Diabetes Self-Management Education in the Home.

PURPOSE: Diabetes self-management education and home visits have been found to improve clinical outcomes in individuals living with diabetes. The purpose of this pilot project was to evaluate the feasibility and effectiveness of conducting self-management education in patients' homes. METHODS: Baseline biometric data was collected from a cohort of adult patients with diabetes. Home visits to 19 patients were conducted by doctoral students from Rutgers University School of Nursing. The visits included knowledge assessment, review of foods in the home, diabetes self-management education, and teaching the proper use of monitoring tools such as the glucometer and blood pressure monitor. Biomarkers were obtained post-intervention and were compared to baseline biomarkers. Descriptive lifestyle data was collected and opportunities for customized patient education were provided. RESULTS: The biomarkers improved overall during the four months after the education intervention. The mean A1C reduced 12% (p=0.0107), the mean glucose reduced 12% (p=0.0994), the mean BMI reduced 2% (p=0.1490), the systolic pressure reduced 1% (p=0.4196), and the diastolic pressure remained stable. Specific goal setting further increased the improvement in the area the individual planned to address. CONCLUSIONS: This project supports prior studies that found that in-home educational programs can improve the self-management of diabetes and lead to improvement in health indicators. The benefits of the study included personal attention in ensuring the correct use of home health monitoring devices, building self-management confidence, and identifying treatment barriers that may not be easily discerned in a clinic setting.

Doctor of Nursing Practice Program Capacity Building and Scalability: Improving the Capstone Experience.

Innovations in the educational process are required to address the divergent needs of nursing students depending on their point of entry, either postbaccalaureate or postmaster's degree preparation. The requirement of the scholarly doctor of nursing practice (DNP) project demands significant student and faculty resources. With the variability of students' education, practice experience, and interest, the expectations of the project need to fit the needs of the adult learner. Linking these projects to clinical settings is an end goal for these efforts which supports the scalability of these programs.Faculty from Rutgers School of Nursing considers practice change and quality improvement a priority in preparation of the DNP graduate. With curricular enhancements, students are considering patient access, safety, and quality from the beginning of their doctoral education. An innovative course series progression was implemented to prepare students for the scholarly practice evaluation. In addition, capstone and residency courses were reformatted to assist students in evaluating models of evaluation, systems of care, and to further define the issue they wish to address through their scholarly inquiry. Throughout the clinical doctoral preparation, students are encouraged to evaluate practice in a standardized critical format and ultimately, execute a scholarly project.By linking these projects to the clinical setting, the DNP program increases its scalability. Connecting the academic institution with the clinical setting allows for increase student access to learning experiences and the capability of scholarly projects to continue in the setting. Faculty resources are well used in this manner. This process allows for continued capacity building within the academic and clinical setting.

Addressing the Health Care Delivery Needs in the Acute Care Setting by Developing a Postmaster's Acute Care Certification Program.

The state of New Jersey certifies nurse practitioners and clinical nurse specialists from all specialties as advanced practice nurses (APNs). There are more than 4,000 certified APNs in the state in 17 specialty areas. APNs in the state have the privilege of practicing in various settings such as ambulatory, inpatient, and long-term care. The state does not limit the setting where an APN chooses to practice. A trend is emerging in the state to address the concern of primary care-educated APNs to prepare them for the delivery of care in the acute care setting. Some institutions within the state of New Jersey are requiring their primary care educated and certified adult primary care APNs working in an inpatient setting to obtain an acute care certification. Recognizing the needs of these adult primary care APNs, Dr. Helen Miley developed a postmaster's certificate program which has been approved by Rutgers School of Nursing faculty. Although the first cohort has not yet been admitted to the program, it will be implemented in the near future. Because it is important to address the educational needs of adult primary care APNs, this article describes the needs assessment and development plan used for this program.

Is this case an EMTALA violation?

The advanced practice registered nurse (APRN) working in the emergency department (ED) is asked to see a patient with an "eye infection." The patient has a severe retrobulbar orbital abscess requiring complex multidisciplinary specialty management and is ultimately transferred to a tertiary care center. The patient had first presented to a community ED per the recommendation of her ear, nose, and throat (ENT) specialist. The patient was advised to leave the first ED during triage and to go to a second community ED. Although the referring physician was made aware of the recommendation to have the patient drive to another facility, the APRN questions whether this is a case of an Emergency Medical Treatment and Active Labor Act (EMTALA) violation. This article defines EMTALA and evaluates the case.

The legal and ethical implications of social media in the emergency department.

Social media is a growing and popular means of communication. It is understandable that health care providers may not share identifying information on patients through these sources. Challenges arise when patients and family members wish to record the care provided in the emergency department. The health care provider may be faced with an ethical and possibly legal dilemma when social media is present in the emergency department. This article seeks to discuss the legal and ethical principles surrounding social media in the emergency department.