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What this paper adds: * This case study demonstrated that facilitating ongoing education opportunities that draw on the expertise of local palliative care champions or internal specialists can enhance care provision. * Nurse care managers believe the value of generalist services, particularly home care services, in the generalist-specialist palliative care partnership, needs to be understood and respected. * Tailored investment in home care to provide a general palliative approach would be beneficial given the unique challenges of this mobile workforce. Keywords: Palliative care;home care services;Education, Nursing;qualitative research;Nurse Practitioner BACKGROUND Palliative care focuses on improving the quality of life of people affected by life-threatening illnesses, including the prevention and relief of suffering through identification, assessment and treatment.1 This care extends to family members, and encompasses physical, psychological, social and spiritual support. Home nursing and care organisations are key providers of community-based palliative care, with staff often the linchpin, in supporting palliative clients, organising and providing care, coordinating the input of other professionals and of specialist equipment.5 Previous research has identified the difficulties faced by home care nurses in meeting their clients' palliative care needs, such as symptom management and communication, as well as requirements for further training to enhance their knowledge and confidence of caring for palliative clients.5-7 In this context, generalist palliative care is delivered by health and care professionals with broad clinical responsibilities who provide primary, ongoing care;and have established relationships with the person and their care community.2 This is distinct from specialist palliative care services which support complex needs through multidisciplinary teams with specialised palliative care training. FINDINGS AND DISCUSSION Thematic analysis identified the following overarching themes: 1) targeted education increased staff knowledge and confidence, but more is needed;2) collaborative teamwork with effective communication and information sharing underpins a successful generalist-specialist partnership;3) the home care setting is unique and requires accessible systems and processes.
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"5 However, more recent findings, such as the presentation of joint swelling without EM in Black children, are the result of research efforts to identify differences among racial and ethnic groups in presentations of disease symptoms, with the aim of greater diagnostic accuracy and reduced health care disparities.4 Treatment of Lyme disease Although most resources, such as the CDC's website,1 published articles and sites,2,3 and the Red Book,5 recommend that pediatric, adolescent, and young adult patients with Lyme disease receive an antibiotic, such as doxycycline, amoxicillin, or cefuroxime (for penicillin-allergic patients), these publications differ in recommended dosage and duration of treatment. [...]PHCPs who are unfamiliar with antibiotic treatments for Lyme disease should consult with infectious disease specialists. Children who have evidence of Lyme carditis, Lyme arthritis, cranial neuritis, Lyme meningitis, or radiculoneuritis should immediately be referred to infectious disease and the appropriate pediatric specialists.2 Respiratory infections and health care inequities Although researchers have reported studies on racial and ethnic inequities among children related to respiratory diseases over the last 20 years, few randomized controlled trials have scientifically investigated the problem or have identified and rigorously investigated evidencebased interventions. The COVID-19 pandemic brought a new focus in pediatric health care on the inequities experienced by Black, Hispanic, American Indian or Alaska Native, and Pacific Islander children living in poverty, who regularly experience a disproportionate number of respirator y illnesses and infections.6 Several studies have shown increased hospitalization rates for Blac k and H ispan ic children who contracted COVID-19.6 One team of researchers studying children from birth to 4 years old reported a hospitalization rate of 55% for Black and Hispanic children.7 For years, PHCPs have observed and treated children for asthma in all health care settings. Bhavnani et al reported that Black children had a 7-fold higher rate of emergency department visits compared with White children in 2019, 1 year before the pandemic began.8 However, the difference decreased to a 2-fold increase for Black children compared with White children in 2020, when COVID-19 measures such as masking, social distancing, and school closures were in place.8 Researchers are continuing to investigate why Black and Hispanic children are more vulnerable to upper respiratory infections with viruses such as influenza, rhinovirus, and adenovirus.8 Summertime prevention of respiratory infections Talking about prevention strategies with families is the first step toward reducing asthma episodes and exacerbations.
