Achieving Health Equity: Examining Telehealth in Response to a Pandemic

The coronavirus disease 2019 (COVID-19) pandemic necessitated social distancing mandates, the conservation of personal protective equipment, and the prioritization of health care resources, thus prompting the rapid scale-up of telehealth services. The COVID-19 pandemic illustrates the importance of taking a broader view of health policy that facilitates the optimal conditions in which patient-centered care occurs and health equity is pursued. This article examines the use of telehealth during the pandemic as a case for demonstrating the necessity for advanced practice nurses to engage in broad policy initiatives to address social determinants of health care.     

Telehealth Billing for Nurse Practitioners During COVID-19: Policy Updates

Telehealth is a growing valuable strategy to assist patients accessing needed care when unable to get to a health care setting for one of several reasons. During the coronavirus disease 2019 (COVID-19) pandemic of 2020, many health care practices were forced to implement telehealth services to meet patient and practice needs. In 2020, several temporary waivers, exceptions, and telehealth policy changes emerged across the nation. Many telehealth policies are state or federal specific. This report provides a general overview of essential telehealth policies and legislative updates along with resources and websites to guide and support nurse practitioners with contemporary regulations regarding telehealth billing.     

Telehealth Education of Nurse Practitioner Students

Telehealth is rapidly becoming a viable mode of health care delivery. Telehealth education of nurse practitioners (NPs) is recommended during their academic careers to increase confidence in the use of this technology. On the basis of competencies developed by the National Organization of Nurse Practitioner Faculties and using the Multimodal Framework as a guide, telehealth was integrated into an NP curriculum. This article provides a high-level overview of the structure, process, and outcomes of how telehealth was integrated into an NP program of study, inclusive of didactic, experiential, and clinical components.     

Nurse Practitioner Transition to Practice: Development of a Residency Program

Nurse practitioner residency programs assist new graduates to transition to practice. This article describes the development of a primary care nurse practitioner residency program at a large academic medical center in the mid-Atlantic region. Organizational factors related to program development and support as well as fiscal and human resource considerations are presented. Curricular considerations inclusive of both clinical and didactic content are presented in conjunction with a curricular outline. Finally, recommendations for nurse practitioner residency program development and expansion within academic and nonacademic medical centers are provided.     

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.     

Opportunities and Challenges of Telehealth in Disease Management during COVID-19 Pandemic: A Scoping Review

Objective  The novel coronavirus disease 2019 (COVID-19) pandemic is an unexpected universal problem that has changed health care access across the world. Telehealth is an effective solution for health care delivery during disasters and public health emergencies. This study was conducted to summarize the opportunities and challenges of using telehealth in health care delivery during the COVID-19 pandemic. Methods  A structured search was performed in the Web of Science, PubMed, Science Direct, and Scopus databases, as well as the Google Scholar search engine, for studies published until November 4, 2020. The reviewers analyzed 112 studies and identified opportunities and challenges. This review followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocols. Quality appraisal was done according to the Mixed Methods Appraisal Tool (MMAT) version 2018. Thematic analysis was applied for data analysis. Results  A total of 112 unique opportunities of telehealth application during the pandemic were categorized into 4 key themes, such as (1) clinical, (2) organizational, (3) technical, and (4) social, which were further divided into 11 initial themes and 26 unique concepts. Furthermore, 106 unique challenges were categorized into 6 key themes, such as (1) legal, (2) clinical, (3) organizational, (40 technical, (5) socioeconomic, and (6) data quality, which were divided into 16 initial themes and 37 unique concepts altogether. The clinical opportunities and legal challenges were the most frequent opportunities and challenges, respectively. Conclusion  The COVID-19 pandemic significantly accelerated the use of telehealth. This study could offer useful information to policymakers about the opportunities and challenges of implementing telehealth for providing accessible, safe, and efficient health care delivery to the patient population during and after COVID-19. Furthermore, it can assist policymakers to make informed decisions on implementing telehealth in response to the COVID-19 pandemic by addressing the obstacles ahead.     

Advancing Nurse Practitioner Preceptor and Student Engagement in Evidence-based Practice at the Point of Care

Nurse practitioner students focus on the diagnosis, treatment, and management of patient conditions and are less diligent in searching and using evidence to guide clinical decision making. It can be time-consuming for students and preceptors to identify the evidence that supports clinical decisions and to integrate this skill at the point of care. This article presents strategies to assist students and preceptors in translating research into evidence at the point of care and provides concrete suggestions and examples to advance evidence-based practice skills in students and preceptors.     

