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Child maltreatment in the pediatric population is becoming more prevalent in today’s society and is being seen more frequently in the primary care setting. Universal prevention of child maltreatment plays a significant role in nursing practice. The American Academy of Pediatrics set forth guidance for pediatricians to practice when assessing a pediatric patient for maltreatment; however, such guidance is not available for advanced practice nurses and little to no training is provided in the clinical setting. In order to accurately identify the child who is a suspected victim of maltreatment, advanced practice nurses must possess the ability to assess, evaluate, refer, investigate, and provide appropriate outcomes for the child and his/her families. The purpose of this Doctor of Nursing (DNP) project was to create an on-line learning tutorial for advanced practice nurses regarding the prevention of child maltreatment in the clinical setting. The goal of the on-line learning tutorial was to address the crucial role advanced practice nurses have in the prevention of child maltreatment and promote the well-being and safety of children. This project used a quasi-experimental, one-group, pre-test/post-test design to determine the effectiveness of an on-line learning tutorial related to child maltreatment. The pre-test and post-test would determine the inferences on the effect of the intervention by examining the differences in the pre- and post-test results. This study provided significant evidence demonstrating that an on-line learning tutorial on the implementation of child maltreatment prevention in the clinical setting was an effective means for increasing knowledge of nurse practitioner graduate students on child maltreatment. The results demonstrated a significant increase in the test scores of the participants after viewing the on-line learning tutorial, indicating the tutorial was effective.

Purposes/Aims: The purpose of this study was to determine the professional, workplace and personal factors that significantly relate to advanced practice nurses' (APNs) self-efficacy to treat intimate partner violence (IPV).Rationale/Conceptual Basis/Background: IPV affects one in three women in the U.S. and is the leading cause of maternal death during the prenatal and first year post-partum periods. Older women victims suffer earlier death from all causes. IPV is under diagnosed and undertreated based on large surveys of emergency departments and outpatient clinics. APNs are providing health care to large numbers of potential victims, thus they are important as diagnosticians and treating clinicians. Methods: A national quantitative survey of APNs was performed with the aim of obtaining APNs from diverse specialties, geographic areas, and demographics within the U.S. Participants completed an electronic survey using modifications of standardized questionnaires on professional factors of hours of previous IPV education, IPV knowledge, years in practice, current practices, role belief, and self-efficacy to treat IPV. A new scale was developed to test workplace factors of screening tools and protocols, institutional, and community supports. Personal factors of age, gender, past IPV experience, vicarious trauma (VT), resilience, and general self-efficacy were tested using previously validated tools. Results: A sample of 494 APNs was obtained. Respondents were demographically representative of U.S. practicing APN population. Findings from this study indicate that APNs' current self-reported practice behaviors regarding IPV, total hours of IPV education, age in years, role belief, resilience, absence of VT and IPV knowledge are the most significant contributors to APNs' self-efficacy to treat IPV. Implications: APNs with strong clinical experience with IPV, more hours of IPV education, older age, belief that it is their role to treat IPV, and greater IPV knowledge, reported the best self-efficacy to treat IPV. Educational institutions should provide more formal and ongoing education in IPV. VT in APNs who treat IPV should be further explored. Health care organizations should provide continuing IPV education and provide work environments that promote the treatment of IPV for APNs to effectively identify and engage in treatment those patients who may be victims.

