The recent study by Goossens et al. (2012) concluded that, “By means of an Advanced Practice Nursing (APN) team, malfunctions can be effectively managed, giving staff nurses more time but less stress in their daily care for patients with TIVADs [totally implantable venous access devices]”. However, that conclusion is not supported by their study because there was not a control group and no data was provided that had any bearing on whether the malfunctions were effectively managed or whether the staff nurses had more time or less stress.

Background: Due to arduous demands of graduate education, advanced practice nursing (APN) students who are classified as adult learners are at risk for suffering sleep deprivation. Factors contributing to sleep deprivation include stress, expected academic challenges, and everyday life stressors. Purpose: This study investigated if APN students’ grade-point average (GPA), gender, and employment status predicted levels of daytime sleepiness. Theoretical Framework. The psychological well-being model selected for this study was consistent with the theory that sleep is a resource essential to well-being; adequate sleep is the resource needed to optimally manage stressful life demands. Methods. Bivariate and multiple regression were employed to examine the relationship between GPA, gender, and employment status with daytime sleepiness on a sample of APN students (N = 123) in their second academic year. The Epworth Sleepiness Scale and a demographic questionnaire were used to record data on GPA, gender, and employment status. Results. Results showed ESS and GPA were negatively correlated and statistically significant (r = -.24, p < .05). This indicates that as the tendency for sleepiness increased, GPA decreased, thereby supporting the alternative hypothesis. Although not statistically significant, employed participants reported greater daytime sleepiness, as did women. Conclusions: When GPA, gender, and employment were combined, multiple correlation showed a statistically significant shared variance of 8% with daytime sleepiness, due primarily to the correlation between GPA and daytime sleepiness. The effect size of shared variance was between small and medium with respect to magnitude of importance.

Bakgrund: I dagens läge finns det kunskapsluckor om hur den perioperativa omvårdnadsprocessen uppfattas ur operationssjuksköterskans synvinkel. För att operationssjuksköterskan ska kunna ge god vård till patienten utifrån dennes önskningar och behov är det viktigt att operationssjuksköterskan får en bra kontakt med patienten. Får operationssjuksköterskan dela patientens värld d.v.s. om patienten både vill och är förmögen till att dela med sig av sina tankar och önskemål, då blir det lättare att ge en personcentrerad vård. Syfte: Syftet med föreliggande litteraturstudien är att undersöka hur operationssjuksköterskan uppfattar den vårdande relationen ur ett perioperativt synsätt. Metod: Det är en litteraturstudie med elva artiklar som har en kvalitativ ansats och en artikel som har en kvantitativ ansats. Föreliggande studien har en kvalitativ ansats då fokus är att beskriva och tolka operationssjuksköterskans upplevelser av omvårdnadsprocessen. Resultat: Generellt sett hade operationssjuksköterskorna en positiv inställning till den perioperativa processen. Operationssjuksköterskorna upplevde att den perioperativa processen  bidrog till ökad kontinuitet och ökad trygghet hos patienterna men framförallt också hos dem själva. Operationssjuksköterskorna utvecklades i sin yrkesroll men också som individer. De kände att deras arbete var meningsfullt och att det fanns en vårdande relation mellan patienten och operationssjuksköterskan. Slutsats: Föreliggande studie lyfter fram att arbetet för operationssjuksköterskor skulle bli effektivare, säkrare vård, få mer kontinuitet och gynna både sjuksköterskorna och patienterna om den perioperativa processen användes i större utsträckning. Det skulle bli lättare att uppnå välmående och god omvårdnad i slutändan. / Background: At present, there are gaps in the knowledge of how the perioperative process is seen from the point of view of the operating room nurse. When it comes to the operating theater nurse to provide quality care to the patient, it is important that the operating theater nurse gets a good contact with the patient. The operating room nurse has to share the patients’ world. Then, it will be easier to give a patient-centered care. Aim: The purpose of this study is to investigate how the operating theater nurse experienced the perioperative process from her/his point of view. Method: This study is a literature review of eleven articles that have a qualitative approach and one article which has a quantitative approach. This study has a more qualitative approach. Its focus is describing and interpreting the surgery nurses’ experience of the perioperative process. Result: The surgical nurses had, to a large extent, a favorable attitude to the perioperative process. Surgical nurses felt that the perioperative process contributed to increased continuity and increased safety for patients, but above all for themselves. Surgical nurses developed professionally, but also as individuals, they felt that their work was meaningful and that there was a caring relationship between the patient and the surgical nurse. Conclusion: This paper emphasizes that if the perioperative process would be used on a larger scale, the work for operative nurses would be more efficient, provide a more secure care, give more continuity and be very favourable to nurses as well as patients. The result for the patients would be a good care and well-being.

