Ultrasound-guided phlebotomy in primary care for people who inject drugs.

OBJECTIVES: Persons who inject drugs (PWID) commonly experience venous degradation as a complication of prolonged injection, which makes routine phlebotomy difficult. Clients may decline care due to the perceived lack of skilled phlebotomy services, and this contributes to significant delays in infectious disease screening and treatment. In this study, we investigated ultrasound-guided phlebotomy in clients with difficult venous access receiving care at two low-threshold buprenorphine clinics. Our objectives were to increase the accuracy of vascular access, expedite infectious disease treatment for hepatitis C virus (HCV) and human immunodeficiency virus (HIV), and increase client satisfaction with phlebotomy services. METHODS: PWID who declined routine phlebotomy at two clinic sites were offered ultrasound-guided vascular access by a trained clinician. Participants completed a survey to collect data regarding acceptability of the intervention. RESULTS: Throughout a 14-month period, 17 participants were enrolled. Of the total 30 procedures, 41.2% of clients returned for more than one phlebotomy visit, and 88.2% of clients achieved vascular access within 1 attempt. Of participating clients, 52.9% described themselves as having difficult venous access and at conclusion of the study, 58.8% expressed more willingness to have phlebotomy performed with an ultrasound device. CONCLUSIONS: Offering ultrasound-guided phlebotomy for PWID with difficult venous access resulted in decreased access attempts, increased patient satisfaction, and expedited screening and treatment for HIV and HCV point-of-care ultrasound technology is an effective approach to improving care for persons who inject drugs.

Community Wound Care Program Within a Syringe Exchange Program: Chicago, 2018-2019.

People who inject drugs (PWID) are at increased risk for developing wounds in addition to skin and soft tissue infections. The University of Illinois at Chicago College of Nursing, College of Medicine, and School of Public Health collaborated to establish a medical clinic serving PWID attending a Chicago syringe exchange program. A wound care program was implemented to improve clinicians' competence. During October 2018 to August 2019, 24% of all encounters were related to wound complaints.

Practice guidelines for the supervising professional: intraoperative neurophysiological monitoring.

The American Society of Neurophysiological Monitoring (ASNM) was founded in 1989 as the American Society of Evoked Potential Monitoring. From the beginning, the Society has been made up of physicians, doctoral degree holders, Technologists, and all those interested in furthering the profession. The Society changed its name to the ASNM and held its first Annual Meeting in 1990. It remains the largest worldwide organization dedicated solely to the scientifically-based advancement of intraoperative neurophysiology. The primary goal of the ASNM is to assure the quality of patient care during procedures monitoring the nervous system. This goal is accomplished primarily through programs in education, advocacy of basic and clinical research, and publication of guidelines, among other endeavors. The ASNM is committed to the development of medically sound and clinically relevant guidelines for the performance of intraoperative neurophysiology. Guidelines are formulated based on exhaustive literature review, recruitment of expert opinion, and broad consensus among ASNM membership. Input is likewise sought from sister societies and related constituencies. Adherence to a literature-based, formalized process characterizes the construction of all ASNM guidelines. The guidelines covering the Professional Practice of intraoperative neurophysiological monitoring were initially published January 24th, 2013, and subsequently that document has undergone review and revision to accommodate broad inter- and intra-societal feedback. This current version of the ASNM Professional Practice Guideline was fully approved for publication according to ASNM bylaws on February 22nd, 2018, and thus overwrites and supersedes the initial guideline.

Building nurses' capacity to address health inequities: incorporating lesbian, gay, bisexual and transgender health content in a family nurse practitioner programme.

AIMS AND OBJECTIVES: To describe our experience in incorporating lesbian, gay, bisexual and transgender health content into the family nurse practitioner curriculum at a Midwestern college of nursing in the United States. BACKGROUND: Globally, lesbian, gay, bisexual and transgender people face disparities in the domains of physical health, behavioural risks, mental health and victimisation. There remains a paucity of nursing research on most aspects of lesbian, gay, bisexual and transgender health and access to care. To date, nursing leadership and curricular bodies have not provided clear guidance on the role of nurse educators in preparing nursing students to provide care to lesbian, gay, bisexual and transgender people. DESIGN: Discursive paper describing the development of a lesbian, gay, bisexual and transgender health learning module for inclusion in a family nurse practitioner programme. METHODS: We summarise health disparities experienced by lesbian, gay, bisexual and transgender people, describe the process of module development and outline the learning content included in the module. We also discuss challenges faced in incorporating lesbian, gay, bisexual and transgender content into nursing curricula. CONCLUSIONS: Despite the lack of formal direction from the nursing sector, nursing faculty should prepare nursing students to provide culturally sensitive and competent care to lesbian, gay, bisexual and transgender people. Our experience incorporating lesbian, gay, bisexual and transgender-specific content into the family nurse practitioner programme has proven to be positive for both students and faculty. RELEVANCE TO CLINICAL PRACTICE: Given their large numbers and presence across systems of care, nurses are uniquely positioned to address barriers to care faced by lesbian, gay, bisexual and transgender people. Modules such as the one described here can be used by nurse faculty to guide the inclusion of lesbian, gay, bisexual and transgender-specific content in family nurse practitioner or other nursing courses-as well as to guide the development of nursing competencies in the care of lesbian, gay, bisexual and transgender people.

