Caring for the future: strategies for promoting violence prevention in pediatric primary care

PURPOSE: To identify strategies that will assist nurse practitioners (NPs) to incorporate universal youth violence screening and prevention strategies into their practices. DATA SOURCES: Extensive reviews of the extant literature, clinical and anecdotal information, and professional experiences and encounters were utilized to explore and identify current practice recommendations related to youth violence prevention. CONCLUSIONS: NPs' expertise in health promotion makes them an important member of interdisciplinary team efforts to prevent youth violence. Knowledge of risk factors, appropriately focused assessment, and relevant intervention strategies can assist NPs to fulfill a valuable role in this critical endeavor. IMPLICATIONS FOR PRACTICE: Recently, there has been an increased recognition of the role that healthcare providers at all levels can play in decreasing youth violence. A greater emphasis on strategies already employed by NPs to promote the development of healthy families can contribute greatly to reducing the problem of youth violence. Universal screening for warning signs and level of violence risk in youth, as well as utilizing appropriate interventions and referrals will provide NPs with the opportunity to contribute to this important goal.     

Promotion of Cardiovascular Health in Children by Nurse Practitioners and Physicians in Family Practice

The purpose of this study was to describe cardiovascular (CV) health promotion practices of nurse practitioners (NPs) and physicians (MDs). Clinical practice was described for three age groups of children both with and without parental premature heart disease. Differences in clinical practice by type of provider and by age and risk level of the child were examined. A 42-question survey was mailed to all family NPs in North Carolina and to MDs randomly selected from the roster of the North Carolina Academy of Family Physicians; 94 responded. A high level of blood pressure measurement for all children and counseling regarding smoking for 13 to 19 year olds was found among all participants. Fewer health promotion activities were reported for other risk factors for the oldest group and for the younger children in general. Health promotion practices increased with the age of the child. Nurse practitioners had significantly higher total CV health promotion scores than did MDs, regardless of the age or risk level of the child. An increase in counseling about prudent diet and increased physical activity is needed for all children, regardless of risk level. In addition, there should be an increase in CV health promotion activities with younger children.     

Childhood obesity: prevention practices of nurse practitioners

PURPOSE: The purposes or this study were to (a) describe the prevention practices of nurse practitioners (NPs) regarding childhood obesity, (b) compare the practices of NPs by specialty, practice setting, and awareness of childhood obesity prevention guidelines, (c) identify relationships between prevention practices and demographic variables of NPs, and (d) examine the resources for and barriers to implementing prevention practices. DATA SOURCES: A convenience sample of 99 family NPs (FNPs) and pediatric NPs (PNPs) from the Intermountain area was used. Participants completed a questionnaire based on documented risk factors for childhood obesity as well as prevention guidelines developed by the American Academy of Pediatrics (AAP). CONCLUSIONS: NPs working in family practice or general pediatric practice settings were not consistently using the BMI-for-age index to screen for childhood obesity, as recommended by the AAP. However, they were teaching parents to promote healthy food choices and physical activity in their families. PNPs and FNPs working in a pediatric practice setting and NPs who were aware of prevention guidelines were more likely to perform several prevention strategies than FNPs working in a family practice setting and those who were unaware of guidelines. Major barriers to implementing childhood obesity prevention strategies included parental attitudes, the American lifestyle, and lack of resources for both the NP and the family. The main resources NPs used in preventing childhood obesity were a dietician, journal articles, and Web sites. IMPLICATIONS FOR PRACTICE: Although the majority of the NPs in this study reported being aware of childhood obesity prevention guidelines (73.7%), most were not consistently using BMI for age or monitoring children at increased risk for obesity. Because childhood obesity is escalating at such a rapid rate, it is critical that NPs working in family practice and pediatric practice settings take the necessary steps to help curtail obesity in childhood, including calculating BMI for age, targeting children at risk, and helping families develop healthy nutrition and physical activity habits. In addition to proper health supervision of children, NPs also need to be advocates in their communities to overcome barriers to childhood obesity prevention.     