Information technology is ubiquitous in society and industry; however, healthcare is just beginning to explore how health information technology (HIT) can be optimized to support quality care. HIT can assist with standardizing care delivery, increasing access to evidence-based medicine, improving accuracy and ease of documentation, and assisting with patient education. Advanced Practice Registered Nurses (APRNs), specifically nurse practitioners (NPs) and certified nurse midwives (CNMs), play a pivotal role in the healthcare delivery system. To be effective practitioners, providers must manage, integrate, and assimilate a multitude of knowledge with each patient encounter. HIT can serve as the channel through which the NP and CNM provides cost-effective, efficient, and quality care. However, healthcare providers have been slow to adopt and implement HIT resources. We know that adoption of HIT by healthcare providers is varied among provider and practice settings. However, few studies have examined the impact on and utilization of information technology by APRNs, specifically nurse practitioners and certified nurse midwives.The purpose of this research was to investigate the utilization and influence of HIT on the clinical decision making of Kentucky nurse practitioners and nurse midwives (Kentucky APRNs). A descriptive cross-sectional design using survey methodology and convenience sampling was employed. Participants were asked to complete an author-modified, web-based survey tool that was based on current research. The 40-question tool was designed to explore providers' attitudes and perceptions of technology, determine their knowledge and utilization of various electronic and traditional print medical resources, and assess the penetration of and daily usage of HIT in practice.This study revealed information related to Kentucky APRN's utilization and influence of HIT on clinical decision making. Establishing exploratory Kentucky APRN findings will assist in evaluating further HIT utilization in Kentucky. Findings suggested that APRNs in Kentucky are beginning to explore the benefits of HIT; however, additional research will be required to identify the true penetration and utilization of technology in Kentucky. Although additional research is needed, HIT appears to be having an overall impact on the clinical practice of Kentucky APRNs.

One out of 2 women and 1 out of 5 men over age 50 will sustain a fragility fracture (FF) in their lifetime. The risk of a 2nd FF increases dramatically after the 1st fracture and can lead to pain, disability, and mortality. Despite the evidence that secondary prevention programs are effective, the local facility did not have a formal mechanism to address this need. The purpose of this project was to design a program for secondary prevention of FFs and to address the need for a program for secondary FF prevention that was sustainable locally. The program was designed for facility patients age 50 or older who sustained a wrist fragility fracture within 6 months. The reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework was used to guide the project and program evaluation. A needs assessment was conducted prior to developing the program and included secondary data from the facility's provider survey. The 'Own the Bone' program, a nationally recognized program, was chosen as the intervention model. The 'Own the Bone' program provided a registry data for performance measures which assisted in the development of the program. The program included a short survey for providers to assess satisfaction with the referral process, and a telephone survey to referred patients who chose not to attend. Patient satisfaction with the program incorporated the Standardized Clinician Group Consumer Assessment of Healthcare Providers and Systems survey. Data collection and analysis plans were provided to the site with recommendations for implementation. This program was the 1st step in closing the local research-practice gap of secondary fragility fracture prevention. The project offers an opportunity to promote positive social change through the prevention of FF in a setting that had not previously addressed the problem.