Practice guidelines for the supervising professional: intraoperative neurophysiological monitoring.

The American Society of Neurophysiological Monitoring (ASNM) was founded in 1988 as the American Society of Evoked Potential Monitoring. From the beginning, the Society has been made up of physicians, doctoral degree holders, technologists, and all those interested in furthering the profession. The Society changed its name to the ASNM and held its first Annual Meeting in 1990. It remains the largest worldwide organization dedicated solely to the scientifically based advancement of intraoperative neurophysiology. The primary goal of the ASNM is to assure the quality of patient care during monitored procedures along the neuraxis. This goal is accomplished through programs in education, advocacy of basic and clinical research, and publication of guidelines. The ASNM is committed to the development of medically sound and clinically relevant guidelines for intraoperative neurophysiology. Guidelines are formulated based on exhaustive literature review, recruitment of expert opinion, and broad consensus among ASNM membership. Input is likewise sought from sister societies and related constituencies. Adherence to a literature-based, formalized process characterizes the construction of all ASNM guidelines. The guidelines covering the Professional Practice of intraoperative monitoring were established by a committee of nearly 30 total participants and ultimately endorsed by the Board of Directors of ASNM on January 24th 2013. That document follows.

Affirming Care for Transgender and Gender-Diverse Youth.

ABSTRACT: Nurses play a critical role in providing gender-affirming care for transgender and gender-diverse youth. With heightened debate about the clinical care for transgender and gender-diverse youth in the national and global spotlight, now more than ever before nurses must equip themselves with the knowledge and the evidence spanning more than 4 decades that support the clinical use of gender-affirming care for youth and young adults. By exploring gender development and gender-affirming care approaches through the lifespan perspective, this review provides an up-to-date discussion about best practices and clinical implications for providing equitable care for transgender and gender-diverse youth from birth to childhood and through adolescence developmental phases. A transgender and gender-diverse youth's future willingness to access health care is dependent on how positive their interactions are with their care team at this sensitive moment in their life. Nurses must not let political rhetoric impede their practice and ethical guidelines to provide competent, skilled, and unbiased care. Knowledgeable, informed, and empowered nurses can provide life-saving care to transgender and gender-diverse youth and their families.

The National Organization of Nurse Practitioner Faculties Leadership Mentoring Program: Ten years of positive outcomes.

BACKGROUND: Nursing leadership programs can have a positive impact on organizations and communities. Health equity in nursing requires leaders who parallel the population demographics. PURPOSE: This work evaluated the National Organization of Nurse Practitioner Faculties Leadership Mentoring Program (LMP) 10 years from its inception. Lessons learned from this evaluation can inform leadership initiatives in nursing and other health professions. METHOD: This cross-sectional evaluation applied the Context, Inputs, Process, and Products model to gauge effectiveness of the LMP. All 48 participants were invited to participate. RESULTS: Thirty-two survey respondents, a 67 % response rate, demonstrated a 767 % increase in extramural scholarship collaborations and promotion to associate and full professor at 43 % and 90 %, respectively. Academic leadership positions to department chair, assistant/associate dean, and dean increased 200 %, 167 %, and 100 %, respectively. Seventy-seven percent of program participants are engaged on boards and committees at local, state, national, and international levels. These roles significantly impact legislative, policy, advocacy, and regulatory efforts, signifying the LMP's influence on broader societal and professional domains. CONCLUSION: Identifying clear program outcomes and metrics for leadership program evaluation can advance diversity, equity, and inclusion efforts. Sustainable funding models for leadership development will have a high return on investment for health professions.

Moving Toward Equity and Transparency in NP Faculty Workload: It's More Than Just Credits.

