ABSTRACT
PURPOSE: To describe the lived experience of patients communicating with their nurse practitioners and physicians while using paper health records (PHRs) and electronic health records (EHRs) in the examination rooms. The significance of the study lies in the salience of communication between the patient and provider in promoting optimal clinical outcomes and the highest level of patient satisfaction. DATA SOURCES: The study used a qualitative, phenomenological design. Audio-taped focus group interviews were conducted with 21 patients from a diabetes clinic in Baltimore, Maryland. Patients had visits with the provider before and after implementation of EHRs in the clinic. CONCLUSIONS: The four themes that emerged from the three focus groups included communication issues, patient preferences for electronic records, safety and security concerns, and transition problems with implementation of EHRs. IMPLICATIONS FOR PRACTICE: Potential benefits for nurse practitioners implementing the recommendations in this study include enhanced communication between patients and providers while using EHRs, increased patient satisfaction, higher levels of nurse practitioner and physician satisfaction, and avoidance of communication issues during implementation of EHR systems.
Subject(s)
Communication , Electronic Health Records/statistics & numerical data , Nurse-Patient Relations , Patient Satisfaction , Primary Health Care/methods , Attitude to Computers , Electronic Health Records/standards , Focus Groups , Humans , Physician-Patient Relations , Primary Health Care/standards , Qualitative ResearchSubject(s)
Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Patient Selection , Diabetes Mellitus, Type 2/nursing , Drug Administration Schedule , Drug Monitoring , Female , Humans , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Male , Middle Aged , Patient Education as TopicABSTRACT
Peripheral neuropathy (PN) is a common and often progressive condition frequently seen in primary care. The chronic pain associated with PN, or neuropathic pain, can significantly diminish patients' quality of life and be challenging to treat.
Subject(s)
Evidence-Based Nursing , Neuralgia/nursing , Nursing Assessment , Peripheral Nervous System Diseases/nursing , Aged, 80 and over , Diabetic Neuropathies/nursing , Female , HIV Infections/complications , Herpes Zoster/complications , Humans , Male , Mass Screening/nursing , Middle Aged , Peripheral Nervous System Diseases/epidemiology , Peripheral Nervous System Diseases/etiology , Quality of LifeABSTRACT
The 2011-2012 season will hit while the United States is still recovering from the 2009-2010 novel H1N1 pandemic. Signs and symptoms, high-risk groups, immunization recommendations, and the latest guidelines from the CDC are reviewed.
Subject(s)
Epidemics/prevention & control , Immunization , Influenza, Human/prevention & control , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Influenza A Virus, H1N1 Subtype , Influenza, Human/nursing , Middle Aged , Practice Guidelines as Topic , Pregnancy , Risk Assessment , United States/epidemiologyABSTRACT
PURPOSE: The purpose of this article is to evaluate the contributions of diabetic complications to depression beyond the contributions of demographic characteristics in patients with type 2 diabetes. Further, this article evaluates the contributions of diabetic complications, depression, and quality of life to A1C (also know as HbA1c) beyond the contributions of demographic characteristics in individuals with type 2 diabetes. DATA SOURCES: A cross-sectional survey of 55 individuals with type 2 diabetes attending an inner city diabetes specialty clinic. Patients completed the Beck Depression Inventory - II, the Inventory of Depressive Symptomatology Self-Report, the Medical Outcome Study Short Form-36, and a demographic questionnaire. A1C and diabetes-related comorbidities were obtained from the patients' medical records. CONCLUSIONS: Being younger and female were associated with depression in individuals with type 2 diabetes. After controlling for age and gender, neuropathy tended to add to the prediction of depression; other comorbidities did not. Being black was associated with poor diabetic control (A1C > 7). After controlling for race, neuropathy and retinopathy predicted poor diabetes control and depression tended to predict poor diabetes control. IMPLICATIONS FOR PRACTICE: Given the high prevalence of depression, the relationship of depression with poor diabetic self-care and medication adherence, and the increased cost of treatment for patients with depression among individuals with type 2 diabetes, assessment of depression is crucial. Further research is needed to establish effective treatment of depression and its effect on glycemic control in patients with type 2 diabetes.
