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1.
BMC Cancer ; 21(1): 236, 2021 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-33676431

RESUMO

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) negatively affects physical function and chemotherapy dosing, yet, clinicians infrequently document CIPN assessment and/or adhere to evidence-based CIPN management in practice. The primary aims of this two-phase, pre-posttest study were to explore the impact of a CIPN clinician decision support algorithm on clinicians' frequency of CIPN assessment documentation and adherence to evidence-based management. METHODS: One hundred sixty-two patients receiving neurotoxic chemotherapy (e.g., taxanes, platinums, or bortezomib) answered patient-reported outcome measures on CIPN severity and interference prior to three clinic visits at breast, gastrointestinal, or multiple myeloma outpatient clinics (n = 81 usual care phase [UCP], n = 81 algorithm phase [AP]). During the AP, study staff delivered a copy of the CIPN assessment and management algorithm to clinicians (N = 53) prior to each clinic visit. Changes in clinicians' CIPN assessment documentation (i.e., index of numbness, tingling, and/or CIPN pain documentation) and adherence to evidence-based management at the third clinic visit were compared between the AP and UCP using Pearson's chi-squared test. RESULTS: Clinicians' frequency of adherence to evidence-based CIPN management was higher in the AP (29/52 [56%]) than the UCP (20/46 [43%]), but the change was not statistically significant (p = 0.31). There were no improvements in clinicians' CIPN assessment frequency during the AP (assessment index = 0.5440) in comparison to during the UCP (assessment index = 0.6468). CONCLUSIONS: Implementation of a clinician-decision support algorithm did not significantly improve clinicians' CIPN assessment documentation or adherence to evidence-based management. Further research is needed to develop theory-based implementation interventions to bolster the frequency of CIPN assessment and use of evidence-based management strategies in practice. TRIAL REGISTRATION: ClinicalTrials.Gov, NCT03514680 . Registered 21 April 2018.


Assuntos
Antineoplásicos/efeitos adversos , Tomada de Decisão Clínica/métodos , Técnicas de Apoio para a Decisão , Neoplasias/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/diagnóstico , Adulto , Idoso , Algoritmos , Medicina Baseada em Evidências/normas , Estudos de Viabilidade , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/terapia , Assistentes Médicos/estatística & dados numéricos , Médicos/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Qualidade de Vida , Índice de Gravidade de Doença , Inquéritos e Questionários/estatística & dados numéricos
2.
N Z Med J ; 133(1523): 29-40, 2020 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-33032301

RESUMO

AIM: The aim of the survey was to describe the demographics, distribution, clinical settings and employment arrangements of the New Zealand nurse practitioner workforce in primary healthcare settings; and organisational factors limiting their practice. METHOD: An online survey was developed and sent to all NPs in mid-2019. RESULTS: The survey was completed by 160 nurse practitioners who worked in settings broadly defined as primary healthcare (response rate 71.4%). In addition to clinical work, nurse practitioners engaged in teaching and clinical supervision; leadership and management; policy development; locum work; and research; but 14% continued to do at least some work as a registered nurse. One hundred and fifty-one respondents were working clinically and 48% of these worked in more than one clinical setting. General practice-type settings (39%), of which over 40% were very low-cost access practices, and aged residential care (19%) were most commonly identified as the main clinical setting. Others included long-term conditions; mental health and addiction; sexual health/family planning; whanau ora; child/youth health; and various community nursing service roles. Seventy-three percent of nurse practitioners earned less than $120,000 per annum for full-time work; and 60% had $2,000 or less available for professional development. Three quarters had worked in the same setting for at least two years, and 60% intended to stay a further three years. Fourteen percent worked rurally. Employment models, models of care, and access to diagnostics, particularly radiology, were most limiting to their practice. CONCLUSION: The nurse practitioner workforce offers stability and flexibility in working across multiple clinical settings in primary healthcare. They provide the potential solution to the general practitioner workforce shortage by improving access to primary healthcare and reducing health inequalities. As authorised prescribers able to enrol patients, receive capitation payments and claim general medical services, it is timely to facilitate the expansion of the nurse practitioner workforce in New Zealand.