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Am J Manag Care. 2023;29(6):In Press _____ Takeaway Points The value of direct-to-consumer (DTC) telemedicine services offered by academic health systems is understudied. * DTC telemedicine services for low-acuity or minor illnesses are increasingly offered as an employee benefit, but any per-episode unit cost advantage may be offset by overuse of care. * DTC telemedicine staffed by an academic health system and offered to its employees resulted in lower per-episode unit costs for care within 7 days and only marginally increased the use of services. * DTC telemedicine staffed by an academic health system and offered directly to employees was cost-saving. _____ Employers in the United States have increasingly been offering a direct-to-consumer (DTC) telemedicine benefit for low-acuity or minor illnesses to their employees.1-3 By 2021, more than 95% of employers with 50 or more employees provided some coverage for DTC telemedicine in their largest health plan;more than 75% felt that offering telemedicine was important and nearly 20% either limited or eliminated cost sharing for telemedicine.4 Despite these trends among general employers, few health systems have directly provided DTC telemedicine to their own employees. [...]because these services are easy to access (often available immediately, around the clock, and without travel), they may induce overuse of care, especially for self-limited conditions such as viral upper respiratory infections for which the alternative to in-person care is no care at all, thus increasing the overall cost of care.5-11 Telemedicine will save money relative to in-person care if any unit price advantages are not overwhelmed by the increased use of care overall, induced by its convenience. Employers provide health insurance coverage for 158 million Americans or nearly 50% of the population. Since the COVID-19 pandemic began, telemedicine has represented a significantly larger portion of all medical claims—consistently more than 5% of all medical claims by mid-202112-15—and the estimated value of the global telemedicine industry is projected to reach a quarter of a trillion dollars by 2024.13 Yet, the future of telemedicine remains undetermined with reimbursement rates in debate,16-18 driven in large part because its economic value is understudied and uncertain. Penn Medicine is self-insured and more than 95% of employees use its only employer-sponsored plan—a preferred provider organization (PPO) plan—rather than insurance obtained individually or through a family member. Since 2017, these PPO-insured employees have been offered Penn Medicine OnDemand,19 a 24/7 DTC telemedicine benefit to employees and their adult (≥ 18 years) dependents.
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Resumo Objetivo Analisar o impacto da pandemia da Coronavirus Disease 2019 (COVID-19) no trabalho de enfermagem em unidades de urgência e emergência. Métodos Pesquisa de abordagem qualitativa realizada entre profissionais de enfermagem atuantes em unidades de urgência e emergência no estado do Rio de Janeiro, Brasil. Dados coletados via online por meio de formulário semiestruturado e submetidos à análise lexicográfica no software Interface de R pour Analyses Multidimensionnelles de Textes Et de Questionnaires (IRAMUTEQ). Resultados Participaram 31 profissionais de enfermagem. O aproveitamento do corpus textual foi de 94,9% mediante a geração de seis classes de segmentos de textos, que possibilitou identificar que os profissionais que atuam nessas unidades têm vivenciado sobrecarga no desenvolver laboral, dada a carga horária de trabalho exaustiva, bem como a falta de infraestrutura, de equipamentos de proteção e de recursos humanos. Ainda, evidenciaram-se desgastes físicos e mentais, com ênfase para o estresse e a exaustão, além do sentimento de medo pelo receio de contaminação. Conclusão A pandemia da COVID-19 promoveu impactos diretos no trabalho de enfermagem em unidades de urgência e emergência no que tange a aspectos relacionados a recursos humanos e materiais e infraestrutura, além da assistência prestada aos pacientes em condições graves.
