Use of an Evidence-Based Teaching Strategy to Improve Sexual Health Assessment Among Nurse Practitioners in the Retail Health Environment

The Centers for Disease Control and Prevention Sexually Transmitted Disease Surveillance 2018 report estimates that approximately 20 million new sexually transmitted infections (STIs) occur every year. This accounts for more than $16 billion in health care costs annually. This project assessed change in use of an STI assessment tool by nurse practitioners (NPs) after education on strategies for obtaining a sexual health history. A quality improvement project was implemented to assess use of the tool after an educational webinar vs a group receiving an email reminder only. While there was insufficient use data on the webinar class group, there was a statistically significant increase in the use of the STI assessment tool by the email reminder-only group.     

Climate and Environmental Health: Education for Rural Communities

Rural populations experience underinvestment in communication and technology infrastructure that may contribute to an information gap about climate change and the relationship to health impacts in rural communities. This report describes how a student and nursing faculty member provided community education to 3 rural communities about how climate change impacts the health of rural communities through the local community newspaper serving the 3 communities. Climate and health-related topics in a weekly newspaper column in this project included extreme heat events, Lyme disease, air pollution, water quality, soil health, environmental justice, and the role of the nurse in planetary health.     

Educating Nurse Practitioners About Climate Change,Health, and Climate Justice

Climate change poses unprecedented threats to health, leading to higher rates of heat stress; cardiopulmonary illness; food-, water-, and vector-borne diseases; adverse pregnancy outcomes; poor mental health; and premature death. These impacts are inequitably distributed, with vulnerable populations bearing the greatest burdens. Nurse practitioners must be prepared to care for people affected by climate change and to advocate for policies to mitigate its harm. To date, efforts to integrate climate change and health concepts into health professions education are lacking. This article describes one nursing school’s experience incorporating these concepts into nurse practitioner curricula.     

Development trends and future challenges in community nurse practitioner

Community health nursing is an innovative aspect of healthcare that has grown in response to changing environmental and social structure changes into a worldwide movement. Taiwan's fast growing elderly population, improving health technologies and rising healthcare costs impact significantly upon the development and definition of the scope of practice for community health nurse nurses. This paper explores the innovative community care model development experiences of several countries and reviews the scope of practice of community health nurse practitioners in each. We further explore the current situation of nurse practitioners in Taiwan and suggest a future path for Taiwan community health nurse practitioners development and policymaking.     

Abdominal aortic aneurysm: diagnosis, treatment, and implications for advanced practice nursing

The nurse practitioner needs to acknowledge that not all patients are insightful. The patient who is naive, stoical, or in denial may not return to his previous level of health. Behavioral or environmental changes may be a necessary part of recovery. The advanced practice nurse, through her research and subsequent knowledge, can identify and implement holistic changes necessary for the maintenance of health and the development of appropriate health-seeking behaviors that lower the morbidity and mortality for such conditions as abdominal aortic aneurysms. Nurse practitioners play a vital role in research, prevention and early detection of major threats to wellness (Lawler and Schmidt, 1992). Gender-sensitive research regarding factors affecting recovery are also necessary as females respond differently to such conditions as renal failure (Carlson and Eisenstat, 1995).     

The Effect of Potential Climate Change on Infectious Disease Presentation

A changing climate may alter the expected patterns of infectious disease emergence in North America, requiring nurse practitioners to become familiar with these changes in infectious disease emergence in their local communities. This report reviews how potential climate change might affect seasonal patterns of infectious diseases, including the impact on the agents that cause them and alterations in host behaviors/the environment that may modify the pattern of infectious diseases locally. This knowledge base will aid nurse practitioners in making accurate diagnosis/treatment plans for diseases they may not be familiar with currently.     

America Needs Nurse Practitioners to Advocate for Social Justice

The era of COVID-19 has highlighted disparities within the health care system. The pandemic, in combination with the death of George Floyd, has resulted in professional organizations condemning racism as a public health issue. But what is the role of individual nurse practitioners in addressing systemic racism within the healthcare system? The Code of Ethics for Nurses requires that all nurses actively work to reduce disparities. The code states that universal access to nursing is a human right and that health must be considered in the frame of social determinants. America needs nurse practitioners to reimagine the healthcare system and to develop policy and legislation that results in change. Nurse practitioners are among the most trusted professionals in America, and we can help the country heal from centuries-old injustices.     

