Managing Celiac Disease for Women: Implications for the Primary Care Provider.

Although many people have symptoms of celiac disease, it can take a while to diagnose. Villous atrophy may be present long before any gastrointestinal symptoms. An important point to acknowledge is that celiac disease could be identified earlier in some women with a positive family history. The disease also could be the cause of some women's reproductive problems. Primary care providers, using comprehensive history taking, are in the unique position to identify individuals who may have celiac disease, assist women in gaining knowledge about a gluten-free diet, order diagnostic testing, and refer to a gastroenterologist. The positive change in fertility with a simultaneous improvement of nutrient deficiencies shortly after adopting a gluten-free diet indicates a possible link between such nutrients and sex hormone function. High levels of homocysteine, which can negatively impact fertility, have also been linked to individuals with problems, such as celiac disease, that decrease vitamin B12 absorption. The purpose of this article is to review the literature and the evidence-based care guidelines for comprehensive screening, diagnostics, and pathophysiology of celiac disease, with a specific focus on the female reproductive system, anemia management, and gluten-free diet integration.

Simulation Pedagogy With Nurse Practitioner Students: Impact of Receiving Immediate Individualized Faculty Feedback.

Family nurse practitioner (FNP) students must achieve basic competency in managing patients' primary care needs across the lifespan. Students in the FNP program have simulations integrated throughout their clinical theory courses to increase practice time with various patient cases. Students who received individualized faculty feedback immediately after self-evaluation of simulation performance showed statistically significantly increased knowledge (as evidenced by higher grades in course examinations and preceptor evaluations) than a control group of students who received feedback in a group class via a rubric grading guide 2-4 weeks after all students completed their individual simulations.

Nurses' Knowledge of Heart Failure: Implications for Decreasing 30-Day Re-Admission Rates.

Heart failure affects 5.1 million Americans. It is the leading cause of hospitalization in older adults and the most common cause of readmissions, which cost approximately $12 billion annually. Readmissions can be reduced through increased nurses' knowledge in heart failure.

Seeing the forest and the trees: increasing nurse practitioner students' observational and mindfulness skills.

Accurate, objective observation is a critical component of clinical diagnosis and patient management, which in turn is essential for successful diagnostic reasoning by advanced practice nurses. The purpose of this quasi-experimental study was to enhance nurse practitioner students' observation and reflective thinking skills using Looking Is Not Seeing, a reflective practice/experiential learning technique that uses art objects to teach observation (Pellico, Friedlaender, & Fennie, 2009). Students' posttest observation and interpretation scores showed statistically significant improvement over pretest scores. Students' mindfulness scores and their own perceived observational and interpretive ability were statistically significantly higher after participating in the study. Building on the established record of successful visual literacy programs for nursing and medical students at other institutions, this research can help educators implement the Looking Is Not Seeing pedagogy.

Validity and reliability of the geriatric sexuality inventory.

Effective health care for older adults requires that providers assess and manage sexual health needs with high priority. This assessment begins with an effective sexuality assessment tool. A two-step, research approach was undertaken to develop and test the Geriatric Sexuality Inventory (GSI). Literature and expert review resulted in a 34-item instrument that was initially completed by 34 older adults ages 60 to 91 (mean age = 75). The testing was repeated in 19 of the original participants. The sample was 75% women, and 88% Caucasian with 9% single, 27% married, 18% divorced, and 46% widowed participants. Internal consistency reliability was run on all 53 responses and revealed adequate reliability (alpha = 0.74). Test-retest analysis also revealed good initial instrument reliability (r = 0.78; p < 0.001). Responses to open-ended questions regarding sexual information and care needs supported evidence gathered from the literature. Initial testing of the GSI revealed content validity and good internal consistency and test-retest reliability.

Celiac disease: implications for patient management.

Celiac disease is an autoimmune disorder that is known specifically for causing inflammation of the mucosa in the small intestine. Through multiple diagnostic and screening tools such as small intestinal biopsy sample, serological testing, and human leukocyte antigen testing, healthcare providers can diagnose this disease that contains components related to genetic predisposition and intake of gluten proteins found in wheat, barley, and rye. There are some who believe that having an autoimmune disease may predispose one to acquiring another disease. With patients experiencing mostly diarrhea, abdominal pain, and weight loss, the implementation of a gluten-free diet is the treatment that healthcare providers recommend. Through monitoring gluten intake and providing nutritional supplementation, those diagnosed with celiac disease can lead a relatively normal life without complications. With celiac disease affecting all age ranges in the population, and with a documented higher frequency, there is a growing awareness in society that can be easily seen in grocery stores, restaurants, and food manufacturers.

