Evaluating Advanced Practice Nurses’ Burnout and Potential Helping Modalities

Health care providers are experiencing increased stress during the coronavirus disease 2019 pandemic. While it is understood that increased stress leads to burnout, limited research has been conducted to evaluate advance practice nurse response to coronavirus disease 2019, and more specifically, self-identified modalities that may decrease stress in the workplace or at home. This pilot study evaluated advance practice nurse-perceived burnout and evaluated perceived needs and/or perception of modalities aimed at reducing stress and improving well-being, such as essential oils, quiet room, soothing music, art therapy, pet therapy, and mobile applications, that could be easily accessed in the workplace.     

Evaluating Advanced Practice Nurses’ Knowledge and Use of Electronic Consultations

Timely access and appropriate referrals to a specialist are shared problems among primary care providers. Historically, consultations with a specialist have required long waits for patients; often, these referrals result in unnecessary and costly appointments. Recently, primary care providers have begun to use electronic consultation (e-consult) for provider-to-provider consultation. Medicare released Current Procedural Terminology codes in February of 2019 that allow for billing of this type of visit. Little information regarding e-consult was found in the nurse practitioner literature. This pilot study evaluated e-consult knowledge and the use of advanced practice nurses in a state that has robust telehealth policies and reimbursement.     

Do State Restrictions on Advanced Practice Registered Nurses Impact Patient Outcomes for Hypertension and Diabetes Control?

The Institute of Medicine recommends that nurses practice to the full extent of their education and training, yet, state regulations continue to limit the scope of practice for advanced practice registered nurses (APRNs). One reason is the unproven belief that patient outcomes will be inferior if APRNs practice without regulations. This study examined whether the absence of restrictions on APRNs results in inferior outcomes for patients with hypertension or diabetes. We used publicly available data for patients seen in Federally Qualified Community Health Centers during 2013 in 6 states with the most restrictions and in 10 states with the least restrictions.     

Advanced Practice Registered Nurse–directed Care Coordination Interventions and Outreach After Critical Illness

The purpose of this pilot study was to implement care collaboration measures into a critical care advanced practice. The intervention included an outreach algorithm and a standardized handoff tool during care transition. One hundred eight patients were enrolled; 5 (4%) experienced unplanned readmission. There was no significant association with transition time and the ability to complete the algorithm. Comorbidities of chronic obstructive pulmonary disease (P < .005), a PaO₂ ratio < 200 (P < .003), and pulmonary disease (P < .027) showed increased unplanned readmission within 48 hours of transition. Implementing critical care collaborating measures was not affected by transition time and unit care flow.     

United Nations’ Sustainable Development Goal 3 Target Indicators: Examples of Advanced Practice Nurses’ Actions

In 2015, the United Nations created 17 Sustainable Development Goals. Sustainable Development Goal 3, “Good Health and Wellbeing,” includes 13 health target metric goals. This short report describes how advanced practice nurses (APNs) have addressed Goal 3 around the world. Given the variation in the APN roles internationally, it is important to capture common aspects of projects conducted during the first 5 years of this initiative. This report serves as a template for further evaluations of the importance of APNs in supporting global health policies. These findings inform how the workforce can effectively pursue these goals.     

Setting or Patient Care Needs: Which Defines Advanced Practice Registered Nurse Scope of Practice?

The purpose of this article is to provide insight into the roles and population focus of both the family nurse practitioner and the adult gerontology/acute care nurse practitioner. The article looks at problems that seem to be increasing in prevalence in terms of who should be taking care of primary care patients and who should be taking care of acute care patients. Solutions are offered that could keep both types of practitioners out of the sphere of litigation.     

