary in nature.


Assuntos
Profissionais de Enfermagem , Assistentes Médicos , Humanos , Pacientes Ambulatoriais , Eficiência , Atenção Primária à Saúde
9.
J Am Assoc Nurse Pract ; 34(8): 957-962, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-36330550

RESUMO

BACKGROUND: Atrial fibrillation is a cardiac rhythm disorder associated with embolic stroke risk, decreased functional capacity, and worsening quality of life. Increasing patient access to atrial fibrillation specialists via telemedicine has the potential to improve patient outcomes. OBJECTIVES: The purpose of this systematic review was to describe atrial fibrillation telehealth education treatment programs unrelated to postablation or early detection of atrial fibrillation. DATA SOURCES: PubMed and CINAHL databases were searched using key terms identified by the authors and informed by a panel of clinicians with expertise in cardiac electrophysiology. CONCLUSIONS: Little literature exists on educational telehealth programs for atrial fibrillation treatment unrelated to postablation or early detection of atrial fibrillation. Only three studies met our inclusion criteria. Three themes emerged from review of these studies: (a) atrial fibrillation requires specialty care that is difficult to obtain; (b) comprehensive atrial fibrillation education should include a broad overview of the condition, management options, stroke prevention, and symptom management; and (c) telemedicine is effective for diagnosing and managing atrial fibrillation. IMPLICATIONS FOR PRACTICE: Telemedicine clinics for atrial fibrillation represent an emerging form of clinically important health care delivery. These clinics can potentially decrease wait time for specialty care access, reduce unnecessary emergency department visits, reduce stroke risk, and increase guideline adherence. Nurse practitioners are well suited to create and lead telemedicine atrial fibrillation clinics with relevant clinical expertise and collaborative skills.


Assuntos
Fibrilação Atrial , Profissionais de Enfermagem , Acidente Vascular Cerebral , Telemedicina , Adulto , Humanos , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Qualidade de Vida , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle
11.
Br J Nurs ; 31(21): 1104-1110, 2022 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-36416635

RESUMO

The establishment of advanced nurse practitioners (ANPs) has expanded considerably in recent years and shown to result in substantial contributions to numerous fields of health care. Due to advancements in treatments and innovations in medicine, patients with cancer are living longer, requiring a multifactorial holistic approach in which ANPs, due to their skills and knowledge, can be best utilised, as they are able to provide the expert care required at various stages of the patient journey. This article explores scopes of practice from ANPs working with oncology patients in a tertiary cancer centre, making explicit their roles, in addition to highlighting experienced challenges and future directions of care.


Assuntos
Neoplasias , Profissionais de Enfermagem , Humanos , Neoplasias/terapia
12.
BMC Med Educ ; 22(1): 781, 2022 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-36371179

RESUMO

BACKGROUND: The availability of new immuno-oncology therapeutics markedly impacts oncology clinicians' treatment decision-making. To effectively support healthcare professionals (HCPs) in their practice, it is important to better understand the challenges and barriers that can accompany the introduction of these agents. This study aimed to establish the types and causes of clinical challenges posed by the introduction of new immuno-oncology agents. METHODS: The mixed-methods design included qualitative in-depth interviews and group discussions with HCPs, in which participants discussed clinical challenges and potential underlying reasons for these challenges. Qualitative findings informed a quantitative survey. This survey investigated the extent and distribution of challenges using HCPs' self-rating of knowledge, skill, confidence, and exposure to system-level effects. These two phases were conducted sequentially with distinctly stratified samples of oncologists, nurse practitioners (NPs), physician assistants (PAs), pathologists, clinical pharmacists, interventional radiologists, rheumatologists, pulmonologists, and emergency department physicians. Participants were from the United States and had various levels of clinical experience and represented both academic and community-based settings. RESULTS: The final sample included 107 HCPs in the qualitative phase and 554 in the quantitative phase. Analyses revealed clinical challenges related to the use of pharmacodiagnostics. For example, 47% of pathologists and 42% of oncologists reported skill gaps in identifying the appropriate marker and 46% of oncologists, 61% of PAs, 66% of NPs, 74% of pulmonologists and 81% of clinical pharmacists reported skill gaps in selecting treatment based on test results. Challenges also emerged regarding the integration of immuno-oncology agents, as oncologists, rheumatologists, pulmonologists, clinical pharmacists, PAs, and NPs reported knowledge gaps (74-81%) of the safety profiles of recently approved agents. In addition, 90% of clinical pharmacists reported skill gaps weighing the risks and benefits of treating patients with immuno-oncology agents while affected by lupus. Finally, patient communication challenges were identified: HCPs reported difficulties discussing essential aspects of immunotherapy to patients as well as how they might compare to other types of therapies. CONCLUSION: The challenges highlighted in this study reveal substantial educational gaps related to the integration of immuno-oncology agents into practice for various groups of HCPs. These findings provide a strong base of evidence for future educational initiatives.


