Anabolic steroids: implications for the nurse practitioner

Anabolic steroids are being used by athletes in a wide variety of sports in efforts to enhance their athletic performances. Steroid abuse is complex to evaluate due to the highly emotional subject matter and the limitations in researching anabolic steroids. This article has been written to heighten the practitioner's awareness of the problem of "sports doping" with anabolic steroids. It will provide practical information on possible consequences of steroid use and outline essential information to obtain through the history, physical exam and laboratory studies. Intervention strategies based on the three levels of prevention are described. With awareness of the problem of sports doping and knowledge of how to deal with it in primary care, the nurse practitioner can enhance the health care provided to aspiring athletes, athletes and retired athletes.     

Educational implications of nurse practitioner students and medical residents' attitudes toward managed care.

The increasing number of individuals enrolled in managed care organizations is a key consideration when planning effective models of education for future health care professionals. This study compares attitudes toward managed care between medical residents (MRs) (n = 431) and advanced practice nursing students (APNSs) (n = 153) in a Midwestern U.S. state, and it reports the results of a factor analysis of the attitude survey. MRs and APNSs completed a 34-item questionnaire. Results show that MRs were more likely than APNSs to believe that cost has priority over quality of care in a managed care setting and that managed care threatens the autonomy of health care providers. APNS were more likely than MRs to believe that managed care encourages preventive health care. Other comparisons related to Medicaid, capitation, practice guidelines, and success factors are discussed. Findings indicate that MRs were more inclined to see managed care as an economic threat to quality of care than APNSs. At the same time, MRs were somewhat less enthusiastic about practice guidelines and patient outcomes as measures of success in managed care settings than APNSs. Educational implications of findings are discussed.     

Family physician/nurse practitioner: stories of collaboration

AIMS: This paper presents the experiences of nurse practitioners and family physicians working in collaborative practice at four Canadian rural primary care agencies. It focuses on the qualitative segment of a larger study examining the impact of an educational intervention on interprofessional practice. BACKGROUND: Growing awareness of the importance of health promotion and disease prevention, the increased complexity of community-based care, and the need to use scarce human healthcare resources, especially family physicians, far more efficiently and effectively, have resulted in increased emphasis on primary healthcare renewal in Canada. Key to primary healthcare renewal is care delivery through interdisciplinary teams that include nurse practitioners. METHODS: Narrative analysis, a form of interpretive analysis that respects the integrity of the stories told by participants, was chosen as the strategy to examine the narrative data gathered in two sets of interviews with the nurse practitioners and family physicians. The study was undertaken during 2000. RESULTS: Thirteen family physicians and five nurse practitioners with diverse educational backgrounds and varied experience with collaboration participated in the qualitative component of the study. A number of issues related to working in a shared practice were identified in nurse practitioner and family physician interviews across the research sites. The themes identified in participants' stories included issues related to the scope of practice, emphasizing the importance of role clarity and trust, the ideological difference regarding disease prevention and health promotion, differences in perceptions about the operation of collaborative practice, and the understanding that collaborative relationships evolve. CONCLUSIONS: The placement of nurse practitioners and family physicians in a common clinical practice without some form of orientation process does not produce collaborative practice. Educational strategies related to role expectations are necessary to facilitate the development of care delivery partnerships characterized by interdependent practice.     

Community of practice: a nurse practitioner collaborative model

A study was undertaken with nurse practitioners (NPs) in 2008-2009 to examine post-legislation role development in British Columbia. The authors used a participatory action research approach to engage NPs in social investigation, education and action, and to explore, from the participants' perspective, how collaboration advances NP role integration in primary healthcare. A particular discovery of the study was the Interior Health Authority Community of Practice (CoP) established in collaboration with health leaders and NPs. The purpose of this paper is to report on the CoP and the five characteristics describing this collaborative CoP model, including sanctioned social structure, knowledge exchange network, practice discovery and innovation, generating meaning and value, and power sharing for strategic improvement. The CoP helped NPs to build collegial and collaborative relationships, enhance practice learning and competence, extend and apply new knowledge, enrich professional identities, and shape health organizational policy and politics. Because healthcare research about CoPs is limited, principles of a collaborative CoP model are offered for broader healthcare use. The authors conclude that a collaborative CoP model addresses the internal interests and needs of participating members while attending to the external concerns of the organization, and thus contributes to healthcare improvement.     

Use of oral examinations to teach concepts of evidence-based practice to nurse practitioner students

Evidence-based practice has become part of nurse practitioner education. One innovative approach to teaching and evaluating evidence-based practice is the implementation of oral examinations, in which students orally present their review of a research article. Prior to the examination, students are given a research article to critique and can prepare for the examination using their notes and textbooks. At a scheduled time, they meet with a faculty member to respond to both predetermined and unexpected questions requiring critique of the research and thorough explanation of how it will (or will not) influence their practice. Although this approach may produce anxiety in students, it provides another way to evaluate students' ability to communicate about a complex topic and is an excellent complementary evaluation method to other approaches, such as case studies or written examinations.     

Cultural competence of nurse practitioner students: a consortium's experience

Professional standards require culturally competent care, but competencies are rarely assessed. An instrument adapted from the work of cultural competence experts was used to assess the cultural competence of nurse practitioner students (n = 122). The 30-item instrument indicated adequate reliability scores (.78 to .87). Students reported high levels of comfort with people who are different from themselves and felt that cultural knowledge was important. Students scored fairly low on engaging in community-related culturally relevant behaviors. Predictors of culturally competent behaviors in clinical practice and the community were: comfort with others who are different from themselves, the degree of importance attached to cultural knowledge, and likelihood of future practice in rural areas. Nurse practitioner programs need to concentrate on increasing students' comfort with culturally diverse client groups and stressing a deeper cultural knowledge in clinical practice.     

Assessing nurse practitioner students using a modified objective structured clinical examination (OSCE)

Limitations of applying the traditional final medical examination for the assessment of clinical competence of nurse practitioners are a matter of concern. This paper discusses a modified Objective Structured Clinical Examination (OSCE) to assess physical examination skills of student nurse practitioners at Bournemouth University. This assessment was developed to standardize the evaluation of examining skills by using healthy volunteers from the student body as patients. This modified OSCE can be used as an assessment tool for formative and summative assessment, as a resource for learning, as a basis for abbreviated versions of physical examination assessments and to identify gaps and weaknesses in clinical skills. The emphasis, therefore, is not only on the product but also the process. The Bournemouth experience may be of interest to other organizations that are developing OSCEs for formative and summative purposes in nurse practitioner education.