Assuntos
Profissionais de Enfermagem/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Recursos Humanos/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Inquéritos e Questionários
3.
Med Care ; 58(10): 934-941, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925417

RESUMO

BACKGROUND: Primary care practices increasingly include nurse practitioners (NPs), in addition to physicians. Little is known about how the patient mix and clinical activities of colocated physicians and NPs compare. OBJECTIVES: To describe the clinical activities of NPs, compared with physicians. RESEARCH DESIGN: We used claims and electronic health record data from athenahealth Inc., on primary care practices in 2017 and a cross-sectional analysis with practice fixed effects. SUBJECTS: Patients receiving treatment from physicians and NPs within primary care practices. MEASURES: First, we measured patient characteristics (payer, age, sex, race, chronic condition count) and visit characteristics (new patient, scheduled duration, same-day visit, after-hours visit). Second, we measured procedures performed and diagnoses recorded during each visit. Finally, we measured daily quantity (visit volume, minutes scheduled for patient care, total work relative value units billed) of care. RESULTS: Relative to physicians, NPs treated younger and healthier patients. NPs also had a larger share of patients who were female, non-White, and covered by Medicaid, commercial insurance, or no insurance. NPs scheduled longer appointments and treated more patients on a same-day or after-hours basis. On average, "overlapping" services-those performed by NPs and physicians within the same practice-represented 92% of all service volume. The small share of services performed exclusively by physicians reflected greater clinical intensity. On a daily basis, NPs provided fewer and less intense visits than physicians within the same practice. CONCLUSIONS: Our findings suggest considerable overlap between the clinical activities of colocated NPs and physicians, with some differentiation based on intensity of services provided.


Assuntos
Profissionais de Enfermagem/estatística & dados numéricos , Padrões de Prática em Enfermagem/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Adolescente , Adulto , Idoso , Registros Eletrônicos de Saúde , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Medicaid , Pessoa de Meia-Idade , Estados Unidos
5.
Nurs Outlook ; 68(5): 601-610, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32620272

RESUMO

BACKGROUND/PURPOSE: The patient-centered medical home (PCMH) is an enhanced model of primary care. This study examined to what extent nurse practitioner (NP)-led PCMHs differed from traditional physician-led PCMHs. METHODS: We tested for differences between 391 NP-led PCMHs and 11,479 physician-led PCMHs, as well as across two distinct clusters identified by the Two-Step cluster analysis procedure using a sample of 136 practices. FINDINGS: NP-led PCMHs were more likely to serve vulnerable populations in rural and underserved areas than physician-led PCMHs. NP-led PCMHs tended to be more responsive to population health needs in the areas during the recognition process, while physician-led PCMHs emphasized practice improvements through enhanced access to care and management of patient information data. DISCUSSION: The findings suggest possible differences in capabilities, priorities and needs of the population served across practices. This is an important guide as policymakers track the adoption of PCMHs.


Assuntos
Área Carente de Assistência Médica , Profissionais de Enfermagem/estatística & dados numéricos , Assistência Centrada no Paciente/organização & administração , Médicos/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Registros Eletrônicos de Saúde , Humanos , Profissionais de Enfermagem/provisão & distribução , Médicos/provisão & distribução , Serviços de Saúde Rural
6.
Nurs Outlook ; 68(5): 611-625, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32713732

RESUMO

BACKGROUND: Internationally, most studies have focused on quality and safety in long-term care. However, studies focusing on the economic evaluation of quality and security in long-term care are sparse. Moreover, the economic evaluation of nurse practitioner care in long-term care is lacking, particularly in Québec Canada where roles are new. PURPOSE: To evaluate the effectiveness of introducing nurse practitioners in six long-term care facilities in Québec using a cost-savings analysis in terms of reduction of nurse practitioner sensitive events (NPSEs). METHODS: A cost savings analysis was completed using a prospective observational study. All residents (n = 538) under the care of teams that included nurse practitioners who experienced at least one of the following NPSEs: falls, pressure ulcers, short-term transfers, and a change in the time needed to administer the medications consumed were included. Data were collected from September 1st 2015 to August 31st 2016. Descriptive statistics identified numbers of cases for falls, pressure ulcers, short-term transfers, and the number of medications consumed. A literature analysis was used to estimate excess median long-term care facility related costs of these NPSEs. Costs were calculated in 2016 Canadian dollars. The cost savings with the reductions that occurred for falls, pressure ulcers, short term transfers, and the time needed to administer medications after the implementation of a primary healthcare nurse practitioner role in the six long term care facilities were also estimated. FINDINGS: The median cost of 341 cases of falls, 32 cases of pressure ulcers and 53 cases of short-term transfers in the six long-term facilities would range between CAD 4,516,337.8 and CAD 5,281,824.4. Moreover, the total costs savings from the reduction of adverse events including the reduction of nursing administration time for medications would be between CAD 1,942,533.6 and CAD 3,254,403.4. DISCUSSION: This is the first study to present the financial consequence of adverse events sensitive to nurse practitioner care in long-term care. Important cost savings were generated from the reduction of adverse events after the implementation of nurse practitioner roles in long-term care. Government should consider these results for prevention and improvements in quality and safety in long-term care.