Assuntos
Neoplasias , Profissionais de Enfermagem , Humanos , Oncologia , Neoplasias/tratamento farmacológico , Pessoal de Saúde , Comunicação
13.
Adv Skin Wound Care ; 35(12): 646-652, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36409187

RESUMO

GENERAL PURPOSE: To provide information on the surgical management of fungating malignancies as a distinct wound entity. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Identify characteristics of patients in a study examining the treatment of fungating malignancies.2. Select common symptoms experienced by patients with fungating malignancies.3. Explain issues related to the surgical treatment of fungating malignancies.4. Identify a reason why patients with fungating breast masses may avoid medical care.


To address the literature gap on malignant fungating wound treatment by reporting two institutions' experiences with this disease process and proposing practices to improve care. A multi-institutional retrospective review was conducted of 44 patients with 45 malignant fungating wounds over an 11-year period. Patient characteristics, treatment history, and outcomes were analyzed. Of the 44 patients who met the inclusion criteria, 31 (70.5%) were women and 13 (29.5%) were men. The average age at presentation was 63.0 (SD, 16.1) years. The most common malignancy was breast cancer, accounting for more than half of cases (54.5%). The average surface area of the tumors at presentation was 110.3 (SD, 215.0; range, 2.2­1,140) cm2, whereas the average surface area at time of discharge/death was 104.6 (SD, 310.7; range, 0­1,800) cm2. Neither surface area at presentation (P = .504) nor surface area at time of final follow-up (P = .472) were significantly associated with death during the study time frame. In the era of advancing technologies and medical innovation, the benefits of palliative surgery, which helps mitigate an open wound, should not be overlooked. Improving end-of-life care is beneficial to the patient and families alike. As surgeons, we strive for a tangible cure, but providing palliative resection to enable death with dignity might be the most humane service of all.


Assuntos
Neoplasias , Profissionais de Enfermagem , Humanos , Cicatrização , Pele
14.
J Nurs Adm ; 52(12): 687-689, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36409264

RESUMO

This column highlights 5 key categories in which nurse practitioners continually strive for excellence: practice, education, advocacy, research, and leadership, also known as "PEARL."


Assuntos
Liderança , Profissionais de Enfermagem , Humanos
17.
J Am Assoc Nurse Pract ; 34(11): 1216-1224, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36367241

RESUMO

BACKGROUND: Telemental health services grew during the COVID pandemic, resulting in psychiatric-mental health nurse practitioner students obtaining clinical hours through this modality. Although patient outcome data demonstrate the efficacy of telemental health services, data on the efficacy of learning through telehealth clinical experiences are lacking. PURPOSE: To explore perceptions of learning through telehealth clinical experiences by students, preceptors, and faculty and to identify perceived barriers and facilitators to facilitating telehealth clinical experiences. METHODOLOGY: Mixed-methods exploratory study using web-based, researcher-designed, cross-sectional surveys eliciting perceptions of learning and perceived barriers and facilitators to telemental health clinical experiences sent to current and former PMHNP students and their preceptors of a state university in the southwest along with PMHNP faculty in the National Organization of Nurse Practitioner Faculties. Students and preceptors were offered the option to participate in a semistructured interview. RESULTS: Twenty students (35.7%), 22 preceptors (24.7%), and 19 faculty (25.3%) participated in the surveys. Three preceptors and three students volunteered for interviews. Telemental health clinicals were perceived by students as equivalent to or superior to in-person learning. Preceptors rated the teaching/learning environment through telemental health as equivalent or better as compared with in-person clinicals with two exceptions. Faculty-rated greatest barrier to telemental health clinicals was telephone visits because of technology issues. CONCLUSIONS: Telemental health clinicals can provide a high-quality learning experience for students. IMPLICATIONS: Preceptors should be provided with resources for facilitating telemental health clinicals. Ongoing discussions regarding the number of clinical hours recommended through telehealth are needed.


