Establishing interprofessional clinical learning experiences in primary care safety-net sites.

This paper describes an interprofessional clinical learning experience for students within two primary care safety-net sites. An interprofessional team of faculty at one university partnered with two safety-net systems to provide students opportunities to work in an interprofessional team providing care for socially and medically complex patients. Our evaluation outcomes are student-centered, focusing on students' perceptions of caring for medically underserved populations and satisfaction with the clinical experience. Students reported positive perceptions of the interprofessional team, clinical experience, primary care, and caring for underserved populations. Strategic development of partnerships between academic and safety-net systems to offer learning opportunities can increase future healthcare providers' exposure and appreciation for interprofessional care of underserved populations.

Alignment of an interprofessional student learning experience with a hospital quality improvement initiative.

Assessment of interprofessional education (IPE) frequently focuses on students' learning outcomes including changes in knowledge, skills, and/or attitudes. While a foundational education in the values and information of their chosen profession is critical, interprofessional learning follows a continuum from formal education to practice. The continuum increases in significance and complexity as learning becomes more relationship based and dependent upon the ability to navigate complex interactions with patients, families, communities, co-workers, and others. Integrating IPE into collaborative practice is critical to enhancing students' experiential learning, developing teamwork competencies, and understanding the complexity of teams. This article describes a project that linked students with a hospital-based quality-improvement effort to focus on the acquisition and practice of teamwork skills and to determine the impact of teamwork on patient and quality outcome measures. A hospital unit was identified with an opportunity for improvement related to quality care, patient satisfaction, employee engagement, and team behaviours. One hundred and thirty-seven students from six health profession colleges at the Medical University of South Carolina underwent TeamSTEPPS® training and demonstrated proficiency of their teamwork-rating skills with the TeamSTEPPS® Team Performance Observation Tool (T-TPO). Students observed real-time team behaviours of unit staff before and after staff attended formal TeamSTEPPS® training. The students collected a total of 778 observations using the T-TPO. Teamwork performance on the unit improved significantly across all T-TPO domains (team structure, communication, leadership, situation monitoring, and mutual support). Significant improvement in each domain continued post-intervention and at 15-month follow-up, improvement remained significant compared to baseline. Student engagement in TeamSTEPPS® training and demonstration of their reliability as teamwork-observers was a valuable learning experience and also yielded an opportunity to gather unique, and otherwise difficult to attain, data from a hospital unit for use by quality managers and administrators.

Enhancing Doctor of Nursing Practice Students' Diagnostic and Clinical Reasoning Skills.

BACKGROUND: This article describes one school of nursing's successful approach to augmenting Doctor of Nursing Practice students' diagnostic and clinical reasoning skills. METHOD: Faculty convened a taskforce to evaluate the current clinical tracking system to expand the clinical log and develop a formative assessment tool. RESULTS: The clinical log enhancement allowed faculty to assess students' learning, clinical decision making, and readiness for clinical progression throughout the program. CONCLUSION: The expansion of the clinical log system resulted in students' heightened understanding of documentation and clinical practice, and also allowed faculty to comprehensively assess students in diagnostic and clinical reasoning. [J Nurs Educ. 2023;62(2):109-111.].

Pulmonary function testing for the primary care nurse practitioner.

ABSTRACT: Knowledge of which pulmonary function tests are commonly performed in primary care and interpretation of their results is integral for the diagnosis, care, and management of those with pulmonary symptoms. This article provides an overview of the most common pulmonary function tests and interpretation of their results.

Enhancing primary care and preventive services through Interprofessional practice and education.

Interprofessional (IP) practice and education are important when seeking to respond to the growing demand for primary and preventive care services. Multiple professions with synergistic expertise are needed to effectively provide health promotion, disease prevention, and patient education and to help patients with multiple comorbidities, chronic health conditions, and care coordination. A recent study by Schor et al. titled, "Multidisciplinary work promotes preventive medicine and health education in primary care: a cross-sectional survey," compares the implementation of preventive services in three primary care models. Higher rates of health services, patient education, and health outcomes were documented in two different models of care involving persons in multiple professions when compared with independent solo physicians' practices. In this commentary, we focus on the value of IP team-based care, continuing professional development, and the impact of the team on practice performance and health outcomes. Key components of effective IP teams include using consistent terminology to describe the team composition and function, team structures with purposeful selection of professions to address gaps in care, leadership support, and IP continuing professional development and education.

Virtual Interprofessional Learning.

