Comparing satisfaction and outcomes in on-campus versus virtual education for nurse practitioner students.

ABSTRACT: This article highlights the development and implementation of interactive training experiences for graduate nursing students as part of specialty training in endocrinology. Emphasis was placed on accomplishing the shift from on-campus to virtual training while maintaining fidelity and student satisfaction. A total of 106 graduate nursing students from five cohorts submitted evaluations. Student satisfaction remained high regardless of whether the content was delivered in person or virtually. Most students in the virtual cohorts evaluated the online training positively. Student presentation grades were highest with on-campus delivery. Transitioning in-person training to a virtual environment can be an effective method of delivering nurse practitioner education while promoting student satisfaction. Recommendations for optimizing hybrid learning experiences are offered based on adult learning principles.

Blood Pressure Control and the Association With Diabetes Mellitus Incidence: Results From SPRINT Randomized Trial.

The SPRINT (Systolic Blood Pressure Intervention Trial) demonstrated reduced cardiovascular outcomes. We evaluated diabetes mellitus incidence in this randomized trial that compared intensive blood pressure strategy (systolic blood pressure <120 mm Hg) versus standard strategy (<140 mm Hg). Participants were ≥50 years of age, with systolic 130 to 180 mm Hg and increased cardiovascular risk. Participants were excluded if they had diabetes mellitus, polycystic kidney disease, proteinuria >1 g/d, heart failure, dementia, or stroke. Postrandomization exclusions included participants missing blood glucose or ≥126 mg/dL (6.99 mmol/L) or on hypoglycemics. The outcome was incident diabetes mellitus: fasting blood glucose ≥126 mg/dL (6.99 mmol/L), diabetes mellitus self-report, or new use of hypoglycemics. The secondary outcome was impaired fasting glucose (100-125 mg/dL [5.55-6.94 mmol/L]) among those with normoglycemia (<100 mg/dL [5.55 mmol/L]). There were 9361 participants randomized and 981 excluded, yielding 4187 and 4193 participants assigned to intensive and standard strategies. There were 299 incident diabetes mellitus events (2.3% per year) for intensive and 251 events (1.9% per year) for standard, rates of 22.6 (20.2-25.3) versus 19.0 (16.8-21.5) events per 1000 person-years of treatment, respectively (adjusted hazard ratio, 1.19 [95% CI, 0.95-1.49]). Impaired fasting glucose rates were 26.4 (24.9-28.0) and 22.5 (21.1-24.1) per 100 person-years for intensive and standard strategies (adjusted hazard ratio, 1.17 [1.06-1.30]). Intensive treatment strategy was not associated with increased diabetes mellitus but was associated with more impaired fasting glucose. The risks and benefits of intensive blood pressure targets should be factored into individualized patient treatment goals. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062.

Developing Innovative On-Campus Intensives to Enhance Distance-Based Nurse Practitioner Programs.

BACKGROUND: The delivery of higher education has changed dramatically in recent years due to the shift toward distance learning, resulting in a need for creative education delivery methods. This article describes the implementation of on-campus intensives (OCIs) within a revised curricular framework for nurse practitioner (NP) students. Sequential OCIs are designed to promote role transition and professional and clinical development throughout the NP student's coursework. METHOD: The OCIs were established using a core curriculum framework. The development of the OCIs was an extensive process that requires widespread collaboration between faculty and staff. RESULTS: The OCIs have been successfully implemented over multiple semesters. Faculty, staff, and students have suggested benefits along with opportunities for improvement. CONCLUSION: The OCI experiences promote engagement, clinical competency, and professional development to prepare NP students to lead in today's complex and evolving health care system. [J Nurs Educ. 2019;58(9):543-547.].

Development of an Innovative Endocrinology Training Program for Nurse Practitioners.

BACKGROUND: Nurse practitioners (NPs) have a critical role in meeting the growing demand for health care in the current complex health care system. The use of NPs in both primary care and specialty settings is expected to rise significantly by 2025 in response to increased demands and a shortage of physician providers. METHOD: The Duke University School of Nursing, with funding from the Health Resource Services Administration, has implemented the first endocrinology specialty training program for primary care NP students. RESULTS: The first in the country, this innovative, hybrid training program prepares primary care NP students to manage complex diabetes mellitus and general endocrine conditions. CONCLUSION: Well-trained NPs can help meet the increased demands in primary care. This subspecialty certificate program provides a framework for other graduate nursing schools that are considering adding specialty content as a supplement to primary care training. [J Nurs Educ. 2018;57(8):506-509.].

