Background: Sports-related concussions (SRC) are very common in youth in the US and represent a major clinical challenge. Clinical Practice Guidelines (CPG) have been developed to help guide the health care provider (HCP) in the diagnosis and management of SRC. Seventy-three percent of HCPs report that they deviate from current concussion CPGs in their clinical practices. The Protection of Athletes with Head Injuries Law in Utah requires HCPs caring for youth with concussions receive continuing education (CE) regarding SRC every three years. Currently, there are no CE modules on SRC developed for nurse practitioners (NPs) in the state of Utah. Project Purpose: The purpose of this DNP project was to develop and pilot an evidence-based educational module for primary care NPs in Utah on the evaluation and management of SRC in children and adolescents under the age of 18 years old. Methods: The education module integrates the concussion education curriculum developed by Pamela Mapstone DNP, PCNP. The module incorporates current CPGs and an extensive literature search. Following development of the module three clinical experts in SRC independently reviewed the module. Modifications were made accordingly and a pilot study evaluating the quality and usability of the education module was conducted. Sixteen NPs working in Utah were invited to complete the module followed by a short survey related to user satisfaction. The final version of the education module was modified based on the results of the pilot study. Results: An education module on SRC in youth for NPs working in primary care in Utah was successfully developed and piloted for quality and usability. The results of the pilot study support the content addressing the learning objectives; and that the module was easy to use. Conclusion: The education module tailored to the needs of NPs working in primary care in Utah has the potential to improve NPs’ knowledge of SRC in youth. Further study is recommended to evaluate the effects of the education module on clinical practice outcomes.

Background: Cardiology is but one of the many clinical foci available to certified Advanced Practice Registered Nurses (APRNs). In fact, more acute care APRNs choose cardiology as their focus than any other. With such strong interest in cardiac advanced practice nursing, it is imperative to assess the adequacy of preparation for those who wish to follow this career path. Known barriers exist in the educational and clinical preparation of this APRN population, however, there is little research detailing the specifics of those barriers. Purpose: This study describes the needs of APRNs who plan to specialize in cardiology. Method and Sampling: A qualitative design was used to describe the motivation of APRNs specializing in cardiology, tools they currently utilize to achieve their specialization, and their needs based on the current approach. I recruited participants, APRNs specializing in cardiology, through meetings at a local cardiology practice. Seven APRNs specializing in cardiology with experience ranging from 10 months to 15 years, and currently working in a cardiac setting, participated in the study. Structured interviews were conducted to describe the needs of APRNs who plan to specialize in cardiology. The interviews were audiotaped and analyzed to reveal commonalities. Findings: After analyzing the audio recordings three major commonalities emerged: APRNs specializing in cardiology must overcome limited educational opportunities, APRNs specializing in cardiology require a higher level of skill than their formal training and licensing requirements provide, and the need to validate APRNs specializing in cardiology knowledge. Additional commonalities included availability and the type of degree programs, and a lack of cardiac focus in educational preparation. Conclusion: The findings showed the needs of APRNs who plan to specialize in cardiology are rooted in their educational preparation. There is a vast amount of variability among degree programs and a severe lack of cardiac focus in their educational preparation. In order to achieve competency, 100% of study participants secured a mentorship with an expert cardiac clinician for a minimum of one year post-graduation and without assistance from their educational programs. Additionally, APRNs specializing in cardiology believe a national certification or examination requirement would be beneficial to their practice.

Background: The rate of childhood cancer survivors has grown to nearly 80% in the past few decades. Current evidence reveals that primary care providers report feeling unprepared with inadequate knowledge about the variable types of late effects and diagnostic screenings recommended for childhood cancer survivors (Dulko et al., 2013; Potosky et al., 2011). However, the current evidence reflects data mainly from physicians. None of the current literature addresses the specific preparedness of primary care nurse practitioners. Such data would be helpful in better understanding how education and current resources affect nurse practitioner preparedness for such a narrow, but growingly prevalent, patient population.Purpose: To assess primary care nurse practitioner preparedness when caring for childhood cancer survivors.Methods: This descriptive study obtained data using a survey disseminated to primary care nurse practitioner members of the Puget Sound Nurse Practitioner Association in Seattle, WA. Analysis was conducted by calculating the means and modes for each survey item. Results: This sample (n=5) revealed that 50% of nurse practitioners identify as feeling adequately trained to care for childhood cancer survivors. Time and insurance coverage were not found to be barriers to care. Less than 50% of nurse practitioners utilized guidelines from the Children’s Oncology Group. The most wanted resources included the Children’s Oncology Group guidelines, survivor care plans, and electronic health record prompts. Discussion: According to the results of this study imply that nurse practitioners in the Seattle area feel adequately prepared to care for childhood cancer survivors. In addition, nurse practitioners identify that clinical practice guidelines may be beneficial in guiding their care. However, certain limitations, including small sample size, may affect the trustworthiness of the results. Thus, more research is warranted to gather more comprehensive knowledge and understanding regarding nurse practitioner preparedness when caring for childhood cancer survivors in the primary care setting.

