ABSTRACT
BACKGROUND: Musculoskeletal disorders affect a third of the U.S. population and are among the most prevalent, costly, and debilitating medical conditions. Basic familiarity with musculoskeletal conditions is essential for all primary care providers, including nurse practitioners (NPs). PURPOSE: The purpose of this study was: (1) to estimate the quantity of musculoskeletal education provided in NP programs; (2) to evaluate NPs' perceptions of their own confidence in providing musculoskeletal care versus other areas of primary care; and (3) to determine how well NPs score on a test of basic musculoskeletal knowledge. METHODS: An online self-reporting survey was conducted to evaluate NPs' knowledge, competence, and confidence in treating common musculoskeletal disorders. RESULTS: Most NPs receive fewer than 10 hours of musculoskeletal education, are subjectively less confident about their musculoskeletal skill set compared to other areas of primary care, and lack the basic knowledge to competently manage musculoskeletal problems in primary care. CONCLUSION: The findings of this study confirm earlier conclusions that, like our physician colleagues, the vast majority of nurse practitioners lack adequate preparation to manage common nonsurgical musculoskeletal problems.
Subject(s)
Clinical Competence , Musculoskeletal Diseases/therapy , Nurse Practitioners/education , Curriculum , Education, Nursing, Graduate , Humans , Internet , Nurse Practitioners/psychology , Primary Health Care , Surveys and QuestionnairesABSTRACT
This article examines the economic, social, ethical, and political issues affecting total joint replacement patients in a managed care environment. Using general systems theory as a framework, it examines the interrelated historical events that have shaped the development of both joint replacement procedures and managed care, and discusses the extent to which these two phenomena have been mutually influential. Specifically, the article examines the initial development, implementation, and continuing evolution of clinical pathways as an easily identified and relatively discrete manifestation of managed care for the joint replacement population. While the overall impact of managed care is beyond the scope of this presentation, it is hoped that a focus on the practical application of clinical pathways to joint replacement will allow some general principles to emerge that may be useful for both patients and practitioners operating in other aspects of the managed care environment.
