ABSTRACT
PURPOSE: To examine the use of clinical preventive services (CPSs) by nurse practitioners (NPs) in practice. DATA SOURCES: A total of 53 transcribed NP-patient encounters and 28 NP surveys. CONCLUSIONS: Based on content analysis of the transcribed interviews, only a small majority of NPs (60.4%) used at least one CPS per visit. From the post-survey results, it appears that what NPs think they do varies greatly from what they actually do in clinical practice. IMPLICATIONS FOR PRACTICE: The knowledge gained about the use of recommended CPSs may help promote better clinical practice among NPs and foster improvement in graduate school preparation of NP students.
Subject(s)
Health Promotion , Nurse Practitioners/statistics & numerical data , Preventive Health Services/statistics & numerical data , Primary Health Care/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Female , Health Care Surveys , Humans , Male , Middle Aged , Tape Recording , Young AdultABSTRACT
PURPOSE: The purpose of this review was to examine the published research from 1999 to 2005 describing nurse practitioner (NP)-patient interactions and to determine the best practice to enhance patient outcomes. DATA SOURCES: Databases searched included Academic Search Elite, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Source Consumer Edition, Health Source Nursing/Academic Edition, Medline, and PsychInfo. CONCLUSIONS: Two communication styles described in the literature and determined by authors were (a) biomedical and (b) biopsychosocial. The biopsychosocial style is identified as patient-centered communication. Seven studies were then analyzed for NPs' communication styles and the impact that they had on patient outcomes. The studies analyzed demonstrated that biopsychosocial (patient-centered) communication style positively influences patient outcomes as evidenced by (a) improved patient satisfaction, (b) increased adherence to treatment plans, and (c) improved patient health. IMPLICATIONS FOR PRACTICE: The results of this review indicate that patient-centered communication incorporated into the NPs' practice is associated with improving patient outcomes such as (a) improved patient satisfaction, (b) increased adherence to treatment plans, and (c) improved patient health. Future research needs to be performed in order to fully study the relationship between NPs using patient-centered communication style and its impact on patient outcomes. Clinical recommendations are made based on findings of the integrated literature review.
Subject(s)
Communication Barriers , Nurse Practitioners , Nurse-Patient Relations , Humans , Patient SatisfactionABSTRACT
Overcoming barriers to clinical preventive services.
Subject(s)
Mass Screening/organization & administration , Nurse Practitioners/organization & administration , Primary Prevention/organization & administration , Evidence-Based Medicine , Guideline Adherence , Health Knowledge, Attitudes, Practice , Health Planning Guidelines , Health Promotion , Health Services Accessibility/organization & administration , Health Services Needs and Demand , Healthy People Programs , Humans , Nurse's Role , Nursing Evaluation Research , Practice Guidelines as Topic , Practice Patterns, Physicians'/organization & administration , Preventive Health Services/organization & administration , Risk AssessmentABSTRACT
PURPOSE: The implementation of patient-centered care (PCC) has been hampered by the lack of a clear definition and method of measurement. The purpose of this review is to identify the fundamental characteristics of PCC to clarify its definition, propose a method for measurement of PCC, and recommend effective PCC practices. DATA SOURCES: Review of literature related to PCC, adherence and communication from Cinahl, PubMed Academic Search Premier, and Cochrane Library databases. CONCLUSIONS: Research has shown that patient-centered interactions promote adherence and lead to improved health outcomes. The fundamental characteristics of PCC were identified as (a) patient involvement in care and (b) the individualization of patient care. The use of a numeric rating scale to measure the presence of these characteristics allows quantification from the patient perspective. Effective PCC practices were related to communication, shared decision making, and patient education. IMPLICATIONS FOR PRACTICE: PCC is a measure of the quality of health care. Understanding the characteristics of PCC facilitates its implementation and measurement. Promoting PCC activities will improve adherence and encourage patient responsibility for health status.
Subject(s)
Nursing Evaluation Research/organization & administration , Patient Care Planning/organization & administration , Patient Compliance , Patient Participation/methods , Patient-Centered Care/organization & administration , Total Quality Management/organization & administration , Communication , Cooperative Behavior , Decision Making , Holistic Health , Humans , Models, Nursing , Nurse-Patient Relations , Outcome Assessment, Health Care/organization & administration , Paternalism , Patient Compliance/psychology , Patient Education as Topic , Patient Participation/psychology , Philosophy, Nursing , Quality of Health Care/organization & administration , Self Care/methods , Self Care/psychology , Social SupportABSTRACT
Attitudes and sociocultural perceptions provide the context within which women experience menopause. Cultural influences greatly affect how women perceive and manage their menopausal symptoms. Cultures may be categorized based on way of life, including traditional, immigrant, and modern. Varying perceptions and symptom experiences are described, including modifiable and nonmodifiable factors that affect the level of distress women feel with menopause. Helping women actively participate in management of menopausal symptoms including self-care strategies will contribute to feelings of control of menopausal symptoms and overall health. By using the highest levels of evidence regarding management of menopause, becoming familiar with the cultural and psychosocial influences of menopause and then empowering women to make decisions regarding management, health care providers can improve their care of perimenopausal and menopausal women.
