bluuebunny/crossref_metadata_2025 huggingface dataset:
Legislative Issues Impacting On The Practice Of The South African Nurse Practitioner
Authors: Geyer Nelouise , Naude Susan , Sithole Gladys
Published: May 2005

Purpose

To present an overview of the impact of the nurse practitioner (NP) on the South African health care arena and describe the legislative framework for NP practice.

Data Sources

Statutes and laws of the government of South Africa; published professional guidelines; authors’ experiences.

Conclusions

The key challenges for NPs in South Africa lie in lobbying for enabling legislation, obtaining access to education and training opportunities, and managing risks within the rapidly changing environment.

Implications for Practice

Some aspects of the NP's accountability and responsibilities have as yet not been adequately addressed in the current legislative framework and will certainly increase the risk for malpractice. South African NPs will have to establish partnerships with important role players, not only in South Africa, but also internationally, to ensure that an enabling environment for quality health services is created.
The Female Athlete Triad: A Terrible Trio Implications for Primary Care
Authors: Schumann Lorna , Kleposki Raymond W.
Published: May 2005

Purpose

To describe the components of the female athlete triad, including definitions and clinical criteria for diagnosis, methods of screening, and treatment options.

Data Sources

Selected scientific literature; standard diagnostic guidelines.

Conclusions

The female athlete triad is a cascading event consisting of disordered eating, amenorrhea, and osteoporosis. This disorder can occur in any sport but is seen most often in events that emphasize thinness and appearance such as gymnastics, ballet, and diving. It can often go unrecognized and result in irreversible bone loss and possible death.

Implications for Practice

Primary care nurse practitioners (NPs) may be the first health care professionals encountering these females; they need to recognize the risk factors and institute a multidisciplinary approach to treatment. The treatment team should be composed of the patient, the NP, a dietitian, a psychologist, psychiatrist, or psychiatric nurse specialist, and the patient's family, coaches, and trainers.
Secondary Hypertension In A Migrant Farm Worker: A Case Report Of Coarctation Of The Aorta
Authors: Fleming Scott , Lefranc Yves , Rodway George , Wilson Beth Ann
Published: May 2005

Purpose

To report a case of undetected aortic coarctation in an adult Hispanic migrant farm worker that presented with uncontrolled hypertension and transient left flank pain. A primary care overview of the disorder, clinical diagnosis, testing, and treatment are discussed.

Data Sources

Case report, scientific literature, diagnostic evidence.

Conclusions

Coarctation of the aorta is a significant congenital cardiovascular anomaly and cause of secondary hypertension. The majority of patients with coarctation of the aorta are diagnosed during infancy. Older children and adults may have a subtle presentation, but can be identified as being at risk by having a thorough history and physical, as well as noninvasive diagnostic testing.

Implications for Practice

Primary care providers must have a high degree of suspicion in patients with risk factors or in individuals that may have not benefited from adequate health screening. Early diagnosis and correction of the coarctation is important to reduce persistent postoperative hypertension and improve long‐term survival.
Primary Care Cancer and Diabetes Complications Screening of Black Women with Type 2 Diabetes
Authors: Melkus Gail D'Eramo , Maillet Nancy , Novak Jennifer , Womack Julie , Hatch‐Clein Annette
Published: May 2005

Purpose

To determine the frequency with which Black women with type 2 diabetes receive routine primary health care screening for cancer and diabetes complications.

Data Sources

Pilot study data from a convenience sample of 21 Black women (mean age 46.8 years) with type 2 diabetes.

Conclusions

Cancer screening consisted of Pap smear, mam‐mography, and colon cancer screening consistent with current American Cancer Society recommendations. Ninety percent reported having had a Pap smear, 86% mammogram and 33% colon cancer screening. Diabetes complications screening was based on the American Diabetes Association care recommendations. Fifty‐five percent received screening eye exams, 40% were screened for renal proteinuria, and 50% received foot examinations and diabetes foot care instruction.

Implications for Practice

This sample of mid‐life, Black, educated, working women with type 2 diabetes utilize healthcare services and have high rates of primary care cancer screening. Rates of diabetes complications screening are less than optimal. Because Black American women suffer disproportionately high rates of diabetes and related complications, it is imperative that they receive quality diabetes care in an effort to improve health outcomes and decrease premature mortality.
The State Children's Health Insurance Program (CHIP)
Authors: Jenkins Jami , Faulkner Tracy
Published: May 2005

Purpose

To provide an overview of the Children's Health Insurance Program (CHIP), along with implications for practice as it applies to nurse practitioners.

