Promoting understanding of medical decision-making coding for nurse practitioner students.

ABSTRACT: Nurse practitioners (NPs) are often responsible for coding patient encounters for reimbursement. Students should learn the basics of this skill during their educational preparation. On January 1, 2021, the American Medical Association and the Centers for Medicare & Medicaid Services implemented new guidelines to the evaluation and management office appointment documentation and coding. The new medical decision-making (MDM) guidelines created a learning curve for NP students, faculty, and preceptors. An additional obstacle was encountered when on-campus preclinical intensives, which included a coding practice session, were canceled due to the COVID-19 pandemic. The faculty of an NP program identified MDM coding as a difficult concept to teach in an asynchronous learning environment. In response, the faculty developed and implemented synchronous online case study sessions that incorporated active student participation and real-time feedback, thus increasing engagement with peers, faculty, and the MDM concepts. The purpose of this article was to present a synchronous method for teaching MDM coding to NP students, and the outcomes, lessons learned, and implications for nursing education and practice.

Keys to Trust-Building with Patients.

ABSTRACT: A focal point for nurses and nurse practitioners is developing trust within the nurse-patient relationship. A stable foundation of trust between patient and nurse can diminish patients' mistrust of the healthcare system while engaging patients in their own care and improving health outcomes. Trust can be fostered through active listening as well as strengthening verbal and nonverbal communication skills. Biblical elements that undergird a trusting and honest nurse-patient relationship are described along with a patient narrative with some strategies for nursing implementation.

Prompt evaluation and treatment of third-trimester bleeding.

ABSTRACT: Third-trimester bleeding is an obstetric emergency and is associated with significant maternal and fetal morbidity and mortality. The two most common causes for third-trimester bleeding are placental abruption and placenta previa, which account for about half of all cases. Clinicians should have a thorough understanding of the risk factors, clinical presentation, and appropriate management of these conditions. Timely management is necessary for the survival of mother and fetus and to reduce the incidence of neonatal complications.

Infertility: A primer for primary care providers.

Infertility is a potentially life-changing diagnosis for couples who are trying to conceive. A diagnosis of infertility and the associated management plan can lead to psychological stress, anxiety, and depression for one or both partners. Infertility affects 6% of married women of reproductive age in the United States. Once a couple is determined to be infertile, prompt referral to a specialist is indicated. Treatment varies according to the cause and may include medication, surgical intervention, or assisted reproductive technology.

Recognizing age-related macular degeneration in primary care.

Age-related macular degeneration (AMD) is a disabling condition that results in central vision loss and significantly affects the quality of life for the growing population of older adults. Primary care providers play a vital role in early recognition of disease. This article reviews the risk factors, symptoms, physical examination findings, and management of AMD. Although there is no cure at this time, early referral and treatment may prevent some patients from progressing to complete vision loss.

A longitudinal online interprofessional education experience involving family nurse practitioner students and pharmacy students.

Interprofessional education (IPE) continues to gain traction worldwide. Challenges integrating IPE into health profession programmes include finding convenient times, meeting spaces, and level-appropriate assignments for each profession. This article describes the implementation of a 21-month prospective cohort study pilot programme for the Master of Science in nursing family nurse practitioner (FNP) and doctor of pharmacy (PharmD) students at a private university in the United States. This IPE experience utilised a blended approach for the learning activities; these students had initial and final sessions where they met face-to-face, with asynchronous online activities between these two sessions. The online assignments, discussions, and quizzes during the pilot programme involved topics such as antimicrobial stewardship, hormone replacement therapy, human papilloma virus vaccination, prenatal counselling, emergency contraception, and effects of the Affordable Care Act on practice. The results suggested that the FNP students held more favourable attitudes about online IPE and that the PharmD students reported having a clearer understanding of their own roles and those of the other participating healthcare students. However, the students also reported wanting more face-to-face interaction during their online IPE experience. Implications from this study suggest that effective online IPE can be supported by ensuring educational parity between students regarding the various topics discussed and a consistent approach of the required involvement for all student groups is needed. In addition, given the students desire for more face-to-face interaction, it may be beneficial to offer online IPE activities for a shorter time period. It is anticipated that this study may inform other programmes that are exploring innovative approaches to provide IPE to promote effective collaboration in patient care.

Respite Care for Families of Children with Disabilities: A University/Faith Community Model.

Families of children with disabilities or special healthcare needs report respite care as a great need, yet availability of such care is scarce. A partnership developed between a nursing school in the Southeast and a faith community, to provide respite care and summer camps, resulted in a win-win situation for families, children, interprofessional students and educators, the faith community, and volunteers. This article explains the need for respite, how schools of nursing and faith communities can partner, and the benefits to all stakeholders.

Cerebrospinal fluid levels of opioid peptides in fibromyalgia and chronic low back pain.

BACKGROUND: The mechanism(s) of nociceptive dysfunction and potential roles of opioid neurotransmitters are unresolved in the chronic pain syndromes of fibromyalgia and chronic low back pain. METHODS: History and physical examinations, tender point examinations, and questionnaires were used to identify 14 fibromyalgia, 10 chronic low back pain and 6 normal control subjects. Lumbar punctures were performed. Met-enkephalin-Arg6-Phe7 (MEAP) and nociceptin immunoreactive materials were measured in the cerebrospinal fluid by radioimmunoassays. RESULTS: Fibromyalgia (117.6 pg/ml; 85.9 to 149.4; mean, 95% C.I.; p = 0.009) and low back pain (92.3 pg/ml; 56.9 to 127.7; p = 0.049) groups had significantly higher MEAP than the normal control group (35.7 pg/ml; 15.0 to 56.5). MEAP was inversely correlated to systemic pain thresholds. Nociceptin was not different between groups. Systemic Complaints questionnaire responses were significantly ranked as fibromyalgia > back pain > normal. SF-36 domains demonstrated severe disability for the low back pain group, intermediate results in fibromyalgia, and high function in the normal group. CONCLUSIONS: Fibromyalgia was distinguished by higher cerebrospinal fluid MEAP, systemic complaints, and manual tender points; intermediate SF-36 scores; and lower pain thresholds compared to the low back pain and normal groups. MEAP and systemic pain thresholds were inversely correlated in low back pain subjects. Central nervous system opioid dysfunction may contribute to pain in fibromyalgia.

Knee pain and radiographic osteoarthritis interact in the prediction of levels of self-reported disability.

OBJECTIVE: To determine predictors of disability depending on whether joint deformity and pain reporting exist independently or concurrently. METHODS: Subjects were 154 volunteers for an osteoarthritis screening examination. Eligible subjects completed questionnaires for physical function, pain, and depressive symptoms; underwent evoked pain testing for tenderness assessment; and had anteroposterior and lateral radiographs taken of both knees. Two blinded rheumatologists scored the images using Kellgren-Lawrence criteria to determine presence of deformity. RESULTS: Subjects were divided into 3 subgroups based on radiographic evidence of deformity and self-reported pain. Disability was greatest when pain and deformity occurred together (F[2,151] = 18.8, P < 0.0001). Self-reported disability in the absence of deformity was predicted by body mass index, pain threshold, and anxiety symptoms; disability was predicted by the number of osteophytes and depressive symptoms when pain and deformity occurred together. CONCLUSION: Self-reported disability in osteoarthritis of the knee is greatest with concurrent pain and joint deformity. When pain and deformity do not cooccur, disability appears to be related to separate factors, including anxiety and pain threshold (e.g., tenderness).