Emergency Departments Treating Veterans for Suicide: Ensuring Quality Care for Veterans Outside of Department of Veterans Affairs Health Care Facilities

IntroductionVeterans die by suicide at higher rates than nonveterans. Given that the emergency department is often the first point of entry to healthcare following a suicide attempt, it would be beneficial for community providers to have knowledge of the characteristics, medical issues, and effective treatments most often associated with those having served in the military to ensure guideline concordant and quality suicide care. This study aimed to identify assessment and referral practices of emergency departments at rural community hospitals related to care for suicidal veterans and explore the feasibility and acceptability of identifying veterans in need of postdischarge aftercare.MethodsThis qualitative exploratory study involved content analysis of semistructured interviews. Ten emergency clinicians from 5 rural Arkansas counties with high suicide rates were interviewed about their experiences working with suicidal patients within the emergency department and perceptions of assessment, management, and referral practices.ResultsAlthough most of the emergency departments had a process for assessing for suicide risk, emergency clinicians did not always feel confident in their knowledge of assessing and caring for suicidal patients. Military history was not included in assessment, treatment, or aftercare planning, nor were brief interventions such as safety planning or lethal means safety education provided.DiscussionBest practices for suicide assessment and management of veterans exist; however, challenges specific to the emergency department regarding staff training and engaging the community to effectively link at-risk veterans to needed care hinder implementation. Veteran-inclusive assessment and intervention practices could enhance the quality of care provided in community emergency departments.     

军队重症监护专科护士培训模式的构建与实践

目的构建军队重症监护专科护士培训模式。方法通过临床调研、分析研究等方法构建了科学高效的ICU专科护士培训模式,主要包括培训目标、培训方式、培训内容及方法、考核要求等4部分。结果应用此培训模式举办了全军第一期ICU专科护士培训班,取得了很好的效果。结论为军队示范基地开展专科护士培训提供了借鉴,也为军队ICU专科护士的培养开辟了一条有效的途径。     

Nurse practitioner prescribing practice in Australia: Confidence in aspects of medication management

The findings of the 2010 national survey of nurse practitioner (NP) prescribing in Australia related to confidence in prescribing are reported. A significant correlation between years endorsed as a NP and prescribing confidence was found. NPs in Australia were significantly more confident in the prescribing aspects of commencing a new medication than adjusting or ceasing a medication prescribed by others. These findings are discussed in relation to promotion of the quality use of medicines and identification of potential strategies to promote the ongoing positive evolution of NP practice in Australia.     

The Experience of Enablement Within Nurse Practitioner Care: A Conceptual Framework

Patient enablement after consultations has not yet been adequately investigated among patients of nurse practitioners (NP) in primary health care. The lens of enablement and a qualitative parallel multistrand approach were used to explore patients’ experiences and NPs’ perspectives of consultations. Metainferences made from this study suggest NPs enable patients by creating opportunities for education and knowledge transference and building on patients’ strengths and promoting self-efficacy. Three existential components of the experience of consultations (ie, relationality, temporality, and corporality) also played a role. These findings were used to develop a conceptual framework of how patient enablement is experienced within an NP consultation.     

Primary Care Practice Environment and Burnout Among Nurse Practitioners

Poor practice environments contribute to burnout, but favorable environments containing support, resources, autonomy, and optimal relations with colleagues may prevent burnout. Compared with all nurse practitioners (NPs), 69% of these NPs provide primary care to patients, yet whether the practice environment is associated with NP burnout is unknown. A study to examine environmental factors related to NP burnout was conducted. Overall, 396 NPs completed the survey, and 25.3% were burnt-out. Higher scores on the professional visibility, NP-physician relations, NP-administration relations, independent practice, and support subscales were associated with 51%, 51%, 58%, and 56% lower risk of NP burnout, respectively.     

Adolescent Patient and Nurse Referrals for Pastoral Care: A Comparison of Psychiatric vs. Medical-Surgical Populations

PROBLEM: Referrals for pastoral care can expedite interventions that focus on the spiritual needs of hospitalized adolescents. METHODS: An uncontrolled, retrospective review of referrals (N = 73) to pastoral care for adolescents ages 10 to 22 in a pediatric hospital over an 18-month period. FINDINGS: A majority of the patients (65%) was referred from the psychiatric unit. Psychiatric patients made more self-referrals, whereas PICU nurses made more nurse-generated referrals for pastoral care. CONCLUSIONS: Spiritual care of patients in a pediatric hospital is an important component of care. Since the importance of spiritual care is well documented, referrals for spiritual issues and care are essential interventions that should not be overlooked. A better understanding of the referrals can aid in early recognition of factors that may prompt nurses to advocate for spiritual care of the patient.     