Thesis advisor: Karen S. Lyons / Background: Health equity is a complex phenomenon that embodies both the social determinants of health (structural and intermediary) and external factors, such as the health system. As a well-researched phenomenon, it is known that certain populations are more vulnerable than others to experiencing health inequities; specifically, those of low socioeconomic status, racial/ethnic minorities, older adults, and rural residents. However, gaps in knowledge exist in understanding why certain populations remain at higher risk of experiencing health inequities during a time of improved health insurance coverage and technological advances in health care. The purpose of this manuscript dissertation was to identify and address influential factors that serve as road blocks in achieving health equity, guided by the World Health Organization’s Conceptual Framework on the Social Determinants of Health. Methods: First, an integrative review was performed in order to determine current scope of practice restrictions and patient outcomes across the continuum of licensure for advanced practice registered nurses (APRNs), especially certified registered nurse anesthetists (CRNAs). Next, a secondary analysis of large national data set was done to identify the social determinants and risk factors for poor health effect among a national sample at high risk for poor health. And finally, a survey methodology study was completed to determine the roles that satisfaction with health care and physical function have on the perceived health status for rural, older adults in Massachusetts, and to explore the willingness of rural, older adults to use non-physicians for their health care needs. Results: The integrative review revealed the inconsistent use of APRNs at their full licensure. Nationally, APRNs had better geographic distribution in rural areas compared to physicians; yet many states continue to restrict APRN SOP. Second, across the U.S., older adults at the highest risk for poor health live in rural areas, are of lower socioeconomic status, and identify as racial/ethnic minorities. Third, both satisfaction with health care and the physical function of a small sample of older rural adults were significantly associated with physical health. And finally this body of work found that among a small sample of older rural adults, most were willing to use APRNs to meet their health care needs. Conclusions: With the ultimate goal of health equity it is necessary to empower those experiencing health inequities to be both aware of the problems as well as informed enough to push for change. Understanding why the experience of health differs among some individuals more than others helps to target change. The fusion of findings from this body of research has revealed a gap in health care that can be easily filled with simple policy change. APRNs at full SOP can generate means for high quality preventative, cost-saving care, and can better access the most vulnerable populations at a lower cost than physician counterparts. / Thesis (PhD) — Boston College, 2020. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

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Objectifs: Etudier l'évolution de l'introduction du rôle de l'IPA et proposer des recommandations pour les études ultérieures.Méthodes: Une revue de la littérature française et internationale concernant l'IPA. Participation à un groupe de travail national concernant l'avancement de ce rôle et les réformes éducationnelles. Une étude rétrospective comparant la prise en charge de patients hypoglycémiques en milieu pré-hospitalier par infirmiers et physiciens. Un questionnaire étudiant les perceptions des premiers étudiants en cursus IPA.Résultats: Différents niveaux de transferts de compétence et de collaboration médecin/infirmière existent déjà en France. Dans l'étude rétrospective, la qualité de soin des infirmières a été similaire à celle des médecins. Dans l'étude sur l'IPA, la majorité des étudiants a indiqué que les autres infirmières et docteurs ne sont pas au courant du rôle de l'IPA, et que des barrières bloquent son développement.Conclusions: La création du rôle d'IPA et le développement de la formation des infirmières en France peuvent répondre aux défis de santé publique, telle l'incidence croissante des maladies chroniques et la pénurie de médecins. Les recommandations suivantes furent proposées pour le développement du rôle de l'IPA : définir et faire reconnaître le rôle de la pratique infirmière avancée et ses compétences, promouvoir le rôle plus largement dans les disciplines médicales, soutenir les efforts de communication entre l'état et les professionnels de santé, développer des programmes au niveau master et doctorat, et promouvoir des travaux de recherche infirmiers et interdisciplinaires. / Background: In the context of public health challenges and health care reforms in France, the evolving advanced practice nurse (APN) role may be a solution. Objectives: To study the introduction of the ANP role and provide evidence-based recommendations for future research.Methods: A review of the international and French APN literature was performed. Participation in a national task force concerned advancement of the role and education reforms. In a retrospective study, nurses and physicians were compared in the pre-hospital management of hypoglycemic patients. Finally, a survey was administered to the first French APN Master's students to identify their perceptions of the APN role.Results: Variables levels of skill transfer and doctor-nurse collaboration currently exist in France. In the retrospective study, the pre-hospital quality of care of nurses was comparable to that of doctors. In the APN student survey, the majority indicated that other nurses and doctors were not aware of the APN role, and that barriers exist in role development. Conclusions: Creation of the APN role and advancement of nursing education in France can respond to public health challenges including the rising incidence of chronic diseases and an impending physician shortage. The following recommendations were proposed for APN role development: to define and recognize the advanced practice nurse role and related competencies, promote the role in a wider range of medical disciplines, facilitate clear communication between government and health care professionals, develop nursing Master's and Doctorate programs, and promote nursing and interdisciplinary research.