Having a newborn can be a big change for families, especially for first-time parents. At hospital discharge, parents are often provided with a lot of information, which can be difficult to retain. Due to shortened postnatal lengths of stay, nurses typically have less time to educate parents, which often results in families feeling overwhelmed. After hospital discharge, it is recommended for families to see a health care provider (i.e., physician, nurse practitioner, or registered midwife) within 72 hours for a follow-up appointment. This follow-up appointment is meant to assess both the mother and newborn to ensure they are both in good health and to provide any needed support. Unfortunately, completing the appointment within this timeframe may not be possible for every family or they may not be aware of its importance. Depending on the family’s model of care, completing the follow-up appointment within 72 hours after hospital discharge can be challenging. Families that have a physician as their health care provider may experience delays in scheduling the follow-up appointment. This can be due to the physician’s lack of availability, as there is a physician shortage in most communities. Furthermore, some families do not have access to a health care provider and, therefore, do not see a care provider after hospital discharge. Completing the follow-up appointment later than when it is recommended, or not at all, can result in negative health consequences for the mother and newborn and can also increase re-admission hospital rates and related costs (Cargill et al., 2007). At the moment, postnatal lengths of stay are shortening but the service delivery has not changed to accommodate this trend (Lemyre et al., 2018). This means that the services typically provided to families in the hospital now need to be provided in the community. The follow-up appointment after hospital discharge is an opportunity to provide these services; however, timely access to a health care provider, specifically a physician, can be challenging. Thus, this thesis explores the development of a general design methodology for a postpartum nurse practitioner-led clinic. The aim of the clinic is to provide timely access to any family that needs to complete the necessary postpartum services after hospital discharge within a community. An analytical model was developed to explore the characteristics of a postpartum nurse practitioner-led clinic and how it would operate (i.e., what services would be offered, the amount of time needed for these services, what is needed to offer these services, etc.). The model conducts a simulation of the appointment scheduling process based on the input values entered into it and evaluates a number of performance metrics (e.g., number of diversions, patient wait times, resource idle time, clinic overtime, number of appointments provided within 72 hours and number of appointments provided beyond 72 hours). The findings from the model can support the potential implementation of a postpartum nurse practitioner-led clinic in any community. Implementing such clinics could increase awareness, further educate parents and increase access to postpartum services.

Background: Type 2 diabetes mellitus (T2DM) is a complex health condition that impacts multiple organ systems and contributes to both acute and chronic health problems. In the United States (U.S.), T2DM is a growing health concern with increasing prevalence among both adult and pediatric populations (American Diabetes Association [ADA], 2015; Dea, 2011). Developing a comprehensive plan of care that incorporates a multifaceted treatment and prevention plan is necessary to address this growing health concern and reduce overall morbidity and mortality. Problem: The Edmund Primary Care (EPC) practice data for routine annual diabetic foot exams, annual eye exams, annual urine microalbumin, smoking cessation education and recommendations for pneumococcal polysaccharide do not meet the ADA (American Diabetes Association, 2015) recommendations for patients with T2DM.Design: Quality improvement (QI) project applying the Plan-Do-Study-Act (PDSA) cycle to develop a process change to improve diabetic preventative care measures for hemoglobin A1C, urine microalbumin, diabetic foot exams, and optometry referrals. Setting: A small, nurse practitioner owned, family practice clinic targeting patients 18 years and older with a diagnosis of T2DM.Intervention: A fishbone diagram to conduct a root cause analysis led to identification of key factors contributing to the problem. A comprehensive process change integrating a Diabetic Assessment Flow Sheet (DAFS) and diabetic foot exam sheet was developed to address the problem. Expected Outcome: Increase in rates of completion to at least 90% over eight weeks. Results: Analyzed with run charts demonstrating an increase in rates of completion to 100% for A1C, urine microalbumin, diabetic foot exams, and optometry referrals. A positive percent of change for each measure is as follows: A1C 7%; urine microalbumin 43%; diabetic foot exams 150%; and referrals to optometrist 43%. Significance: This QI project emphasizes the importance of implementing a system to evaluate the quality of care being delivered. It also highlights the usefulness of the PDSA cycle as a method to implementing quality improvement measures in health care. Lastly, this QI project demonstrated the effectiveness of flow sheets in improving the quality of care delivered to patients with T2DM.