Resumen Objetivo Analizar el impacto de la pandemia de Coronavirus Disease 2019 (COVID-19) en el trabajo de enfermería en unidades de urgencia y emergencia. Métodos Investigación de enfoque cualitativo realizada entre profesionales de enfermería que actúan en unidades de urgencia y emergencia en el estado de Rio de Janeiro, Brasil. Datos recopilados en línea a través de formulario semiestructurado y presentados para análisis lexicográfico en el software Interface de R pour Analyses Multidimensionnelles de Textes Et de Questionnaires (IRAMUTEQ). Resultados Participaron 31 profesionales de enfermería. El aprovechamiento del corpus textual fue del 94,9 % mediante la producción de seis clases de segmentos de textos, lo que posibilitó identificar que los profesionales que actúan en esas unidades han vivido una sobrecarga en el quehacer laboral, considerando la duración de la jornada de trabajo agotadora, como también la ausencia de infraestructura, de equipos de protección y de recursos humanos. Además, se evidenciaron desgastes físicos y mentales, con énfasis en el estrés y el agotamiento, además del sentimiento de miedo por el temor a la contaminación. Conclusión La pandemia de COVID-19 ocasionó impactos directos en el trabajo de enfermería en unidades de urgencia y emergencia en lo que se refiere a aspectos relacionados con recursos humanos y materiales y con la infraestructura, además de la atención brindada a los pacientes en condiciones graves.
Abstract Objective To analyze the impact of the Coronavirus Disease 2019 pandemic (COVID-19) on nursing work in emergency units. Methods A qualitative research conducted among nursing professionals operating in emergency units in the state of Rio de Janeiro, Brazil. Data collected online through a semi-structured form and submitted to lexicographic analysis in the software Interface de R pour Analyses Multidimensionnelles de Textes Et de Questionnaires (IRAMUTEQ). Results Thirty-one nursing professionals participated. The use of the text corpus accounted for 94.9%, through the generation of six classes of text segments, which made it possible to identify that professionals working in these units have experienced overload in developing work, given the exhausting workload, as well as the lack of infrastructure, protective equipment and human resources. Also, physical and mental exhaustion was evidenced, with emphasis on stress and exhaustion, in addition to the feeling of fear for fear of contamination. Conclusion The COVID-19 pandemic promoted direct impacts on nursing work in emergency units regarding aspects related to human and material resources and infrastructure, in addition to the care provided to patients in severe conditions.
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Active learning methodologies support the development of higher-order thinking and knowledge application necessary for modern health care environments. Through active learning, nurse practitioner students apply their understanding of population-specific competencies while developing critical thinking and reasoning skills for safe and effective care. Myths regarding student-centric learning, such as cost, time, and design, may create barriers for faculty to incorporate competency-based methods into didactic curricula. This article provides evidence-based strategies and exemplars for active learning as a method to evaluate student competency beyond clinical skills.
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Owing to the increased use of telehealth as a widely accepted means of providing patient care and the movement toward competency-based education, implementation of telehealth teaching, learning, and evaluation strategies into the graduate nursing plan of study is evolving quickly. This report uses Rutledge's "4Ps of Telehealth” framework to provide resources for faculty to incorporate telehealth knowledge, skills, attitudes, core telehealth competencies, and evaluation practices into the bachelor of science nursing to doctor of nursing practice program curriculum based on the National Organization of Nurse Practitioner Faculties Nurse Practitioner Core Competencies. Formal preparation of students ensures future nurse practitioners are able to provide proficient, effective care through telehealth upon graduation.
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Objective: To analyze the relationship between fatigue, sleep quality, variables of health and work in intensive care nursing workers during the COVID-19 pandemic. Methods: Cross-sectional, correlational study conducted from July 2020 to February 2021 with a random and probabilistic sample of nurses and nursing technicians from university hospitals in Rio Grande do Sul, Brazil. A sociodemographic/occupational questionnaire, the Fatigue Assessment Scale and the Pittsburgh Sleep Quality Index were used in data collection. The chi-square test, Mann-Whitney U test and the Spearman correlation coefficient were used in the analyzes, adopting a significance level of 5%. Binary logistic regression analysis was performed. Results: Participation of 114 workers. There was prevalence of low fatigue and poor sleep quality. High fatigue was associated with the variables going to work sick and perceiving noise/vibrations as a cause of discomfort. Nursing technicians were associated with poor sleep quality and concern about exposure to chemical substances. Fatigue and sleep quality were moderately and directly correlated. Adjusted analyzes showed that nurses and nursing technicians with high fatigue were four times more likely to have poor sleep quality (OR = 4.86;CI = 1.50-15.75). Conclusion: Fatigue and sleep quality were directly correlated and are associated with individual and work factors. High fatigue increased the chances of having worse sleep quality assessment. Institutional and organizational strategies should be reviewed in order to prioritize the health protection of these nursing workers.