Telemedicine Adoption during the COVID-19 Pandemic: Gaps and Inequalities

Background  The telemedicine industry has been experiencing fast growth in recent years. The outbreak of coronavirus disease 2019 (COVID-19) further accelerated the deployment and utilization of telemedicine services. An analysis of the socioeconomic characteristics of telemedicine users to understand potential socioeconomic gaps and disparities is critical for improving the adoption of telemedicine services among patients. Objectives  This study aims to measure the correlation of socioeconomic determinants with the use of telemedicine services in Milwaukee metropolitan area. Methods  Electronic health record review of patients using telemedicine services compared with those not using telemedicine services within an academic-community health system: patient demographics (e.g., age, gender, race, and ethnicity), insurance status, and socioeconomic determinants obtained through block-level census data in Milwaukee area. The telemedicine users were compared with all other patients using regression analysis. The telemedicine adoption rates were calculated across regional ZIP codes to analyze the geographic patterns of telemedicine adoption. Results  A total of 104,139 patients used telemedicine services during the study period. Patients who used video visits were younger (median age 48.12), more likely to be White (odds ratio [OR] 1.34; 95% confidence interval [CI], 1.31–1.37), and have private insurance (OR 1.43; CI, 1.41–1.46); patients who used telephone visits were older (median age 57.58), more likely to be Black (OR 1.31; CI 1.28–1.35), and have public insurance (OR 1.30; CI 1.27–1.32). In general, Latino and Asian populations were less likely to use telemedicine; women used more telemedicine services in general than men. In the multiple regression analysis of social determinant factors across 126 ZIP codes, college education (coefficient 1.41, p  = 0.01) had a strong correlation to video telemedicine adoption rate. Conclusion  Adoption of telemedicine services was significantly impacted by the social determinant factors of health, such as income, education level, race, and insurance type. The study reveals the potential inequities and disparities in telemedicine adoption.     

Implementation of a Nurse Practitioner-Led Drive-Through COVID-19 Testing Site

Efficient strategies for testing large numbers of patients must be developed to limit the spread of coronavirus disease 2019 (COVID-19). We demonstrate that our drive-through model is an efficient method of testing large numbers of patients during a pandemic. In the drive-through, cost per patient and personal protective equipment use were significantly less than in 3 brick-and-mortar clinics providing testing. We provide an example of effective nurse practitioner leadership in a drive-through testing site and demonstrate that nurse practitioners are ideally suited to provide leadership given their adaptability, ability to function in a variety of settings, and extensive experience with care coordination and logistics.     

Considerations When Using Telemedicine As the Advanced Practice Registered Nurse

Accessibility to health care is crucial to management of chronic and acute conditions. Although the severe acute respiratory syndrome coronavirus 2 pandemic significantly impacts the issue of access to health care, with the introduction of Waiver 1135, telehealth has become a positive strategy in increasing safe access to health care. This report addresses considerations to take into account when advanced practice registered nurses use telehealth to facilitate access to care.     

Statewide Mapping of Nurse Practitioner Models of Practice Throughout Victoria

As nurse practitioner (NP) numbers increase, diversity and location of practice varies. This exploratory, prospective, observational, cross-sectional multicenter study was conducted to determine diversity and location of NPs in Victoria, Australia. An online survey about NP workplace and models was sent to 339 NPs throughout Victoria. Forty health services employed ≥1 NPs. Of those working in hospital settings, most were inpatient settings in a metropolitan hospital. Most NPs had a prescriber number, and less than half had a Medicare provider number. We identified heterogeneity in NP models with gaps in service provision in community and mental health.     

Nurse Practitioner Post-Graduate Residency Program: Best Practice

This review aims to better understand the novice nurse practitioner (NP) transition to practice, while providing content from organizations focused on quality transitional programs. A major problem is the shortage of NPs in primary care. This is related to high turnover due to the difficult transition from expert RN to novice NP. To better understand this transition, Duchscher’s Transition Shock Theory was examined and used to support the importance of residency programs. This review provides support for the use of NP residencies to positively impact the transition to practice for the novice NP. The Community Health Center Inc. NP Residency Program promotes quality NP residencies and is used as an exemplar. The article also addresses the concern with residency variability and the cost associated with these programs.     

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.     

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.     

Telehealth: An Effective Model of Care for Renal Cancer Surveillance

The coronavirus disease 2019 pandemic presented challenges for urology patients to receive care in the format of a traditional clinic visit. For renal cancer patients, active surveillance and postintervention surveillance are the standard components of management. Telehealth, which was defined as a televideo encounter via the BlueJeans (Verizon) platform (a telehealth platform), was used to ensure continuity of care. Telehealth using the televideo modality was shown to be an effective model of care delivery to provide an optimal patient experience with ease of use.     

Nurse Practitioner Role,Independent Practice,and Teamwork in Primary Care

Primary care nurse practitioner (NP) workforce represents a substantial supply of primary care providers able to meet the demand for care. However, many barriers influence NP practice and care. This study conducted a survey of NPs in New York state to better understand NPs' role, independent practice, and teamwork in primary care organizations. Overall, 278 NPs completed the online survey. Forty-two percent of NPs had their own patient panel. The mean score of the Autonomy and Independent Practice scale was higher than that of the Teamwork scale. These scales were positively correlated, suggesting that NP independent practice may improve teamwork.     

Using New Communication Technologies: An Educational Strategy Fostering Collaboration and Telehealth Skills in Nurse Practitioners

Collaboration skills and proficiency in telehealth communication technologies are essential competencies for all advanced practice nurses and are especially important for those in rural or remote sites. This article explores new communication technologies available for use in telehealth and discusses an innovative experiential learning activity that promoted doctor of nursing practice student competencies in using these technologies to connect and collaborate from a distance.     

The Nurse Practitioner in Saudi Arabia: Potentials and Threats

The provision of the nurse practitioner (NP) began in the mid-1960s and is defined more clearly nowadays in many developed countries, such as the United States, Canada, United Kingdom, and Australia. Their scope of practice is legally well defined in these nations. However, the countries of the Middle East, including Saudi Arabia, face the problem of lack of enough numbers of NPs and even lack well-defined NPs’ roles and duties. Several challenges face the effective adoption of the NP title and roles in Saudi Arabia, where it cannot be identified successfully without a clear recognition, definition, scope, legislation, or a regulatory framework