Interprofessional "on-call" e-learning for family nurse practitioner students: Preparing for primary care across the life span.

BACKGROUND AND PURPOSE: Nurse practitioners (NPs) are expected to fill gaps in providing primary care in the United States and need vital skills to meet the growing need for primary care providers. One necessary skill is managing "on-call" clinical questions/concerns by patients across the life span. To date, there are no published studies that address "on-call" simulations for family NP (FNP) students across the life span. METHODS: This quasi-experimental, mixed-methods design used a confidence scale and Krippendorff's method for content analysis of discussion pages to determine the effectiveness and confidence of simulated "on-call" scenarios for FNP students during each of their clinical courses. CONCLUSIONS: There was a significant increase in the confidence level of students as measured by the confidence questionnaire (t = 3.07 [33]; p < .001), at the end of the FNP didactic and clinical courses. Krippendorff content analysis revealed three themes: self-reliance; thinking on your feet; and uncertainty of management. IMPLICATIONS FOR PRACTICE: "On-call" processing is a skill that is needed in graduate FNP programs so that these providers are fully prepared to meet any challenge they may encounter.

Managing Celiac Disease for Women: Implications for the Primary Care Provider.

Although many people have symptoms of celiac disease, it can take a while to diagnose. Villous atrophy may be present long before any gastrointestinal symptoms. An important point to acknowledge is that celiac disease could be identified earlier in some women with a positive family history. The disease also could be the cause of some women's reproductive problems. Primary care providers, using comprehensive history taking, are in the unique position to identify individuals who may have celiac disease, assist women in gaining knowledge about a gluten-free diet, order diagnostic testing, and refer to a gastroenterologist. The positive change in fertility with a simultaneous improvement of nutrient deficiencies shortly after adopting a gluten-free diet indicates a possible link between such nutrients and sex hormone function. High levels of homocysteine, which can negatively impact fertility, have also been linked to individuals with problems, such as celiac disease, that decrease vitamin B12 absorption. The purpose of this article is to review the literature and the evidence-based care guidelines for comprehensive screening, diagnostics, and pathophysiology of celiac disease, with a specific focus on the female reproductive system, anemia management, and gluten-free diet integration.

Managing Sjogren's Syndrome.

There are approximately 4 million Americans diagnosed with Sjogren's Syndrome. This article discusses the epidemiology, pathophysiology, diagnostics, and implications for home care clinicians who may encounter patients with this syndrome. Chronic pain is discussed as well as interventions to manage symptoms such fatigue, dry eyes mouth and skin.

Simulation Pedagogy With Nurse Practitioner Students: Impact of Receiving Immediate Individualized Faculty Feedback.

Family nurse practitioner (FNP) students must achieve basic competency in managing patients' primary care needs across the lifespan. Students in the FNP program have simulations integrated throughout their clinical theory courses to increase practice time with various patient cases. Students who received individualized faculty feedback immediately after self-evaluation of simulation performance showed statistically significantly increased knowledge (as evidenced by higher grades in course examinations and preceptor evaluations) than a control group of students who received feedback in a group class via a rubric grading guide 2-4 weeks after all students completed their individual simulations.

Transforming doctoral education through the clinical electronic portfolio.

The DNP is a terminal degree focusing on the preparation of expert clinicians with advanced leadership, evidence-based practice, and systems management skills. An electronic clinical portfolio (e-portfolio) allows students to showcase their individual experiences, provides an objective measure of their achievement, and demonstrates integration of the core doctoral competencies within each specialty. The purpose of this article was to describe the development of an e-portfolio and provide general guidelines for successful implementation and evaluation.

Seeing the forest and the trees: increasing nurse practitioner students' observational and mindfulness skills.

Accurate, objective observation is a critical component of clinical diagnosis and patient management, which in turn is essential for successful diagnostic reasoning by advanced practice nurses. The purpose of this quasi-experimental study was to enhance nurse practitioner students' observation and reflective thinking skills using Looking Is Not Seeing, a reflective practice/experiential learning technique that uses art objects to teach observation (Pellico, Friedlaender, & Fennie, 2009). Students' posttest observation and interpretation scores showed statistically significant improvement over pretest scores. Students' mindfulness scores and their own perceived observational and interpretive ability were statistically significantly higher after participating in the study. Building on the established record of successful visual literacy programs for nursing and medical students at other institutions, this research can help educators implement the Looking Is Not Seeing pedagogy.