Abstract Background: Access to adequate palliative care has been identified as a challenge globally, in Canada, and in the province of Ontario. While pockets of excellence exist, there is a national call for allocation of resources and implementation of best practices to improve the care for individuals with life limiting illnesses. Furthermore, the location of care along with a desire for dying at home has shifted responsibility onto family members often without the equivalent shift in community resources to meet patient and family needs. To respond to issues of access and quality, nurse practitioners (NPs) have been increasingly added to diverse practice settings across the globe and research showing how they are contributing to diverse care settings. As a strategy to improve community palliative care locally, NPs have been added to community settings in Ontario. However, because NPs are new to palliative care settings little is known about how NPs enact their role within this unique context. NP role enactment is defined as the actual activities that NPs engage in that constitute their daily work. Aim: The purpose of this study is to better understand how NPs enact their role as consultants in a specific community palliative care setting in Ontario. Methodology and Methods: A focused ethnography was conducted in one specific geographic health administration region of Ontario between July of 2018 and October of 2020. A convenience sample was used recruiting NPs from one community palliative care consultation team. Data collection methods included observation (487.5 hrs over 89 discrete observation sessions, distributed across 7 study participants), fieldnotes and semi-structured interviews with participants (n = 7 NPs). Results: The NPs enacted their role with patients by formulating relationships, that for them, facilitated a deeper understanding of the patient and family situation, strengths, challenges and desires. Using conversations and conversational skills to have difficult and important conversations, NPs facilitated future planning for patients. Conversations also included addressing questions about MAiD, which were nuanced and often about more than MAiD, also addressing fears of suffering and uncertainty. The NPs used advanced clinical judgment and skill to diagnose and treat complex and difficult to manage symptoms and supported families to understand complicated medication regimes. Valuing their role as educators, the NPs supported their peers by offering teaching and providing clinical support in complex care scenarios. Pull together disparate and loosely connected care providers, NPs created a shared understanding of patient needs. Deficiencies in community care resourcing and organization made it difficult at times for NPs to facilitate continuity in care or to build capacity. The NPs often navigated an environment where nursing staffing was transient, inconsistent and overextended and where physicians were inconsistently available to support rapidly evolving situations. Conclusion: Findings suggest that NPs have an important role to play in supporting patients and families as well as supporting their nursing and physician colleagues. Furthermore, the broader system would benefit from embedding palliative care NPs more systematically. However, broader structural enhancements like shared communication and documentation mechanisms and adequate staffing across care settings need to be addressed to maximize the potential contributions NPs are able to offer.

The Doctor of Nursing Practice (DNP) Family Nurse Practitioner (FNP) curriculum was developed to incorporate learning outcomes and experiential opportunities for students to attain the core FNP knowledge for doctoral education. Historically, challenges related to developing clinical skills in blended/online programs has been problematic. The appeal of online FNP education has challenged educators to develop new ways to provide students opportunities to experience hands-on clinical skills within the subspecialties of the DNP, FNP role. With limited clinical sites, and now with more clinical access constraints imposed by the COVID-19 pandemic, it is imperative that new models of instruction provide students opportunities for skills training. The purpose of this project is to describe use of scaffolding methodology to design student skills learning activities using synchronous online and on-ground sessions during DNP intensives. Student and faculty input identified the types of practice skills and procedures needing improvement, such as suturing, electrocardiogram, etc. An intensive task force was organized to evaluate curricular elements; content was then mapped to analyze gaps. The first step included aligning advanced practice nursing skills sessions in each intensive with the related clinical courses offered within that semester. Then, students were organized into a skills rotation plan based on their date of admission and place within their program of study. Modifications required by COVID-19 on-ground restrictions necessitated re-thinking intensive skills sessions. Student satisfaction scores significantly improved after the intensive sessions were restructured. Faculty continue to seek feedback from the students to provide beneficial practice opportunities during the DNP intensives.

No description available.