BACKGROUND: Nurse practitioner (NP) programs rely on a highly educated and experienced faculty to deliver the curriculum. Full-time NP faculty are expected to be doctorally prepared, with responsibilities for instruction, an active clinical practice, scholarship, and service. PROBLEM: Although the majority of faculty workload comes from effort in instruction, there is significant variability in how faculty workload is assigned. Absent a national model, schools of nursing are challenged to develop workload models for NP faculty to allocate effort for the full scope of work that NP faculty are expected to perform to meet requirements for academic credentialing bodies, licensure, and academic promotion. APPROACH: This article examines current practices in NP workload allocation and explores ways to allocate effort to the domains of work integral to NP education. CONCLUSION: NP faculty workload models should align with academic promotion expectations to encourage equity and transparency.

Equity and inclusivity in the faculty ranks: Our experience with a clinical track.

BACKGROUND: The evolution of nursing education requires a combination of strong academic faculty and expert clinicians. Different professional growth and development pathways are necessary to build a robust faculty with clinical and research expertise. Some schools have implemented a formal clinical track (CT) to complement the traditional tenure track for the professional advancement of CT. METHODS: The article presents a case example of how one institution maintains and advances a strong CT using the Kotter Change Model and discusses future directions. RESULTS: The school's infrastructure for promotion, which follows a similar structure and guidelines as Tenure Track (TT) Promotion and Tenure Guidelines, has led to an increase in the school's scholarly productivity among CT faculty across ranks. Increasing poster and podium presentations as well as publications to a national and international audience results in greater reach and improved reputation for the school, both nationally and internationally. CONCLUSIONS: While there is still work to be done to advance equity and inclusion for nursing CTs, developing and maintaining a CT with system-level structures holds significant value and provides a clear path to promotion, invests in clinical scholarship, and includes clinical faculty as full citizens in academia.

Community Health Outside the Exam Room: Extracurricular Learning to Augment Nurse Practitioner Student Practice Readiness.

BACKGROUND: The curricular requirements of nurse practitioner (NP) programs are well established. NP students' clinical practicums provide a context for the extracurricular acquisition of administrative, operational, and systems-focused NP skills. PROBLEM: Acquisition of extracurricular NP skills is variable and highly dependent on a student's clinical placements. The COVID-19 pandemic exacerbated this variability by limiting students' access to traditional clinical rotations. APPROACH: With our practice partners, we inventoried the behaviors that are associated with new graduate NP readiness for practice in community health centers. We then developed an extracurricular seminar series to develop these behaviors. Each seminar in the series was presented by a preceptor. OUTCOMES: Students reported gains in their perceived readiness to practice. The casual format and preceptor presenters were highly valued by students. CONCLUSIONS: NP educators should consider leveraging academic-practice partnerships to standardize students' acquisition of administrative, operational, and systems-focused NP competencies.

Cultivating diversity in the advanced practice registered nurse workforce: An exemplar from an advanced practice registered nurse fellowship program.

ABSTRACT: Diversity in the nursing workforce is an important driver of patient satisfaction, adherence to care, and quality outcomes. Systemic barriers exist that prevent individuals from underrepresented minority groups entering and advancing in the nursing workforce. To advance the health of the community we serve and with grant support from the Health Resources and Services Administration, we developed a postgraduate advanced practice registered nurse (APRN) fellowship in community health. This program is a partnership between a federally qualified health center and a college of nursing. We developed a deliberate plan to recruit and admit diverse applicants who would continue to practice in our community at the conclusion of their fellowship year. Using targeted recruitment outreach, we identified new-graduate APRNs who were representative of the community we serve. Using holistic review methodology, we interviewed applicants with explicit efforts to mitigate the effects of bias towards race, ethnicity, gender, and academic affiliation. We embraced a quality-improvement ethos that enabled evolution and growth with each iteration of the program. Understanding that intention does not translate to outcomes, we undertook ongoing critique of our methods and engaged diverse resources to improve our processes. Over two admission cycles, our fellowship in community health for new graduate APRNs has demonstrated improvements in strategies to diversify the community health workforce. We will describe our process of nonjudgmental self-critique and a quality-improvement framework that can serve as a strategy to promote diversity, equity, and inclusion in the community health workforce.

A Correctional Facility Academic-Practice Partnership: Implementation of a Nurse-Led COVID-19 Initiative.

