Do We Really Listen, Improving End-of-Life Conversations

Having end-of-life (EOL) conversations is often difficult for even seasoned clinicians. There are many well-developed conversation guidelines used in the specialty of palliative medicine. There is no one ultimate guide that makes having an emotion-filled conversation easy. However, using the tenets of medical ethics, cloaked with experience, compassion, empathy, and respect makes EOL conversations less traumatic for the patient-family system and for the provider. Palliative specialists have the training and experience in effectively having EOL conversations, especially when death is unavoidable. Utilizing shared decision making, palliative specialists ensure there is mutual respect and communication between providers and the family system.

Barriers, facilitators, and opportunities for Doctor of Nursing Practice engagement in translational research

BACKGROUND

Little is known about how Doctor of Nursing Practice (DNP) graduates apply translational research competencies in the practice setting.

PURPOSE

This qualitative descriptive study aimed to explore the barriers, facilitators, and opportunities for engaging in translational research among DNPs in practice.

METHODS

We conducted semi-structured interviews with 11 DNPs working within an 8-hospital health system from November 2020 through July 2021.

DISCUSSION

We identified four themes related to barriers (invisibility of the DNP degree and skillset; lack of role clarity and organizational structure for DNPs; lack of time for engagement in translational research; lack of support for engagement in translational research), one theme related to facilitators (encouragement from colleagues and supervisors), and two themes related to opportunities (DNP education promotes recognition of nurse role in translational research; DNPs are interested in role expansion to include translational research).

CONCLUSION

DNPs have the interest and training to engage in translational research but face structural barriers to doing so.

The State of Nurse Anesthetist Practice and Policy: An Integrative Review

The enactment of the Affordable Care Act in 2010 prompted the Institute of Medicine to release The Future of Nursing report to help guide the necessary changes in nursing to accommodate millions of newly insured individuals. A key point of the campaign was for advanced practice registered nurses (APRNs) to practice at the fullest extent of their licensure to meet the needs of the newly insured population. Certified Registered Nurse Anesthetists (CRNAs) experience the most restricted scope of practice among APRNs. An integrative review was conducted to examine CRNA practice and policy since The Future of Nursing was released. Ten research articles were included in the final review. Key findings related to CRNA practice and policy that emerged from the review were (1) patient complications and mortality rates are no different under the care of CRNAs compared with anesthesiologists; (2) CRNAs are more accessible to vulnerable populations and rural areas; and (3) state legislators are being influenced by factors other than evidence, such as strong professional group influence, to make policy decisions for CRNAs. Future interdisciplinary research investigating outcomes from the patients' perspectives could help remove bias and strengthen the evidence of the quality of care given by CRNAs.

Effective Partnership Care Models with Advanced Practice Psychiatric Nurses

The unmet behavioral health treatment needs of children and adolescents have become a public health crisis in the United States, with only 20% of youths obtaining assessment and intervention when indicated. Workforce shortages, including mental health professionals who can provide pharmacologic intervention within an appropriate biopsychosocial context, directly impede our ability to address this crisis. The authors examine the history, education, regulation, and practice of advanced practice psychiatric nurses and consider models of collaborative practice that can be beneficial across treatment settings in order to provide better care of vulnerable youth in ways that foster partnership rather than competition.

Acute Care Pediatric Nurse Practitioners as Leaders: Perceptions, Self-Identity, and Role Congruity

INTRODUCTION

This study aimed to gain an understanding of practicing acute care pediatric nurse practitioners' (AC-PNPs') perceptions of themselves as leaders in both clinical and professional contexts.

METHOD

This qualitative study was conducted at a midwestern quaternary care children's hospital. Cultural domain analysis, semistructured interviews, and free listing techniques were employed to identify areas of consensus and variation among a convenience sample of AC-PNPs.

RESULTS

Findings demonstrated the AC-PNPs have a limited self-view of leadership.

DISCUSSION

Nurse practitioners need additional leadership capacity and capability building during graduate education, the transition to practice, and throughout their careers.

Perspectives, experiences, and opinions precepting advanced practice registered nurse students

BACKGROUND

Significant growth in advanced practice registered nurse (APRN) student placements for clinical practicums have forced APRN preceptors, hospitals, and clinics to restrict the volume of APRN students they can accommodate.

