Rural Midwestern Primary Care Nurse Practitioners’ Transition to Practice

Transition to practice experiences for new primary care nurse practitioners (NPs) is of interest, particularly considering the lack of requirements and options for formal training programs. The purpose of this article is to describe new primary care NPs’ experience and perceived needs of transitioning to practice. New Nebraska NPs were surveyed. The main findings include increased confidence and perceived preparedness after 3 months of practice, as well as challenges and helpful supportive services for transitioning to practice. Additional information on the transition to practice experience was provided and supports developing a formal program.     

Barriers to Guideline-Concordant Opioid Management in Primary Care—A Qualitative Study

Prior studies have demonstrated poor physician adherence to opioid management guidelines in primary care. The objectives of this qualitative study were to understand physicians' and patients' perspectives on recommended opioid management practices and to identify potential barriers to and facilitators of guideline-concordant opioid management in primary care. Individual semistructured interviews were conducted with 14 primary care physicians and 26 of their patients receiving long-term opioid therapy. Data were analyzed using a qualitative immersion/crystallization approach. We identified 3 major barriers to and 1 facilitator of use of recommended opioid management practices. Major barriers were inadequate time and resources available; relying on general impressions of risk for opioid misuse; and viewing opioid monitoring as a “law enforcement” activity. The third barrier was most apparent for physicians in the context of drug testing and for patients in the context of opioid agreements. Beliefs about the need to protect patients from opioid-related harm emerged as a major facilitator, especially among patients. We hypothesize that future interventions to improve opioid management in primary care will be more effective if they address identified barriers and use a patient-centered framework, in which prevention of opioid-related harm to patients is emphasized as the primary goal.PerspectiveThis article describes primary care perspectives on guideline-recommended opioid management practices. Barriers identified in this study may contribute to underuse of recommended opioid management practices. Consideration of barriers and facilitators to guideline-concordant care could improve effectiveness of future interventions aimed at improving opioid management in primary care.     

Mentorship ReSPeCT Study: A Nurse Mentorship Program’s Impact on Transition to Practice and Decision to Remain in Nursing for Newly Graduated Nurses

The COVID-19 pandemic has worsened a pre-existing US nursing shortage, leaving newly graduated nurses vulnerable in their early career. This study analyzed the effectiveness of a mentorship program offering individualized mentorship through culturally congruent, customized pairing for 96 mentees. Key findings of this study show that this nursing mentorship was beneficial for the majority of mentees on their decision to remain in nursing, and on their self-confidence, problem-solving, professional communication, and transition to practice, with perceived benefits steadily increasing for mentees up to 2 years. These findings have valuable implications for innovative recruitment and retention interventions to address the nursing shortage.     

Transferring service provision from a Primary Care Trust to a charity: what needs to be considered?

On 1 April 2011, specialist palliative care (SPC) services in NHS Berkshire West transferred to Sue Ryder, a third sector provider of health and social care in the UK. Prior to the transfer, Berkshire West Primary Care Trust (PCT) commissioned services from its own provider arm and from Sue Ryder's Nettlebed Hospice in South Oxfordshire.     

Diagnosis and Management of Bell’s Palsy in Primary Care

Bell’s palsy is characterized by rapid, unilateral paralysis of cranial nerve VII and is the most common cause of acute facial paralysis, although the pathogenesis of the condition is poorly understood. Bell’s palsy can be managed by the nurse practitioner in primary care, and the majority of clients achieve full recovery. Appropriate diagnosis through history and physical examination to exclude other causes allows for timely diagnosis, intervention, and patient reassurance. Pharmacologic and adjunctive treatment is available to shorten the duration and improve symptoms. Nurse practitioners should be able to identify circumstances in which referral to a specialist for intervention and follow-up may be appropriate.     

Designing new collaborative learning spaces in clinical environments: experiences from a children’s hospital in Australia

Abstract

Hospitals are complex places that provide a rich learning environment for students, staff, patients and their families, professional groups and the community. The “new” Royal Children's Hospital opened in late 2011. Its mission is focused on improving health and well-being of children and adolescents through leadership in healthcare, research and education. Addressing the need to create “responsive learning environments” aligned with the shift to student-centred pedagogy, two distinct learning environments were developed within the new Royal Children’s Hospital; (i) a dedicated education precinct providing a suite of physical environments to promote a more active, collaborative and social learning experience for education and training programs conducted on the Royal Children’s Hospital campus and (ii) a suite of learning spaces embedded within clinical areas so that learning becomes an integral part of the daily activities of this busy Hospital environment. The aim of this article is to present the overarching educational principles that lead the design of these learning spaces and describe the opportunities and obstacles encountered in the development of collaborative learning spaces within a large hospital development.     