Assuntos
Redução de Custos/economia , Análise Custo-Benefício , Assistência de Longa Duração , Profissionais de Enfermagem/estatística & dados numéricos , Atenção Primária à Saúde , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Papel do Profissional de Enfermagem , Casas de Saúde , Estudos Prospectivos , Quebeque
7.
Nurs Outlook ; 68(5): 591-600, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32622648

RESUMO

BACKGROUND: The delivery of emergency, trauma, critical, and intensive care services requires coordination among all members of the care team. Perceived teamwork and role clarity may vary among physicians (MDs) and nurse practitioners (NPs). PURPOSE: To examine differences in perceived roles and responsibilities of NPs and MDs practicing in emergency, trauma, critical, and intensive care. METHODS: Secondary Analysis of the National Survey of Emergency, Intensive, and Critical Care Nurse Practitioners and Physicians, a cross-sectional national survey of clinicians. Mail survey of randomly selected stratified cross-sectional samples of MDs and NPs drawn from national lists of clinicians in eligible specialties working in emergency, trauma, intensive, and critical care units in the United States. 814 clinicians (351 NPs and 463 MDs) were recruited from national by postal mail survey. Our initial sample included n = 2,063 clinicians, n = 1,031 NPs and n = 1,032 MDs in eligible specialties. Of these, 63.5% of NPs and 70.1% of MDs completed and returned the survey excluding those who were ineligible due to lack of current practice in a relevant specialty. FINDINGS: NPs in ICU/CCU are more likely to be female and report working fewer hours than do MDs and provide direct care to more patients. 55% of NPs and 82% of MDs agree that their individual role in their unit is clear (p < .001); 34% of MDs and 42% of NPs agree that their unit is an example of excellent team work among professionals (p = 0.021); 41% of MD and 37% of NP clinicians (p = 0.061) agree that their teams are "prepared to provide outstanding care in a crisis or disaster." Perceived role clarity was significantly associated with increased perceptions of excellent teamwork and disaster preparedness. DISCUSSION: At the time of this survey, and majority of NPs and MDs working in emergency, critical and intensive care did not agree that their teams were prepared for a crisis or disaster. Leaders of health organizations should encourage teamwork and professional role clarity to assist units to perform effectively in emergency and disaster preparedness.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Profissionais de Enfermagem/estatística & dados numéricos , Papel do Profissional de Enfermagem , Médicos/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos
8.
Nurs Outlook ; 68(4): 459-467, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32593462

RESUMO

BACKGROUND: Full practice authority laws that permit nurse practitioners (NPs) to practice independently and prescribe medications may influence NPs' workforce outcomes. PURPOSE: To examine whether implementation of full practice authority laws affect NP self-employment, average earnings, and likelihood of residing in a primary care health professional shortage area (HPSA). METHODS: A nationally representative U.S. sample of 9,782 NPs employed in health care during 2010 to 2018 was drawn from the American Community Survey. Difference-in-differences regression was used to estimate covariate-adjusted mean differences in NPs' workforce outcomes after full practice authority implementation. FINDINGS: Among full-time employed NPs, full practice authority was associated with an increased probability of residing in a HPSA (adjusted odds ratio [aOR]:2.34, 95%CI 1.14, 4.83) and with a higher mean probability of self-employment (aOR:4.97, 95%CI 1.00, 24.86). DISCUSSION: Full practice authority implementation improves access to primary care providers in health professional shortage areas and may increase practice ownership among NPs.


