Incorporating the Transitional Care Model within NP program curricula to achieve care coordination competency.

PURPOSE: Education for nurse practitioners (NPs) requires knowledge and skill acquisition for managing transitions in care, especially among older adults with complex care needs. A team of nurse researchers and educators provided a competency-based approach for educating future NPs on the care delivery of older adults using the Transitional Care Model's (TCM) evidence-based interventions. METHODS: NP faculty integrated an online course offering didactic teaching that would enhance clinical learning. The online content included a case study of an NP navigating an older adult through transitions in care. Students completed evidence-based interventions with patients while in their clinical rotations. RESULTS: Using the structured and purposeful interventions within the clinical practicum provided exposure to and experience with the application of the model's nine components. NP students applied knowledge and demonstrated skills through direct care experiences in the clinical setting. This learning supports the achievement of advanced nursing practice competencies depicted in the American Association of Colleges of Nursing (AACN)'s The Essentials: Core Competencies for Professional Nursing Education (2021). CONCLUSIONS: This is one example of how a NP program integrates evidence-based interventions to ensure that NP graduates are well-positioned and ready for managing transitions of complex care for older adults.

Diagnostic Reasoning Competency and Accuracy by Nurse Practitioner Students Following the Use of Structured Reflection in Simulation: A Mixed-Methods Experiment.

AIM: The aim of this study was to examine the effect of structured reflection used during a simulated patient's diagnostic workup on diagnostic reasoning competency and accuracy and explore participants' cognitive bias experience and perceived utility of structured reflection. BACKGROUND: Reasoning flaws may lead to diagnostic errors. Medical learners who used structured reflection demonstrated improved diagnosis accuracy. METHOD: Embedded mixed-methods experiment examined diagnostic reasoning competency and accuracy of nurse practitioner students who did and did not use structured reflection. Cognitive bias experience and perceptions of structured reflection's utility were explored. RESULTS: Diagnostic Reasoning Assessment mean competency scores and categories were not changed. Accuracy trended toward improvement with structured reflection. The theme, diagnostic verification, prompted diagnosis change by both structured reflection users and control participants. CONCLUSION: Despite no changes in quantitative outcomes, explicit users of structured reflection believed that this strategy is helpful to their reasoning, and control participants used the strategy's components with the same noted benefits.

Diagnostic Reasoning Outcomes in Nurse Practitioner Education: A Scoping Review.

BACKGROUND: Diagnostic reasoning is the process of collecting, considering, and analyzing information to determine a diagnosis. Educational strategies that structure diagnostic reasoning exposure, experience, and evaluation are hypothesized to improve diagnostic safety. However, few studies measure diagnostic reasoning outcomes in nurse practitioner education. This review sought to identify the educational interventions intended to improve diagnostic reasoning competency, determine which components of reasoning are evaluated, and examine how they are measured. METHOD: Four databases were searched, and 12 studies were identified that met the inclusion criteria. RESULTS: Simulation was the most common intervention. The most frequently measured diagnostic reasoning components were information gathering, differential diagnosis, and leading diagnosis. Checklists and patient management problems were the most used assessment method. CONCLUSION: More studies are needed to assess the reasoning processes of hypothesis generation, problem representation, and diagnostic justification. Within simulation, methods capable of capturing these components include think-aloud, global assessments, checklists, and note evaluation. [J Nurs Educ. 2022;61(10):579-586.].

Opioid Use Disorder: Treatment Outcomes in U.S. Veterans.

BACKGROUND: Substance use disorders are a leading cause of morbidity and mortality in the United States, with opioid use disorder representing a growing public health concern and economic burden. Veterans within the Veterans Health Administration are impacted by opioid use disorder. SIGNIFICANCE: A common medication-assisted treatment is sublingual Suboxone (buprenorphine/naloxone) used in combination with behavior modification therapy. Missed Suboxone doses may lead to withdrawal and potential drug diversion. Sublocade (buprenorphine extended-release) is an alternative once-monthly subcutaneous injection administered by a healthcare provider. The purpose of this quality improvement project was to examine the effects of Sublocade on cravings in veterans with opioid use disorder. METHODS: Veterans were considered for Sublocade monthly injections if they were enrolled in the Suboxone program, not taking Suboxone as prescribed, and disenrolled from the Suboxone program more than 2 times. Cravings were measured before and after Sublocade program enrollment. RESULTS: Fifteen veterans were enrolled in the Sublocade program over a 12-month timeframe. Most were male (93%) with a median (range) age of 42 (33-62) years. The following were the primary opioids used before enrollment in the substance use disorder program: hydrocodone (47%), oxycodone (20%), and heroin (20%). Sublocade significantly reduced cravings (p = .001). In this small group, cravings were fully eliminated. DISCUSSION: Recent studies have shown Sublocade effectively blocks the effects of other opioids and minimizes the risk of medication diversion that occurs with Suboxone. For these reasons, Sublocade is an alternative medication-assisted treatment for veterans with opioid use disorder.