Preceptorship is a teaching-learning approach in which learners are individually assigned to expert practitioners in the practice setting. The purpose is to provide them with daily experience on a one-to-one basis with a role model and resource person who is immediately available to them. Currently, the literature is replete with research on various aspects of preceptorship, including the preceptor role, the evaluation process, professional socialization, the promotion of clinical competence, and the fostering of critical thinking in undergraduate and graduate education, to name a few. To date, however, no studies have specifically explored the process involved in promoting the education of nurse practitioner students in preceptorship. The purpose of this grounded theory study was to explore the process used in preceptorship to prepare nurse practitioner students for their future role in professional practice. To that end, the process in which preceptors, nurse practitioner students, and faculty engage was explored. The sample comprised nurse practitioner students, preceptors and faculty from a large university in western Canada. Findings from this study revealed that as students proceeded through the preceptorship program they worked through or navigated what could be described as the liminal space or an in-between place. As a result of the findings of this study, several crucial points have been recognized that have implications for the nurse practitioner student who engages in preceptorship. First, upon acceptance into an advanced practice nursing program it is important for students who are themselves experienced professionals in their own right, to understand the preceptorship process of transition, found in this study to be the liminal space, intrinsic to which are adjustments from the role of nurse, to that of student and finally to that of the nurse practitioner. Second, to adequately prepare students for their transition, faculty need to develop curricula that address the challenges involved with this phenomenon, specifically knowledge related to threshold concepts and troublesome knowledge. Third, support for these students from faculty, preceptors and fellow students was found to directly affect the ability of these learners to successfully navigate their transitional process in preceptorship.

As a result of changing demographics and an increasing need for access to healthcare, in 2013, the Nevada Legislature passed Assembly Bill 170 (AB170) allowing nurse practitioners (NPs) full practice authority in Nevada in 2013 (VanBeuge & Walker, 2014). With the movement from collaborative agreement to independent practice, recent NP graduates need to be prepared for transitioning from the NP student role to an independent practitioner role. Historically, speaking there have been numerous studies citing that NPs provide high-quality health care and have high patient satisfaction, yet there has been almost no research regarding the readiness for clinical practice post-graduation (Hart & Macnee, 2007). The purpose of this project was to develop a better understanding of readiness to practice, perceived barriers, and to develop recommendations for post-graduation nurse practitioners in Nevada. A brief survey was provided electronically to NPs who were members of the Nevada Advanced Practice Nurses Association (NAPNA).

No description available.

Purpose: To examine stakeholder participation in the primary care system change process that led to the introduction of the first Nurse Practitioner-Led Clinic in Ontario. Design: Qualitative case study guided by the principles of stakeholder and system change theory. Setting: Northern Community in Ontario, Canada. Participants: Purposeful sample of healthcare providers, healthcare managers and health policy stakeholders. Procedures: This case study was bound by place (Sudbury), time (January 2006–January 2008), activity (stakeholder participation), and process (introduction of an innovation, the first Nurse Practitioner-Led Clinic in Ontario, during a primary care system change). Semi-structured individual interviews were conducted with participants who represented the clinic, the local community, and the province. Public documents, such as newspaper articles published during the 2 year time boundary for this case and professional healthcare organization publications, were also examined. Interviews were analyzed using qualitative content analysis and public documents were reviewed for key messages to complement the interview findings. Field notes written during data collection and analysis were used to provide additional depth, contribute insights to the data, and ascribe meaning to the results. Main Findings: Sixteen interviews were conducted with key stakeholders. Twenty public documents which yielded the most specific information relevant to the case study time boundaries and activities were selected and reviewed. Six main themes are reported: felt need, two visions for change (one for a Nurse Practitioner-Led Clinic and one for Family Health Teams [FHTs]), vision processes related to ensuring the visions became or continued to be a reality in Ontario’s healthcare system (shaping, sharing, and protecting the vision), stakeholder activities, and sustaining and spreading the vision. Conclusions: In this case, stakeholder participation influenced policy decisions and was a key contributor to the primary care system change process to introduce the first Nurse Practitioner-Led Clinic in Ontario. Stakeholders are motivated by various needs to engage in activities to introduce an innovation in primary care. One of the most common needs felt by both those who supported the introduction of the first Nurse Practitioner-Led Clinic and those who were opposed to it was the need for improved patient access to primary care.