Assuntos
Profissionais de Enfermagem/estatística & dados numéricos , Profissionais de Enfermagem/normas , Autonomia Profissional , Competência Profissional/estatística & dados numéricos , Competência Profissional/normas , Papel Profissional , Recursos Humanos/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
9.
Med Care ; 58(8): 681-688, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32265355

RESUMO

OBJECTIVE: The objective of this study was to compare health care utilization and costs among diabetes patients with physician, nurse practitioner (NP), or physician assistant (PA) primary care providers (PCPs). RESEARCH DESIGN AND METHODS: Cohort study using Veterans Affairs (VA) electronic health record data to examine the relationship between PCP type and utilization and costs over 1 year in 368,481 adult, diabetes patients. Relationship between PCP type and utilization and costs in 2013 was examined with extensive adjustment for patient and facility characteristics. Emergency department and outpatient analyses used negative binomial models; hospitalizations used logistic regression. Costs were analyzed using generalized linear models. RESULTS: PCPs were physicians, NPs, and PAs for 74.9% (n=276,009), 18.2% (n=67,120), and 6.9% (n=25,352) of patients respectively. Patients of NPs and PAs have lower odds of inpatient admission [odds ratio for NP vs. physician 0.90, 95% confidence interval (CI)=0.87-0.93; PA vs. physician 0.92, 95% CI=0.87-0.97], and lower emergency department use (0.67 visits on average for physicians, 95% CI=0.65-0.68; 0.60 for NPs, 95% CI=0.58-0.63; 0.59 for PAs, 95% CI=0.56-0.63). This translates into NPs and PAs having ~$500-$700 less health care costs per patient per year (P<0.0001). CONCLUSIONS: Expanded use of NPs and PAs in the PCP role for some patients may be associated with notable cost savings. In our cohort, substituting care patterns and creating similar clinical situations in which they practice, NPs and PAs may have reduced costs of care by up to 150-190 million dollars in 2013.


Assuntos
Diabetes Mellitus/economia , Pessoal de Saúde/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Diabetes Mellitus/psicologia , Feminino , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem/economia , Profissionais de Enfermagem/normas , Profissionais de Enfermagem/estatística & dados numéricos , Assistentes Médicos/economia , Assistentes Médicos/normas , Assistentes Médicos/estatística & dados numéricos , Médicos/economia , Médicos/normas , Médicos/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Estados Unidos , United States Department of Veterans Affairs/economia , United States Department of Veterans Affairs/organização & administração , United States Department of Veterans Affairs/estatística & dados numéricos
10.
J Am Assoc Nurse Pract ; 32(3): 187-189, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32132455

RESUMO

Academic and health care institutions are charged with improving quality-of-care outcomes by creating culturally educated health care professionals to practice in a global health care environment. International short-term service learning experiences provide nurse practitioner students an opportunity to meet clinical competency skills aligned with course curricula. Faculty can directly observe students' clinical practice, and students broaden diagnostic reasoning skills while earning credit for clinical hours. As project and research ideas are formulated, students develop system-level thinking to implement evidence-based practices and disseminate their knowledge and experience of caring for the underserved. Students who participate in service-learning opportunities foster their awareness of cultural humility, easing transition into practice. Some academic institutions established short-term service-learning opportunities for students, and evidence supports faculty and students' sense of well-being after participation. We describe an example of a short-term, international service-learning opportunity in Haiti where students work with an interprofessional team and experience the effect of social determinants of health on delivering quality care.


Assuntos
Competência Cultural/psicologia , Educação Continuada em Enfermagem/métodos , Internacionalidade , Profissionais de Enfermagem/educação , Estudantes de Enfermagem/psicologia , Humanos , Profissionais de Enfermagem/psicologia , Profissionais de Enfermagem/estatística & dados numéricos , Estudantes de Enfermagem/estatística & dados numéricos , Ensino/psicologia , Ensino/normas
11.
J Am Assoc Nurse Pract ; 32(3): 200-217, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32132457

RESUMO

BACKGROUND: Competency-based education (CBE) has been recommended for nurse practitioner (NP) education. To implement CBE, existing NP core competencies need to be reduced in number and refined. PURPOSE: This study refined and reduced redundancy in the National Organization of Nurse Practitioner Faculties (NONPF) and the American Association of Colleges of Nursing (AACN) NP core competencies through the consensus of experts in NP practice. This study used the current NP Core Competencies (NONPF, 2017), the Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006), and the Common Advanced Practice Registered Nurse Doctoral-Level Competencies (AACN, 2017a) because these documents are the competencies-accredited NP programs commonly used in curriculum development. The primary aim of this study was to refine and reduce redundancy of these competencies; a secondary aim was to ensure that the final competencies were clear and measurable. METHODS: A Delphi approach was used to reach consensus among an expert panel who reviewed the core competencies via an online questionnaire. Descriptive statistics were used to calculate median and interquartile ranges; content analysis was conducted with qualitative data. RESULTS: Consensus was reached after 3 rounds and resulted in 49 final core competencies. IMPLICATIONS FOR PRACTICE: This study provides the NP community with a manageable list of relevant, clear, and measurable competencies that faculty members can use to implement CBE in their programs.