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Known as "dual-eligible beneficiaries," they account for 20% of Medicare beneficiaries and 15% of those receiving Medicaid, but account for one-third of total expenditures for each program.1 Most qualify for Medicare on the basis of age or a disability, and all dual-eligible beneficiaries have incomes below or near the federal poverty level. AHRF data were also used to identify PAs in each county. Because the HPSA designation only considers PCPs, to identify primary care NPs (PCNPs) we used methods previously developed, based on National Provider Identifier numbers from CMS.4 We calculated the county-level number of PCNPs and PAs per 1000 population and categorized them into the highest (ie, ≥ 75th percentile) and lowest (ie, < 25th percentile) supply density quartiles. [...]in the face of the competing challenge of the coronavirus disease 2019 (COVID-19) pandemic, we observed the prevalence of infection rates in counties with a high density of dual-eligible beneficiaries to understand the challenge of coordinating care for these beneficiaries. The quality of care provided to vulnerable populations, such as dual-eligible beneficiaries, by PCNPs and PAs has been proved to be comparable with that delivered by PCPs.11-13 However, at the state level, scope-of-practice regulations often restrain the flexibility of having care furnished by nonphysician providers.
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Introduction: COVID-19 has increased the use of telehealth in healthcare. The World Health Organization and the Health Resources and Services Administration have both acknowledged the value of telemedicine in improving access to care for vulnerable populations, including rural youth. Telepsychiatry may be especially beneficial for the three million Native American youth who live in isolated areas. However, due to geography, a scarcity of providers, and cultural stigma, they do not have easy access to primary and mental health care. Aim: The purpose of this paper is to investigate the potential benefits of telepsychiatry for Native American youth living in rural and isolated areas who have limited access to primary and mental health care due to geography, provider shortages, and cultural stigma. In particular, the role of psychiatric-mental health nurse practitioners is investigated. Results: Telepsychiatry via mobile devices is a viable intervention for geographically isolated Native youth with limited access to computers and stable Internet connectivity. Telepsychiatry research outcomes emphasize the potential for improved mental health outcomes among Native American youth and a clear role for psychiatric-mental health nurse practitioners. Conclusion: By engaging in telepsychiatry with Native American populations, psychiatric-mental health nurse practitioners have the opportunity to fill a current void. For the successful implementation of telepsychiatry to address mental health disparities among Native American youth, these practitioners would require training and support.
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The COVID-19 pandemic has highlighted the need for increased adolescent mental health support in the school setting. This evidence-based quality improvement project aimed to determine if implementing a clinical mental health pathway increases the number of mental health screenings completed and increases school nurse practitioners' comfort and confidence in completing mental health screenings. A Mental Health Toolkit was developed to include program-specific management recommendations, a school collaboration flowsheet, and educational and community resources for the nurse practitioner, students, and school community. The 15-week pilot intervention was evaluated using quantitative pre-and post-survey and qualitative interviews. The intervention increased the number of depression screenings performed compared to the previous school year. In addition, the post-intervention interview provided clarity to the persistent system-level and clinic-level barriers and provided personal insights into performing mental health screenings within the school setting. This pilot project allowed the nurse practitioner to model the normalization of mental health discussions. It also provided an opportunity for increased collaboration between the nurse practitioner and school partners, which can substantially impact adolescent mental health outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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This case study presents the diagnosis and treatment of an older adult with depression and passive suicide ideation (SI). While treating depressed patients at risk for suicide, family nurse practitioners must stay grounded in patient data related to medications, ideally using the patient's psychiatric condition (ie, depression with suicidal risk) as the separate and appropriate target of clinical intervention, and discuss the risks and benefits of medications targeting both conditions with the patient. The response and ongoing management of individuals with passive SI depend on determining their risk level.
