Implementation of Diabetic Retinopathy Screening in Adult Patients With Type 2 Diabetes in a Primary Care Setting.

Diabetic retinopathy (DR) is a microvascular complication of type 2 diabetes and the leading cause of blindness globally. Although diabetes-related eye exams are widely recognized as an effective method for early detection of DR, which can help to prevent eventual vision loss, adherence to screening exams in the United States is suboptimal. This article describes a quality improvement project to increase DR screening rates and increase knowledge and awareness of DR in adults with type 2 diabetes in a primary care setting using mobile DR screening units. This project addressed gaps of care and demonstrated that primary care settings can increase access to DR screening through a patient-centered process and thereby help to prevent irreversible outcomes of DR and improve quality of life.

Interprofessional Education and Essential Approach to Health care.

In today's changing landscape of the US health care system, it is imperative to have a health care delivery model that is patient-centered and delivered by a multidisciplinary collaborative team with an understanding of each other's roles and responsibilities as well as communicate effectively. Academic institutions must create partnerships with health systems and ambulatory care settings to provide health profession students with authentic and inclusive interprofessional learning opportunities which include practice-ready skills which are needed to enter the health care workforce. Nurses are well positioned to lead this effort and practice within interprofessional teams in health care organizations.

Increasing Medicare Annual Wellness Visit Utilization: An RN-Led Model of Care Pilot.

Annual wellness visits (AWVs) are an important component of primary care as they provide preventive services and an opportunity to identify safety and health risk factors for Medicare beneficiaries. However, primary care practices are facing unprecedented demands with high patient volumes, multimorbidity, a rapidly growing aging population, and primary care provider (PCP) shortages. RN-led models of care are increasingly recognized as a major key to providing quality care while relieving PCP demands. This article describes the implementation of an RN-led model of care pilot in an urban family practice to increase Medicare AWV completion and alleviate PCP burden.

Using the community of inquiry as a framework to promote online teaching and learning in advanced practice nursing education.

ABSTRACT: As advanced practice nursing education continues to shift toward a distance and hybrid format, it is important that nurse educators engaged in distance learning create and facilitate an online environment that successfully incorporates critical thinking, problem-solving skills, collaboration, and a sense of community. Although many learning theories and frameworks exist, there is a lack of literature on the applicability of these theories and frameworks to online teaching and learning in advanced practice nursing education. The purpose of this article is to describe the Community of Inquiry (CoI) framework and how it can be applied to online teaching and learning activities in advanced practiced nursing courses. This CoI is an effective framework for online learning and has been successful in promoting student engagement, an important factor in and predictor of academic success.

An exploration of language: How nurses describe social factors that contribute to health.

BACKGROUND: Over the last two centuries nurses have been practicing, teaching, and conducting research on social factors that contribute to health and the language has evolved over this time. PURPOSE: To explore how social factors that contribute to health are described by nurse authors and how that use has changed over time. METHODS: A scoping review using the JBI Manual for Evidence Synthesis, Cochrane Handbook, and PRISMA guidelines was completed. FINDINGS: From 1967 to 2021, nurses used the term "social factors" most commonly and there was a shift from demographic to social factors. DISCUSSION: As the language that nurses use has shifted from demographic descriptions to the social factors that may be associated with those descriptions, nurses have an opportunity to promote the use of non-deterministic language for health promotion and research.

A transition of care model from hospital to community for Hispanic/Latino adult patients with diabetes: design and rationale for a pilot study.

BACKGROUND: The Hispanic/Latino population is disproportionately affected and has a higher risk of developing diabetes than their non-Hispanic White counterparts and worse diabetes-related outcomes. Diabetes continues to be an economic burden. This economic burden is partially due to the significantly higher rates of hospital readmission for individuals with diabetes. People with diabetes, particularly those who are members of racial/ethnic minority groups, are at higher risk for readmission and emergency department (ED) visits. Despite recommendations regarding transition of care, an optimal approach to the transition of care for ethnic/minority patients remains unclear. METHODS: The study population includes self-identified Hispanic/Latino adults with diabetes. We have two aims: (1) designed and developed a transition of care model and (2) pilot test the newly developed transition of care model. For aim 1, semi-structures interviews conducted with patients and providers. For aim 2, patients admitted to the hospital enrolled to receive the newly designed transition of care model. For aim 1, patients and providers completed a short questionnaire. For aim 2, patients completed a set of questionnaires including demographic information, medical history, sociocultural, and social support. The primary outcome for aim 2 is emergency department visit within 30 days post-discharge. The secondary outcome is 30- days unplanned readmissions. Feasibility outcomes include the number of participants identified, number of patients enrolled, number of participants who completed all the questionnaires, number of participants with a 30-day follow-up call, and number of participants who completed the 30-day post-discharge questionnaire. Due to the COVID-19 pandemic, the study design was adapted to include the Plan-Do-Study-Act framework to adjust to the ongoing changes in transition of care due to the pandemic burden on the health care systems. CONCLUSION: Transition of care for Hispanic/Latino patients with diabetes remains a major area of interest that requires further research. The pandemic required that we adapted the study to reflect the realities of health care systems during a time of crisis. The methods share in this manuscript can potentially help other investigators as they designed their studies. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT04864639. 4/29/2021. https://clinicaltrials.gov/ct2/show/NCT04864639 .