Assuntos
Competência Clínica/estatística & dados numéricos , Educação de Pós-Graduação em Enfermagem/métodos , Profissionais de Enfermagem/educação , Currículo/normas , Currículo/tendências , Técnica Delfos , Educação de Pós-Graduação em Enfermagem/tendências , Humanos , Profissionais de Enfermagem/normas , Profissionais de Enfermagem/estatística & dados numéricos , Inquéritos e Questionários
12.
J Prof Nurs ; 36(1): 62-68, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32044056

RESUMO

BACKGROUND: Doctoral-prepared nurses with diverse skillsets are required to meet nursing care needs in a complex and changing healthcare environment. A better understanding of the roles of doctoral-prepared nurses in Veterans Health Administration (VHA) workforce will help leverage their expertise to meet the needs of Veterans. PURPOSE: Assess the current roles of doctoral-prepared nurses within the VHA. METHOD: A cross-sectional survey was used to collect information on doctoral-prepared nurses within the VHA in 2016. Multiple strategies were used to identify doctoral-prepared nurses to recruit for an online survey. Survey invitations were sent electronically to unique individuals identified (N = 2403). RESULTS: Responses were received from 1015 nurses (42.2% response rate), with 929 nurses with a doctoral degree identified. DNP/DNAP degrees were most common (55%), followed by a PhD or DNS (33%). Significant differences were noted between nurses in different doctoral education categories across four main roles: research, clinical, educational, and administration. CONCLUSIONS: This survey generated the first comprehensive list of VHA doctoral-prepared nurses. Findings are being used by the VHA Office of Nursing Services to align degree types, duties of different positions, functional statements, and position expectations. Results support the continued need for collaboration between nurses with PhDs and DNPs to achieve research and clinical goals.


Assuntos
Assistência à Saúde , Educação de Pós-Graduação em Enfermagem , Papel do Profissional de Enfermagem , Objetivos Organizacionais , United States Department of Veterans Affairs , Estudos Transversais , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos , Saúde dos Veteranos
13.
PLoS One ; 15(2): e0228372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32027686

RESUMO

Social media is increasingly utilized as a resource in healthcare. We sought to identify perceptions of using social media as an educational tool among healthcare practitioners. An electronic survey was distributed to healthcare administrators, nurses, nurse practitioners, pharmacists, physicians, and physician assistants f hospital systems and affiliated health science schools in Georgia, Maryland, South Carolina, and Wisconsin. Survey questions evaluated respondents' use and views of social media for educational purposes and workplace accessibility using a Likert scale (1 = strongly disagree, 5 = strongly agree). Nurses (75%), pharmacists (11%), and administrators (7%) were the most frequent respondents. Facebook® (27%), Pinterest® (17%), and Instagram® (17%) were the most frequently accessed social media platforms. Nearly 85% agreed or strongly agreed that social media can be an effective tool for educational purposes. Among those who had social media platforms, 43.0% use them for educational purposes. Pinterest® (30%), Facebook® (22%), LinkedIn® (16%), and Twitter® (14%) were most frequently used for education. About 50% of respondents had limited or no access to social media at work. Administrators, those with unlimited and limited work access, and respondents aged 20-29 and 30-39 years were more likely to agree that social media is an educational tool (OR: 3.41 (95% CI 1.31 to 8.84), 4.18 (95% CI 2.30 to 7.60), 1.66 (95% CI 1.22 to 2.25), 4.40 (95% CI 2.80 to 6.92), 2.14 (95% CI 1.53 to 3.01) respectively). Residents, physicians, and those with unlimited access were less likely to agree with allowing social media access at work for educational purposes only. Healthcare practitioners frequently utilize social media, and many believe it can be an effective educational tool in healthcare.