The Use and Effect of the Health Storylines mHealth App on Female Childhood Cancer Survivors' Self-efficacy, Health-Related Quality of Life and Perceived Illness.

BACKGROUND: mHealth apps have been not been well tested among childhood cancer survivors (CCSs) to track physical and psychosocial functioning for improved self-management of post-treatment needs. OBJECTIVES: This pilot study had 3 aims: (1) assess the usage of the Health Storylines mHealth app; (2) examine its effect in improving self-efficacy in managing survivorship healthcare needs, health-related quality of life, and perceived illness; and (3) determine if app usage moderated the effects on the above patient-reported outcome measures among female CCSs. METHODS: Study participants accessed the Health Storylines mHealth app on their own personal device. This single-group, pilot study included 3 measurement points: baseline and 3 and 6 months after initiation of using the app. RESULTS: Use of the mHealth app ranged from 0 times to 902 times. Every study participant who used the app (n = 26) also used the mental health app component of the Health Storylines app. Generalized estimating equations were fit to examine the effect of the mHealth app use on self-efficacy, perceived illness, and health-related quality of life, between baseline, 3-month follow-up, and 6-month follow-up. No statistically significant changes were evident, on average, from baseline to 3- or 6-month follow-up on any outcome. Subsequent testing of effect moderation showed differential trends for high versus low users. CONCLUSIONS: Studies are needed among this clinical population to determine who will benefit and who will perceive the app as a useful aspect of their survivorship care. IMPLICATIONS FOR PRACTICE: Sharing mental health functioning tracked on mhealth apps with healthcare providers may inform needed interventions for young adult female CCSs.

Addressing Preterm Birth History With Clinical Practice Recommendations Across the Life Course.

Preterm birthrates, coupled with excellent preterm birth survival rates, guarantee that every health care provider, regardless of specialty, is caring for patients who were born preterm. Patients and families may not share a preterm birth history however, eliciting this information is important for mitigating potential risk. Long-term health outcomes research supports health implications associated with preterm birth throughout the life course. Through an in-depth review of literature and validation from health care experts in pediatric and adult care, recommendations for primary care providers were developed. The aim was to enhance the identification of those born prematurely, empower health care providers to employ familiar screening strategies, and advocate for mitigations strategies with anticipatory guidance and health promotion. These recommendations advocate a paradigm shift toward proactive intervention, rather than the reactive practice of waiting for children to fail to meet specific milestones or begin to show comorbid tendencies.

Education initiatives in cognitive debiasing to improve diagnostic accuracy in student providers: A scoping review.

BACKGROUND: The high prevalence of diagnostic errors by health care providers has prompted medical educators to examine cognitive biases and debiasing strategies in an effort to prevent these errors. The National Academy of Medicine hypothesized that explicit diagnostic reasoning education of all health care professionals can improve diagnostic accuracy. OBJECTIVES: The purpose of this scoping review is to identify, analyze, and summarize the existing literature on student health care providers' use of cognitive debiasing strategies to reduce diagnostic error. DATA SOURCES: The review was guided by the Joanna Briggs Institute methodology for scoping reviews. A systematic search of PubMed, CINAHL, PsychINFO, and Scopus databases for debiasing strategies in student provider education yielded 33 studies. CONCLUSIONS: The 33 studies included in this review represent four categories of debiasing strategies: increased medical knowledge or experience (seven studies), guided reflection (eight studies), self-explanation of reasoning (nine studies), and checklists to expand diagnosis considerations (seven studies). The studies were inclusive of medical students and residents; no studies included nurse practitioner (NP) students. Guided reflection, the most clearly defined and implemented strategy, showed the most promise for improvement of diagnostic accuracy. Educational interventions were wide ranging in content and delivery but did yield a path for future research. IMPLICATIONS FOR PRACTICE: There are myriad debiasing strategies student providers may use to mitigate cognitive bias. Structured reflection and education initiatives demonstrated the most consistent improvements in diagnostic accuracy. Future studies on debiasing strategies must include NP students to understand their response to these initiatives.

