Motivational interviewing: helping patients move toward change.

Motivational Interviewing (MI) is a valuable tool for nurses to help patients address behavior change. MI has been found effective for helping patients with multiple chronic conditions, adherence issues, and lifestyle issues change their health behaviors. For Christian nurses, MI is consistent with biblical principles and can be seen as a form of ministry. This article overviews the process of MI, stages of change, and offers direction for further learning.

Pediatric obsessive-compulsive disorder: an update for advanced practice psychiatric nurses.

Obsessive-compulsive disorder (OCD) may have an onset in childhood or adolescence resulting in significant functional impairment and disability into adulthood. There are frequently developmental differences in the content of the obsessions and compulsions in youth compared to adults. Lack of insight or shame may result in failure of the youth to seek treatment. This delay in treatment may lead to the development of other psychiatric comorbidities, including suicide. Evidence-based treatments for OCD include cognitive behavioral therapy and exposure/response prevention, and in moderate to severe cases, use of selective serotonin reuptake inhibitors is indicated. Advanced practice psychiatric nurses are in a unique position to provide psychoeducation, psychotherapy, and medications, if indicated, to youth with this condition to improve functioning and reduce morbidity and mortality. This article will provide an overview of the diagnostic criteria for OCD, etiologies, assessment strategies, differential diagnoses, common comorbidities, and evidence-based treatment options.

Psychosocial issues in patients with congestive heart failure.

Psychosocial issues are important variables that need to be addressed in patients with congestive heart failure (CHF). Unfortunately, these issues are often overlooked. Depression and lack of social support have been shown to have a negative impact on patients with CHF. Patients with CHF who are depressed or who lack social support have been shown to have increased morbidity and hospital readmission rates, to be less adherent to their medical regimen, and to have an overall increase in cost of care. The variables are often interrelated, as high levels of social support may lessen the impact of depression on mortality. In addition, certain biologic factors may influence the impact of psychosocial factors in patients with CHF. This review addresses the effects of depression, treatment adherence, and social support in patients with CHF and suggests interventions targeted to these problems. Health care professionals must assess these issues in all patients with CHF, address their specific needs, and intervene appropriately when warranted.

Testing the effects of a pharmaceutical program on fall rates in older adults.

A pretest-posttest no control group design was used to test knowledge on fall incidence in residents of a rehabilitation center. Twenty-six staff nurses were educated on fundamental geriatric pharmacology. Results of a two-tailed t test showed a significant increase in posttest scores (t test(50) = 3.53, p = .003). Retrospective fall and medication data collected over 2 months in 2011 and 2 months in 2012 were compared. The incidence of falls decreased (44.7%) with total number of residents falling (30.7%) post intervention in 2012. Staff nurses need to have continuing pharmaceutical education and medication management classes about the elderly.

Radiation exposure and diagnostic imaging.

PURPOSE: The purpose of this article is to increase clinician awareness of current radiation exposures of diagnostic testing, discuss current practice patterns, and suggest strategies to address issues at the systems level, institution level, and the healthcare provider level. DATA SOURCES: Evidence-based literature including interdisciplinary peer-reviewed articles in the biological and health-related fields. CONCLUSIONS: Radiation exposure related to diagnostic testing is often higher than anticipated for both the clinician and the patient. Strategies to address radiation exposure need to be implemented at many different levels in the system. Best practice initiatives are surfacing and will require a team approach for success. IMPLICATIONS FOR PRACTICE: Nurse practitioners need to be aware of the benefits and risks of diagnostic testing involving radiation exposure. Patients should also be informed of potential risks and benefits. Alternative imaging should be considered and repetitive testing should be monitored closely.

Undergraduate students as standardized patients to assess advanced practice nursing student competencies.

Evaluating clinical skills of students in an online distance education program can be challenging because of the diverse location of students. The authors describe a unique and cost-efficient method of using standardized patients to evaluate these skills. The project involved undergraduate students representing standardized patients for graduate advanced practice nurse students.