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Developmental, behavioral, and mental health (DBMH) conditions among pediatric populations have increased in prevalence in primary care. Approximately 1 in 5 children have mental health conditions, but only 20% receive care. In October 2021, a national emergency in children's mental health was declared. The Pediatric Nursing Certification Board offers a pediatric primary care mental health specialist (PMHS) examination that validates the knowledge, skills, and abilities of certified nurse practitioners caring for children, adolescents, and young adults with DBMH conditions. This review describes the methodology, data analysis, and results of the job task analysis that ensures examination quality measuring preparedness to practice as a certified PMHS.
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Telehealth demand increased precipitously among all populations, particularly Medicare beneficiaries with complex care needs, during the coronavirus disease 2019 pandemic. Current nurse practitioner (NP) graduates require practice readiness in telehealth when transitioning to advanced practice. Competency-based education models integrate progressive, multimodal evaluation of core practice competencies, including telehealth. Self-reflection supports student acquisition of new competencies. Thematic analysis of guided reflections after a pilot gerontologic robot-enabled telehealth simulation identified curricular opportunities in a primary care NP program. NP students' perceived challenges in communication and adaptation to virtual patient presence were considered in building integrated telehealth curricula in clinical courses applying the 4Ps of Telehealth Education (Planning, Preparing;Providing;and Performance Improvement) framework.
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OBJECTIVES: Evidence shows paediatric critical care (PCC) nurses display high rates of burnout, moral distress, symptoms associated with post-traumatic stress disorder (PTSD) and poor well-being. The COVID-19 pandemic magnified these pressures producing extremely challenging working conditions. The objective was to understand PCC nurses' lived experience of working during COVID-19 to determine the impact it had on their well-being. DESIGN: A qualitative design was used with individual, semi-structured online interviews analysed using thematic analysis. RESULTS: Ten nurses from six PCC units in England participated. Five themes were generated: (i) Challenges of working in Personal Protective Equipment (PPE), (ii) Adapting to redeployment to adult intensive care, (iii) Changes to staff working relationships, (iv) Being unable to attain work-life balance and (v) Unprocessed traumatic experiences of working in COVID-19. It was clear COVID-19 presented novel challenges to PCC nurses' well-being. With those came enforced changes in practice; some were temporary, for example use of PPE and redeployment, but others provided insight into the prerequisites for good staff well-being, for example strong professional relationships, work-life balance and managing one's psychological health. CONCLUSIONS: Findings show authentic connections between peers, verbal and non-verbal communication and a sense of belonging were crucial to nurses' well-being. A dent in PCC nurses' perceived competence significantly affected their well-being. Finally, staff need a psychologically safe space to process distress and trauma experienced during COVID-19. Future research needs to test evidence-based, theoretically-informed well-being interventions to improve and maintain PCC nurses' well-being.
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INTRODUCTION: Redeployment of orthopaedic consultants to a minor injuries unit (MIU) during the COVID-19 pandemic provided a unique opportunity to assess the impact of early senior specialist input on patient management. METHODS: Patient demographics, diagnosis, location of injury and disposal method were compared between three 7-day periods: during the April 2020 COVID-19 lockdown (period A), one month prior to period A (period B) and one year prior to period A (period C). Orthopaedic consultants staffed the MIU during period A, and emergency nurse practitioners staffed the MIU during periods B and C. RESULTS: Period A witnessed higher injury severity either due to modified activities or altered healthcare-seeking behaviour during lockdown. For fractures, compared with periods B and C, period A saw a lower rate of referral to fracture clinic (41% vs 100% vs 86%, p<0.001) and higher rate of discharge (38% vs 0% vs 9%, p<0.001). The median time to fracture clinic was also longer (15 days vs 6 days vs 10 days, p<0.001), indicating earlier institution of definitive care. There were no other significant differences between periods with radiology alerts and complaints received remaining largely unchanged. CONCLUSION: Early senior orthopaedic input in the patient journey from MIU had clear benefits, this being most true for fracture diagnoses. Earlier definitive management planning was observed as lower rates of fracture clinic referral, higher rates of discharge and deferred first fracture clinic reviews. This study highlights the benefits of greater partnership between MIU and orthopaedics. As the pandemic subsides and redeployed staff return to normal duties, a modification of this model could be utilised to ensure this partnership is sustainable.
