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.     

Liability Risks for Psychiatric Mental Health Nurse Practitioners

Psychiatric/mental health nurse practitioners play a key role in providing care to patients with mental illness. This role is increasing caused in part by a nationwide shortage of psychiatrists, as well as a lack of primary care physicians trained in basic psychiatric services. However, with increased clinical responsibilities come important legal considerations. Psychiatric nurse practitioners should become familiar with legal issues surrounding this practice area in order to ensure best practices for patients and to avoid malpractice litigation and licensing issues.     

Health Problems Encountered by Nurse Practitioners and Physicians in General Medicine Clinics

Distribution of health problems encountered by nurse practitioners and physicians in general/adult medicine clinics was studied. Proportional samples by clinics were selected from a total of 13,039 patient visits made to four clinics during an 18-week period in 1978. A Patient Encounter Form was used as the instrument and the ICD-9-CM as the coding system. Results showed that (a) 25.1% of the 13,039 patient visits were made to the nurse practitioners and 74.9% to the physicians, (b) 23 frequently reported health problems constituted more than 50% of all health problems seen by both provider groups, and (c) health problems with V codes constituted less than 30% of all health problems seen by both provider groups. Many similarities in health problems seen by nurse practitioners and physicians may indicate that nurse practitioners in the general/adult medicine specialty are used more to substitute for physicians in managing selected health problems than to complement medical practice.     

Smoking Cessation Counseling by Emergency Physicians: Opinions, Knowledge, and Training Needs

Objectives: To determine: 1) the extent of emergency physicians' (EPs') training in smoking cessation counseling; 2) their understanding of counseling and pharmacologic treatment techniques; 3) their current practices in screening, counseling, and referring patients who smoke; and 4) perceived barriers to routine smoking cessation counseling in emergency medical practice.
Methods: A 26-item questionnaire addressing the above issues was mailed to all 256 members of the Colorado Chapter of the American College of Emergency Physicians.
Results: Completed questionnaires were returned by 196 physicians (77% response rate). The majority of respondents were men (80%), practiced in urban settings (87%), and were board-certified in emergency medicine (82%). Most EPs lacked formal smoking cessation training (55%) and felt poorly prepared to counsel patients about smoking cessation (65%). A minority (27%) of the physicians reported routinely asking patients to quit smoking. The physicians with formal smoking cessation training were more likely to counsel and refer patients routinely (34% vs 20%, p = 0.03). The physicians cited the following barriers to routine smoking cessation counseling: a lack of time; a perception that patients are not interested; a belief that the ED setting is inappropriate for counseling; and a sense that counseling is ineffective. Lack of reimbursement was cited by only 13% of the respondents. The physicians who had formal smoking cessation training perceived fewer barriers to ED-based counseling.
Conclusions: Emergency physicians have received little training in smoking cessation and perceive many barriers to ED-based smoking cessation interventions. Not surprisingly, they infrequently take action to encourage or assist their patients to quit smoking.     

Multicenter Study of Preferences for Health Education in the Emergency Department Population

Objectives: Emergency departments (EDs) are increasingly proposed as high‐yield venues for providing preventive health education to a population at risk for unhealthy behaviors and unmet primary care needs. This study sought to determine the preferred health education topics and teaching modality among ED patients and visitors. Methods: For two 24‐hour periods, patients aged 18 years and older presenting to four Boston EDs were consecutively enrolled, and waiting room visitors were surveyed every 3 hours. The survey assessed interest in 28 health conditions and topics, which were further classified into nine composite health education categories. Also assessed was the participants’ preferred teaching modality. Results: Among 1,321 eligible subjects, 1,010 (76%) completed the survey, of whom 56% were patients and 44% were visitors. Among the health conditions, respondents were most interested in learning about stress and depression (32%). Among the health topics, respondents were most interested in exercise and nutrition (43%). With regard to learning modality, 34% of subjects chose brochures/book, 25% video, 24% speaking with an expert, 14% using a computer, and 3% another mode of learning (e.g., a class). Speaking with an expert was the overall preferred modality for those with less than high school education and Hispanics, as well as those interested in HIV screening, youth violence, and stroke. Video was the preferred modality for those interested in learning more about depression, alcohol, drugs, firearm safety, and smoke detectors. Conclusions: Emergency department patients and visitors were most interested in health education on stress, depression, exercise, and nutrition, compared to topics more commonly targeted to the ED population such as substance abuse, sexual health (including HIV testing), and injury prevention. Despite many recent innovations in health education, most ED patients and visitors in our study preferred the traditional form of books and brochures. Future ED health education efforts may be optimized by taking into account the learning preferences of the target ED population. ACADEMIC EMERGENCY MEDICINE 2010; 17:652–658 © 2010 by the Society for Academic Emergency Medicine     