Registered Nurses’ understanding,knowledge and perceptions of the association between sexually transmitted infections and domestic violence

BackgroundDomestic violence (DV) and sexually transmitted infections (STIs) are major healthcare issues, with known detrimental health outcomes. Though evidence confirms that individuals who experience DV are at a greater risk of acquiring STIs, there is paucity in the literature focused on nurses’ knowledge of the relationship between DV and STIs.AimThis study aimed to explore Registered Nurses’ (RNs’) knowledge of the association between DV and STIs.MethodsThe study was approved by the relevant Human Research Ethics Committee. Data were collected via face-to-face, telephone and computer-mediated interviews guided by a semi-structured interview schedule. The interviews were digitally recorded, transcribed verbatim, and thematically analysed using Braun and Clarke (2006).FindingsThree themes emerged from the data: Knowledge of DV/STIs: My knowledge is just general; Education: I feel I need a bit more education, and Knowledge of Association between DV/STIs: I really don’t know the answer.DiscussionThe study found that as a result of participants having a lack of education and knowledge associated with DV and STIs, they were unable to identify and articulate a relationship between DV and STIs. Because of these knowledge deficits participants did not consider transmission of STIs in an intimate relationship where DV could exist.ConclusionOur study suggests that nurses are unaware of the increased risk for STI acquisition within the context of DV. This lack of awareness would no doubt lead to missed opportunitites for screening and provision of appropriate care.     

Increasing Access to Health Care by Implementing a Consensus Model for Advanced Practice Registered Nurse Practice

Advanced practice registered nurses (APRNs) are expert clinicians who manage the patient’s overall care. The APRN Consensus Work Group and the National Council of State Boards of Nursing APRN Advisory Committee developed a Consensus Model to standardize APRN regulations and licensing. This model focuses on 4 roles: certified registered nurse anesthetist, certified nurse-midwife, clinical nurse specialist, and certified nurse practitioner. Twenty-three states have implemented this Consensus Model. This article focuses on increasing awareness for implementation of the APRN Consensus Model. Eliminating practice barriers will standardize the regulatory process for APRNs, increase state-to-state practice mobility, and increase access to APRN care nationwide.     

Medical‐Surgical Patients’ and Registered Nurses’ Satisfaction and Comprehensiveness of Patient Assessment Using the Clinically Aligned Pain Assessment Tool

BackgroundThe pain experience is complex, and nurses are challenged to objectively assess and document patients’ subjective reports of pain. There is a clear need for an assessment tool that is easy to use and provides meaningful, actionable information for patients and nurses.AimsThis study explored nurses’ and patients’ satisfaction with the Clinically Aligned Pain Assessment (CAPA) as well as nurses’ charting.Setting and ParticipantsA convenience sample of adult patients and nurses on four medical-surgical units in one community hospital.MethodsA quantitative, two-group comparison design between patients and nurses using questionnaires to determine satisfaction and a retrospective chart review to determine comprehensiveness of nurse charting.ResultsNo significant differences existed between patients’ and nurses’ responses to seven of eight satisfaction questions The median score for seven of eight questions was 5 (using a 6-point Likert scale with 1 = strongly disagree and 6 = strongly agree), which demonstrated more than 80% agreement (somewhat agree, agree, strongly agree) among both groups that CAPA was superior to the NRS, based on individual responses. The one significant difference (p = 0.03) revealed patients were more likely to respond “agree or strongly agree” compared to nurses regarding the nurse thoroughly addressing patients’ needs using CAPA. Inter-rater reliability using CAPA was determined to be 89.5%, and a panel of clinical experts determined CAPA had strong content validity of 88.33%. In addition, 70.41% of nurses charted comprehensively using CAPA.ConclusionAs a result, CAPA was determined to be convenient, accurate, and valuable in guiding intervention decisions.     