Assuntos
Educação Continuada/métodos , Pessoal de Saúde , Percepção , Mídias Sociais , Adulto , Feminino , Georgia/epidemiologia , Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Humanos , Disseminação de Informação/métodos , Internato e Residência/estatística & dados numéricos , Masculino , Maryland/epidemiologia , Profissionais de Enfermagem/educação , Profissionais de Enfermagem/psicologia , Profissionais de Enfermagem/estatística & dados numéricos , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Assistentes Médicos/educação , Assistentes Médicos/psicologia , Assistentes Médicos/estatística & dados numéricos , Médicos/psicologia , Médicos/estatística & dados numéricos , Mídias Sociais/normas , South Carolina/epidemiologia , Inquéritos e Questionários , Wisconsin/epidemiologia , Adulto Jovem
14.
Adv Skin Wound Care ; 33(3): 1-11, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32058443

RESUMO

OBJECTIVE: To conduct a meta-analysis of the literature on training programs that aimed to improve nurses' pressure injury management skills. METHODS: Literature searches were conducted using Ovid-MEDLINE, Cochrane Library, CINAHL, and Korean databases. The search terms used were: (nurse* AND ((pressure OR decubitus) AND (ulcer* OR injur*)) OR bed sore OR bedsore OR decubitus) AND (program* OR training)). Random-effects models were used to calculate the standardized mean difference and odds ratios, with 95% confidence intervals (CIs) to analyze the effects. MAIN RESULTS: Initial searches yielded 1,067 studies. Of these, 23 met the selection criteria. Nurses' knowledge (standard mean difference, 1.23; 95% CI, 0.50-1.96; P < .001), visual discrimination ability (standard mean difference, 1.13; 95% CI, 0.88-1.38; P < .001), and clinical judgment (odds ratio, 1.52; 95% CI, 1.46-1.57; P < .001) improved after the programs. CONCLUSIONS: Pressure injury training programs can improve nurses' competency. The results from this study indicate that such programs may help improve nurses' knowledge, visual discrimination ability, and clinical judgment and can be considered continuing education programs. However, large-scale studies are needed to confirm this conclusion.


Assuntos
Educação em Enfermagem/métodos , Profissionais de Enfermagem/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Lesão por Pressão/enfermagem , Ferimentos e Lesões/enfermagem , Competência Clínica , Feminino , Humanos , Masculino , Papel do Profissional de Enfermagem , Lesão por Pressão/diagnóstico , Estados Unidos
15.
Health Serv Res ; 55(3): 476-485, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32101334

RESUMO

OBJECTIVE: To assess the impact of nonphysician providers on measures of spatial access to primary care in Iowa, a state where physician assistants and advanced practice registered nurses are considered primary care providers. DATA SOURCES: 2017 Iowa Health Professions Inventory (Carver College of Medicine), and minor civil division (MCD) level population data for Iowa from the American Community Survey. STUDY DESIGN: We used a constrained optimization model to probabilistically allocate patient populations to nearby (within a 30-minute drive) primary care providers. We compared the results (across 10 000 scenarios) using only primary care physicians with those including nonphysician providers (NPPs). We analyze results by rurality and compare findings with current health professional shortage areas. DATA COLLECTION/EXTRACTION METHODS: Physicians and NPPs practicing in primary care in 2017 were extracted from the Iowa Health Professions Inventory. PRINCIPAL FINDINGS: Considering only primary care physicians, the average unallocated population for primary care was 222 109 (7 percent of Iowa's population). Most of the unallocated population (86 percent) was in rural areas with low population density (< 50/square mile). The addition of NPPs to the primary care workforce reduced unallocated population by 65 percent to 78 252 (2.5 percent of Iowa's population). Despite the majority of NPPs being located in urban areas, most of the improvement in spatial accessibility (78 percent) is associated with sparsely populated rural areas. CONCLUSIONS: The inclusion of nonphysician providers greatly reduces but does not eliminate all areas of inadequate spatial access to primary care.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Profissionais de Enfermagem/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Médicos de Atenção Primária/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Atitude do Pessoal de Saúde , Humanos , Iowa , Características de Residência/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Estados Unidos
16.
Health Serv Res ; 55(2): 178-189, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31943190

RESUMO

OBJECTIVE: To examine whether nurse practitioner (NP)-assigned patients exhibited differences in utilization, costs, and clinical outcomes compared to medical doctor (MD)-assigned patients. DATA SOURCES: Veterans Affairs (VA) administrative data capturing characteristics, outcomes, and provider assignments of 806 434 VA patients assigned to an MD primary care provider (PCP) who left VA practice between 2010 and 2012. STUDY DESIGN: We applied a difference-in-difference approach comparing outcomes between patients reassigned to MD and NP PCPs, respectively. We examined measures of outpatient (primary care, specialty care, and mental health) and inpatient (total and ambulatory care sensitive hospitalizations) utilization, costs (outpatient, inpatient and total), and clinical outcomes (control of hemoglobin A1c, LDL, and blood pressure) in the year following reassignment. PRINCIPAL FINDINGS: Compared to MD-assigned patients, NP-assigned patients were less likely to use primary care and specialty care services and incurred fewer total and ambulatory care sensitive hospitalizations. Differences in costs, clinical outcomes, and receipt of diagnostic tests between groups were not statistically significant. CONCLUSIONS: Patients reassigned to NPs experienced similar outcomes and incurred less utilization at comparable cost relative to MD patients. NPs may offer a cost-effective approach to addressing anticipated shortages of primary care physicians.


