Nurse practitioners and barriers to diabetic foot treatment.

BACKGROUND: Even with full practice authority, nurse practitioners (NPs) face limitations in care and treatment options. An example of this is current federal law prohibiting NPs from ordering diabetic shoes. PURPOSE: This study reviewed the background of this problem, potential impacts on patient health and NP practice, and viable solutions for consideration. METHODS: This was a descriptive study of NPs in a northwestern state with full practice authority. An anonymous online survey was used. There were 54 total NP respondents. RESULTS: The potential negative patient outcomes associated with restricted NP ability to prescribe diabetic footwear were supported through the literature review and the survey, including increased foot complications and acuity, translating to increased costs. Of the NPs queried, 80% felt inability to prescribe diabetic footwear was limiting to their practice, and 92% felt this affected patient outcomes. Federal legislative changes with support of bipartisan bills allowing NPs to prescribe diabetic footwear could facilitate timeliness and access to care while reducing costs. IMPLICATIONS FOR PRACTICE: Legislation affecting NP scope of practice is an important issue with implications related to patient outcomes. Nurse practitioners should continue to support legislation at the federal level to pass bills allowing for NPs to certify orders for diabetic shoes.

Childhood vaccine status and correlation with common nonvaccine-preventable illnesses.

BACKGROUND AND PURPOSE: Current trends in parental decision making involve alteration from vaccine schedules in children, citing concerns for altered immune function. The purpose of this study was to determine if there is a difference in incidence of common childhood illnesses dependent on vaccination status. METHODS: An investigator-designed survey was administered to parents of children aged 12 months to 7 years. Participants were separated into one of three groups: fully vaccinated, partially vaccinated, and unvaccinated. There were 111 total participants. Power analysis indicated a minimum of 30 participants per group to detect an 80% effect. Descriptive statistics were applied to variables with chi-square for group comparison. CONCLUSIONS: The results indicated a statistically significant difference between all three groups in the categories of ear infections, influenza, and common colds. Fully immunized group had significantly more ear infections than partial or unimmunized. The unimmunized group had significantly more colds and flu. IMPLICATIONS FOR PRACTICE: Nurse practitioner practice implications relate directly to further education of parents, support, and trust building. Many parents question the possible association between childhood vaccines and immune function and have a distrust of current research. This study showed that most common childhood illnesses are equitable across the population and not dependent on vaccine status.

Advanced practice nursing: shaping health through policy.

PURPOSE: To highlight the importance of advanced practice nurses (APNs) becoming politically engaged as key to promoting the healthcare interests of patients, communities and the profession and to offer specific strategies on how to become politically competent. DATA SOURCES: Robert Wood Johnson Foundation, CINAHL, PubMed. CONCLUSIONS: APNs must come to see political engagement as a professional obligation and health policy as something that they can shape rather than something that happens to them. IMPLICATIONS FOR PRACTICE: The overall goal of healthcare reform is the provision of quality, safe and cost-effective healthcare for all Americans. APNs are graduate prepared clinicians that focus on health and illness management and are strategically positioned to lead the way in shaping and implementing health policy priorities.