Scoping review: Diagnostic reasoning as a component of clinical reasoning in the U.S. primary care nurse practitioner education.

AIMS: Diagnostic Reasoning (DR) is an essential competency requiring mastery for safe, independent Nurse Practitioner (NP) practice, but little is known about DR content included in NP education programs. The aims of this study were to identify whether and how the concept of DR is addressed in NP education. DESIGN: We conducted a scoping review on DR-related content and teaching innovations in U.S. primary care NP education programs, with implications for NP education programs worldwide. Concepts and principles with global applicability include: conducting focused and hypothesis-directed histories and exams, generating the problem statement, formulating the differential diagnosis, appropriate and relevant diagnostic testing, determining the working diagnosis and developing evidence-based, patient-centred management plans. DATA SOURCES: N = 1115 articles retrieved from Medline, Embase, PsycINFO, and CINAHL for the period 2005-2021. Forty-one scholarly articles met inclusion/exclusion criteria. REVIEW METHODS: Data were extracted, synthesized and grouped by theoretical frameworks, content included, educational interventions and assessment measures. RESULTS: Most articles provided descriptions of approaches for teaching NP clinical or diagnostic reasoning. Ten papers directly referenced the current science and theory of DR. CONCLUSION: The US NP education literature addressing DR is limited and demonstrates a lack of shared conceptualizations of DR. Whilst numerous components of DR are identifiable in the literature, a robust teaching/learning scholarship for DR has not yet been established in the US NP education literature. IMPACT: Whilst primary care NP education programs are beginning to incorporate DR education into their curricula, little research has been conducted to demonstrate the effectiveness of educational outcomes. Increased integration of DR content into NP education is needed, including increased educational research on teaching DR competencies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was included in this review, as the public is generally not familiar with DR or its teaching approaches.

The growing need to provide training in clinical procedures in family nurse practitioner educational programs.

ABSTRACT: Family nurse practitioners (FNPs) have a plethora of employment options upon graduation. Besides primary care, many are working in nontraditional settings such as urgent care, emergency departments, retail health, and specialty practices. In many of these settings, practitioners are required to perform procedures. However, more information is needed on the type of settings in which recent FNP graduates are working, the procedures being performed in these settings, and the perceptions of graduates of how prepared they felt to perform these procedures. Family nurse practitioners who completed an FNP program within the previous five years and who attended the 2019 AANP National Conference were invited to participate in a survey to assess their preparation in clinical procedures. Results revealed that more than half of the 198 respondents reported doing incision and drainage of abscesses and laceration repair. Respondents were divided on how they first learned to perform the procedures, with 47% stating that a preceptor demonstrated procedures to them during a clinical practicum experience, 42% stating that they learned on the job after graduation, and 43% reported that their FNP program provided training or simulation activities related to procedures. More than a quarter of respondents reported that they took a class on procedures. In all, 61% reported that they did not feel adequately prepared to perform procedures on graduation. Results indicated that colleges of nursing should ensure that FNP students have opportunities to master the procedures that are frequently performed by FNPs.

Understanding Experiences of Diabetes Medications Among African Americans Living With Type 2 Diabetes.

African American (AA) adults are disproportionally affected by type 2 diabetes and are diagnosed at an earlier age, but are less adherent to diabetes medications compared with the general population. This qualitative study sought to describe the experiences of taking diabetes medications among midlife AA men and women with type 2 diabetes and to identify factors that influence these experiences. Fifteen AAs completed semistructured interviews. Using the Roy adaptation model, thematic analysis coded for both adaptive and ineffective experiences. Adaptive experiences included self-confidence in one's ability to control diabetes, a belief in the value of diabetes medication, assuming responsibility for one's health, developing a routine for taking medication, and positive relationships with the care team. Ineffective experiences for medication taking included: feeling powerless over diabetes, self-blame, and fear. One's self-concept as a person with diabetes, as well as assuming the role of "medication taker," were prominent themes.

Perceptions of Insulin Treatment Among African Americans With Uncontrolled Type 2 Diabetes.

PURPOSE: Little is known regarding perception of insulin treatment among midlife and older African American (AA) adults with type 2 diabetes, or how perception affects self-management behaviors. Using the Roy adaptation model, this qualitative descriptive study explored the perception of insulin treatment in midlife and older AAs living with uncontrolled type 2 diabetes. METHOD: Three 1-hour focus groups were conducted with a total of 13 participants. Thematic analysis of transcribed audio recordings used the constant comparative method. RESULTS: Themes identified include (a) insulin as instigator of negative emotions, (b) adapting to a lifestyle with insulin, and (c) becoming an insulin user: a new identity. CONCLUSION: Adapting to insulin is a psychosocial process that commonly results in negative emotions, identity conflict, and new roles. IMPLICATIONS FOR PRACTICE: Further research is needed to understand how AA adults perceive insulin treatment, understand the role of perception in self-management behaviors, and determine whether interventions to change perceptions may be effective in improving adaptation to diabetes.

Antithrombosis management in community-dwelling elderly: improving safety.

Thrombus-related conditions are increasing in the elderly population. This article provides an overview of thrombus formation and describes the various pharmacologic options for prevention. Thromboprophylaxis requires an assessment of the risks and benefits of treatment so that catastrophic bleeding does not result. A practice model, the "S.A.F.E. Triad" is proposed to provide a framework for addressing safety concerns, while algorithms assist with decision-making.