Integrating Climate Change in the Curriculum: Using Instructional Design Methods to Create an Educational Innovation for Nurse Practitioners in a Doctor of Nursing Practice Program

An applied epidemiology course for doctor of nursing practice students was revised to include a module on the impact of climate change on population health. The Analyze, Design, Develop, Implement, and Evaluate (ADDIE) model of instructional design is a gold standard framework for creating course content and guided the module development. A nurse content expert discussed the environmental impacts of climate change on health using literature, actual clinical scenarios, and the application of epidemiologic data. Topics included safeguarding workers and vulnerable populations within the context of the coronavirus disease 2019 pandemic. Students posted reflections on their understanding of module content in response to structured prompts electronically in the learning management system for review by the faculty. Faculty evaluation of responses identified the need to further develop and integrate environmental epidemiology and climate change content more fully within the doctor of nursing practice curriculum.     

When the family asks, 'what happened?'

Because of the high level of acuity of hospitalized patients, untoward events can and do occur. Very often, nurses develop a caring relationship with the families of these patients. As a result, the family may approach the nurse about this negative turn of events. The questions that the family raises may create an ethical dilemma for the nurse. The nurse may wonder how to respond, feel powerless and "caught in the middle," and experience moral distress because of constraints in the health care system. This article discusses the ethical perspective of caring and the "nurse in the middle" phenomenon. Several strategies to help nurses manage this issue include consulting with a mentor, consulting with the institutional ethics committee, and promoting an ethical climate within the health care setting.     

25+ and Going Strong: Nurse Practitioners and Nursing Practice

The purpose of this study was to examine relationships between role attitudes and values of nurse practitioners and their level of confidence about practice knowledge and skills. The stratified random sample comprised 482 nurse practitioners representing the specialty areas of certified nurse practitioners. Findings indicate a relationship between level of confidence and role orientation. The sample also rated themselves as more confident about hands-on skills than about indirect role components such as utilization of research, change theory, and evaluation of practice outcomes.     

Insurers' contracting policies on nurse practitioners as primary care providers: the current landscape and what needs to change

A national survey showed that most insurance companies refuse to credential nurse practitioners as primary care providers in nurse-managed health centers. These prohibitive policies, along with weak federal and state laws, threaten the long-term sustainability of nurse-managed health centers as safety-net health care providers and limit the ability for nurse practitioners to become an accepted primary health care source in the United States. Interviews with national managed care organizations revealed that these companies' current business practice and policies are unlikely to change without regulatory change at state and/or federal levels.     

Skill mix change between physicians,nurse practitioners,physician assistants,and nurses in nursing homes: A qualitative study

Nursing home physicians face heavy workloads, because of the aging population and rising number of older adults with one or more chronic diseases. Skill mix change, in which professionals perform tasks previously reserved for physicians independently or under supervision, could be an answer to this challenge. The aim of this study was to describe how skill mix change in nursing homes is organized from four monodisciplinary perspectives and the interdisciplinary perspective, what influences it, and what its effects are. The study focused particularly on skill mix change through the substitution of nurse practitioners, physician assistants, or registered nurses for nursing home physicians. Five focus group interviews were conducted in the Netherlands. Variation in tasks and responsibilities was found. Despite this variation, stakeholders reported increased quality of health care, patient centeredness, and support for care teams. A clear vision on skill mix change, acceptance of nurse practitioners, physician assistants, and registered nurses, and a reduction of legal insecurity are needed that might maximize the added value of nurse practitioners, physician assistants, and registered nurses.     

Human identical hormones: real people, real problems, real solutions

Increasing numbers of women are seeking alternative treatments for menopause and other hormone-related gynecologic disorders. Standard agents may provide symptomatic relief but are linked to high side-effect profiles, decreased compliance, and reduced client satisfaction. They also may contribute to other health issues. This report proposes the use of human identical hormones or natural hormone replacement therapy as a holistic alternative to standard therapy. Guidelines for prescribing and client monitoring are presented. It is critical for nurse practitioners to be aware of alternative treatments as they strive to meet client requests in an ever-changing climate in women's health care.     