Assuntos
Assistência à Saúde/economia , Profissionais de Enfermagem/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Médicos de Atenção Primária/economia , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/economia , Adulto , Assistência à Saúde/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medicina Militar/economia , Medicina Militar/estatística & dados numéricos , Profissionais de Enfermagem/estatística & dados numéricos , Médicos de Atenção Primária/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estados Unidos
17.
Adv Skin Wound Care ; 33(1): 12-19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31856028

RESUMO

GENERAL PURPOSE: To provide information about changes associated with aging skin and the implications for wound care practitioners. 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 should be better able to:1. Describe proposed biologic theories of aging and the biology of aging skin.2. Discuss the clinical consequences of aging skin and the implications for wound care practitioners. ABSTRACT: Aging is a complex phenomenon manifested by macromolecular damage, adverse changes to the genome, blunted immunologic function, alterations in body composition, and decreased adaptation to stress. Understanding the changes that skin undergoes with age is essential for wound care practitioners. Accordingly, this article will introduce the reader to theories of aging, the biologic changes associated with aging skin, and clinical considerations for the wound care practitioner, including the concepts of skin failure, Skin Changes At Life's End, and frailty.


Assuntos
Profissionais de Enfermagem/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Equipe de Assistência ao Paciente/organização & administração , Envelhecimento da Pele/genética , Envelhecimento da Pele/fisiologia , Ferimentos e Lesões/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fragilidade , Pessoal de Saúde/organização & administração , Serviços de Saúde para Idosos/estatística & dados numéricos , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Medição de Risco , Cicatrização/fisiologia , Ferimentos e Lesões/fisiopatologia
18.
Nurse Educ Pract ; 42: 102687, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31841811

RESUMO

Acute care nurse practitioners (ACNPs) require special training and educational preparation to meet their role expectations. Using high fidelity simulation with debriefing modalities is considered one of the innovative learning strategies in graduate nursing. No studies have investigated debriefing modalities in nurse practitioner programs specially ACNPs leadership skills. The purpose of this study was to examine the difference in students' knowledge, code team leader skills and self-efficacy using two debriefing modalities. A two group, pretest-posttest quasi-experimental design was used. Students were divided into video-assisted debriefing group vs. verbal debriefing following a simulation scenario of managing emergency codes. There were no significant differences between the two groups in knowledge acquisition/retention, leadership skills, and self-efficacy, but there was a significant difference in self-efficacy in both groups between two-time points. There was a general improvement in teams' performance. Students preferred verbal debriefing over video-assisted debriefing. The debriefing session plays an important role in graduate nursing education. Acute care nurse practitioners are lacking a formal leadership training to meet their advanced role. Nurse Educators, and simulation/debriefing leaders may benefit from our study results to develop a structured, formal curriculum and educational instruction focusing on acute care nurse practitioners' role change especially leading a resuscitation team.


Assuntos
Arritmias Cardíacas/enfermagem , Retroalimentação , Liderança , Estudantes de Enfermagem/psicologia , Adulto , Educação de Pós-Graduação em Enfermagem/métodos , Feminino , Humanos , Masculino , Profissionais de Enfermagem/educação , Profissionais de Enfermagem/psicologia , Profissionais de Enfermagem/estatística & dados numéricos , Simulação de Paciente , Projetos Piloto , Aprendizagem Baseada em Problemas , Ressuscitação/educação , Autoeficácia , Estudantes de Enfermagem/estatística & dados numéricos
19.
Diabetes Care ; 43(3): 549-555, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31882407