Assuntos
COVID-19 , Profissionais de Enfermagem , Humanos , Preceptoria , Estudos Transversais , Profissionais de Enfermagem/educação , Estudantes
18.
Rev Mal Respir ; 39(10): 822-831, 2022 Dec.
Artigo em Francês | MEDLINE | ID: mdl-36371331

RESUMO

INTRODUCTION: While pulmonary rehabilitation is registered in the COPD management guidelines with a high level of evidence, it is not adequately performed in accordance with patients' needs. Advanced nurse practitioners (IPA, in French) provide expertise enabling improved access and enhanced implementation of rehabilitation programs. Based on foreign experience, the present study has been designed to propose avenues for the development of more effective practices in France. METHODS: Using Google Scholar and Pubmed databases, a search algorithm was used to identify international publications from 2003 to 2022 dealing with the role of nurse practitioners (IP, in French) in respiratory rehabilitation for COPD patients. RESULTS: Fourteen articles, mainly from English-speaking countries, were analysed. The involvement of nurse practitioners in pulmonary rehabilitation is very broad-based, their main missions being initial disease assessment, therapeutic education, improved professional sensitivity and patient follow-up at all stages of a rehabilitation program. CONCLUSION: Nurse practitioners have a major role in the implementation of pulmonary rehabilitation programs for COPD patients. Their involvement at different levels can improve access and success of programs over time.


Assuntos
Profissionais de Enfermagem , Doença Pulmonar Obstrutiva Crônica , Humanos , Profissionais de Enfermagem/educação , Doença Pulmonar Obstrutiva Crônica/terapia , França/epidemiologia
19.
JAMA Netw Open ; 5(10): e2239068, 2022 10 03.
Artigo em Inglês | MEDLINE | ID: mdl-36287559

RESUMO

Importance: In 2021, New Mexico passed legislation allowing nurse practitioners and physician assistants (referred to herein as advanced practice professionals [APPs]) to prescribe medications for medical aid in dying (MAID). Other US states with existing MAID laws (eg, Washington) are also considering expanding MAID prescribing authority to APPs. There is a lack of research exploring APP knowledge of, willingness to, and comfort with acting as a prescribing or consulting clinician for MAID. Objective: To assess perspectives of oncology APPs regarding MAID, including their willingness to prescribe and/or consult for MAID and factors associated with willingness. Design, Setting, and Participants: This cross-sectional, self-report survey study used data collected from APPs working at a comprehensive cancer center in Washington State in fall 2021. Main Outcomes and Measures: The primary survey question was whether APPs would be willing to participate in death with dignity, the term used for MAID in Washington. Survey questions evaluated how influential specific factors were on APP views on MAID as well as respondents' knowledge of and comfort with aspects of the MAID process. Results: Of 167 eligible APPs, 77 (46.1%) responded to the survey. Most respondents (68 [88.3%]) reported their race and ethnicity as White; 72 (93.5%) identified as a woman. Medical oncology (28 [36.4%]) was the most common field of practice, and 21 respondents (27.3%) reported having practiced as an APP for 6 to 10 years. Of all respondents, 61 (79.2%) reported having at least 1 patient who inquired about MAID; depending on the question, less than a third of respondents (5.0%-27.0%) endorsed feeling knowledgeable or very knowledgeable about any aspect of the MAID process. In this study, 39 APPs (50.6%) endorsed being willing to participate in MAID either as a consulting or prescribing clinician, whereas 31 (40.3%) were uncertain of whether they would participate. Willingness to participate was associated with having had more patients pursue MAID (33 of the 39 willing participants [84.6%] vs 15 of the 31 unsure participants [48.4%] reported having 1 or more patients pursue MAID). Higher knowledge and comfort scores were both significantly associated with increased odds of being willing to participate (odds ratio, 1.14 per 1-point score increase [95% CI, 1.03-1.27]; P = .01) vs unsure (1.18 [95% CI, 1.07-1.30; P = .001). Conclusions and Relevance: The results of this survey study suggest that oncology APPs may require preparation for the addition of MAID to their scope of practice. This study also raises questions for future research regarding support for APPs who may be considering participation in MAID but question their role or want physician involvement.


Assuntos
Profissionais de Enfermagem , Assistentes Médicos , Suicídio Assistido , Feminino , Humanos , Estudos Transversais , Oncologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...