PURPOSE

Describe the experiences and opinions of APRNs regarding their precepting experiences of APRN students in three main areas; placement antecedents, placement postcedents, and preceptor incentives.

METHODS

Quality improvement study conducted via electronic survey that contained quantitative short answer and a qualitative open-ended question of APRNs licensed in the State of REDACTED in June, 2019.

FINDINGS

A total of 757 surveys were quantitatively analyzed. Qualitative thematic analysis resulted in identifying one overarching theme, the need for shared responsibility and accountability, and six unique primary themes.

DISCUSSION

Our findings indicate that APRN preceptors recognize their critical role but lack support and preparation to fully execute academic and profession strategic goals and objectives. There is the need for academic and professional ownership of APRN education at every level.

Development of an innovative curriculum-to-career transition program for nurse practitioners in primary care

BACKGROUND

Unlike physicians, there are no current requirements or funding for the post graduation training of advanced practice nurses. Given the complexity of health care, more post graduate training programs are needed to meet growing demand.

PURPOSE

A taskforce was convened to research gaps in preparation for real-world practice, as well as effective models of curricular and clinical support to promote positive patient outcomes.

METHODS

Supportive structures for advance practice nurses are dependent upon understanding the barriers, facilitators and structural support required to implement such a program.

FINDINGS

Starting a curriculum-to-career program the semester prior to graduation is a relatively untested model for advanced practitioners to receive enhanced mentored education and support to increase resiliency, reduce early burnout and burden on the health setting.

DISCUSSION

Advanced practice nurse fellowships should be considered as essential as medical residencies are for physicians in clinical practice.

The use of national collaborative to promote advanced practice registered nurse-led high-value care initiatives

BACKGROUND

High-value healthcare focuses on improving healthcare to produce cost effective care, however limited information on the role of advanced practice registered nurses (APRNs) exists.

PURPOSE

This descriptive report describes APRN-led initiatives implemented as part of a national collaborative promoting the Choosing Wisely® campaign and high-value care measures.

METHOD

An APRN national collaborative focuses on developing and implementing high-value care initiatives. Monthly calls, podcasts, and a file sharing platform are used to facilitate the work of the national collaborative.

FINDINGS

A total of 16 APRN teams from 14 states are participating and have implemented a number of initiatives to reduce unnecessary testing and treatments, promote appropriate antibiotic use, and promote optimal clinical practices such as mobility for hospitalized elderly patients, among others.

DISCUSSION

A national collaborative has proven to be a successful way to engage APRN teams to focus on targeting high-value care and promoting evidence-based practices in clinical care.

The Disruptive bEhavior manageMEnt ANd prevention in hospitalized patients using a behaviORal intervention team (DEMEANOR) study protocol: a pragmatic, cluster, crossover trial

BACKGROUND

Disruptive behavior in hospitalized patients has become a priority area of safety concern for clinical staff, and also has consequences for patient management and hospital course. Proactive screening and intervention of patients with behavioral comorbidities has been reported to reduce disruptive behavior in some settings, but it has not been studied in a rigorous way.

METHODS

The Disruptive bEhavior manageMEnt ANd prevention in hospitalized patients using a behaviORal intervention team (DEMEANOR) study is a pragmatic, cluster, crossover trial that is being conducted. Each month, the behavioral intervention team, comprising a psychiatric-mental health advanced practice nurse and a clinical social worker, with psychiatrist consultation as needed, rotates between an adult medicine unit and a mixed cardiac unit at Vanderbilt University Medical Center in Nashville, TN, USA. The team proactively screens patients upon admission, utilizing a protocol which includes a comprehensive chart review and, if indicated, a brief interview, seeking to identify those patients who possess risk factors indicative of either a potential psychological barrier to their own clinical progress or a potential risk for exhibiting disruptive, aggressive, or self-injurious behavior during their hospitalization. Once identified, the team provides interventions aimed at mitigating these risks, educates and supports the patient care teams (nurses, physicians, and others), and assists non-psychiatric staff in the management of patients who require behavioral healthcare. Patients who are both admitted to and discharged from either unit are included in the study. Anticipated enrollment is approximately 1790 patients. The two primary outcomes are (1) a composite of objective measures related to the patients' disruptive, threatening, or acting out behaviors, and (2) staff self-reported comfort with and confidence in their ability to manage patients exhibiting disruptive, threatening, or acting out behavior. Secondary outcomes include patient length of stay, patient attendant (sitter) use, and the unit nursing staff retention.