Data Sources

Extensive review of the on‐line and published literature on CHIP.

Conclusions

Congress established CHIP in an effort to reduce the high number of uninsured children in America. Each state administers its own program and children who are under age 19, 200% below federal poverty levels, and ineligible for Medicaid may qualify. Even though CHIP has made health care possible for over million children, there are still many obstacles that need to be overcome to ensure that access to healthcare is a reality for America's children.

Implications for Practice

Although CHIP has made healthcare accessible for many low income children, there are still hundreds of children left without health insurance. Many children who could qualify for CHIP remain without access to healthcare. Nurse practitioners have the opportunity to make healthcare a reality for children by becoming knowledgeable about this plan in order to refer patients to the program who are eligible and by advocating for future legislation that will ensure its long term success.
Implications of Self‐administered St. John's Wort for Depression Symptom Management
Authors: Boehnlein Beth , Denise Linda
Published: May 2005

Purpose

To provide nurse practitioners (NPs) with a greater understanding of the complex issues surrounding St. John's wort as a self‐treatment for depression; to review laws regulating the production and sale of herbal products in the United States (U.S.); and to review clinical and practice implications for the self‐administration of St. John's wort and herbal treatments.

Data Sources

Federal regulations pertaining to herbal products, current research literature, and anecdotal and consumer reports.

Conclusions

Current research findings suggest that St. John's wort may be an effective treatment for mild depression; however, evidence of significant adverse drug interactions with St. John's wort should not be overlooked.

Implications for Practice

Clinical assessment of the mildly depressed patient wishing to self‐administer St. John's wort requires basic knowledge of this herbal supplement including regulation and risk information. An open Nppatient relationship helps to ensure patient disclosure of self‐administered St. John's wort.
The Advanced Practice Nurse's Role Regarding Women's Delay in Seeking Treatment with Myocardial Infarction
Authors: Lefler Leanne
Published: May 2005

Purpose

To synthesize nursing literature on reasons women delay in seeking treatment for signs and symptoms of an acute myocardial infarction (AMI), to hypothesize upon the primary reason(s) for this delay, and to propose advanced practice nurse (APN) interventions to reduce this delay.

Data Sources

Utilizing Stetler's Model of Research Utilization, all reports published in nursing journals within the last 10 years specifically examining prehospital delay related to gender factors were analyzed.

Conclusions

Women, especially those in advanced age, delay longer before seeking treatment for signs and symptoms of AMI. Effective treatment is time dependent; mortality and morbidity rise with increased prehospital delay. The reasons identified in the literature for this delay included severity, specificity, atypical presentation of symptoms, differences in event perception according to gender roles, and the interpretation and attribution of symptoms.

Implications for Practice

Identifying and teaching women at highest risk for delay, dispelling internal and external gender bias, increasing one's perception of patient vulnerability to AMI, and developing one's awareness of atypical presentations are the major factors that are likely to impact APN practice and consequently reduce prehospital delays for women at risk.
Asthma: A Case Study, Review of Pathophysiology, and Management Strategies
Authors: Schumann Lorna , Guthrie Carlton M. , Tingen Martha S.
Published: May 2005

Purpose

To review the pathophysiology of asthma, present a case study, and provide management strategies for treating this common, yet complex disorder in children and adults.

Data Sources

Selected clinical guidelines, clinical articles, and research studies.

Conclusions

Asthma is a chronic inflammatory airway disorder with acute exacerbations that currently affects approximately 14 million‐15 million children and adults in the United States. Costs for asthma are staggering and nurse practitioners (NPs) are frequently presented with management decisions for the acute treatment and chronic management of this disorder. Disparities exist with the occurrence of asthma between race and gender. Additionally, there an increased incidence in acute exacerbations resulting from poor long‐term control and follow‐ up care among the socioeconomically disadvantaged.