Subject(s)
Depressive Disorder/epidemiology , Diabetes Mellitus, Type 2/psychology , Glycated Hemoglobin/metabolism , Quality of Life , Adult , Aged , Cross-Sectional Studies , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/complications , Female , Humans , Hypoglycemic Agents/therapeutic use , Male , Medication Adherence , Middle Aged , Risk FactorsSubject(s)
Influenza, Human/prevention & control , Vaccination , Adolescent , Adult , Antiviral Agents/therapeutic use , Child , Child, Preschool , Humans , Immunization Schedule , Infant , Influenza Vaccines/administration & dosage , Influenza Vaccines/adverse effects , Influenza Vaccines/immunology , Influenza, Human/diagnosis , Influenza, Human/drug therapy , Middle Aged , Patient Acceptance of Health Care , United States , Vaccination/statistics & numerical dataABSTRACT
PURPOSE: The pathogenesis of gestational diabetes mellitus (GDM) and insulin resistance, risk factors, links to diabetes following the pregnancy, and clinical practice recommendations for this population are reviewed. Economic implications and future research needs are included. DATA SOURCES: Review of original studies and meta-analyses from Medline, PubMed, CINAHL, Cochrane Library Online, and other scientific and public health literature; personal clinical experience with the population and dissertation research with women who experience GDM. CONCLUSIONS: GDM is a common condition experienced during pregnancy that is associated with long-term maternal risks for the development of type 2 diabetes following the index pregnancy. For the woman with GDM, the trajectory of diabetes development can often be prevented or postponed with comprehensive education and lifestyle changes, but there is evidence to suggest that preventive efforts directed at this population can be improved. Because the prevalence of type 2 diabetes and glucose intolerance as well as the costs of treatment of these disorders are escalating in the United States, attention should be focused on this vulnerable population. IMPLICATIONS: Nurse practitioners need to be cognizant of the risks for diabetes and should follow clinical practice recommendations for routine screening and implementing preventive strategies for women who experience GDM. Office reminder systems such as standardized documentation flow sheets and electronic medical records may assist with provider adherence to practice recommendations. Strict postpartum screening and management may help reduce risks for developing diabetes in this vulnerable population.
Subject(s)
Diabetes, Gestational/prevention & control , Health Policy , Nurse Practitioners , Postnatal Care/methods , Practice Guidelines as Topic , Aftercare/organization & administration , Blood Glucose/metabolism , Diabetes Mellitus, Type 2/etiology , Diabetes Mellitus, Type 2/prevention & control , Diabetes, Gestational/diagnosis , Diabetes, Gestational/epidemiology , Diabetes, Gestational/etiology , Evidence-Based Practice , Fasting , Female , Forecasting , Glucose Tolerance Test , Guideline Adherence , Humans , Life Style , Mass Screening , Medical Records Systems, Computerized , Nurse Practitioners/organization & administration , Nursing Assessment , Pregnancy , Risk Factors , United States/epidemiologySubject(s)
Attitude of Health Personnel , Cooperative Behavior , Nurse Practitioners/psychology , Physician-Nurse Relations , Physicians/psychology , Education, Medical, Graduate/organization & administration , Education, Nursing, Graduate/organization & administration , Humans , Models, Nursing , Nurse Practitioners/education , Nurse Practitioners/organization & administration , Nurse's Role/psychology , Philosophy, Nursing , Physicians/organization & administration , Power, Psychological , Primary Health Care , Professional Autonomy , Public Health , Training Support , TrustABSTRACT
Practitioners rely on a variety of measures of a patient's physical condition, including physiologic and clinician assessments. Occasionally, patient self-report data are collected. What insight into the physical health and functioning of patients does each of these types of information yield? This study suggests that each type of information provides a somewhat different insight into a patient's physical condition and that a combination of physiologic, clinician, and patient self-assessments can provide a more thorough assessment of a patient's condition. Using data from a clinical study of patients with heart failure, the Studies of Left Ventricular Dysfunction (SOLVD), measures of these three types of physical health assessments are compared as predictors of hospitalization. Results indicate that the self-report measures performed as well as or better than the physiologic or clinician assessments as predictors of hospitalization. The self-report measures have the added advantage of being inexpensive, noninvasive, and easily obtained over time, allowing for assessments of change. These findings suggest that, while related, each type of measure captures a different aspect of patient physical health and functioning.