Assessment of advanced practice palliative care nursing competencies in nurse practitioner students: implications for the integration of ELNEC curricular modules.

Advanced practice nurses (APRNs) have key roles in the care of patients who are nearing death and those living with a disabling chronic disease. This article describes a mixed-method formative assessment of 36 graduate nursing students' knowledge about and attitudes toward palliative care preliminary to curricular integration of the End-of-Life Nursing Education Consortium (ELNEC) graduate core modules. Students' knowledge about palliative care was assessed using the 106-item ELNEC examination. In addition, qualitative data were gathered regarding students' definitions of palliative care, the role of the APRN in palliative care, and their definitions of a "good" and "bad" death. Results revealed students' limited knowledge about palliative care. Qualitative findings indicated that most students exclusively linked palliative care with end-of-life care and believed that the treatment they provide should have the goal of prolonging life over maintaining quality of life. Implications for curriculum design, advanced practice role development, and collaboration with community health partners are discussed.

Interprofessional "on-call" e-learning for family nurse practitioner students: Preparing for primary care across the life span.

BACKGROUND AND PURPOSE: Nurse practitioners (NPs) are expected to fill gaps in providing primary care in the United States and need vital skills to meet the growing need for primary care providers. One necessary skill is managing "on-call" clinical questions/concerns by patients across the life span. To date, there are no published studies that address "on-call" simulations for family NP (FNP) students across the life span. METHODS: This quasi-experimental, mixed-methods design used a confidence scale and Krippendorff's method for content analysis of discussion pages to determine the effectiveness and confidence of simulated "on-call" scenarios for FNP students during each of their clinical courses. CONCLUSIONS: There was a significant increase in the confidence level of students as measured by the confidence questionnaire (t = 3.07 [33]; p < .001), at the end of the FNP didactic and clinical courses. Krippendorff content analysis revealed three themes: self-reliance; thinking on your feet; and uncertainty of management. IMPLICATIONS FOR PRACTICE: "On-call" processing is a skill that is needed in graduate FNP programs so that these providers are fully prepared to meet any challenge they may encounter.

Teaching about cardiac emergencies: implications for maternal/child nurse educators.

Women with comorbidities and obesity and aging women are presenting obstetrical challenges to healthcare providers. Cardiovascular events such as myocardial infarction, spontaneous coronary artery dissection, and stroke on obstetrical units are not as rare as they may have been even 5 years ago. Early recognition and treatment of these maladies can assist in decreasing the mortality of both the mother and unborn baby. The Joint Commission advocates using periodic drills for obstetric emergencies. The content on cardiac emergencies and case studies in this article will assist staff development educators to integrate didactic and clinical practice time into orientation and continuing education programs.

Integrating spirituality into undergraduate nursing curricula.

Nursing programs have done a commendable job keeping pace with the rapid advances in disease management. Yet, spirituality has received far less attention in nursing curricula (Keefe, 2005) and nursing students often do not have a strong foundation in this area. The purpose of this project was to integrate spirituality into the undergraduate nursing curricula and measure student outcomes related to spiritual knowledge and attitudes. Nursing faculty participated in a spirituality education program and followed this with sessions focused on integration of spiritual content into individual nursing courses. Student pre and post-tests were administered using a standard instrument to evaluate the effectiveness of the program. Significant differences in spirituality knowledge and attitudes among senior-level nursing students (t = -3.059, p = .004) were revealed. As the healthcare system becomes increasingly complex, providing students with tools to identify and strengthen inner resources is essential to patient care.

Assisting critical care nurses in acquiring leadership skills: development of a leadership and management competency checklist.

Critical care nurses need to be more effective leaders and managers in healthcare. Delivering quality and cost-effective patient outcomes have become goals of all nurses. To achieve these goals, nurses must practice and attain leadership ability. This article describes a program to help nurses gain quality leadership skills.

The journey toward geriatric excellence in a non-research-intensive university.