DISCUSSION

This ongoing trial will provide evidence on the real-world effectiveness of a proactive behavioral intervention to prevent disruptive, threatening, or acting out events in adult hospitalized patients.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03777241. Registered on 14 December 2018.

How collaborative practice agreements impede the provision of vital behavioral health services

BACKGROUND

The critical shortage of behavioral health professionals impairs the ability of the U.S. health care system to respond to the growing demand for services to address mental illness and substance use disorders.

PURPOSE

To identify how restrictive state regulations act as barriers to full utilization of psychiatric mental health advanced practice registered nurses (PMH-APRN), whose scope of practice enables them to provide a full range of behavioral health services.

METHODS

A sequential mixed methods study combining interview data (n = 94) from a qualitative study of PMH-APRN practice with a subset of quantitative data (n = 699) from a national APRN survey examining the impact of state-mandated APRN/MD collaborative practice agreements.

DISCUSSION

Data sources converged to portray challenges to optimal use of APRNs providing psychiatric/mental health services, including high out-of-pocket fees, irregular communication with supervisors, mandated chart reviews, and supervisor turnover.

CONCLUSION

Inconsistent and burdensome supervision requirements contribute to cost inflation and may limit patient access.

Development, Implementation, and Satisfaction With a Nurse Practitioner Professional Ladder: A Children's Hospital Experience

This article describes the development and implementation of a nurse practitioner professional ladder (NPPL) at a large freestanding urban pediatric hospital. The NPPL was created to recognize advanced practice registered nurses and differentiate levels of clinical expertise, role development, leadership, and professional contributions into a three-tiered approach, designated as NP I, NP II, and NP III. The results of a nurse practitioner satisfaction survey at Year 2 and Year 4 after the development of the NPPL are summarized. The NPPL helped create an empowering environment for continued nurse practitioner professional growth.

The future of the psychiatric mental health clinical nurse specialist: evolution or extinction

The role of the psychiatric mental health clinical nurse specialist (PMHCNS) is now in a precarious position. At first glance, some may say it is on the verge of extinction. In this article, a brief history of the role of the PMHCNS is reviewed along with current education, practice, role, and American Nurses Credentialing Center certification of the PMHCNS. The future implications and considerations of the unique functions of the PMHCNS for an advanced practice registered nurse with a psychiatric mental health specialization are discussed.

Re-envisioning clinical education for nurse practitioner programs: themes from a national leaders' dialogue

As the need for primary care providers increases, nursing education programs face significant challenges to meet future workforce needs. A more resource-efficient approach for the clinical education of nurse practitioner students is needed. A think tank involving 20 thought leaders representing multiple disciplines was convened to discuss this issue. This article presents seven themes that emerged from this national leaders' dialog: academic practice co-design, standardized preclinical preparation, standardized student assessment, entrustable professional activities, immersive clinical experiences, interprofessional education for team-based care, and innovative education practices.

Identifying and evaluating electronic learning resources for use in adult-gerontology nurse practitioner education

Enhancing existing curricula to meet newly published adult-gerontology advanced practice registered nurse (APRN) competencies in an efficient manner presents a challenge to nurse educators. Incorporating shared, published electronic learning resources (ELRs) in existing or new courses may be appropriate in order to assist students in achieving competencies. The purposes of this project were to (a) identify relevant available ELR for use in enhancing geriatric APRN education and (b) to evaluate the educational utility of identified ELRs based on established criteria. A multilevel search strategy was used. Two independent team members reviewed identified ELR against established criteria to ensure utility. Only resources meeting all criteria were retained. Resources were found for each of the competency areas and included formats such as podcasts, Web casts, case studies, and teaching videos. In many cases, resources were identified using supplemental strategies and not through traditional search or search of existing geriatric repositories. Resources identified have been useful to advanced practice educators in improving lecture and seminar content in a particular topic area and providing students and preceptors with additional self-learning resources. Addressing sustainability within geriatric APRN education is critical for sharing of best practices among educators and for sustainability of teaching and related resources.