State responses to COVID-19: Potential benefits of continuing full practice authority for primary care nurse practitioners.

BACKGROUND: During the COVID-19 pandemic, federal and state governments removed the scope of practice restrictions on nurse practitioners (NPs), allowing them to deliver care to patients without restrictions. PURPOSE: To support policy makers' efforts to grant full practice authority to NPs beyond the COVID-19 pandemic, this manuscript summarizes the existing evidence on the benefits of permanently removing state-level scope of practice barriers and outline recommendations for policy, practice, and research. METHODS: We have conducted a thorough review of the existing literature. FINDINGS: NP full scope of practice improves access and quality of care and leads to better patient outcomes. It also has the potential to reduce health care cost. DISCUSSION: The changes to support full practice authority enacted to address COVID-19 are temporary. NP full practice authority could be part of a longer-term plan to address healthcare inequities and deficiencies rather than merely a crisis measure.

Examining spiritual support among African American and Caucasian Alzheimer's caregivers: A risk and resilience study.

Research shows African Americans at greater risk of developing Alzheimer's disease (AD) compared to the Caucasian population, suggesting African American AD caregivers are rising in numbers at a greater rate than Caucasian counterparts. Over a decade ago, an article in Geriatric Nursing revealed spiritual well-being differences among these caregiver groups. The purpose of this study was a quasi-follow-up, utilizing a larger caregiver sample to test spiritual support as a moderator via a risk-and-resilience framework. Secondary data analysis from a sample of 691 AD caregivers examined data on demographics and standardized measures of spiritual support, caregiver burden, and psychological resilience. One-third of the sample reported as African American. Resilience negatively regressed, though not significantly, on caregiving burden among both groups. Spiritual support positively, significantly impacted resilience among both groups, slightly stronger among African Americans. Spiritual support did not significantly moderate risk with either group. Implications for professional healthcare practice are discussed.

Developing an Information Literacy Workshop to Foster Evidence-Based Practice Among Nurse Practitioner Students.

The increased autonomy and responsibility associated with the nurse practitioner (NP) role compounded with the plethora of electronic health information requires advanced practice registered nursing (APRN) students to possess information literacy (IL) skills associated with identifying, locating, and evaluating the quality of health-related literature (Majid, Chaudhry, & Xue, 2008). Without the proper IL skills needed to select high-quality clinical practice guidelines (CPGs) for decision making when developing treatment plans, NP students will be ill-equipped to perform evidence-based practice (EBP) during their clinical practicum experiences. The incorporation of IL skills training in NP educational programs is paramount for the actualization of EBP in clinical nursing (Majid et al., 2008). However, few studies have discussed IL skills and EBP as they relate to NP students' abilities to critically appraise CPGs and make EBP clinical decisions. This article discusses the development of a 4-hr IL workshop to enhance NP students' abilities to effectively search and critically appraise evidence-based research to make well-informed clinical decisions as advanced practice nurses.

Patient preferences: do they contribute to healthcare disparities?

OBJECTIVES: The purpose of this study was to examine the effect of race on whether or not a patient would accept an invasive cardiac procedure when referred by a physician. METHODS: A retrospective longitudinal review of medical records at a public health hospital in southeastern Louisiana was conducted to determine cardiovascular patient acceptance/ rejection differences. Patient charts were examined using specific indicators (type of pain, laboratory values, blood pressure, and radiographic tests) to determine which patients were eligible to be referred. In order to be selected, each medical record had to have documentation of a physician referral for an invasive cardiac procedure. Medical charts without this referral were deemed ineligible for the cohort. RESULTS: Patient preferences were similar for both minorities and Caucasians, despite the fact that the study controlled for disease severity, age, income, sex, race, social support, diagnosis, and family history. CONCLUSION: Race did not contribute to disparate acceptance and rejection rates among African Americans and Caucasians. A possible reason for this occurrence is that the site was a teaching hospital, which may indicate more physician oversight and better articulation of treatment options. Future studies should delve deeper into physician and institutional bias in non-teaching facilities during patient/physician interactions.

Reliability and validity of the Personal Wellness Profile (PWP) Questionnaire in African American college women.

BACKGROUND AND PURPOSE: The Personal Wellness Profile (PWP) is a 75-item questionnaire used to assess an individual's level of wellness in clinical and non-clinical settings. Currently, there are no published scientific data regarding the validity and reliability of the PWP. Therefore, this study was designed to assess convergence validity of the PWP using established instruments in which validity has been previously supported and to determine the reliability of the PWP using the test-retest method. METHODS: A correlational design was used with a non-probability convenience sample of 100 African American women, ages 18 to 40 years, enrolled in a university in southern Louisiana. Convergence validity of the PWP was assessed by using the Michigan Alcoholism Screening Test (MAST), Drug Abuse Screening Test (DAST), Geiselman Food Preference Questionnaire II (GFPQ II), Weekly Stress Inventory (WSI), Fagerstrom Test for Nicotine Dependence (FTND), and the 7-Day Physical Activity Recall Questionnaire (PAR) as criteria. RESULTS: The PWP had statistically significant correlations with two of the six subscales of the GFPQ II, and with the WSI, MAST, and FNTD. Findings also suggest that the PWP has moderate to moderately high internal consistency as a whole (r = .77), and that the subscale scores were also reliable over time (r = .52 to .90). CONCLUSIONS: The PWP will be valuable as a valid, standardized, highly portable tool that can be taken into the community and administered to African-Americans and other populations who do not readily have access to treatment, research and health care centers.