Hyperglycemia Syndromes.

Diabetes mellitus and its complications are among the leading causes of organ failure around the world. It is imperative that timely, patient-centered care is provided to avoid microvascular and macrovascular damage. People with well-controlled diabetes can live long and healthy lives through interprofessional management, emphasizing optimal, individualized care.

Effectiveness of Implementing Initial Education Strategies to Promote Awareness and Healthy Habits in Childhood Obesity: A Quality Improvement Project.

BACKGROUND: Rising incidence and prevalence of childhood obesity and related costly health consequences suggest the need for an effective training tool at the primary care level. Evidence-based studies show how a healthy diet and physical activity help reduce the incidence of obesity. METHODS: The objective for this quality improvement project was to evaluate the effectiveness of an evidence-based educational tool in improving healthy eating and physical activity habits among overweight and obese children in a primary care setting over 3 months. RESULTS: There was a positive statistically significant change in behavior in eating more fruits and vegetables and decreased intake of sugary drinks and sedentary habits (p < .05). CONCLUSION: After receiving education on the importance of healthy lifestyle changes with regard to nutrition and physical activity, pediatric patients adopted better diet and physical activity habits. However, there was little effect on reducing body mass index in a 3-month timeframe.

Diabetes Distress or Major Depressive Disorder? A Practical Approach to Diagnosing and Treating Psychological Comorbidities of Diabetes.

The presence of major depressive disorder (MDD) in people with diabetes may be up to three times more common than in the general population. People with diabetes and major depressive disorder have worse health outcomes and higher mortality rates. Diabetes distress refers to an emotional state where people experience feelings such as stress, guilt, or denial that arise from living with diabetes and the burden of self-management. Diabetes distress has also been linked to worse health outcomes. There are multiple treatment options for MDD including pharmacotherapy and cognitive behavioral approaches. Providers treating patients with diabetes must be aware of the frequent comorbidity of diabetes, diabetes distress, and depression and manage patients using a multidisciplinary team approach. This article discusses the epidemiology, pathophysiology, and bi-directional relationship of diabetes and depression and provides a practical, patient-centered approach to diagnosis and management.

Diabetes Self-management Quality Improvement Initiative for Medically Underserved Patients.

The burden of diabetes is greater for minorities and medically underserved populations in the United States. An evidence-based provider-delivered diabetes self-management education intervention was implemented in a federally qualified health center for medically underserved adult patients with type 2 diabetes. The findings provide support for the efficacy of the intervention on improvement in self-management behaviors and glycemic control among underserved patients with diabetes, while not substantially changing provider visit time or workload.

Caring for women with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting reproductive-age women. PCOS causes hyperandrogenism and anovulation and increases the risk of multiple health conditions including infertility, diabetes mellitus, and cardiovascular disease. This article outlines current recommendations for diagnostic testing, treatment options, and holistic care of the woman with PCOS.

Type 1 diabetes & cardiovascular disease.

Individuals with type 1 diabetes mellitus (T1DM) have a high risk of developing cardiovascular disease (CVD), but some risk factors can be mediated by lifestyle modification and medication. NPs should understand evidence-based management approaches to counsel patients with T1DM on appropriate self-management interventions to reduce the likelihood of CVD.

Transitioning safely from intravenous to subcutaneous insulin.

The transition from intravenous (IV) to subcutaneous (SQ) insulin in the hospitalized patient with diabetes or hyperglycemia is a key step in patient care. This review article suggests a stepwise approach to the transition in order to promote safety and euglycemia. Important components of the transition include evaluating the patient and clinical situation for appropriateness, recognizing factors that influence a safe transition, calculation of proper SQ insulin doses, and deciding the appropriate type of SQ insulin. This article addresses other clinical situations including the management of patients previously on insulin pumps and recommendations for patients requiring glucocorticoids and enteral tube feedings. The use of institutional and computerized protocols is discussed. Further research is needed regarding the transition management of subgroups of patients such as those with type 1 diabetes and end-stage renal disease.