Umbrella Review of School Age Health Outcomes of Preterm Birth Survivors.

Preterm birth affects approximately 10% of U.S. births, with survival rates close to 95%. All health care providers, regardless of population or setting, are treating preterm birth survivors. The purpose of this manuscript is to present an umbrella review of the health outcomes of 2- to 12-year-old children who were born preterm. The current umbrella review consisted of 29 reviews, 14 meta-analyses, eight systematic reviews, and seven described as both meta-analysis and systematic review. Studies were grouped into six health outcome categories: neurodevelopmental, motor and/or cerebral palsy, pulmonary, mental and/or behavioral health, quality of life and/or leisure, and eczema. The analysis supports a resounding recommendation to recognize preterm birth, at all gestations, as a risk factor to health and educational outcomes. Increased attention to developmental screenings is critical, specifically recognition that children who are on the lower ranges of normal may benefit from therapies or interventions that support the attainment of future skills.

The Influence of preterm birth beyond infancy: Umbrella review of outcomes of adolescents and adults born preterm.

BACKGROUND AND PURPOSE: In recent decades, increased neonatal survival has enabled research of long-term outcomes of those born preterm. The purpose of this article is to present the findings of an umbrella review, an examination of published systematic reviews and meta-analyses, to examine the outcomes of adolescents and adults born preterm. METHODS: The research was guided by the Joanna Briggs Institute methodology for umbrella reviews. A systematic search of PubMed, CINAHL, and PsycINFO databases with the search years 2010 through September 2018 yielded 16 reviews for inclusion. CONCLUSIONS: The 16 reviews included in this umbrella review represent five clinical outcomes: neurodevelopmental (3 reviews), mental/behavioral health (5 reviews), cardiovascular (4 reviews), pulmonary (3 reviews), and life experience outcomes (4 reviews). One review included data for multiple clinical outcomes. This umbrella review highlights the adolescent and adult risks related to cognitive scores, executive function, anxiety, depression, attention-deficit hyperactivity disorder, long-term effects on systolic blood pressure, low-density lipoproteins and cholesterol levels, pulmonary symptoms, including asthma, pulmonary function, radiographic changes in the lungs, sports and leisure participation, and educational attainment and employment. IMPLICATIONS FOR PRACTICE: There is a preponderance of evidence that supports targeted screening for a history of preterm birth by all health care providers. This screening should facilitate the promotion of healthy lifestyles and improving psychosocial and neurodevelopmental difficulties through early and continued support services. Curricular and practice standards are advocated to support this change.

On-call simulation for adult gerontology acute care nurse practitioner students: A comparative descriptive study.

BACKGROUND: It is now commonplace for acute care nurse practitioners (ACNPs) to work in positions that include an on-call component or management of emergent concerns through telephone. There are no published reports on the inclusion of an on-call component in ACNP clinical preparation of students; novice ACNPs feel unprepared to competently and confidently manage emergent patient situations and on-call responsibilities. PURPOSE: To examine ACNP student perception of stress, necessary skills, confidence, and benefit of participating in a simulated on-call experience. METHODS: Using simulated faculty callers as nurses, ACNP students participated in a simulated on-call experience that included receiving two calls, eliciting key information from the nurse, diagnosing and managing the patient, and submitting documentation of the encounter. Students completed preparticipation and postparticipation perception surveys, and they were evaluated by the simulated nurse (faculty) using standardized evaluation tools. RESULTS: Acute care nurse practitioner students rated the simulated on-call experience as educationally valuable. High levels of anxiety before participation were notably improved after participation. Students identified critical thinking, clear communication, and knowledge with the specific disease as the most important skills needed to manage nurse calls successfully. Students reported marked improvement in their confidence and were receptive to accepting an nurse practitioner position with call/triage responsibilities after their on-call experience. IMPLICATIONS FOR PRACTICE: Inclusion of a simulated on-call experience in the final semester of an ACNP program is both feasible and relevant to ACNP student development. On-call exposure within the clinical practicum is inconsistent and, therefore, should be added through simulation.