Effect of Pain Education Interventions on Registered Nurses’ Pain Management: A Systematic Review and Meta-Analysis

ObjectivesThis review and meta-analysis aims to reveal how pain education interventions affect registered nurses’ pain management.DesignA systematic review and meta-analysisData sourcesPubMed, Scopus, CINAHL (EBSCOhost), and ERICReview methodsA systematic search of four electronic databases was conducted to identify relevant peer-reviewed English or Finnish-language articles published between 2008 and 2021. The review included a quality appraisal and a meta-analysis of articles providing group-level data before and after the intervention (n = 12). The methods followed the PRISMA guidelines.ResultsOverall, 23 articles met the inclusion criteria for the review, of which 15 were evaluated as good quality. Based on the articles on document audits (n = 10), pain education interventions reduced the risk of not receiving the best pain management by 40%, whereas based on the articles on patients’ experiences (n = 4), they reduced the risk by 25%. The study quality and design of these articles were considerably heterogenous.ConclusionsPain education study strategies varied widely among the included articles. These articles used multivariate interventions without systematization or sufficient opportunity to transfer the study protocols. It can be concluded that versatile pain nursing education interventions, as well as auditing of pain nursing and its documentation combined with feedback, can be effective to nurses in adapting pain management and assessment practices and increasing patient satisfaction. However, further research is required in this regard. In addition, well-designed, implemented, and reproducible evidence-based pain education intervention is required in the future.     

Contradictions between Ideals and Reality: Swedish Registered Nurses’ Experiences of Dialogues with Inpatients in Psychiatric Care

This study explored ten registered nurses’ experiences of dialogues with inpatients in psychiatric care. Data were collected through four focus group discussions, and two individual interviews. The nurses described contradictions between their nursing ideals about dialogues and the reality faced in psychiatric inpatient care, resulting in an unsatisfactory work situation and feelings of insufficiency. We conclude that in order to improve quality of care and increase well-being for both patients and health care workers, nursing interventions, such as dialogues and meaningful activities, need to be offered to patients. A management that is visible and present on-site should encourage and facilitate health care workers’ participation in clinical supervision.     

Nociception Coma Scale–Revised: Nurses’ Experience in Clinical Practice

BackgroundThe Nociception Coma Scale–Revised (NCS-R) is a rating scale developed and validated for measurement of nociception and pain among patients with brain injuries in unresponsive wakefulness syndrome or minimally conscious state. However, little is known about its use in daily clinical practice.AimsThe aim of this study was to explore clinical experience with the NCS-R by means of focus group interviews with nurses and nurse assistants in a subacute rehabilitation ward for patients with severe brain injuries.DesignQualitative focus group interview study.SettingsDepartment for highly specialized neurorehabilitation for patients with severe brain injuries.Participants/SubjectsNurses and nurse assistants.MethodsIn total, 12 experienced registered nurses and nurse assistants participated in two recorded focus group interviews. The participants were selected from the subacute neurorehabilitation ward on the following criteria: Employed at the ward for at least 11 months and being introduced to and having experience with using the NCS-R in own patients for a minimum period of 6 months. An inductive qualitative analysis was conducted by reading the interview text through several times, and meaning units were defined first separately and later jointly between the authors. Then meaning units were coded and categorized into subthemes and themes.ResultsWe found three themes, general relevance of the NCS-R, NCS-R versus level of consciousness, and overall assessment of pain in patients with disorders of consciousness, with a total of eight subthemes.ConclusionsThe content and subscales of the NCS-R are relevant for pain assessment in patients with severe brain injury in subacute rehabilitation. However, with the present cutoff value at 4 points, challenges are associated with using NCS-R, especially in patients with unresponsive wakefulness syndrome because they are at risk of not being assessed with respect to pain.     

Nurse Leaders’ Strategies and Tool Kit For Internationally Educated Filipino Nurses’ Transition to Practice in the United States

The purpose of the article is to share strategies and a tool kit for nurse leaders in providing support to internationally educated Filipino nurses (IEFNs)’ meaningful and successful transition to providing high-quality, safe, and excellent patient care in the United States. My lived experiences and study as an IEFN are the impetus of this valuable article. The 3 takeaways from the article: IEFNs have the purpose, positive outlook, and perseverance to better themselves personally and professionally, and to contribute significant outcomes to the health care, people, and society in the United States, and they need support systems: family, hospital leaders/management, coworkers, professional organizations, and community/civic organizations.