Subject(s)
Attitude to Health , Cultural Characteristics , Holistic Health , Menopause , Social Support , Emigration and Immigration , Female , Hot Flashes , Humans , Nurse's Role , Quality of Life , Social Environment , Socioeconomic Factors , Women's HealthABSTRACT
PURPOSE: The purpose of the pilot study was to determine the feasibility of investigating nurse practitioners' (NPs) use of clinical preventive services (CPS) in practice and the influence of provider-patient communication in achieving the CPS outcome. NP-patient communication styles were also explored. DATA SOURCES: Five NPs were audio-taped each during one patient encounter. Using manifest content analysis, the transcripts were evaluated for the presence of CPS and communication styles. CONCLUSION: Because this was a pilot study and the sample size was small, no generalizations could be made. The presence of health promotion and disease prevention activities, as evaluated by the use of recommended CPS, was present in only one NP-patient encounter. NPs did use patient-centered communication style in all the encounters. No correlations could be made to link communication styles with CPS. IMPLICATIONS FOR PRACTICE: Further study with a larger sample size needs to be done. NPs may not be using health promotion and disease prevention, as demonstrated by CPS, in actual practice. This may be an area that needs greater emphasis in education and practice.
Subject(s)
Communication , Nurse Practitioners , Nurse-Patient Relations , Primary Health Care/organization & administration , Primary Prevention/organization & administration , Adult , Cooperative Behavior , Feasibility Studies , Female , Guideline Adherence , Health Promotion/organization & administration , Humans , Male , Mass Screening/organization & administration , Middle Aged , Nurse Practitioners/organization & administration , Nurse Practitioners/psychology , Nurse's Role/psychology , Nursing Evaluation Research , Outcome Assessment, Health Care , Patient Education as Topic/organization & administration , Patient Participation/methods , Patient Participation/psychology , Patient-Centered Care/organization & administration , Pilot Projects , Practice Guidelines as Topic , Tape Recording , VaccinationABSTRACT
PURPOSE: To discuss the regulatory history of dietary supplements, define the term dietary supplement, clarify ingredient and nutrition information labeling, and discuss safety issues and implications for practice. DATA SOURCES: Review of primary and secondary sources, including both Internet sites and journal articles. CONCLUSIONS: In the United States, 6 out of every 10 people use dietary supplements. For decades, the Food and Drug Administration (FDA) protected the public from mislabeled and unsafe products by regulating as foods those dietary supplements that included only essential nutrients. The Nutrition Labeling and Education Act of 1990 included herbs as dietary supplements. When the Dietary Supplement and Health and Education Act (DSHEA) of 1994 was passed, the FDA lost its regulatory power. The DSHEA expanded the definition of dietary supplements beyond essential nutrients. Dietary supplements are no longer considered food additives, which makes them exempt from prescreening or any safety and efficacy studies before they are released to the public. Under the DSHEA, the FDA may take action if a product poses a direct health threat and only after adverse health effects have already occurred. IMPLICATIONS FOR PRACTICE: A good understanding of the regulatory procedures for dietary supplements will aid nurse practitioners (NPs) in patient education regarding these products. Patients should be advised to choose supplements that are made by nationally known food and drug manufacturers that belong to trade groups. NPs and patients can contact the manufacturer directly and can access government Internet sites for more product information.
Subject(s)
Dietary Supplements/standards , Food Labeling/standards , Health Promotion/methods , Nurse Practitioners/standards , Nurse's Role , Consumer Product Safety/legislation & jurisprudence , Humans , Nursing Methodology Research , Quality Assurance, Health Care , United States , United States Food and Drug Administration/standardsABSTRACT
PURPOSE: To 1) conduct a thorough search of the literature for randomized controlled trials (RCTs) addressing the efficacy of garlic as an antihyperlipidemic agent, 2) critically appraise those studies, and 3) make a recommendation for practicing health care professionals. DATA SOURCES: Two independent reviewers extracted data from the articles identified from several data bases, using the previously tested Boyack and Lookinland Methodological Quality Index (MQI) as the standard. RESULTS: Six of ten studies found garlic to be effective. The average drop in total cholesterol was 24.8 mg/dL (9.9%), LDL 15.3 mg/dL (11.4%), and triglycerides 38 mg/dL (9.9%). The overall average MQI score was 39.6% (18%-70%). Major shortcomings of many of the RCTs included short duration, lack of power analysis and intention to treat analysis, as well as lack of control of diet as a confounding variable. CONCLUSION/IMPLICATIONS: The low methodological quality of the studies make it difficult to recommend garlic as an antihyperlipidemic agent. Until larger RCTs of longer duration, which correct the existing methodological flaws, are designed and carried out, it is best not to recommend garlic be used to treat mild to moderate hyperlipidemia.
Subject(s)
Anticholesteremic Agents/pharmacology , Garlic , Hyperlipidemias/blood , Plants, Medicinal , Anticholesteremic Agents/therapeutic use , Bezafibrate/pharmacology , Cholesterol/blood , Female , Humans , Hyperlipidemias/drug therapy , Lipids/blood , Male , Randomized Controlled Trials as Topic , Research Design , Treatment Outcome , Triglycerides/bloodABSTRACT
PURPOSE: To systematically review the published research and report on the efficacy of using a metered-dose inhaler with a spacer (MDI-S) device in a pediatric setting to treat acute exacerbations of asthma. DATA SOURCES: A literature search was conducted on the CINAHL, Medline, and Cochrane databases; additional searches were made by hand from the reference lists in each study retrieved from databases and from review articles written on the same topic. CONCLUSION: This critical appraisal of the research demonstrates the MDI-S is as effective as the nebulizer, faster in the delivery of medication, and cost-effective. IMPLICATIONS FOR PRACTICE: No significant difference between the MDI-S and nebulizer in delivering medication in an acute exacerbation of asthma was found in this analysis. The practitioner's choice of delivery methods should reflect the family's preference, the practice situation, and economic considerations.