Lesbian,Gay, Bisexual,and Transgender Patient Care: Medical Students' Preparedness and Comfort

Phenomenon: Lesbian, gay, bisexual, and transgender (LGBT) individuals face significant barriers in accessing appropriate and comprehensive medical care. Medical students' level of preparedness and comfort caring for LGBT patients is unknown. Approach: An online questionnaire (2009–2010) was distributed to students (n = 9,522) at 176 allopathic and osteopathic medical schools in Canada and the United States, followed by focus groups (2010) with students (n = 35) at five medical schools. The objective of this study was to characterize LGBT-related medical curricula, to determine medical students' assessments of their institutions' LGBT-related curricular content, and to evaluate their comfort and preparedness in caring for LGBT patients. Findings: Of 9,522 survey respondents, 4,262 from 170 schools were included in the final analysis. Most medical students (2,866/4,262; 67.3%) evaluated their LGBT-related curriculum as “fair” or worse. Students most often felt prepared addressing human immunodeficiency virus (HIV; 3,254/4,147; 78.5%) and non-HIV sexually transmitted infections (2,851/4,136; 68.9%). They felt least prepared discussing sex reassignment surgery (1,061/4,070; 26.1%) and gender transitioning (1,141/4,068; 28.0%). Medical education helped 62.6% (2,669/4,262) of students feel “more prepared” and 46.3% (1,972/4,262) of students feel “more comfortable” to care for LGBT patients. Four focus group sessions with 29 students were transcribed and analyzed. Qualitative analysis suggested students have significant concerns in addressing certain aspects of LGBT health, specifically with transgender patients. Insights: Medical students thought LGBT-specific curricula could be improved, consistent with the findings from a survey of deans of medical education. They felt comfortable, but not fully prepared, to care for LGBT patients. Increasing curricular coverage of LGBT-related topics is indicated with emphasis on exposing students to LGBT patients in clinical settings.     

The Organizational Climate for Nurse Practitioners Working in Primary Health Care in New Zealand: A National Survey

Little is known about the working conditions of nurse practitioners (NPs) in primary health care in New Zealand. Data were collected using an online organizational climate questionnaire from NPs and managers who employed NPs. Nearly two-thirds of all primary health care NPs in the country (n = 136) responded together with a purposive sample of 58 managers. More than 90% of respondents from both groups identified that organizations created an environment where NPs could practice independently and autonomously with collegial support. Other results signaled opportunities for improvement in local and national health policy. This study adds to international evidence on creating positive practice environments for NPs.     

Patient trust and patient safety for low-priority patients: A randomized controlled trial pilot study in the prehospital chain of care

BackgroundPatients who call for an ambulance but only have primary care needs do not always get appropriate care. The starting point in this study is that such patients should be assigned to as basic of care as possible, while maintaining high levels of patient trust and patient safety.AimTo evaluate patient trust and patient safety among low-priority ambulance patients referred to care at either the Community Health Centre (CHC) or the Emergency Department (ED).MethodsThis randomized controlled trial pilot study compared the level of patient trust and patient safety among low-priority ambulance patients who were randomized into two groups: CHC (n = 105) or ED (n = 83).ResultsThere was a high level of trust in the care received, regardless of whether the patient received care at CHC or ED. Overall 31% fulfilled one or more of the given criteria for potentially jeopardizing patient safety.ConclusionPatient selection for the trial indicated a potential limit in patient safety. There was a high level of trust in the care received regardless of whether the patient received care. The accuracy of patient selection for the new care model needs to be further improved with the intention to enhance patient safety even further.     

Improving Hospice and Palliative Care Through Nurse Practitioner Engagement in a Community Paramedicine Program

More than 80% of Americans would prefer to die at home, but only 20% do. Paramedics have a role in caring for terminally ill patients, especially when involved in a community setting. A knowledge gap was noted with community paramedics (CPs) regarding end-of-life questions and palliative care for paramedics. This evidence-based quality improvement project aimed to provide structured, evidence-based palliative and hospice education to CPs. Nurse practitioners can provide education and training on palliative and hospice care to CPs and help patients remain at home.