COVID-19 on New Primary Care Nurse Practitioners: A Qualitative Exploration

New nurse practitioners (NPs) struggle with the transition to practice and feelings of uncertainty concerning roles and responsibilities. COVID-19 has added a new layer of stress. This pilot study used a qualitative case study design featuring semistructured interviews of 10 newly graduated primary care NPs. Data analysis revealed 2 main themes: (1) emotional burden, and (2) coping and support. Emerging themes highlight the resiliency of NPs, who cope and seek support when faced with emotional burdens. This study informs educators and employers on the needs of new NPs during a global pandemic in order to better support the future workforce.     

Caring behaviors as perceived by nurse practitioners

PURPOSE: To investigate nurse pratctitioners' (NPs') perceptions of their own caring behaviors and to examine NPs' demographics as a function of their caring behaviors. DATA SOURCES: Responses to the Caring Behaviors Inventory(CBI) and a demographic inquiry from 348 NPs in Louisiana. CONCLUSIONS: CBI mean scores and subscale scores were high for all 348 NPs. No statistically significant difference was found between male NPs' and female NPs' total mean CBI scores or between urban or rural total mean CBI scores. The interaction between nurse gender and area o practice was not statistically significant. IMPLICATIONS FOR PRACTICE: NPs often work in clinic situations where productivity is the most valued characteristic and where little time is afforded for identifying caring behaviors of the NP and/or establishing a caring relationship with the patient. NPs must be extremely conscious of the need not to "throw out the baby with the bathwater" and sacrifice characteristics that are inherent in nursing for those emphasized in primary care practice. As their responsibilities in the health care setting continue to expand, NPs must continually evaluate and validate their roles to ensure quality care that satisfies patients.     

Fathers' grief when a disabled child dies

This qualitative study examines the subjective experience of fathers' grief responses to the death of a child with a disability. Eight fathers were interviewed and completed the Grief Experience Inventory (GEI). GEI results indicated that fathers did not differ significantly from parents who lose a child in other ways. However, subjectively, fathers consistently reported that their bereavement was marked by a “double loss”: disability and then death. Consistent with the literature on gender differences in bereavement, fathers reported greater emotional stoicism and used activity, rather than talk or social support, as a primary coping strategy. Clinical implications for professionals working with grieving men or with couples are discussed.     

Assessment of older urban drivers by nurse practitioners

Thirty-five older urban adults who had forfeited a driver's license and 25 nurse practitioners (NPs) who provided health care to them participated in a qualitative study to (a) explore the perception of NPs regarding their role in assessing the driving abilities of older adults, (b) describe the ways in which NPs assist their clients to cope with the loss of a driver's license, and (c) delineate the NPs influence on the elders' decision to forfeit their license. Findings suggest that most NPs had concerns about their older clients' driving abilities. However, assessment of parameters related to driving safety was not their primary objective. An NPs recommendation to forfeit a license was important to the older driver's decision to do so. Assisting clients with the consequences of no longer driving was difficult for a variety of reasons.     

Critical care nurses' experiences of grief in an adult intensive care unit

Title.  Critical care nurses' experiences of grief in an adult intensive care unit.
Aim.  This paper is a report a study of critical care nurses' experiences of grief and their coping mechanisms when a patient dies.
Background.  The goal of patients entering critical care is survival and recovery. However, despite application of advanced technologies and intensive nursing care, many patients do not survive their critical illness. Nurses experience death in their everyday work, exposing them to the emotional and physical repercussions of grief.
Method.  This study adopted a Heideggerian phenomenological approach, interviewing eight critical care nurses. Data collection occurred in 2007/8. Interviews were transcribed verbatim and themes generated through Colaizzi's framework.
Findings.  Participants reported feelings of grief for patients they had cared for. The death of a patient was reported as being less traumatic if the participant had perceived the death to be a 'good death', incorporating expectedness and good nursing care. They described how a patient's death was more significant if it 'struck a chord', or if they had developed 'meaningful engagement' with the patient and relatives. They denied accessing formal support: however, informal conversations with colleagues were described as a means of coping. Participants exhibited signs of normalizing death and described how they disassociated themselves emotionally from dying patients.
Conclusion.  There are many predisposing factors and circumstantial occurrences that shape both the nature of care of the dying and subsequent grief. Repeated exposure to death and grief may lead to occupational stress, and ultimately burn out. Emotional disengagement from caring for the dying may have an impact on the quality of care for both the dying patient and their family.     