How and Why Did a Regional Palliative Care Program Lead to Changes in a Region? A Qualitative Analysis of the Japan OPTIM Study

ContextImproving palliative care is one of the major issues throughout the world.ObjectivesThe primary aim of this study was to explore how and why a regional palliative care program led to changes in a region.MethodsAs part of a nationwide mixed-methods study of a regional palliative care program, a qualitative study was performed with 101 health care professionals involved in the implementation of the program. In-depth interviews were done, focusing on perceived changes and the perceived reasons for the changes. We used thematic analyses.ResultsSeven themes were identified as follows: 1) improved communication and cooperation among regional health care professionals; 2) increased confidence in the system to care for cancer patients at home; 3) improved knowledge/skills, practice, and perception of palliative care; 4) contribution to self-growth; 5) wide variability in perceived changes in the knowledge and perception of patients, family members, and the general public; 6) wide variability in the perceived regionwide effects of the project; and 7) unresolved issues. Participants emphasized improved communication and cooperation among regional health care professionals and stated a variety of ways of how communication and cooperation influenced daily practice. The main reasons for changes included regionwide interdisciplinary conferences and informal interactions at a variety of meetings.ConclusionThis study advances understanding of how the regional palliative care program created a change in the region. The findings are useful for developing a conceptual framework and identifying key interventions to improve regional palliative care for clinicians, researchers, and policy makers.     

Leadership’s Role in Assimilating DEI to Improve Health Care

The Institute for Health Care Improvement (IHI) recently added health equity as the fifth aim to its framework of priorities. This article considers the importance of this aim for nurse leaders interested in transforming their organizations. It addresses a humbleness mindset necessary to begin understanding diversity, equity, and inclusion’s role, and the significant impact of one’s individual uniqueness to problem solve. It calls leaders to be self-reflective and understand the unconscious bias that may prevent inclusivity. Most important is the concept of acceptance of the multiverse that must be embraced to improve the collective health of all populations.     

Imaging Stewardship: A Primary Care Provider’s Guide to Treating and Referring Patients With Musculoskeletal Conditions

This article provides primary care providers (PCPs) a guide when treating patients with musculoskeletal conditions with a specific focus on imaging. Trauma, back pain, and arthritis make up the majority of musculoskeletal reasons patients seek care at PCP offices, emergency departments, and hospitals. In fact, 77% (65.8 million) of all injury-related health care visits are for musculoskeletal injuries. In terms of cost, $176.1 billion were spent in the United States in 2011 to treat musculoskeletal injuries. Developing proficiency with a focused examination, documentation, diagnostic testing, and treatment will lower the cost, improve patient outcomes, and expedite referral to orthopedics.     

Effects of a Doctors’ Strike on Primary Care Utilization in Varkaus,Finland

Changes in out-patient medical care utilization at the health centre of Varkaus were studied during the Finnish doctors’ strike in spring, 1984. In this urban and semi-urban area, about 80% of the out-patient medical services to the population are provided by the municipal health centre. Visits to the physicians decreased by 70% during the strike, and for urgent visits the decrease was 55%. The private sector compensated only a very small share of this “deficit”. Of the common urgent illnesses the relative decrease was greatest for “cold” and ill-defined “abdominal pains”. Open wounds were treated normally although there was some indication that the wounds treated were more serious than normally. The post-strike increase in visits suggests an increase in unmet needs. For all face-to-face encounters the increase was eight per cent, but for low back pain, urinary infection and hypertension the observed post-strike rates were more than 40% higher than expected by pre-strike rates. A marked reduction in various other activities of the health centre, such as telephone calls and home visits, was observed. The present study gave no evidence of harmful effects of the strike. This was the impression of the health care personnel, too. There were no public claims of reduced access to care or its delay. The distress among patients or other experiences of the population were, however, not measured. The strike was fairly short and any conclusions concerning the effects of a more prolonged or extensive strike on health or health care are unwarranted.     

Experiential Learning: Transforming Theory into Practice through the Parkinson’s Disease Buddy Program

Abstract

Problem: Persons over age 65 constitute a large proportion of patients presenting for healthcare services; therefore, physicians must be prepared to provide care to patients that face degenerative neurological diseases. Medical students can have difficulty identifying and caring for older patients with neurological difficulties, and often perceive neurology to be a challenging specialty. Medical education service-learning programming that engages community members and medical students, while fostering specialized neurology training, may help improve care for this patient population. Intervention: We developed the Parkinson’s Disease Buddy Program for first year medical students (M1s), which involved pairing students with patients with Parkinson’s disease (PD) to engage in a social relationship. Students attended monthly seminars covering a range of topics specific to PD patient care and met with their PD buddies throughout the year. A mixed-methods approach was used to evaluate the program and involved pre/post assessments, as well as focus groups with both students and patients. Context: The University of Louisville’s School of Medicine and College of Education implemented this volunteer service-learning program for students by partnering with a locally based nonprofit, dedicated to serving PD patients. A total of 70 (35 M1s and 35 PD patients) participated. Outcome: Students’ total correct PD knowledge scores significantly increased after participation with a large effect size (pre-test mean?=?14.77, [SD?=?2.57]; post-test mean?=?19.69 [SD?=?2.06], Cohen’s d?=?1.64) and a paired t-test indicated a significant change in students’ Parkinson’s Attitude Scale scores (t (34) = 2.22, p < .05). Ninety-one percent of students (31) indicated they would recommend the program and 82% (29) indicated they would participate again. During focus groups, students reflected on the relationships they formed with their buddies, indicating the program provided a support system while helping them learn about PD. Patients indicated the program expanded their social circle and meetings with M1s were beneficial. Lessons Learned: An experiential learning opportunity can help medical students become better acquainted with patients living with a neurological disease. We identified an impact on PD patients’ self-efficacy and social behavior that was not originally expected. We learned the importance of incorporating active learning modalities such as PD buddy panels and peer-to peer group discussions. The resources required to implement programs like ours can be lightened by engaging with local community partners and collaborating within and outside departments.