The Impact of Racial Bias in Patient Care and Medical Education: Let's Focus on the Educator.

Introduction: Racial bias in health care is well documented. Research shows the presence of racial bias among health care providers. There is a paucity of workshops focused on racial bias effects in health professions educators. Method: Two to three workshops were delivered to a diverse group of clinical educators from three programs at a major academic institution. Each workshop included a brief multimedia presentation followed by a facilitated group discussion. Participants completed the online Implicit Association Test (IAT), a baseline demographic questionnaire, and a brief post-then-pre questionnaire. Results: Twenty-four faculty participated in the study (six physicians, eight nurse practitioners, 10 physician assistants). Nineteen (90%) were women, 18 (86%) were White, nine (43%) had more than 10 years of experience as educators, and seven (35%) had previously participated in a biases program. Seventeen completed the IAT. Sixteen educators agreed or strongly agreed that bias has a significant impact on patients' outcomes at the end of the workshop compared to 17 before the workshop. Seventeen educators agreed or strongly agreed that recognizing their own racial bias would positively alter their teaching practice after the workshop compared to 15 before the workshop. Discussion: This series of workshops was created to fill a gap regarding the impact of racial bias on patient outcomes, health disparities, and health professions education. The impact of racial bias in health professions education and the long-term impact of awareness and knowledge of racial bias in education are areas needing further evaluation.

The added value of clinical faculty in building effective academic-practice partnerships.

ABSTRACT: Clinical faculty are entrusted with providing high-quality education for nurse practitioner (NP) students while engaging in clinical practice, scholarship, and service. To provide NP students with utmost clinical training and education, clinical faculty should maintain a clinical practice in their area of expertise. The American Association of Colleges of Nursing and the National Organization of Nurse Practitioner Faculties have asserted that nursing faculty providing clinical education must be expert clinicians. The challenge many clinical faculty face is maintaining a practice while balancing the expectations of the faculty role. This article highlights the value of clinical faculty in a large private academic institution as essential members in building partnerships, supporting preceptors, and enhancing NP students' clinical training. A critical aspect of the partnership was the unique role and the added value the clinical faculty member provided in building and expanding community partnerships.

Colorectal Cancer Screening: A Quality Improvement Initiative Using a Bilingual Patient Navigator, Mobile Technology, and Fecal Immunochemical Testing to Engage Hispanic Adults.

BACKGROUND: Fecal immunochemical tests (FITs) are an effective screening method to detect and prevent colorectal cancer (CRC) when done in appropriate intervals. The use of bilingual patient navigators (PNs) and secure short message service (SMS) has been demonstrated to increase CRC screening rates among Hispanic adults. OBJECTIVES: The purpose of this quality improvement project is to increase CRC screening rates among Hispanic adults in a family clinic by 25% in the post-project implementation period using an unlicensed bilingual PN, secure SMS, and at-home FITs. METHODS: A retrospective chart review was used. Spanish-translated educational videos were delivered using SMS, and instructional screening guidance was provided via telephone in Spanish by the PN. Participants were surveyed to determine satisfaction with the support received from the PN. FINDINGS: Findings showed a 35% increase in the clinic's FIT rates. Findings also showed that having a PN's support influenced the decision to complete FIT as compared to the use of secure SMS.

Preparing RNs for Primary Care: Value Added.