Implications for Practice

Standards of care, along with new and emerging treatment strategies, guide NPs in providing the most comprehensive care to those affected with this chronic disorder. Knowledge about the pathophysiology of asthma and correlated to the case presentation enhances understanding treatment strategies for NPs who are often faced with providing care for patients with this chronic disorder that may sometimes present in an acute exacerbation.
Exploring Telehealth Opportunities in Domestic Violence Shelters
Authors: Mattson Susan , Shearer Nelma , Long Carol
Published: May 2005

Purpose

To determine the degree of interest in using a computer for the purpose of accessing services from a nurse practitioner (NP) at domestic violence shelters (DVSs); and to identify issues of privacy and confidentiality that might arise from participation by victims of intimate partner violence (IPV) in a Telehealth intervention.

Data Sources

Focus groups with 19 women residing in two DVSs. Interviews were recorded, transcribed and themes were identified that answered the questions posed in the interviews.

Conclusions

Most of the women understood the term NP and were favorably inclined to seek services from one. Over half of the women were not familiar with computer use, but were willing to learn in order to receive health care services, both for episodic needs and for maintenance of chronic conditions. After learning of the method proposed to allow them to access an NP through the internet while still protecting their privacy and confidentiality, the women felt comfortable with this approach to meeting their health care needs.

Implications for Practice

Results from this study can be used to support the development and testing of Telehealth interventions for these victims of IPV.
Structure and Process of Outcomes Research for Nurse Practitioners
Authors: Moores Patricia , Breslin Eileen , Burns Margaret
Published: May 2005

Purpose

To present a framework for nurse practitioners (NPs) who wish to engage in outcomes research.

Data Source

Review of scientific literature on the design of outcomes research.

Conclusion

The structure and process of outcomes research includes both the research protocol and the decisions related to designing and implementing a study. Each identified step of the presented framework incorporates issues related to decision making relevant for that specific component of the research protocol.

Implications for Practice

Practical advice guides the NP in beginning to identify researchable problems within the clinical setting suited to outcomes research. Using a framework to design an outcomes study assists the NP in making key study decisions.
Counseling Middle‐Aged Women About Physical Activity Using the Stages of Change
Authors: Dearden Jennifer S. , Sheahan Sharon L.
Published: May 2005

Purpose

To discuss application of the Stages of Change theoretical framework and provide clinical tips on exercise adherence among midlife women. Included is a checklist to assist the nurse practitioner (NP) in effectively delivering the message.

Data Sources

Review of the current scientific literature on exercise adherence and the Stages of change model.

Conclusions

Middle‐aged women comprise a unique population. Determining the woman's readiness for change using the Stages of Change model, NPs can routinely include appropriate exercise recommendations in their practices.

Implications for Practice

Nurse practitioners are in a unique position to promote healthy behaviors by counseling women in midlife about adopting an active lifestyle. Exercise counseling is an essential component of healthcare, especially among middle‐aged women who are experiencing physical, emotional, and social changes.
Challenge and Opportunity: Nurse Practitioner Programs Partnering with Managed Care
Authors: Hayes Eileen F.
Published: May 2005

Purpose

To examine the experiences of nurse practitioner (NP) students who participated in a collaborative educational program between the University of Massachusetts, Amherst, and Health New England (HNE) Health Plan, Springfield, MA. Nurse practitioner faculty and managed care executives shared resources to educate NP students and to address their perceptions about managed care.

Data Sources

Verbatim transcriptions and journal writings of students specifically designated as Partnerships for Quality Education (PQE) trainees” and reports of their fellow classmates, all of whom received varying extent of access to managed care theory, administrative, and clinical experiences within the HNE plan.

Conclusions

The experiences of the PQE trainees revealed a greatly expanded understanding of managed care that challenged students' previous beliefs. They reported greater satisfaction with program participation than their classmates, had an unprecedented opportunity to articulate the NP role to a managed care organization (MCO), and learned that a collaborative, rather than an adversarial, relationship with an MCO produces better outcomes for patients and providers. Many students in the class, including some of the PQE trainees, were concerned, however, about what they perceived as managed care “taking time away from clinical issues,” which they considered more important. Implications for Teaching and Practice There is a need for balance between both managed care and clinical content in NP programs, yet students must have an intimate grasp of both if they are to survive in today's health care environment.
End‐of‐Life Treatment Preferences Among Older Adults: A Nurse Practitioner Initiated Intervention
Authors: Resnick Barbara , Andrews Caryn
Published: May 2005

Purpose

To explore end‐of‐life treatment preferences (ELTP) among older adults and to test the impact of a nurse practitioner (NP) initiated intervention to facilitate the completion of ELTPs.