The health styles of nurse practitioners

PURPOSE: To examine the formal and informal health care beliefs, behaviors, and practices of nurse practitioners (NPs). DATA SOURCES: A self-administered questionnaire with a primarily closed-ended format was distributed over a 3-day period to a convenience sample of 321 NPs attending a national NP conference. CONCLUSIONS: The overall health status and health practices of NPs were found to be fairly good, but there was room for improvement, particularly with regard to nutrition, health responsibility, physical activity, and stress management. IMPLICATIONS FOR PRACTICE: Respondents were more likely to self-diagnose and self-treat minor illnesses and largely received their primary health care from physicians. The majority of NPs indicated a willingness to receive health care from an NP; however, the nonavailability of NPs restricted this option.     

Health promotion in hospitals: the attitudes, beliefs and practices of hospital nurses

This research paper explores the attitudes, beliefs and health promotion practices of hospital nurses working on acute adult wards, as demonstrated through the use of semi-structured postal questionnaires Responses were compared with those from hospital-based occupational therapists, physiotherapists, dietitians and medical consultants, in order to examine issues of consistency and continuity between professional groups and their interaction with patients in relation to health promotion activity The nurses are considered both as a homogeneous group and also in relation to their seniority within the profession Results demonstrate the lack of a coherent health promotion strategy within acute care settings and highlight the differing educational needs of nurses according to their professional role within the hospital By addressing these issues, a strategy can be developed to enhance health promotion in hospital by building on the concerns and needs identified by the nurses themselves Research literature and analysis of this study demonstrate that whilst the current position of health promotion in hospital is generally poor, nurses are keen to integrate health promotion into their practice     

Nurse practitioner, nurse midwife and physician assistant attitudes and care practices related to persons with HIV/AIDS

Although multiple studies of nurses' attitudes toward people living with HIV/AIDS (PLWAs) can be found in the literature, little is known about the attitudes, beliefs and practices of nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs). A survey including a 21-item AIDS Attitude Scale measuring the constructs of Avoidance and Empathy was sent to 1,291 NPs, CNMs and PAs in Louisiana, Arkansas and Mississippi to describe their attitudes and care practices related to PLWAs. Respondents who were more comfortable treating PLWAs had significantly lower avoidance scores and significantly higher empathy scores than respondents with lower comfort levels in providing care. Greater than 80% of respondents indicated that they would provide health care to HIV-infected individuals. Respondents who referred HIV/AIDS patients for all care did so primarily due to lack of experience with HIV and the availability of more experienced providers. Avoidance and empathy scores were not found to be significantly associated with referral for care. This study suggests that this group of providers has relatively low avoidance and high empathy toward PLWAs and is willing to care for HIV-infected individuals.     

Florida nurse practitioners' attitudes and practices regarding oral cancer prevention and early detection

PURPOSE: To examine Florida nurse practitioners' (NPs') attitudes and practices regarding oral cancer prevention and early detection. DATA SOURCE: A statewide mail survey was conducted among Florida NPs who provided primary care. The questionnaire was adapted from an existing survey instrument used to measure NPs' knowledge, attitudes, and practices about oral cancer prevention and early detection. A total of 448 Florida NPs (33% response rate) completed the survey. CONCLUSIONS: Florida NPs reportedly were not well prepared for oral cancer prevention and early detection. Although most NPs realized the importance of annual oral cancer screening for high-risk populations and held positive attitudes toward the benefit of early detection, only 39.3% of respondents thought his or her knowledge about oral cancer was current and more than half had never provided oral cancer examinations. IMPLICATIONS FOR PRACTICE: Florida has among the nation's highest oral cancer rates, but persons at highest risk are among those least likely to see a dentist. Therefore, a multidisciplinary approach involving all relevant healthcare providers, including NPs, may be more effective than relying only on dentists' efforts in improving survival rates for oral cancer. Strategies are needed to increase the involvement of Florida's NPs in oral cancer detection.     

Prevention in the inpatient setting

PURPOSE: To review the literature on and describe approaches to implementing health promotion and disease prevention practices in the inpatient setting. DATA SOURCES: Comprehensive review of nursing and medical literature, clinical practice guidelines, and U.S. government documents. CONCLUSIONS: Preventive screening has been shown to reduce morbidity and mortality from many diseases. Health promotion and disease prevention activities form the foundation of practice for many nurse practitioners (NPs). As increasing numbers of NPs begin to practice in the acute care setting, it is important they incorporate prevention into the inpatient setting. IMPLICATIONS FOR PRACTICE: Because there are many barriers that impact appropriate preventive screening, health care providers must take advantage of every patient encounter including those in the inpatient setting. Although it may not be feasible to actually perform certain screening exams while a patient is hospitalized, it is feasible in many cases to take a few minutes to review recommended preventive screening.     