The U.S. health care system needs a fundamental redesign, as the current model of care is not meeting the needs of the population for primary care. Factors affecting the primary care workforce include a decrease in primary care providers, an increase in the aging population with limited health insurance, and a decrease in health care access. With the current emphasis for primary care redesign and team-based care, RNs practicing with an expanded role are in a unique position to address the primary care crisis. However, limited data exist on the academic and clinical preparation of RNs to practice in an outpatient or primary care setting. This article describes an educational program for RNs hired to work in an expanded role in a primary care setting. [J Contin Educ Nurs. 2021;52(2):100-104.].

Evidence-Based Approach to Healthy Food Choices for Hispanic Women.

Obesity rates have reached epidemic proportions in the United States and Hispanic women, particularly Mexican American women, are disproportionately affected. This quality improvement project, which took place at a clinic in East Los Angeles, California, implemented body mass index calculation, an eight-item starting the conversation (STC) tool, and culturally sensitive nutrition education in an effort to change the overweight/obesity status of these women. There were 36 female Hispanic patients who participated in this study. There was a significant decrease in body mass index percentile from pre implementation to 2-months post implementation. The total STC score decreased significantly from pre implementation to 2-months post implementation, indicating a positive change in dietary behavior. Dietary screening and intervention tools can assist health care providers with early identification of overweight/obesity status and prevention of overweight/obesity-related diseases. The STC tool will allow the health care provider to start the conversation about healthy food choices and provide for further culturally sensitive nutrition education.

Improving Self-Care Management in Low-Income Latinos With Type 2 Diabetes Using Peer-Led U.S. Conversation Maps: A Quality Improvement Project in a Free Clinic.

A culturally sensitive Healthy Interactions Conversations Maps program was implemented for teaching diabetes self-management education (DSME) to Latinos with type 2 diabetes using peer-led educators in a community health center. Patients were invited to participate in a group care setting to improve access to providers and DSME. Goals were to improve diabetes distress, self-efficacy, and glycemic control as measured by A1C. Significant improvements were found for mean diabetes self-efficacy scores from before (2.53 ± 0.59) to after (2.91 ± 0.50) DSME (P <0.001). Mean A1C decreased significantly from before (9.51 ± 1.72%) to after (8.79 ± 1.68%) DSME (P = 0.043) at the end of the 6-month intervention. Thus, this program was found to be a useful tool for providing DSME in community health clinics serving low-income Latinos.

Developing Innovative On-Campus Intensives to Enhance Distance-Based Nurse Practitioner Programs.

BACKGROUND: The delivery of higher education has changed dramatically in recent years due to the shift toward distance learning, resulting in a need for creative education delivery methods. This article describes the implementation of on-campus intensives (OCIs) within a revised curricular framework for nurse practitioner (NP) students. Sequential OCIs are designed to promote role transition and professional and clinical development throughout the NP student's coursework. METHOD: The OCIs were established using a core curriculum framework. The development of the OCIs was an extensive process that requires widespread collaboration between faculty and staff. RESULTS: The OCIs have been successfully implemented over multiple semesters. Faculty, staff, and students have suggested benefits along with opportunities for improvement. CONCLUSION: The OCI experiences promote engagement, clinical competency, and professional development to prepare NP students to lead in today's complex and evolving health care system. [J Nurs Educ. 2019;58(9):543-547.].

Optimizing Advanced Care Planning in Hospitalized Patients With Advanced Cancers: A Quality Improvement Initiative.

BACKGROUND: Advance care planning (ACP) that generates an advanced directive (AD) can ensure patient autonomy at end of life. ACP is challenging for healthcare providers. Delaying patient ACP may lead to poor quality end-of-life care. Facilitation of early ACP by bedside RNs and social workers (SWs) may improve end-of-life care. OBJECTIVE: To determine whether improved ACP by RNs and SWs impacts care transition times for patients with advanced cancers. METHODS: A pre-/post-educational intervention designed to reinforce the roles of RNs and SWs in facilitating early ACP and timely documentation of an AD on an inpatient oncology unit. RESULTS: AD documentation increased by 12% between pre- and post-intervention period. There was a nonsignificant trend toward longer lengths of stay for patients transitioning care without an AD compared to those patients with and AD. DISCUSSION: Bedside RNs and SWs are in a key position to facilitate early ACP which can positively impact care quality at end of life. However, ACP is a collaborative team effort, best initiated early by the primary oncology providers. CONCLUSION: Early ACP may improve quality end-of-life care. IMPLICATIONS FOR NURSING: Continuing education for RNs and SWs to enhance coordination with primary oncology teams to facilitate earlier ACP is recommended.