Data Sources

A descriptive study including 135 older adults living in a continuing care retirement community.

Conclusions

The findings in this study suggest that the majority of older adults do not want life sustaining interventions at the end of life, but are willing to accept interventions that will keep them comfortable. ELTP can, however, change over time. An NP‐initiated teaching intervention about advance directives and ELTP significantly increased the number of individuals who completed advance directive forms.

Implications for Practice

With the advancement of medical technology, various life‐sustaining treatments are available at the end of life. Older adults should be encouraged to establish their ELTPs while they are physically and mentally able to do so. Health care providers should initiate discussions about ELTP at regular intervals (yearly) to assist older adults in participating in decisions about their end‐of‐life care.
Pregnancy Rhinitis and Rhinitis Medicamentosa
Authors: Rambur Betty
Published: May 2005

Purpose

To present guidelines for the recognition, management, and referral of pregnancy rhinitis with a goal of improving the quality of the pregnancy experience for women afflicted with this condition.

Data Sources

A case study illustrating the presentation of a severe case of pregnancy rhinitis is followed a literature review of etiology, diagnosis, and management strategies.

Conclusions

Pregnancy rhinitis is a condition of clinical importance that is frequently exacerbated by use of intranasal decongestant sprays. The resulting rhinitis medicamentosa exacerbates the nasal obstruction, with resulting sleep disruptions that negatively impact the experience of pregnancy.

Implications for Practice

Nurse practitioners may miss opportunities to provide support, anticipatory guidance, and symptom relief. Anticipatory guidance that stresses the critical necessity of avoiding nasal spray decongestants, environmental modification, use of intranasal saline, moderate exercise, and nasal strips for subjective relief may have the potential to markedly decrease escalation of the condition to a serious disorder.
Nurse Practitioners' Treatment of Febrile Infants in Utah: Comparison to Physician Practice Nationally
Authors: Badger Matthew J. , Lookinland Sandra , Tiedeman Mary , Anderson Vickie , Eggett Dennis
Published: May 2005

Purpose

To determine nurse practitioners' (NPs') knowledge of published guidelines involving the treatment of infants with fever without a source and to compare the practice of NPs in Utah to physicians nationally.

Data Sources

Using a comparative descriptive design, a survey was sent to 450 NPs in Utah replicating the methodology of a 1998 survey of physicians. The NPs were asked about their evaluation decisions and management strategies for various ages of infants/toddlers with fever without a source.

Conclusions

The practice decisions of NPs in Utah and physicians nationally were similar. Family NPs' clinical decisions aligned more closely with family practice medical doctors and pediatric NPs' with pediatricians. Overall, the younger the patient, the more likely were NPs to order labs and antibiotics or to hospitalize/refer to a physician. The fact that management decisions were not based upon existing protocols may account for the practice variation seen among NPs.

Implications for Practice

Management of a febrile infant is a common clinical scenario for the primary care provider. Although evidence‐based protocols exist, the treatment of febrile infants remains controversial. Overall, NPs' evaluation and management of these infants were not shown to differ from physicians. Further studies are needed to determine why clinical guidelines are not being followed.
Exploring the Association Between Body Weight, Stigma of Obesity, and Health Care Avoidance
Authors: Alegria Drury Christine Aramburu , Louis Margaret
Published: May 2005

Purpose

To explore the stigma of obesity and its effect on health care utilization, associations between self‐esteem, attribution for weight, body mass index (BMI), satisfaction with medical care and the behavior of delaying/avoiding health care were examined.

Data Sources

A convenience sample of 216 women recruited from church sites in Las Vegas completed self‐administered questionnaires.

Conclusions

The findings show an increase in BMI is asso‐ciated with an increase in the delay/avoidance of health care. Weight‐related reasons for delaying/avoiding health care included having “gained weight since last health care visit,” not wanting to “get weighed on the provider's scale,” and knowing they would be told to “lose weight.”

Implications for Practice

The obese are a stigmatized and vulnerable population. Nurse practitioners are challenged to be aware of attitudes towards obesity and to identify ways to promote continuity of care and regular health maintenance. The goals of Healthy People 2010 to reduce obesity‐related morbidity cannot be met if health care is delayed/avoided.
Prenatal Care Services in the Public and Private Arena
Authors: Blackwell Deborah A.
Published: May 2005

Purpose

This exploratory study described the prenatal care experience in the public and private arena from the perceptions of childbearing women using interpretive interactionism.