Patient satisfaction with nurse practitioner-delivered primary healthcare services

Purpose: To identify levels of satisfaction with nurse practitioner (NP)-delivered primary healthcare services and to determine demographic differences in degrees of general satisfaction reported by patients.
Data sources: The Nurse Practitioner Satisfaction Survey (NPSS), a 28-item, 5-point, Likert-type survey instrument was developed; data from 300 female and male clients over 18 years of age presenting for primary healthcare visits at the employee health department of a not-for-profit hospital in the Southern United States were analyzed.
Conclusions: Although many studies using a variety of healthcare-related patient satisfaction instruments have demonstrated acceptable patient satisfaction with NPs, few have investigated patient satisfaction with NPs in the outpatient primary care occupational health arena. Overall the population seeking health care was satisfied with NP services. In particular, married or cohabitating subjects reported general satisfaction scores that were statistically significantly higher than those who were single and never married. No other differences were found.
Implications for practice: The provision of on-site, employer-sponsored NP primary healthcare services that are perceived as acceptable and satisfactory to employees and families affords significant opportunity and advantage to both employee and employer. Such benefits include enhanced employee and family wellness, facilitated health promotion, enhanced access to care, reduced illness related to time away from work, improved employee productivity, and reduced overall organizational healthcare costs. Knowledge regarding those characteristics contributing to general satisfaction with NP-delivered care serves to facilitate practice pattern changes within the profession that further enhances the visibility, utilization, and acceptability of NPs as primary care providers.     

Physician perceptions of nurse practitioners: a replication study

Purpose: To replicate and update findings from an earlier study on the perceived incentives of physicians to work with nurse practitioners (NPs).
Data sources: Four hundred and three questionnaires were mailed to NPs who distributed them to their collaborating physicians.
Conclusion: Physicians ranked "accessibility to health care" and the "quality of care" as equally important and more important than "physician satisfaction" and "economic incentives." The findings were consistent with findings from the earlier study; however, the original study demonstrated a much clearer distinction among the four groups of incentives.
Implications for practice: These findings imply that collaboration between physicians and NPs is maturing as NPs move into more arenas in health care.     

The U.S. Preventive Services Task Force: An evidence-based prevention resource for nurse practitioners

Purpose: To describe the work of the U.S. Preventive Services Task Force and to encourage nurse practitioners (NPs) to use its evidence-based recommendations for clinical preventive services.
Sources: Evidence reports, recommendation statements, and journal articles published under the auspices of the U.S. Preventive Services Task Force since its establishment in 1984.
Conclusions: A core competency for NPs working in primary care is knowledge about and provision of appropriate preventive services for their patients. The U.S. Preventive Services Task Force, an independent panel of experts in prevention and primary care, is an important resource for NPs.
Implications for Practice: NPs can use Task Force recommendations to guide their screening, counseling, and preventive medication decisions. They can also educate patients about the missed prevention opportunities related to underuse of effective services and the potential harms of overuse of inappropriate preventive services.     

Young Children's Grief: Parents' Understanding and Coping

The grief experiences of young children and the interactional dynamics between parents and children leading to healthy grieving remain comparatively underresearched. This article reports a qualitative evaluation of a Norwegian Bereavement Support Program where 8 parents described their young child's grief reactions and coping and how these intersected with their own grief. Successful parental coping with their child's grief involves understanding the child's genuine concerns following the death and an intricately holistic balance between shielding and including, between informing and frightening, and between creating a new life while cherishing the old.     

A heuristic model of grieving after high-grief deaths

Building on evidence I offered earlier (Horacek, 1991), I develop a heuristic model of grieving that challenges the assumptions that grieving is time limited and that the bereaved should totally detachet or detach themselves from emotional ties to the deceased. This model includes three sets of reactions and grief tasks. Although many reactions will fade and some will disappear, and most grief tasks can be completed, this model states that the basic loss continues to exist like a phantom limb after amputation. Unlike unresolved m chronic grief, this continuing giving or loss does not significantly impair everyday functioning. The implications of this model are discussed.