A competency roadmap for advanced practice nursing education using PRIME-NP.

BACKGROUND: Clinical competency validation is essential for nurse practitioner (NP) education and public accountability. While there has been robust discussion around what constitutes clinical competency and assessment, clear and consistent definitions and measurements remain elusive. PURPOSE: This article describes the PRIME-NP clinical competency model that is scalable, reproducible and accurately documents NP student competency across clinical courses. METHODS: To develop the model, work in 5 discrete domains was necessary: (a) model development, (b) assessment tool to be used in Objective Structured Clinical Exams (OSCE), (c) rubrics to accompany the OSCE exam, (d) faculty education, and (e) evaluating the model use. FINDINGS: Faculty and student outcomes reveal that the model and assessment tool acceptability and effectiveness of the model, especially for early identification for at risk students. CONCLUSION: The PRIME-NP offered faculty the opportunity to identify at-risk students, identify a more nuanced remediation plan, and assess student competency in simulated environments.

Battlefield acupuncture: Opening the door for acupuncture in Department of Defense/Veteran's Administration health care.

Battlefield acupuncture is a unique auricular acupuncture procedure which is being used in a number of military medical facilities throughout the Department of Defense (DoD). It has been used with anecdotal published positive impact with warriors experiencing polytrauma, post-traumatic stress disorder, and traumatic brain injury. It has also been effectively used to treat warriors with muscle and back pain from carrying heavy combat equipment in austere environments. This article highlights the history within the DoD related to the need for nonpharmacologic/opioid pain management across the continuum of care from combat situations, during evacuation, and throughout recovery and rehabilitation. The article describes the history of auricular acupuncture and details implementation procedures. Training is necessary and partially funded through DoD and Veteran's Administration (VA) internal Joint Incentive Funds grants between the DoD and the VA for multidisciplinary teams as part of a larger initiative related to the recommendations from the DoD Army Surgeon General's Pain Management Task Force. Finally, Uniformed Services University of the Health Sciences School of Medicine and Graduate School of Nursing faculty members present how this interdisciplinary training is currently being integrated into both schools for physicians and advanced practice nurses at the Uniformed Services University of the Health Sciences. Current and future research challenges and progress related to the use of acupuncture are also presented.

Effective weight-loss using an e-health delivered physical activity and dietary intervention: A federal credit union pilot study.

BACKGROUND/OBJECTIVE: This pilot study investigated the effectiveness of a distance-based e-health program delivered across multiple rural Federal Credit Union worksites that focused on physical activity and dietary education. Program design and implementation were based on the premises of Social Impact Theory (SIT). METHODS: A sample of fifty-four participants (47 white. 7 black) aged 24 to 58 across different worksite locations completed 10 weeks of e-health delivered physical activity and dietary intervention. Pre to post weight changes were examined as a primary outcome. RESULTS: The findings showed that regardless of worksite location, participants on average reduced their weight by 10.13 lbs if they completed both the exercise and lunch and learn components of the study compared to a decrease of 2.73 lbs for participants who chose not to engage in the exercise related activities. Participant dropout from either group was less than four percent. CONCLUSIONS: The results of this study show the beneficial influence of physical activity integration using SIT upon distance programs targeting weight loss. In addition, the high adherence and weight loss success show promise and demonstrates the potential for e-health delivered exercise and lifestyle interventions. Further replication of results via additional randomized controlled trials is needed.

Multi-disciplinary Care for the Elderly in Disasters: An Integrative Review.

INTRODUCTION: Older adults are disproportionately affected by disaster. Frail elders, individuals with chronic diseases, conditions, or disabilities, and those who live in long-term care facilities are especially vulnerable. Purpose The purpose of this integrative review of the literature was to describe the system-wide knowledge and skills that multi-disciplinary health care providers need to provide appropriate care for the elderly during domestic-humanitarian and disaster-relief efforts. Data sources A systematic search protocol was developed in conjunction with a research librarian. Searches of PubMed, CINAHL, and PsycINFO were conducted using terms such as Disaster, Geological Processes, Aged, Disaster Planning, and Vulnerable Populations. Forty-six articles met criteria for inclusion in the review. CONCLUSIONS: Policies and guidance regarding evacuating versus sheltering in place are lacking. Tenets of elderly-focused disaster planning/preparation and clarification of legal and ethical standards of care and liability issues are needed. Functional capacity, capabilities, or impairments, rather than age, should be considered in disaster preparation. Older adults should be included in disaster planning as population-specific experts. Implications for Practice A multifaceted approach to population-specific disaster planning and curriculum development should include consideration of the biophysical and psychosocial aspects of care, ethical and legal issues, logistics, and resources.

Caring for military children in the 21st century.

PURPOSE: Civilian healthcare professionals provide approximately 2/3 of the healthcare for the 2 million U.S. military children. The President of the United States has made their care and support a top national security priority. The purpose of this article is to arm NPs with information necessary to care for the 21st century military child by providing current data on military family life, deployments, and the impact on children and their health-seeking behaviors. DATA SOURCES: Literature collected from sources identified through searches of PubMed, CINAHL, and PsycInfo covering the periods from 2003 to 2012. CONCLUSIONS: Military children are both resilient and vulnerable. While frequent moves build resilience, combat deployments increase the risk for abuse, neglect, attachment problems, and inadequate coping. The risk is highest right after the service member leaves for deployment and immediately upon return. Children's reactions to deployment differ by age, gender, and individual temperament. There is an 11% increase in outpatient visits for mental or behavioral health issues during deployment. IMPLICATIONS FOR PRACTICE: Healthcare professionals can support the physical and mental health of children by normalizing expectations and using the I CARE (Identify, Correlate, Ask, Ready Resources, Encourage) strategy to facilitate prevention and encourage early engagement with available resources.

Alternative placements for women wearing pedometers.

PURPOSE: The purpose of this pilot study was to determine if pedometer placement sites in women, other than the waist, provide the same results. DATA SOURCES: Three pedometers were given to 12 women to wear on a bra strap, waist, and shoe for a week and then rotated through each site. The participants recorded their daily step counts in a log, turned in weekly, and were instructed not to change their daily routine. Body mass index (BMI), placement preference, and waist and hip measures were collected at enrollment and the concluding sessions. CONCLUSIONS: Women's adiposity distribution patterns and clothing provide potential barriers to pedometer use at the waist. Daily walking is an affordable option for physical activity counseling by nurse practitioners (NPs). The bra and shoe placements were not found to be equitable alternative sites compared with waist placement of pedometers. However, 75% of participants had improvement in BMI and waist-to-hip measures with no lifestyle intervention. The participants preferred a placement perceived as comfortable and consistent. IMPLICATIONS FOR PRACTICE: The results inform NPs that women need to consistently wear pedometers in a daily walking program, which can lead to beneficial changes in BMI. NPs should encourage walking as a form of daily physical activity, which may be monitored by a pedometer worn consistently.