Physician bias: does it occur at teaching hospitals that serve a majority of African American patients?

OBJECTIVES: The purpose of this study was to examine physician bias when patients present with cardiovascular disease in a teaching hospital that treats a majority of African American patients. Physician bias was deemed to occur when cardiovascular disease patients did not receive an invasive procedure when needed. METHODS: The hospital in the study was a teaching facility in southeastern Louisiana. We conducted a longitudinal retrospective review of 177 medical records from patients with cardiovascular disease. Patient charts were examined using specific indicators (type of pain, lab work, blood pressure, and x-ray tests) from the Framingham study (1996) to determine whether patients met the criteria for eligibility of invasive procedures, such as percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG) and if so, whether they were referred accordingly. Next, these charts were used to obtain confounders (race, sex, income, age, disease severity, and diagnoses) from each patient. Finally, a logistic regression analysis was used to determine the effect of these confounders on a patient being referred by a physician. RESULTS: The model failed to find a statistically significant disparity between physician referrals for African Americans and Caucasians when cardiovascular disease patients met specific criteria. Therefore, physician referral disparities did not exist among this study population. This occurred despite the fact that the study controlled for primary diagnoses, disease severity, age, income, sex, and race. CONCLUSION: This research concludes that physicians' referral patterns for cardiac procedures were similar for both African Americans and Caucasians. Moreover, this research suggests that referral disparities may not exist at teaching hospitals that serve a majority of African American patients. Future studies should delve deeper into physician/patient interaction at these institutions to understand what they do to reduce disparities in the hope of implementing their methods at other hospitals.

The effect of race and gender on invasive treatment for cardiovascular disease.

The purpose of this study was to investigate racial and gender differences in the utilization of invasive procedures for cardiovascular treatment. Medical records data of 3015 patients were abstracted from a Medical System Database from 1999 to 2001. Logit models were used to estimate the adjusted odds in the utilization, referral, and acceptance of invasive procedures, while controllingfor confounders (age, race, sex, comorbidity, disease severity, payer type, marital status and family history) simultaneously. When considering utilization of invasive procedures, the adjusted odds were lower for African-Americans compared to Caucasians. There was a statistically significant difference (p < .05) in Coronary Artery Bypass Graft (CABG) utilization between African Americans and Caucasians. African Americans were less likely than Caucasians to receive a CABG. Although not statistically significant, African-Americans were less likely than Caucasians to receive a cardiac catheterization and Percutaneous Transluminal Coronary Angioplasty (PTCA). Findings failed to yield a statistical significance for gender disparities regarding invasive procedure utilizations.

Coping strategies of female adolescents with HIV/AIDS.

This descriptive study was designed to assess coping strategies of female adolescents infected with Human Immunodeficiency Virus (HIV) or the Acquired Immunodeficiency Syndrome (AIDS) (N = 30). Results from the Adolescent Coping Orientation for Problem Experiences Questionnaire (ACOPES) revealed that the most often utilized coping strategies identified by the adolescents were: listening to music, thinking about good things, making your own decisions, being close to someone you care about, sleeping, trying on your own to deal with problems, eating, watching television, daydreaming and praying. The adolescents also reported low utilization of certain maladaptive coping strategies such as alcohol and illicit drug usage. Chronic illnesses such as HIV, cancer and diabetes are difficult for adolescents because of the unique developmental tasks needed to understand the psychological and social impact caused by chronic illnesses. The research presented illustrates the complexities of stress and the effects of coping on psychological well-being, health behavior, and health. This research explores specific coping strategies used by HIV-infected adolescents. Findings provided baseline data of the various coping strategies of female adolescents infected with HIV in an outpatient setting. These findings may serve as a foundation for future studies on coping strategies among females infected with HIV. Furthermore, the findings may also be useful in developing an outpatient behavior-modification/coping effectiveness training program that is both gender-specific and culturally appropriate.

Conceptual frameworks in undergraduate nursing curricula: report of a national survey.

A national survey was conducted to analyze the components of conceptual frameworks to assess how they are being used to organize the curricula of nursing programs and to determine whether there was a difference among types of programs (i.e., baccalaureate degree, associate degree, diploma). A stratified, random sample of 300 National League for Nursing Accrediting Committee-accredited schools of nursing was selected based on percentages of each type of program. Questionnaires were returned from 160 programs. The survey found that the conceptual frameworks of most nursing programs were eclectic and that the nursing process was the most commonly cited component for all types of programs. Significant differences were identified among the three types of programs in their use of simple-to-complex organization, the medical model, and the nursing process. Significant differences also were identified among the three types of programs in incorporation of the metaparadigm concepts of nursing, person, health, and environment, and the emphasis placed on critical thinking, problem solving, and therapeutic nursing interventions.