Training needs analysis. Necessity or luxury?

With the plethora of offerings in post-registration education available to nurses it is at times difficult for individual nurses to identify their current and future needs, and more so to go about meeting those needs through a logical educational or career progression. Nursing and its relationship with other health care professionals is also changing rapidly, and post-registration education, in order to keep abreast of the changes has to evaluate its effectiveness and move forward with programmes of study which actually meet the changing need of nurse practitioners within the society they serve. This article attempts to highlight the importance of needs analysis when considering programme planning in the changing climate of post-registration nurse education.     

Nurse practitioners in accident and emergency departments: reflections on a pilot study

This paper reflects on the conduct of a pilot study which was intended to prepare the ground for a randomized, controlled clinical trial of the assessment and treatment of patients with minor injuries by nurse practitioners or senior house officers (junior doctors) in an accident and emergency department. The authors believe that such reflection makes a useful contribution to the growing debate about methodology in health services research. Following a brief literature review on nurse practitioners, the intended research design is explained. The authors then describe how observation in the chosen department led to a change in design, involving trial use of patient-kept diaries as a means of assessing outcome. Despite promising results from the third diary exercise, doubts remained about the validity of the relationship between process and outcome. The small number of patients managed by nurse practitioners compared to the greater number managed by junior doctors posed difficulties for randomization; similarities in pathways of care for patients managed by the two staff groups made it unlikely that differences in outcome could be demonstrated. These problems led to abandonment of the plan for a clinical trial at that point, but the authors believe that further exploration of the idea is desirable.     

Helping Primary Care Patients Heal Holistically via Trauma-Informed Care

Nurse practitioners regularly treat primary care patients with trauma histories. By incorporating trauma-informed care into practice, nurse practitioners can enhance the provision of clinical care and, ultimately, improve patient health outcomes. This brief report demonstrates how to actively incorporate the principles and practices of the 4R framework of trauma-informed care into primary care to realize the prevalence of trauma, recognize patients’ trauma signs and symptoms, and respond to patients in a manner that resists retraumatization. Through early identification of trauma symptoms and referral to appropriate follow-up treatment, nurse practitioners can significantly improve the life course of their trauma survivor patients.     

Staff counseling specialist. Responding sensitively to workers

Due to changes in the health care environment that have expanded their role, nurse administrators have less opportunity to respond adequately to employee concerns. The position of staff counseling specialist was designed to assist nurse administrators at the University of Minnesota Hospitals and Clinics meet the increased demands of their staff. The staff counseling specialist provides a means of narrowing the gap between the staff and nurse executives by addressing employee concerns such as inadequate leadership, communication breakdown, dissonant physician-nurse relations, and other matters adversely affecting the work climate.     

Roles of Nurse Practitioners: Health Consequences of Climate Change in Vulnerable Older Adults

Nurse practitioners (NPs) have key roles in addressing health consequences of climate change across the lifespan for patients, families, communities, and populations. The role of the NP in the health and well-being of vulnerable populations is critical in understanding the deleterious consequences of climate change. Older adults are considered a vulnerable population for health challenges in our climate-changing world. The link between climate and health via a systems approach includes engaging in health assessment, physical examination, differential diagnoses, and plans for interventions. Social determinants of health, community health, and population health are discussed, with recommendations for the roles of NPs.     

Non clinical problems: nurse practitioner-physician competition

The expected increase in the number of practicing physicians does not necessarily mean that new health practitioners will not have a role. It may mean that adaptation and renegotiation of the roles are required. Filling unmet national needs, including providing primary care in undeserved areas and delivering preventive care can be achieved without unreasonable feelings of competition if nurse practitioners remain flexible and respond to new opportunities.     

Nursing and substance misuse: responding to the challenge

The widespread use and misuse of alcohol, drug and other psychoactive substances are major health and social concerns that affect the lives of many The social and health sequelae of psychoactive drugs and alcohol are preventable and manageable with minimal interventions Nurses and other health workers can effectively respond to substance misuse problems and their existing generic skills can be easily adapted in working with substance misusers This paper considers some of the issues such as the extent of the problem, attitudinal considerations, response to substance misusers and a brief outline of the role of the nurse The urgent need for education and training in substance misuse and addictive behaviour for nurse practitioners is also addressed