RESUMO

OBJECTIVE: The effective redesign of primary care delivery systems to improve diabetes care requires an understanding of which particular components of delivery consistently lead to better clinical outcomes. We identified associations between common systems of care management (SysCMs) and the frequency of meeting standardized performance targets for Optimal Diabetes Care (NQF#0729) in primary care practices. RESEARCH DESIGN AND METHODS: A validated survey of 585 eligible family or general internal medicine practices seeing ≥30 adult patients with diabetes in or near Minnesota during 2017 evaluated the presence of 62 SysCMs. From 419 (72%) practices completing the survey, NQF#0729 was determined in 396 (95%) from electronic health records, including 215,842 patients with type 1 or type 2 diabetes. RESULTS: Three SysCMs were associated with higher rates of meeting performance targets across all practices: 1) a systematic process for shared decision making with patients (P = 0.001), 2) checklists of tests or interventions needed for prevention or monitoring of diabetes (P = 0.002), and 3) physician reminders of guideline-based age-appropriate risk assessments due at the patient visit (P = 0.002). When all three were in place, an additional 10.8% of the population achieved recommended performance measures. In subgroup analysis, 15 additional SysCMs were associated with better care in particular types of practices. CONCLUSIONS: Diabetes care outcomes are better in primary care settings that use a patient-centered approach to systematically engage patients in decision making, remind physicians of age-appropriate risk assessments, and provide checklists for recommended diabetes interventions. Practice size and location are important considerations when redesigning delivery systems to improve performance.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Atenção Primária à Saúde/organização & administração , Melhoria de Qualidade/organização & administração , Adolescente , Adulto , Idoso , Diabetes Mellitus Tipo 2/epidemiologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Profissionais de Enfermagem/organização & administração , Profissionais de Enfermagem/normas , Profissionais de Enfermagem/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Assistentes Médicos/organização & administração , Assistentes Médicos/normas , Assistentes Médicos/estatística & dados numéricos , Médicos/organização & administração , Médicos/normas , Médicos/estatística & dados numéricos , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/normas , Prognóstico , Melhoria de Qualidade/normas , Padrão de Cuidado/organização & administração , Padrão de Cuidado/normas , Inquéritos e Questionários , Adulto Jovem
20.
Int J Pediatr Otorhinolaryngol ; 129: 109770, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31733596

RESUMO

INTRODUCTION: Advanced practice providers (APPs), including nurse practitioners and physician assistants, have been deployed in children's hospital-based academic pediatric otolaryngology practices for many years. However, this relationship in terms of prevalence, roles, financial consequences and satisfaction has not been examined. The objective of this study is to explore how APPs impact healthcare delivery in this setting. METHODS: Pediatric otolaryngology chiefs of all academic children's hospitals in the US were electronically surveyed about the ways APPs intersected clinically and financially in their respective practice. RESULTS: A total of 29 of 36 children's hospital-based pediatric otolaryngology practices completed the survey, of which 26 practices (90%) utilized APP. There were large variances within the APP practice cohort in faculty size (mean/median/range = 9.4/8.5/3-29); annual patient visits (mean/median = 18,373/17,600); number of practice site (mean/median/range = 4.3/4/2-9) and number of outpatient APP (mean/median/range = 6.3/5/1-30). No factors (faculty size, annual visits and number of practice sites) differentiated between the APP and non-APP practices. Among APP practices, significant correlation (p<.00001) was observed between size of APP cohort to faculty size and annual visits. 69% of the practices did not differentiate job functions of nurse practitioners and physician assistants. 85% of the practices utilized APPs in all practice sites and 19% utilized APPs in the operating room. 77% of APPs billed independently and 46% had on-site supervision. The most prevalent APP salary bracket based on 0-5, 6-10 and > 11 years of tenure were $76-100K (65%), $100-150K (77%) and $100-150K (86%), respectively. In 46% of the practices, APPs were able to generate enough revenue to cover more than 75% of their salary and 23% of practices generated a profit. 81% of the chiefs ranked the effectiveness of APPs as high (4 and 5) on a 5-point Likert scale. DISCUSSION: The majority of academic pediatric otolaryngology practices employed APPs. Despite the diversity seen in practice complexity, APP functionality and financial impact, most found the APP model to be beneficial in improving patient care, patient access and faculty productivity.


Assuntos
Profissionais de Enfermagem/estatística & dados numéricos , Otolaringologia/organização & administração , Otolaringologia/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Papel Profissional , Docentes de Medicina/estatística & dados numéricos , Hospitais Pediátricos , Humanos , Renda/estatística & dados numéricos , Profissionais de Enfermagem/organização & administração , Otolaringologia/economia , Otolaringologia/educação , Assistentes Médicos/organização & administração , Inquéritos e Questionários
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