Purpose: To examine stakeholder participation in the primary care system change process that led to the introduction of the first Nurse Practitioner-Led Clinic in Ontario. Design: Qualitative case study guided by the principles of stakeholder and system change theory. Setting: Northern Community in Ontario, Canada. Participants: Purposeful sample of healthcare providers, healthcare managers and health policy stakeholders. Procedures: This case study was bound by place (Sudbury), time (January 2006–January 2008), activity (stakeholder participation), and process (introduction of an innovation, the first Nurse Practitioner-Led Clinic in Ontario, during a primary care system change). Semi-structured individual interviews were conducted with participants who represented the clinic, the local community, and the province. Public documents, such as newspaper articles published during the 2 year time boundary for this case and professional healthcare organization publications, were also examined. Interviews were analyzed using qualitative content analysis and public documents were reviewed for key messages to complement the interview findings. Field notes written during data collection and analysis were used to provide additional depth, contribute insights to the data, and ascribe meaning to the results. Main Findings: Sixteen interviews were conducted with key stakeholders. Twenty public documents which yielded the most specific information relevant to the case study time boundaries and activities were selected and reviewed. Six main themes are reported: felt need, two visions for change (one for a Nurse Practitioner-Led Clinic and one for Family Health Teams [FHTs]), vision processes related to ensuring the visions became or continued to be a reality in Ontario’s healthcare system (shaping, sharing, and protecting the vision), stakeholder activities, and sustaining and spreading the vision. Conclusions: In this case, stakeholder participation influenced policy decisions and was a key contributor to the primary care system change process to introduce the first Nurse Practitioner-Led Clinic in Ontario. Stakeholders are motivated by various needs to engage in activities to introduce an innovation in primary care. One of the most common needs felt by both those who supported the introduction of the first Nurse Practitioner-Led Clinic and those who were opposed to it was the need for improved patient access to primary care.

In 2010, the Patient Protection and Affordable Healthcare Act (PPACA) implemented changes to reduce healthcare spending that incorporated Centers for Medicare and Medicaid (CMS) incentive programs to reduce 30-day readmission rates in seniors with heart failure. This project includes a policy and procedure for private practice using a nurse practitioner navigator (NPN) led multidisciplinary team (MDT) for the patient-centered medical home (PCMH) to improve communication between hospitals and PCMH to decrease readmission rates in seniors with heart failure (HF). This practice change will provide an implementation and evaluation plan along with plans for future expansion. Meetings were held twice weekly along with the use of Skype when team members were unavailable. A literature review explored methods to improve communication between hospitals and PCHM to reduce readmission rates. Thirty-two peer-reviewed articles were identified in a search of CINAHL and ProQuest Nursing and Allied Health Source databases that served as the primary pool of evidence used for this project, supplemented by context considerations provided by the project team. Evaluating the evidence based research provided support for this project using a NPN led MDT to reduce readmission rates. Coleman's transition of care (TOC) model was used as a framework for both the policy and procedure to integrate patient, provider, and environmental contexts, support health care policy changes, and reduce health care spending. This scholarly project supports the role of DNPs as leaders in the medical field working to translate existing evidence into policy and practice and lead interdisciplinary health care teams.

Thesis advisor: Christopher Maxwell / Though much research has been done on the subject of substituting nurse practitioners for physicians as health care providers, both analytic methods and results have been inconsistent. Various studies have shown nurse practitioners to provide equivalent or improved care especially in primary care settings. However, no consensus has been reached on whether or not and under what conditions this substitution is economically efficient. Because of variation in productivity and substitution rates, the economic viability of nurse practitioners must be assessed on a department specific basis, taking into account differences in nurse practitioners’ job descriptions.One specific area this economic efficiency could be assessed in is in the diagnosis of ear infections. A study conducted through the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey showed that 15% of pediatric visits included a diagnosis of middle ear infection (Freid, 1998). If employed properly, nurse practitioners could be used to achieve significant cost savings in this area.This thesis is intended to address the economic efficiency of nurse practitioners as compared to physicians in diagnosing ear infections. First nurse practitioner quality in this specific area will be assessed by comparing nurse practitioner diagnosis error rates to physician error rates based on surveys asking both types of providers to provide diagnoses based on tympanic membrane images collected through previous telemedicine visits. Next the economic practicality of employing nurse practitioners in this field will be assessed in terms of the relative costs of these errors, measured as the cost of unnecessary prescriptions in the case of overdiagnosis and the cost of an unnecessary follow-up visit in the case of underdiagnosis. / Thesis (BA) — Boston College, 2012. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: College Honors Program. / Discipline: Economics Honors Program. / Discipline: Economics.