Nurses' Knowledge of Heart Failure: Implications for Decreasing 30-Day Re-Admission Rates.

Heart failure affects 5.1 million Americans. It is the leading cause of hospitalization in older adults and the most common cause of readmissions, which cost approximately $12 billion annually. Readmissions can be reduced through increased nurses' knowledge in heart failure.

Promoting nursing students' understanding and reflection on cultural awareness with older adults in home care.

It is important for nursing programs to use culturally focused activities to increase student preparation in caring for diverse older adults in their homes. The purpose of this study was to examine strategies that promote students' reflection on cultural awareness using home care-focused case studies, simulations, and self-reflective writing activities. Cases and simulations were designed to depict diverse patients living at home with a variety of demographic characteristics, such as health history, age, culture, religion, dietary preferences, marital status, family involvement, and socioeconomic status. Qualitative data regarding student perceptions of cultural awareness was gathered via written surveys, and findings suggest that junior- and senior-year nursing students enhanced the depth and breadth of how they defined "cultural competence" after participating in culturally focused classroom and clinical laboratory activities. Levels of reflective writing using framework also improved by the semester's end for both groups of students.

Validity and reliability of the geriatric sexuality inventory.

Effective health care for older adults requires that providers assess and manage sexual health needs with high priority. This assessment begins with an effective sexuality assessment tool. A two-step, research approach was undertaken to develop and test the Geriatric Sexuality Inventory (GSI). Literature and expert review resulted in a 34-item instrument that was initially completed by 34 older adults ages 60 to 91 (mean age = 75). The testing was repeated in 19 of the original participants. The sample was 75% women, and 88% Caucasian with 9% single, 27% married, 18% divorced, and 46% widowed participants. Internal consistency reliability was run on all 53 responses and revealed adequate reliability (alpha = 0.74). Test-retest analysis also revealed good initial instrument reliability (r = 0.78; p < 0.001). Responses to open-ended questions regarding sexual information and care needs supported evidence gathered from the literature. Initial testing of the GSI revealed content validity and good internal consistency and test-retest reliability.

Nursing students identify fears regarding working with diverse critically ill patients: development of guidelines for caring for diverse critically ill older adults.

Undergraduate students need to gain more exposure to communicating, assessing, and planning appropriate care and evaluating outcomes of care with diverse critically ill geriatric patients. This project developed teaching strategies that facilitated additional opportunities for gaining these valuable learning experiences for students. Nurse educators can use the Guidelines for Caring for Diverse Critically Ill Older Adults, the case study and simulation examples, and topical outline to assist them in teaching critical care students and nurses about diverse critically ill older adults.

Course strategies for clinical nurse leader development.

The scope of the clinical nurse leader (CNL) is evolving in practice across the country. The preparation of this pivotal role in a complex healthcare environment has prompted the collaboration of nurse academics, nurse administrators, and clinicians to design unique educational experiences to maximize best practice. Knowledge attained regarding healthcare improvement and patient safety must not only be theoretical, but personal and application focused. Utilizing the American Association of Colleges of Nursing's CNL white paper and published resources faculty developed a clinical leadership course focused on active learning and reflection. Students explore concepts of improvement and quality related to business models of high functioning organizations including healthcare. Three key components of the course are described in detail; "quality is personal", executive interviews and the "5P" clinical microsystems assessment. Evaluation outcomes are discussed. Course content and innovative teaching/learning strategies for CNL are shared which may support the growth of CNL program development nationally.

Celiac disease: implications for patient management.

Celiac disease is an autoimmune disorder that is known specifically for causing inflammation of the mucosa in the small intestine. Through multiple diagnostic and screening tools such as small intestinal biopsy sample, serological testing, and human leukocyte antigen testing, healthcare providers can diagnose this disease that contains components related to genetic predisposition and intake of gluten proteins found in wheat, barley, and rye. There are some who believe that having an autoimmune disease may predispose one to acquiring another disease. With patients experiencing mostly diarrhea, abdominal pain, and weight loss, the implementation of a gluten-free diet is the treatment that healthcare providers recommend. Through monitoring gluten intake and providing nutritional supplementation, those diagnosed with celiac disease can lead a relatively normal life without complications. With celiac disease affecting all age ranges in the population, and with a documented higher frequency, there is a growing awareness in society that can be easily seen in grocery stores, restaurants, and food manufacturers.

Innovative solutions: using case studies to generate increased nurse's clinical decision-making ability in critical care.