In response to the unprecedented rise in the U.S. older adult population, nurse educators have intensified efforts to produce graduates who are sensitive to older adults' health care concerns. Critical to accomplishing this goal is strengthening curricula to include specialized gerontological content. Although the science of gerontological nursing has grown significantly over the past several decades, large-scale research projects are often confined to research or doctoral level universities in which typically more support is available. Faculty members in smaller universities in which a great number of nursing students are educated do not always have the resources to readily contribute to science. Such a challenge was faced by one nursing school in a small Jesuit New England university. This article illustrates a process to develop excellence in gerontological nursing education, as well as to promote scholarship and collaboration among faculty members at baccalaureate or master's level universities. Three years ago, the John A. Hartford Foundation, in collaboration with the American Association of Colleges of Nursing, awarded grants to select nursing programs for curricular enhancement. Implementation of this project at a small Jesuit university led to synergy among faculty that resulted in joint publications, presentations, and newly funded projects. In addition, the school earned local and national recognition for excellence in gerontological nursing education/care. The process leading to the outstanding success of this curricular endeavor is presented as a replicable model for schools in other baccalaureate or master's level settings.

Development, implementation, and evaluation of a geriatric nurse education program.

Substantial gaps exist between the number of older adults requiring competent geriatric care and the number of nurses able to provide it. The purpose of this study was to develop, implement, and evaluate a geriatric nurse education program to ensure nurses meet the needs of the increasing elderly population. Establishing partnerships between individuals in academia and those in a clinical practice was imperative in the development of the program. Content for the program was created with the assistance of a geriatric nursing consultant and approved by the State Nurses Association. The program was piloted with 18 participating nurses. Using paired ttests, pretests and posttests revealed significant improvements in the level of knowledge and attitudes toward older adults. As a result of the program, participants showed improved attitudes toward and increased knowledge of older adults' needs, and further program development and dissemination are planned nationally and abroad.

Theories of aging as basis for assessment.

Based on biopsychosocial theories of aging, a tool was developed to assist nurses in conducting holistic adult admission assessments. The Adult Assessment Tool can facilitate comprehensive, best-practice decisions in caring for hospitalized middle-aged and older adults.

Isolation followed by integration: a model for development of a separate geriatric course.

Because of the growing population of older adults in America, nursing faculty throughout the United States have been consistently challenged during the past decade to use the most appropriate methods to strengthen geriatric content in baccalaureate nursing programs. The question of whether to integrate content throughout the curriculum or offer a stand-alone geriatric nursing course has been explored extensively, but no ultimate conclusion has been found. With the support of a grant for geriatric curriculum integration from the John A. Hartford Foundation, one university began the journey to integrate geriatric nursing curriculum throughout all baccalaureate nursing courses. However, at a curriculum evaluation meeting held halfway through the grant period, faculty expressed the need to have concentrated content earlier in the program that could serve as a foundation on which to build geriatric knowledge. Faculty unanimously voted to create a geriatric nursing course to be offered to students during their second year of baccalaureate study.

Managing Sjogren's Syndrome.

There are approximately 4 million Americans diagnosed with Sjogren's Syndrome. This article discusses the epidemiology, pathophysiology, diagnostics, and implications for home care clinicians who may encounter patients with this syndrome. Chronic pain is discussed as well as interventions to manage symptoms such fatigue, dry eyes mouth and skin.

Collaboration yields cost-effective, evidence-based nursing protocols.

Educators and clinicians need to incorporate the results of research into their teaching and practice because they are responsible for facilitating evidence-based practice. Advantages include blended insight for clinical relevance and theoretical conceptualization, sharing of perspectives on identification of significant findings, joint decision making on patient outcome evaluation, and improved access to patient data, library sources, and statistical analysis. After a comprehensive needs assessment was conducted, an evidence-based practice Pin Site Care Quality Improvement Protocol was developed. The nursing staff on this orthopaedic unit identified pin site care as their need for further study. The Quality Improvement protocol developed consists of assessment, patient preparation, ongoing nursing management, comfort, safety, reportable concerns, and documentation.

Using evidence-based practice to develop a protocol for postoperative surgical intensive care unit patients.

Sixty adult postoperative patients from the surgical intensive care unit with core temperatures <35.4 degrees C, as measured by a pulmonary artery catheter, were randomly assigned to one of three treatment options for hypothermia. Results of this study confirmed findings in the literature that forced warm air generated quickest rewarming times. A rewarming protocol for hypothermic patients was developed and implemented. Performance improvement activity demonstrated high compliance rates with nurses using the rewarming protocol.

Transforming doctoral education through the clinical electronic portfolio.

The DNP is a terminal degree focusing on the preparation of expert clinicians with advanced leadership, evidence-based practice, and systems management skills. An electronic clinical portfolio (e-portfolio) allows students to showcase their individual experiences, provides an objective measure of their achievement, and demonstrates integration of the core doctoral competencies within each specialty. The purpose of this article was to describe the development of an e-portfolio and provide general guidelines for successful implementation and evaluation.