The KwaZulu-Natal Health Promotion Model

PURPOSE: To describe a health promotion model aimed at assisting primary health care nurses to incorporate health promotion into their practice. ORGANIZING STRUCTURE: The model is based on empowering people through a systematic, planned, needs-driven curriculum with comprehensive content, using interactive teaching in small groups, and linking the groups with external resources. The process involves identifying and engaging partners, planning the project, implementing it, and then disengaging. METHODS: The implementation of this model in a province of South Africa, KwaZulu-Natal, in a collaborative project involving two universities and the state health services, changed the practice of the primary health care nurses involved. They worked with women's groups over 3 years and changed both their own perspectives and the lives of the women. CONCLUSIONS: Unless nurses have an implementation model available to them, they frequently focus only on illness needs of people and do not participate in health promotion.     

Nurse Practitioners: Need for and Willingness to Hire as Viewed by Nurse Administrators, Nurse Practitioners, and Physicians

The problem investigated in this project was the identification of need for and desire to hire nurse practitioners in a rural western state. Participants included licensed nurse practitioners, nurse administrators of licensed agencies, and licensed physicians in the state of Nevada. The survey examined the participant groups' views of the need for and their desire to hire nurse practitioners. The findings showed differences among the groups in relation to their education levels and whether they were practicing in rural or urban areas. The most pronounced finding was the indicated need for more information related to the role and functions of nurse practitioners before hiring them. Recommendations for future study are also included.     

Nurse Practitioners: Reevaluation of the Need for and Willingness to Hire by Nurse Administrators, Nurse Practitioners, and Physicians

A survey of all nurse administrators and advanced practice nurses and a simple random sample survey of licensed physicians in Nevada were completed to reevaluate the perceived need for and willingness to hire nurse practitioners (NPs). The reevaluation was deemed necessary based on a similar survey that was completed by these authors in 1990. At that time significant questions were raised concerning the lack of understanding of the role of NPs in and their contribution to the health care team.
The results of the study clearly indicate that the unique contributions of the NP to the health care team should be further publicized and clarified. In addition, for some physicians, a significant disparity continues to exist between the optimal, collaborative role and the more readily accepted dependent role of the NP. The family NP (FNP) continues to be the most desired specialty for those who hire NPs.     

Workplace Health Promotion Activities of Finnish Occupational Health Nurses

ABSTRACT Objective: This study describes workplace centered activities performed by occupational health professionals, as well as difficulties linked to workplace centered activities, cooperation with client workplaces, and participation both in risk assessment and in the development of working environment.
Design: The design is a cross-sectional prevalence study.
Sample: The questionnaires were sent to 250 occupational health professionals, of whom 176 (70%) returned the completed forms and of whom 99% were nurses.
Measurements: Their activities, difficulties, cooperation, and participation in risk assessment and development of safe and healthy working conditions.
Analytic strategy: The data were analyzed by using frequencies, means, 1-way ANOVA, and the Kruskal-Wallis test.
Results: Workplace focused activity hours were mainly spent on risk assessment and counseling. One workplace visit took approximately 4 hr. The greatest difficulties were encountered with participation in development projects and in monitoring the effectiveness of improvement activities, especially in health care centers. Occupational health nurses cooperated with client enterprises and participated in risk assessment more often than the other occupational health professionals. Also workplace representatives participated actively in risk assessment. The most difficult modules were considered to be the risk assessment of chemicals, biological factors, and perceived stress, this being especially so in health care centers.
Conclusions: It is essential that occupational health professionals visit more often in their client enterprises and improve their skills in preventing harms caused by chemical and biological factors, and perceived stress.     

Psychiatric Nurse Practitioners as Leaders in Behavioral Health Integration

With up to 70% of primary care visits prompted by psychosocial concerns, busy primary care clinics are increasingly addressing complex behavioral health (BH) needs. Substantial evidence demonstrates that the integration of BH into primary care improves access and outcomes, yet clinics face significant challenges in real-world implementation. This collaborative care integration project used psychiatric mental health nurse practitioner faculty as integration and BH specialists at an urban primary care clinic serving a diverse and largely indigent population. The project weathered leadership changes, information system shortcomings, and a shift to telehealth during coronavirus disease 2019. The initial outcomes include increased levels of integration and improved depression and diabetes metrics.     