Learning to care for critically ill patients requires a high level of critical thinking, clinical decision-making ability, and a substantial knowledge base. At this nursing school, an elective Critical Care Nursing course for last-semester seniors was designed to include active learning strategies, focusing on the use of case studies to facilitate learning. Results indicate significantly improved final examination scores for those involved with the case-study pedagogy. In addition, students identified enhanced communication skills. Two complex cases are presented for others to use with their educational programs.

Assessment of advanced practice palliative care nursing competencies in nurse practitioner students: implications for the integration of ELNEC curricular modules.

Advanced practice nurses (APRNs) have key roles in the care of patients who are nearing death and those living with a disabling chronic disease. This article describes a mixed-method formative assessment of 36 graduate nursing students' knowledge about and attitudes toward palliative care preliminary to curricular integration of the End-of-Life Nursing Education Consortium (ELNEC) graduate core modules. Students' knowledge about palliative care was assessed using the 106-item ELNEC examination. In addition, qualitative data were gathered regarding students' definitions of palliative care, the role of the APRN in palliative care, and their definitions of a "good" and "bad" death. Results revealed students' limited knowledge about palliative care. Qualitative findings indicated that most students exclusively linked palliative care with end-of-life care and believed that the treatment they provide should have the goal of prolonging life over maintaining quality of life. Implications for curriculum design, advanced practice role development, and collaboration with community health partners are discussed.

Peering: the essence of collaborative mentoring in critical care.

To provide and sustain high-quality patient care, nurses must collaborate and gain strength and vision for the future from their peers, young and old. It is known that mentoring assists all people, both mentors and mentees, to be better than what they would be by themselves. This underlying philosophy seems to improve recruitment and retention of staff by fostering a collegial and respectful unit culture. This project paired senior nursing students in critical care in their leadership/management rotation with a nurse and found that both new and experienced nurses had similar perceptions of mentoring and that it should include peer collaboration.

Integration of end-of-life care content in undergraduate nursing curricula: student knowledge and perceptions.

Studies indicate that nurses spend more time with patients at the end of life than any other health care discipline (K. M. Foley & H. Gelband, 2003). So it is imperative that nurses be educated so they can provide this high-quality end-of-life care. The purpose of this project was to provide a current state of end-of-life nursing education in the literature and to report on end-of-life knowledge and experiences of two groups of nursing students in one small, liberal arts university. A total of 111 undergraduate students (61 sophomores and 50 seniors) were administered a 50-item, multiple-choice test to determine their baseline knowledge about end-of-life care. Sophomore scores ranged from 20% to 86% with a mean of 60.98 (SD = 11.83). Senior pretest scores ranged from 70% to 96% with a mean of 83.26 (SD = 6.6). An independent samples t test was conducted to determine if there was a difference in group mean knowledge between sophomore and senior students. Levene's test for equality of variance was significant (F = 4.22, P < .05); thus, a t test with equal variance assumed revealed a significant difference between sophomore and senior group means (t = -10.44, P < .001). The review of literature and student knowledge and experience assessment resulted in the development of a model of end-of-life curriculum integration implemented at the university and sets the stage for future program evaluation studies.

Teaching about cardiac emergencies: implications for maternal/child nurse educators.

Women with comorbidities and obesity and aging women are presenting obstetrical challenges to healthcare providers. Cardiovascular events such as myocardial infarction, spontaneous coronary artery dissection, and stroke on obstetrical units are not as rare as they may have been even 5 years ago. Early recognition and treatment of these maladies can assist in decreasing the mortality of both the mother and unborn baby. The Joint Commission advocates using periodic drills for obstetric emergencies. The content on cardiac emergencies and case studies in this article will assist staff development educators to integrate didactic and clinical practice time into orientation and continuing education programs.

Managing the threat of methicillin-resistant Staphylococcus aureus in home care.

Severe fatal complications such as pneumonia, cutaneous abscesses, empyema, necrotizing fasciitis, and sepsis can result from methicillin-resistant Staphylococcus aureus (MRSA) even for healthy people. An overview of managing the threat of MRSA in home care is presented. The home healthcare nurse can be proactive with MRSA infections by following and teaching strict medical asepsis while assessing the slightest signs and symptoms indicating that a patient is deteriorating or not responding to the prescribed antibiotic or wound care. This article aims to increase awareness of community-acquired (CA)-MRSA, to offer suggestions for preventing CA-MRSA, and to describe methods for managing this infectious process in the home.