Background: In the United States, currently about half (49%) of the 6.7 million pregnancies are reported as mistimed or unplanned, and this rate of unintended pregnancy is significantly higher than the rate in most other developed countries. Abortion services are critical to the prevention and management of unintended pregnancies. Abortion in the United States has been legal since the 1973; however this right has little meaning without access to safe abortion care and access is declining. Medication abortion, the use of medications to induce abortion and terminate an early pregnancy, has been legal in the United States since 2000, is ideal for the outpatient setting, and allows for increased provision of and access to abortion services. The literature assessing the provision of medication abortion has largely been conducted in populations of physicians, and combined groups of advanced practice clinicians including physician assistants (PAs), certified nurse midwives (CNMs), and nurse practitioners (NPs). No studies exist assessing provision of and barriers to medication abortion by NPs and CNMs (Advance Practice Registered Nurses or APRNs) in the state of Vermont. Purpose: This study sought to fill this gap in the literature. Data was collected in order to determine whether APRNs are providing care to women at risk for unintended pregnancy and are providing medication abortion, the characteristics of these providers, and perceived barriers or supports to practice. Methods: The design was a cross-sectional survey, using purposive sampling methods. Between July 2014 and September 2014, 21 eligible participants completed an anonymous, self-administered online survey, recruited via notifications sent out through professional listserv. The survey assessed their personal characteristics, beliefs and clinical practice related to reproductive health care and unintended pregnancy prevention and management. All participants had current APRN certification with prescriptive authority in the state of Vermont. Results: Ninety percent of respondents reported care for women of reproductive age as at least one-third of their clinical work and 85% of respondents reported seeing women with unintended pregnancies as part of their practice. Eighty-five percent agreed or strongly agreed that medication abortions fall within the scope of practice of an APRN and of a primary care provider, and 85% would like to be trained to provide medication abortions to manage unintended pregnancy. Lack of training opportunities, clinical facility constraints, and legal uncertainties were the most frequently reported barriers to provision of medication abortion. Conclusions: Many APRNs in Vermont may be interested in receiving medication abortion training. APRNs are experienced and highly trained health care professionals that have the competence and skills to provide comprehensive reproductive health care, including medication abortion. The perceived barriers of training, clinical facility constraints, and legal uncertainties are amenable to change, and can be decreased through inclusion of these topics into APRN education. The political and social climate of Vermont, combined with the findings of this preliminary study, suggest that the state of Vermont is ready, willing, and able to serve as a model for the primary provision of and improved population access to, comprehensive reproductive health care including abortion services.

Purpose: Transitional care is an emerging model of health care designed to decrease preventable adverse events and associated utilization of healthcare through temporary follow-up after hospital discharge. This study describes the approach and outcomes of two transitional care programs: one is provided by masters-prepared clinical nurse specialists (CNS) with a chronic disease self-management focus, another by physicians specializing in palliative care (PPC). Existing research has shown that transitional care programs with intensive follow up reduce hospitalizations, emergency room visits, and costs. Few studies, however, have included side-by-side comparisons of the efficacy of transitional care programs varying by health care providers or program focus. Design: This is a retrospective cohort study comparing the number of Emergency Department (ED) visits and hospitalizations in the 120 days before and after the intervention for patients enrolled in each transitional care program. Each program included post-hospitalization home visits, but included difference in program focus (chronic disease vs. palliative), assessment and interventions, and population (rural vs. urban). Data from participants in the CNS program 9/2014 ' 12/2014 were analyzed (n=98). The average age of participants was 69 and they were 65% female. Data was collected from patients from the PC program from 9/2014 to 4/2015 (n=71). Thirty participants died within 120 days after the intervention and were excluded, the remaining 41 were included in the analysis. Participants had an average age of 81 and were 63% female. Methods: For the CNS program, a secondary analysis of existing data was performed. For the PC program, a review of patient charts was done to collect encounters data. A Wilcoxon Matched-Pair Signed-Rank test was performed to test for significance. Findings: Patients in the CNS intervention had significantly fewer ED visits (p Conclusions: Both transitional programs have value in decreasing health care utilization. The CNS intervention had a more significant effect on ED visits for their target population than the PC program. Further study with randomized control trails is needed to allow for a better understanding of the healthcare workforce best fitted to enhance transitional care outcomes. Future study to examine the cost savings of each of the interventions is also needed.