Domestic violence: what do nurse practitioners think?

PURPOSE: To examine factors that influence nurse practitioners' (NPs) ability to incorporate universal domestic violence screening practices (e.g., asking, identifying, referring and reporting) into their practices. DATA SOURCES: A stratified random survey of certified NPs in New York state was conducted in 1999. There were 118 family, women's health, OB/GYN, and adult NPs in the survey. Chi-square and ANOVA were used to analyze the data. CONCLUSIONS: There were significant differences in the domestic violence screening practices among women's health, OB/GYN, adult, and family NPs. Women's health and OB/GYN NPs were more likely to ask screening questions and identify victims of domestic violence than their other NP counterparts. IMPLICATIONS FOR PRACTICE: There is a need to identify strategies that encourage all NPs to incorporate universal domestic violence screening behaviors into their practices.     

Caught in the middle: experiences of tobacco-dependent nurse practitioners

PURPOSE: To explore how tobacco-dependent nurse practitioners (NPs) describe their experiences with health promotion and disease prevention practices with patients who smoke. DATA SOURCES: Twelve NPs who completed a graduate level NP program of study participated in face-to-face interviews and/or online chat room interviews. CONCLUSIONS: Participants' responses revealed three themes relevant to their experience as tobacco-dependent clinicians with health promotion responsibilities. These themes centered around (a) living as an insider in the world of tobacco addiction, (b) having the outside-in view of living with a tobacco addiction, and (c) being caught in the middle of a tobacco addiction. IMPLICATIONS FOR PRACTICE: All of the tobacco-dependent participants described limited smoking-cessation interventions with their patients. A barrier to implementation of more aggressive interventions, perhaps, is the provider's own tobacco addiction. With increasing evidence that tobacco-dependent health care professionals are not adequately intervening with tobacco-dependent patients, effective strategies are needed to assist and/or support not only tobacco-dependent patients but providers as well.     

Sickle cell disease: health promotion and maintenance and the role of primary care nurse practitioners

PURPOSE: To discuss the role of nurse practitioners (NPs) with regard to early identification of affected individuals, effective monitoring and screening, effective pain management and prophylaxis, and health education for patients with sickle cell disease (SCD). DATA SOURCES: Electronic database searches were performed using Medline, Cinahl, and PsycINFO. Data were obtained from medical textbooks, research, and review articles. CONCLUSIONS: SCD is a chronic inherited disease belonging to a group of conditions called hemoglobinopathies. Individuals with SCD often require close medical care from specialists. Nonetheless, NPs are in ideal positions to facilitate the health promotion and health maintenance necessary to decrease the high rate of morbidity and mortality associated with this disease. IMPLICATIONS FOR PRACTICE: NPs must understand the importance of early identification of affected individuals, effective monitoring and screening, effective monitoring and screening, effective pain treatment, and prophylaxis. The unpredictable trajectory of SCD can lead to frustration, fear, helplessness, hopelessness, and emotional distress. Ineffective pain management is a major problem for people with SCD. NPs can overcome this problem by initiating effective and prompt pain management in a nonjudgmental manner.     

Nurse Practitioners' Knowledge,Attitudes, and Clinical Practices Regarding Treatment of Tobacco Use and Dependence

This article describes knowledge, attitudes, and clinical practices regarding treatment of tobacco use and dependence reported by nurse practitioners (NPs) interested in learning about evidence-based practices. Researchers analyzed baseline data from 193 licensed NPs prior to participating in Providers Practice Prevention: Treating Tobacco Use and Dependence. Results revealed domains where participants practiced in accordance with clinical practice guidelines and some areas where additional education and support may be necessary. NPs have a tremendous opportunity to reduce tobacco-related morbidity and mortality by addressing tobacco use, making it vitally important to support their implementation of evidence-based strategies.     