Patient satisfaction has been identified as an indicator of quality care. There is no research on patient satisfaction with Nurse Practitioner (NP) care on Guam. Therefore, a cross sectional descriptive study was conducted to assess patient satisfaction with NP care at three primary care clinics on Guam. A convenience sample of patients 18 years and older, seen by an NP were invited to participate in completing the Nurse Practitioner Satisfaction Survey (NPSS). Data collection concluded after a one-month period (N = 108). Descriptive statistics, between group differences, and correlational analyses were conducted. Participation in the survey was voluntary and anonymity, confidentiality, and privacy were ensured. General patient satisfaction was very high for NP care on Guam. "My NP is caring" was the highest scoring item on the NPSS with a mean score of 4.43 (n=56). Participants selected the NP as providing the health education and care the patient found most satisfying. A statistically significant weak negative correlation between patient satisfaction and age and level of injury was found. Singles reported significantly higher patient satisfaction scores than widowers. Study limitations included the small sample size, convenience sampling, social desirability and selection bias. Caring is an essential tenet of NP care and patient satisfaction. Improving NP role clarity is vital to the continued success and growth of the NP profession. The value that NPs bring to primary care is substantiated by the high patient satisfaction levels consistently produced from studies across the globe. In order for NPs to significantly impact the primary care provider shortage all 50 states and the US territories must enact full practice authority (FPA).

ABSTRACT Background. Childhood sexual abuse (CSA) is a silent, but pervasive concern across the United States, the prevalence of which is often vastly underestimated. Some research indicates that as many as one in four girls and one in six boys become victims of CSA. CSA is classified as an adverse childhood experience (ACE), which has been shown to have serious longstanding negative physical, emotional, and mental health impacts. The pediatric primary healthcare provider is well posed to intervene to detect and prevent the occurrence of CSA. Objective. The overall goal of this study is to gain an understanding of the current state of sexual abuse screening and prevention in pediatric primary care settings in the state of Vermont. Methods. An anonymous, 20-item survey was distributed to Vermont pediatric primary care providers via the electronic mailing lists of three Vermont-based professional organizations for healthcare providers. The online survey was conducted with the Limesurvey software through the secure University of Vermont server. The survey remained active for three weeks, and potential participants received three weekly reminder emails inviting them to complete the survey. As an incentive for volunteer participation in the study, all participants received a list of the available local, statewide, and national resources available to them to assist in sexual abuse detection and prevention following survey completion. Results. There were 37 participants who completed the survey. The groups were divided based on professional title, patient population, years of experience in practice, geographic location, and access to a social worker. Each of these groups was analyzed against the survey data to determine any underlying trends that existed. Conclusions. Nurse practitioners were found to be more likely than physicians to routinely screen every child and their caregivers during health supervision visits. NPs were also more likely to report that the electronic health record prompted these screenings. A positive correlation was found between the likelihood of routinely screening children and increased provider confidence with screening. However, no differences were found between NPs and physicians in confidence with screening, nor were there differences in perceived educational sufficiency between the two groups. Across all professional titles, pediatric providers reported greater confidence in their ability to detect risk factors and red flags than family practice providers. A greater perceived sufficiency of education was positively correlated with provider confidence and comfort with screening. Educational sufficiency was also positively correlated with the perception that area resources are highly available and are effectively used in practice. Time was reported as the greatest barrier to screening and prevention by those who have the highest perceptions of their ability to make an impact on prevention. Also, those who felt that there were highly available and accessible resources at their disposal also reported time as their greatest barrier. Additionally, those who reported greater than 20 years of experience in practice were significantly less likely to view access to the patient as the greatest barrier that providers face in their efforts to detect and prevent sexual abuse. Further study is indicated to confirm these findings.

The rising cost of health care and changes in healthcare delivery have prompted a need to improve continuity from the hospital to home. This scholarly project was initiated to assess the impact on patient outcomes related to initiation of a nurse practitioner-led transitional care program (TCP). Using the Diffusion of Innovations and Health Belief Models, the purpose of this study was to identify the impact of a TCP on improving the health of patients with congestive heart failure (CHF), diabetes mellitus Type II (DM II), and chronic obstructive pulmonary disorder (COPD). The impact of the TCP was evaluated by a review of patient satisfaction results, reduction in patient readmission rate, and emergency room consults. Two years of data from a community-based health care program were collated from a sample of 819 individuals with chronic disease between 65- and 85-years-old who had a 30-day hospital readmission after a nurse practitioner home visit and a 30- day readmission for an exacerbation of their CHF, DM II, or COPD. The secondary data were analyzed, using SPSS, to determine changes in rates of readmission. Descriptive statistics were used to represent and compare changes in rates. After implementation of the nurse practitioner home visit program, the 30-day readmission demonstrated an 81.07% reduction and the 30-day readmission for exacerbation of COPD, CHF, and DM II was reduced by 36.77%. The project findings contribute to social change by identifying how a reduction in the frequency of hospitalizations could contribute to decreased health care expenses and improved health outcomes. Home care and chronic health care organizations, as well as advanced-practice nurses working in home care settings, may use the results of the study to establish effective community interventions that reduce health care costs.