BACKGROUND: Interprofessional education is a challenge given the current constraints of clinical education, which is bound by space, location, off-campus clinical rotations, and conflicting academic schedules. New approaches need to be developed if academic settings are to provide high-impact interprofessional education. METHOD: Virtual Interprofessional (VIP) Learning was developed as an innovative, online, asynchronous learning platform utilizing avatars that engages learners in interprofessional clinical learning opportunities across disciplines and settings. Teams of interprofessional students worked together to complete a real-life case scenario focused on patient quality and safety using root cause analysis and interprofessional communication. RESULTS: Evaluation via focus groups, self-assessment survey, and a platform usability assessment found an increase in students' interprofessional knowledge, attitudes, and preference for virtual interprofessional experiences. CONCLUSION: VIP Learning is an innovative approach to advance interprofessional education from siloed, limited experiences to accessible and interactive opportunities that are not bound by time or place. [J Nurs Educ. 2018;57(11):668-674.].

Master of Science in Nursing and Doctor of Nursing Practice Clinical Curriculum Map.

BACKGROUND: The development of a comprehensive and structured clinical curriculum map can outline the specific content covered throughout a nurse practitioner program and provide a method for identifying redundancy and omissions in the didactic clinical content. METHOD: A curriculum map outlining the specific clinical content covered in each didactic course in a Master of Science in Nursing and Doctor of Nursing Practice advanced practice program was created. The curriculum map incorporated accreditation standards, certification testing domains, and common primary care diagnoses. RESULTS: A curriculum map supported the development of organized, consistent, and transparent clinical didactic content across courses and the program. The curriculum map allows for frequent curriculum and course review and updates to help meet program and accreditation standards. CONCLUSION: The development and implementation of the clinical didactic curriculum map facilitates the integration of core clinical content in an organized manner that builds learning and prepares future nurse practitioners. [J Nurs Educ. 2018;57(7):440-445.].

Adult asthma: Diagnosis and treatment.

Adult asthma is a prevalent chronic medical condition that is associated with high morbidity, mortality, and cost. Early identification, evidence-based diagnosis, and step-wise management can lead to improvements in patient outcomes, decrease exacerbations, and eliminate respiratory function decline as the patient ages.

Pain management in patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) is one of the most common inflammatory conditions in the United States affecting approximately 1 million adults. This article briefly reviews the evidence-based diagnosis of RA, mainstays of treatment to prevent joint destruction, and pain management.

Pediatric developmental screenings: a primary care approach.

Early recognition of developmental delay is critical to providing comprehensive pediatric primary care. Advanced practice nurses must be aware of the guidelines for surveillance and developmental screening in children. This article discusses guidelines for screening, examples of screening tools, information for follow up, and referral for positive screenings.

Teaching dual-process diagnostic reasoning to doctor of nursing practice students: problem-based learning and the illness script.

Accelerating the development of diagnostic reasoning skills for nurse practitioner students is high on the wish list of many faculty. The purpose of this article is to describe how the teaching strategy of problem-based learning (PBL) that drills the hypothetico-deductive or analytic reasoning process when combined with an assignment that fosters pattern recognition (a nonanalytic process) teaches and reinforces the dual process of diagnostic reasoning. In an online Doctor of Nursing Practice program, four PBL cases that start with the same symptom unfold over 2 weeks. These four cases follow different paths as they unfold leading to different diagnoses. Culminating each PBL case, a unique assignment called an illness script was developed to foster the development of pattern recognition. When combined with hypothetico-deductive reasoning drilled during the PBL case, students experience the dual process approach to diagnostic reasoning used by clinicians.

Use of nonsteroidal anti-inflammatory drugs in the older adult.

PURPOSE: Annually, approximately 90 million prescriptions are filled for nonsteroidal anti-inflammatory drugs (NSAIDs) with the number prescribed for older adults approximately three times higher than for younger adults. This article examines the benefits and risk of NSAID use in older adults. DATA SOURCES: Electronic data collection of research studies, evidence-based reviews, consensus statements, and guidelines related to the purpose of this article were analyzed if published between 2000 and 2013 in English from Ovid, MEDLINE, and PubMed databases. CONCLUSIONS: While NSAIDs are commonly used to treat pain and inflammation in older adults, strong consideration must be given to the potential adverse effects. A lack of consistency in the guidelines regarding NSAID use poses further challenges for clinicians in the selection of the best pharmacological approach. When prescribing NSAIDs, adverse events, polypharmacy, comorbidities, and treatment guidelines must be considered. NSAIDs are an appropriate option for pain management in select older adults, often after a trial of acetaminophen and if benefits outweigh risks. Alternative pharmacological and nonpharmacological therapies may be more appropriate in many older adults. IMPLICATIONS FOR PRACTICE: The challenge for clinicians prescribing NSAIDs in the treatment of pain in older adults is to utilize safe, individualized, and evidenced-based pain management regimens.