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The article offers information on practice nursing resources as of January 2023 including guidance for nurses working with long COVID patients, the updated yellow fever certificate requirements, and guidance on helping children swallow tablets.
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The COVID-19 pandemic has highlighted the need for increased adolescent mental health support in the school setting. This evidence-based quality improvement project aimed to determine if implementing a clinical mental health pathway increases the number of mental health screenings completed and increases school nurse practitioners' comfort and confidence in completing mental health screenings. A Mental Health Toolkit was developed to include program-specific management recommendations, a school collaboration flowsheet, and educational and community resources for the nurse practitioner, students, and school community. The 15-week pilot intervention was evaluated using quantitative pre-and post-survey and qualitative interviews. The intervention increased the number of depression screenings performed compared to the previous school year. In addition, the post-intervention interview provided clarity to the persistent system-level and clinic-level barriers and provided personal insights into performing mental health screenings within the school setting. This pilot project allowed the nurse practitioner to model the normalization of mental health discussions. It also provided an opportunity for increased collaboration between the nurse practitioner and school partners, which can substantially impact adolescent mental health outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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Nurse Practitioners are registered nurses with additional education and clinical experience. They are able to diagnose conditions, perform physical assessment, interpret diagnostic tests and prescribe medication within a holistic patient-centred framework (Collins & Small, 2019. Can Oncol Nurs J. 29: 4). The COVID-19 pandemic highlighted the need for more nurses with advanced skills, such as prescribing, in our local area. These skills were required to support complex patients and their families in the home environment and achieve a good death.The hospice identified the need to develop a programme which would support developmental roles in the community setting and provide a clinical career pathway. A 2-year programme was developed which identified key learning opportunities for those in the developmental roles, which could be accessed alongside their academic programme of study. Year 1 of the programme focused on learning opportunities, which increased the nurses’ clinical skills and supported their learning in history taking and physical assessment. Year 2 focused on learning opportunities, which supported their learning in relation to prescribing and consolidated their learning from year 1.The aim of the programme was to provide staff with clear career progression, and a programme which would enable them to enter the role of Nurse Practitioner confidently and competently. Whilst formal evaluation is still to take place, the initial indications are that this is an effective programme and as such, the second cohort has been recruited to support succession planning within the organisation. The role has been popular and the career progression has aided retention of staff. The programme has been expanded into the Advice and Referral centre with two new development posts recruited to.
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In April 2022, I was a paediatric NHS nurse and in a bad place emotionally. I was extremely anxious, felt unable to cope and was having nightmares. I was also experiencing what I now know are flashbacks. A series of traumatic events had led me to this point, then an incident with a young patient tipped me over the edge and I realised I needed help.
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This article highlights the critical role of advanced practice registered nurses in the care of older adults living in nursing homes. This population is one of the frailest, marginalized, and often neglected in the United States. The COVID-19 pandemic impact on nursing homes resulted in a stunning number of infections and subsequent resident deaths. This is a shameful reminder of the many challenges and gaps in the nursing home industry including inadequate staffing, high staff turnover, improper isolation technique, and lack of fundamental knowledge of how to adequately implement infection prevention and control processes. Strong advanced practice registered nurse leadership may have mitigated some of these factors.