Minimally invasive aesthetic medicine (MIAM) is a relatively new field, which lacks a clearly defined scope of practice. The purpose of this project was to clarify the scope of practice for nurse practitioners in MIAM in California. Without a clearly defined scope of practice, nurse practitioners are unable to practice to the full extent of their license which causes them to be underutilized and face liability issues. This project sought to answer the question: What is the scope of practice of the nurse practitioner in MIAM in the state of California? The model of professional nursing practice regulation was the model used to guide this project. Sources of evidence included case law that has emerged since 1983; reviewing documents from 3 state boards of nursing; and a survey of nurse practitioners who practice in the field of MIAM. The evidence was analyzed noting themes while determining what the legal backbone is for nurse practitioner's scope of practice in California. This project found that nurse practitioners in this field keep up to date in their knowledge, educate their patients, utilize methods to maintain competency, feel support in their environment, assess and refer to others when appropriate, and teach both staff and patients evidence-based practices. It also found that standardized procedures are the legal backbone to understanding the scope of practice in California. A scope of practice was developed based on the findings of this project which was then reviewed by an expert. It is recommended that nurse practitioners utilize their resources to obtain and maintain knowledge as well as learn what the standardized procedures are in their facility. The implications for clarifying the scope of practice will serve this population to fully utilize their capabilities and practice safely, as well as help to develop this relatively new field.

With more than 700,000 new diagnoses annually, congestive heart failure (CHF) is a chronic condition that affects the chambers of the heart. When not managed correctly, the disease rapidly progresses to substantial fluid volume overload that impacts activities of daily living and the overall quality of life. The financial implications for poor CHF management cost a mean annual medical expenditure of $33,427 per patient per year. The need for a diagnostic and prognostic at-home protocol is needed in the medical community, as there is currently no such tool on the market. Donabedian's framework was used to guide the formulation and interpretation of this research. The purpose of this project was to design a CHF protocol using evidence-based research for clinicians making home visits to homebound patients with a primary diagnosis of CHF with an individualized protocol focusing on disease management, in home support system, knowledge base and financial factors for homebound patients. The protocol was released through a snowballing campaign to clinicians who work with CHF, transitional care, or homecare who then evaluated the protocol on its perceived efficacy if integrated into practice. Findings were analyzed using simple descriptive statistics by 32 nurses and other health care professionals who responded work in home care, cardiology, medical surgical nursing hospitalists, or skilled nursing facilities. Thirty-one of the 32 respondents deemed the protocol useful and stated a clinical need of protocol as evidenced by completed the AGREE II Questionnaire. The findings demonstrate that the CHF Practice Protocol provides clinicians with an evidence-based guidance to manage homebound patients with CHF on a small scale.

Abstract Background: Despite the rise in the occurrence of skin cancer, primary care nurse practitioners are reluctant to perform skin cancer assessments during patient visits. Melanoma is almost always curable if detected in the early stages, but invasive disease accounts for 9,000 deaths per year (American Cancer Society, 2013). Changing knowledge, attitudes and practice regarding skin cancer assessments potentially leads to early detection and treatment of skin cancers and impacts patient outcomes. However, in order to change knowledge and attitudes, we must first assess them. Purpose: The purpose of this research was to validate a new skin cancer assessment tool instrument called KAP-SCA to measure knowledge, attitude, and practice in primary care NPs. Methods: Sequential mixed methods were used. First, focus group interviews with 14 primary care nurse practitioners were conducted during Phase I. Interviews were audio-recorded then transcribed verbatim and imported into ATLAS.ti. Phase II involved instrument development from a blueprint and calculation of content validity indexes (CVI) for items and subscales. Phase III of this study included testing the validity and reliability of a KAP instrument using quantitative methods. This new instrument assesses primary care nurse practitioner knowledge, attitudes, and practice regarding skin cancer assessment. Results: Content validity for the subscales was evaluated by CVI ranged from .90 to .95. The Cronbach's alpha was highest for the practice subscale (alpha =.89) while the lowest was seen with the knowledge subscales (alpha =.50). Construct validity assessed by exploratory factor analysis indicated the presence of three underlying factors, confidence in practice, confidence relating to education and NP role in practice. Implications for Practice: Interventions need to be developed based on the knowledge deficits and barriers to practice identified by these NPs including educational programs that focus on increasing primary care NPs' knowledge and confidence levels regarding skin cancer assessments and identification of malignant lesions. Conclusion: Beginning evidence of validity and reliability were found for the Knowledge, Attitudes and Practice-Skin Cancer Assessments (KAP-SCA), however further studies are warranted.