Attitudes of registered nurses toward nurse practitioners

PURPOSE: Registered nurses (RNs) work closely with nurse practitioners (NPs) in all facets of patient care and often have a direct influence on the patient's perception of the professional who is directing the care, and a patient's perceptions may affect clinical outcomes. However, few studies have been conducted to measure RN acceptance of the NP. The authors surveyed RNs in southern Illinois to assess their attitudes concerning the level of care provided by NPs. Southern Illinois was chosen because of the limited number of NPs in the area and because of concerns that limited exposure might negatively influence RN attitudes about the NP role. DATA COLLECTION: A 26-item research questionnaire, previously used with school nurses, was modified to reflect RNs in general. Seven items related to demographic information, and 19 items created a five-response Likert-formatted scale (r = .93). The questionnaire was mailed to 500 randomly selected RNs from the 11 southernmost counties of Illinois. CONCLUSIONS: The results showed support of the NP role. RNs believed that NPs were knowledgeable, competent health care providers. RNs were also comfortable working with NPs and often consulted them for advice and information. They saw the role of the NP as a positive addition to the health care team. IMPLICATIONS FOR PRACTICE: One identified concern was that scores indicated RNs felt that they received limited respect from NPs. Although the scores were high in this category, some RNs had concerns that NPs might not respect or understand the difficulty of the RN role in providing patient care. NPs need to recognize their collegial and professional ties to RNs and should take time to provide positive feedback to RNs as they collaborate to provide health care. Such behavior would only solidify the health team approach.     

Breast screening education at Australian and Thai worksites: a comparison of program effectiveness

To determine whether a nurse-led breast screening educational program in the workplace improved the breast screening practices and attitudes of women. Worksites are potentially cost-effective and convenient for breast cancer screening education due to their ability to educate several women at one time. This was a collaborative study between industry, university and health services in Australia and Thailand. This was a pre post test group comparative design. Three worksites in Australia and three in Thailand were assigned to one of three groups: treatment (group education), pamphlet only, or control. All groups were assessed pre-education and again 3 months post-education on breast screening attitudes and practices using a mail-out self-report questionnaire. Women were significantly more likely to practice breast self-examination (BSE) following group education, and were more confident in their ability to detect a breast lump. There was a significant increase in breast screening discussion on the workplace for the Thai group following the group education program. An increase of 25% more women saw having a mammography as a priority. The Thai women had less access to free mammographic screening. They also had more negative attitudes and poorer knowledge regarding BSE and physical breast examination (PBE) than the Australian group, with the education program having a more positive impact on them than the Australian group. Relative breast screening attitudes and practices for the treatment, pamphlet and control groups are also presented. This study provides educators and health promotion professionals with further information on the beliefs and practices of women working in both Australian and Thai industries about breast screening. Education programs such as this one can have a positive impact on attitudes and practices including increased likelihood and confidence in practising BSE, promoting women to have a PBE, and promoting discussion of breast screening at the workplace. The findings suggest that Australian women have greater opportunities to ensure their breast health than Thai women, and that there may be a greater need for programs such as this in countries such as Thailand.     

Health promoting attitudes and behaviors among persons with disabilities

Despite the recognized importance of maintaining and improving the health status of persons with disabilities, there has been little research conducted to determine their health care attitudes and behaviors and what interventions might serve to enhance their health. Using Pender's Model of Health Promotion (1987), this study investigated the factors associated with the occurrence of health promoting behaviors among 135 adults with disabilities. Staff and peer counsellors from two Independent Living Centres in Texas administered the questionnaires and conducted brief semi-structured interviews with participants. Seventy-three percent of the sample rated their current health as good or excellent. Findings from both interviews and questionnaires suggest that participants are more likely to define health as being able to function well than as simply the absence of illness. High scores on Adaptive definition of health, the Self-Efficacy-Scale, age, and low scores on the Barriers to Health Promotion Activity for Disabled Persons scale accounted for 31% of the variance in scores on a self-report measure of health promoting behaviors. These findings suggest that interventions which address self-perceived barriers to health promotion, work to build participants' sense of mastery of their health behaviors, and encourage a definition of health that is broader than simply absence of illness may be more effective than those that focus only on information about good health practices.     

Patients on the Move!

Recently, the Surgeon General put out a Call to Action “To Promote Walking and Walkable Communities.” Walking is a powerful health promotion activity that nurse practitioners (NPs) can quickly prescribe as part of a management plan for the vast majority of their patients. NPs are key health care professionals in the promotion of walking and other physical activity for their patients across the life span. NPs should be familiar with physical activity recommendations for all of their patients, including patients with disabilities. NPs need to be able to assess physical activity as well as prescribe individualized physical activity plans.