Consultation With Nurse Practitioners Over the Telephone in Prison Health

The nurse practitioner (NP) role presents opportunities to improve access to care for the management of those in prisons, including telephone consultations with the nursing team after hours. This qualitative study used semistructured interviews with prison nurses to gain insights into the role and capability of NPs to provide telephone advice and direction within an after-hours prison health model of care. Three main themes emerged: value and capability, nursing team, and safety of the on-call model. This study adds to our understanding of the capability of the NP in the prison setting and the value of an on-call model of care within a primary team structure.     

Nurse Practitioners and Meaningful Use: Transforming Health Care

This article describes how the adoption of electronic health records (EHRs) and the achievement of Meaningful Use requirements by nurse practitioners (NPs) can transform patient care. By implementing EHRs, NPs can improve the quality and consistency of care while simultaneously reducing health-care costs. This article provides insight into considerations for NP participation in the EHR Incentive Program. It includes a case study focusing on one NP’s experience with the program, who sought to improve the quality of patient care, safety, and satisfaction through health information technology, along with the challenging yet rewarding journey to practice transformation.     

Preventive Care in the Emergency Department: Diagnosis and Management of Smoking and Smoking-related Illness in the Emergency Department: A Systematic Review

Smoking remains the leading preventable cause of morbidity and mortality in the United States. The efficacy of emergency department (ED)-based patient screening and counseling for smoking cessation is not currently known. OBJECTIVES: To perform a structured, systematic review of the medical literature to assess the efficacy of limited screening and counseling for tobacco use cessation among adults in the primary care and ED settings, and develop recommendations for emergency physicians based on these data. METHODS: A two-person template-driven review of all English-language articles from Medline, the Cochrane Database, and two recent smoking cessation guidelines, with evidence graded according to the scheme of the U.S. Preventive Services Task Force (USPSTF), was performed. Recommendations were developed, and strength graded, based on this evidence. RESULTS: Of 2,078 citations reviewed, 16 were selected for inclusion, based on their methodologic strength and relevance to emergency medicine. Routine physician screening and counseling may increase quit rates at 6-12 months from 3% (usual care) to 8-11%. Interventions include brief counseling (<3 minutes), possibly supplemented with self-help literature, nicotine replacement therapy (NRT), and follow-up telephone calls. CONCLUSIONS: Strong evidence exists, in the primary care setting, that smoking cessation screening and counseling are effective. Limited data exist for ED-based practice, but, based on the burden of disease, relative ease of intervention, and likely efficacy, routine screening of all patients for tobacco use and referral of smokers to primary care and cessation programs are recommended.     

Historic and Future Health Promotion Contexts for Nursing

Purpose: Health promotion in the United States has been narrowly defined focusing primarily on individual behaviors, risk factors, and lifestyle. This article traces the historic and conceptual roots of health promotion care in the United States and critically examines the direction nurses have taken in health promotion.
Scope: Health promotion care in Western ideology emphasizes the value of individuals and the importance of personal responsibility for success or failure.
Conclusions: Health promotion nursing interventions, based on the tenets of individual choice and knowledge, restrict the range of interventions. The complex nature of health promotion requires that nurses consider the economic, sociopolitical, and cultural context in which health care takes place. Recommendations are made for an expanded nursing role in health promotion, one that is consistent with nursing's underlying contextual focus and concern with environments.     

Promotion of the Good Life by Public Health Nurses

The question of what is the good life has been discussed by philosophers since antiquity. The good of an individual and of a community is complicated. Communities influence an individual's experiences and world views, which are always individual. Public health nurses promoting the good life need multidisciplinary knowledge, as well as other skills such as personal competence and qualifications. The focus of the theoretical framework of promotion of the good life is based on models of health promotion and sustainable development. Working with different clients requires nursing theories, other theories, and multidisciplinary models in practice. Continual quality improvement is needed in order to increase customer satisfaction. This article discusses a doctoral thesis that consists of three empirical studies. The theoretical framework for promotion of the good life as the work of public health nurses is outlined, and the outcomes of the first study, the qualifications concerning health, and the environment are described. In the other parts of the study, curriculum building using future methodology and evaluation with concept maps is reported.