Ögoninfektion är vanligt förekommande hos barn särskilt i kombination med övre luftvägsinfektion. 95% av alla barn mellan två och fem år vistas på förskola. Distriktssköterska/Avancerad primärvårdssjuksköterska ser förskolan som en viktig resurs i det förebyggande hälsoarbetet. Personal på förskolan har att ta ställning till sjukdom och ohälsa hos barnen. Syftet med studien är att undersöka förskolepersonalens uppfattningar om ögoninfektion hos barnen.   Fyra intervjuer med förskolepersonal ligger till grund för en kvalitativ studie. Intervjuerna har analyserats enligt fenomenografisk ansats. Sju beskrivningskategorier med tillhörande uppfattningar beskriver personalens olika uppfattningar: Spridning av ögoninfektion; Hur infektionen yttrar sig; Brist på kunskap; Betydelsen av handhygien; Föräldrarnas roll; Hälso- och sjukvårdens betydelse; Den kollegiala samvaron.   Förbättrad kommunikation mellan BVC/vårdcentral och förskola behövs. Undersökningen är tänkt att användas i distriktssköterskans/APS-sjuksköterskans fortsatta arbete för att befrämja hälsa och förebygga sjukdom. / Conjunctivitis is common among infants and children, especially whilst they are suffering from upper respiratory tract infections. 95% of all infants go to nursery from the age of 2 The nurse practitioner finds that nurseries are ideal places for health promotion. In nurseries the staff has to make decisions concerning health problems in the infants. The aim of this paper is to describe how the staff experience eye infection in infants. It is a qualitative study based on four interviews. They are analyzed using the phenomenographic method. The result contains seven different categories with all the significant answers from the participants: The spread of eye infection; The infection's appearance; Lack of knowledge; The importance of hand hygiene; The role of the parents; The importance of the health service; The social intercourse between colleagues. There is a need of improved communication between the GP center and the nurseries. The paper is intended to benefit the nurse practitioner in promoting health.

<p>Ögoninfektion är vanligt förekommande hos barn särskilt i kombination med övre luftvägsinfektion. 95% av alla barn mellan två och fem år vistas på förskola. Distriktssköterska/Avancerad primärvårdssjuksköterska ser förskolan som en viktig resurs i det förebyggande hälsoarbetet. Personal på förskolan har att ta ställning till sjukdom och ohälsa hos barnen. Syftet med studien är att undersöka förskolepersonalens uppfattningar om ögoninfektion hos barnen.</p><p> </p><p>Fyra intervjuer med förskolepersonal ligger till grund för en kvalitativ studie. Intervjuerna har analyserats enligt fenomenografisk ansats. Sju beskrivningskategorier med tillhörande uppfattningar beskriver personalens olika uppfattningar: Spridning av ögoninfektion; Hur infektionen yttrar sig; Brist på kunskap; Betydelsen av handhygien; Föräldrarnas roll; Hälso- och sjukvårdens betydelse; Den kollegiala samvaron.</p><p> </p><p>Förbättrad kommunikation mellan BVC/vårdcentral och förskola behövs. Undersökningen är tänkt att användas i distriktssköterskans/APS-sjuksköterskans fortsatta arbete för att befrämja hälsa och förebygga sjukdom.</p><p> </p><p> </p> / <p>Conjunctivitis is common among infants and children, especially whilst they are suffering from upper respiratory tract infections. 95% of all infants go to nursery from the age of 2 The nurse practitioner finds that nurseries are ideal places for health promotion. In nurseries the staff has to make decisions concerning health problems in the infants.</p><p>The aim of this paper is to describe how the staff experience eye infection in infants. It is a qualitative study based on four interviews. They are analyzed using the phenomenographic method. The result contains seven different categories with all the significant answers from the participants: The spread of eye infection; The infection's appearance; Lack of knowledge; The importance of hand hygiene; The role of the parents; The importance of the health service; The social intercourse between colleagues.</p><p>There is a need of improved communication between the GP center and the nurseries. The paper is intended to benefit the nurse practitioner in promoting health.</p>