In 2020, the COVID-19 pandemic resulted in one in five individuals incarcerated in U.S. correctional institutions contracting COVID-19 and 1,700 deaths. Correctional adult transition centers house incarcerated individuals who typically do not have on-site health care access. A COVID-19 outbreak could devastate this population, who live in high-density conditions and have been documented as high risk for poor health outcomes. Owing to a robust practice partnership between a college of nursing and two adult transition centers, a nurse-led COVID-19 initiative was implemented to minimize transmission in the facilities and ensure appropriate health care referral for residents who tested positive for COVID-19. The initiative identified six residents with positive results, who were transferred to a state prison infirmary for management and to minimize risk for other residents.

Best Practices in Facial Nerve Monitoring.

OBJECTIVES/HYPOTHESIS: Facial nerve monitoring (FNM) has evolved into a widely used adjunct for many surgical procedures along the course of the facial nerve. Even though majority opinion holds that FNM reduces the incidence of iatrogenic nerve injury, there are few if any studies yielding high-level evidence and no practice guidelines on which clinicians can rely. Instead, a review of the literature and medicolegal cases reveals significant variations in methodology, training, and clinical indications. STUDY DESIGN: Literature review and expert opinion. METHODS: Given the lack of standard references to serve as a resource for FNM, we assembled a multidisciplinary group of experts representing more than a century of combined monitoring experience to synthesize the literature and provide a rational basis to improve the quality of patient care during FNM. RESULTS: Over the years, two models of monitoring have become well-established: 1) monitoring by the surgeon using a stand-alone device that provides auditory feedback of facial electromyography directly to the surgeon, and 2) a team, typically consisting of surgeon, technologist, and interpreting neurophysiologist. Regardless of the setting and the number of people involved, the reliability of monitoring depends on the integration of proper technical performance, accurate interpretation of responses, and their timely application to the surgical procedure. We describe critical steps in the technical set-up and provide a basis for context-appropriate interpretation and troubleshooting of recorded signals. CONCLUSIONS: We trust this initial attempt to describe best practices will serve as a basis for improving the quality of patient care while reducing inappropriate variations. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:S1-S42, 2021.

The Reemergence of Syphilis: Clinical Pearls for Consideration.

Despite the near-eradication of syphilis in the United States in the late 1990s, new infections have surged over the past 20 years. Dubbed, "the great imitator," syphilis infections often can be misdiagnosed and resultantly untreated. This leads to people inadvertently infecting others. This article reviews the history of syphilis, including the unethical studies undertaken in the past; current epidemiology; treatment guidelines; and strategies to reduce new infections.

Understanding patient motivations for HIV pre-exposure prophylaxis initiation and adherence.

Consistent dosing of tenofovir/emtricitabine-based HIV pre-exposure prophylaxis (PrEP) can reduce HIV infection risk by up to 92%. However, clinical trials have shown low PrEP adherence (34-71%), resulting in reduced effectiveness. To improve PrEP's effectiveness, adherence to a daily PrEP regimen is essential. This report explores patients' patterns of PrEP initiation and use and their PrEP-related perceptions to provide greater understanding of patient motivations for beginning and adhering to PrEP. At two urban primary care clinics, individual coaching sessions that included semistructured interviews were offered to 10 PrEP patients. Regarding PrEP initiation, 30% of patients were advised to use PrEP by their nurse practitioners (NPs), while the remaining patients requested PrEP themselves. Before they initiated PrEP, all patients were familiar with it through social contacts or internet-based research. Patients' PrEP-related perceptions were identified, including perceived pros and cons of PrEP use, and degrees of PrEP knowledge, uncertainty, and fear. Primary care NPs should take detailed sexual histories to avoid overlooking PrEP candidates. In addition, primary care NPs should introduce easy-to-access, Internet-based resources to reinforce patient education. Last, PrEP promotional campaigns should be focused at the community level in gay, bisexual, transgender and queer populations.

Pharmacoprevention of Human Immunodeficiency Virus Infection.

This article reviews the disparities in human immunodeficiency virus (HIV) incidence, presents evidence on the efficacy of preexposure prophylaxis (PrEP) and nonoccupational postexposure prophylaxis (nPEP), provides an overview of clinical guidelines for prescribing PrEP and nPEP, discusses strategies to promote efficient use of these effective interventions, and reviews best practices in treatment retention for people at high risk for HIV. Nurses are optimally positioned to prevent new HIV infections. When working with sensitive topics such as sexual practices and substance use, nurses excel at building rapport, making shared decisions, and educating about risk reduction with an affirming, nonjudgmental approach.