Data Sources

A face‐to‐face interview comprised of eight open‐ended questions was used to obtain pregnant women's perceptions of their prenatal care experience and prenatal care needs. The purposive sample consisted of six women who received private prenatal care and 14 women who received public prenatal care.

Conclusions

Five essential elements of the prenatal care experience were identified. Prenatal care was viewed as a cooperative effort between informal self‐care and formal care by health professionals. Issues related to individuality and normality were important considerations in the delivery of prenatal care.

Implications for Practice

Controversy exists over the effectiveness of prenatal care in preventing poor outcomes, as the definition of what constitutes adequate prenatal care remains unclear. Advanced practice nurses (APNs) continue to play a pivotal role in the provision of prenatal care services. The expanded knowledge and skills possessed by APNs place them in a pivotal position to develop and implement individualized, developmentally appropriate prenatal care that the women in this study so desperately wanted. In addition, they can assist women in continuing the health promoting behaviors initiated prenatally through out their lifespan.
CLINICAL PRACTICE GUIDELINES
Authors: Goolsby Mary Jo , Blackwell James
Published: May 2005

This month's clinical practice guideline (CPG) review is on fever of uncertain source FUS), also known as fever of unknown origin (FUO). A hospital‐based committee for the Cincinnati Children's Hosptal Medical Center developed this guideline to help practitioners evaluate and manage FUS in a logical manner and with a judicious use of antibiotics. This guideline should have a wide interest to practitioners due to the large number of children that annually present with fever.
Preventing Pediatric Obesity: Assessment and Management in the Primary Care Setting
Authors: Schumann Lorna , Nichols Mary R. , Livingston Dora
Published: May 2005

Purpose

To review the literature on and discuss the role of the primary care provider in assessing and managing overweight children before they become obese.

Data Sources

Selected research, national guidelines and recommendations, and the professional experience of the authors.

Conclusions

The focus of primary care involves early detectionand family interventions that are designed for lifestyle modifications, specifically for improved nutrition and an increase in regular physical activity, to achieve optimal child health. Early identification and management of children who exceed a healthy weight for height, gender, and age will prevent the increasing incidence of pediatric obesity. Early prevention and management of pediatric overweight and obesity will also decrease the potential for associated medical and psychosocial problems.

Implications For Practice

Pediatric obesity has risen dramatically in the United States during the last two decades; it is a significant child health problem that is preventable and largely under‐diagnosed and under‐treated. It is essential to discuss prevention of obesity with parents at every well‐child visit; treatment should be initiated when patterns of weight gain exceed established percentiles for increasing height for age and gender.
Barriers to Preventive Health Care for Young Children
Authors: Kataoka‐Yahiro Merle R. , Munet‐Vilaro Frances
Published: May 2005

Purpose

To review the literature on barriers to availability, access, and utilization of preventive health care for young children three to five years of age and their families and to discuss the role of nurse practitioners (NPs) in future research, education, and practice in this area.

Data Sources

A comprehensive literature search was conducted of online material and CINAHL and Medline (CD‐ROM 1990 to present). In addition, experts in this area were asked to recommend extra reading materials. Additional references in textbooks and articles were examined.

Conclusions

The literature review supports that there are major barriers to be addressed in the areas of availability, access, and utilization of preventive health care services for young children and their families. Major concerns include mandatory system for preventative health care, lack of health insurance coverage, cultural issues, and parental effects.

Implications for Practice

Health professionals in the community will need to work together to reevaluate current preventive health care practices for young children. Alternative methods for approaching and providing preventive health care services may become increasingly important if these services for young children are to be provided at current or increased levels.
New Vaccine Technology ‐ What Do You Need to Know?
Authors: Minichiello Virginia
Published: May 2005

Purpose

To review the vaccine technology presently under development, in trials, or in some cases already available with a focus on applications for the primary care provider.

Data Sources

Selected scientific literature and Internet sources.

Conclusions

Vaccine technology has made significant advances in the last 100 years. Newer approaches in vaccine designs include recombinant subunit vaccines, reassortment virus vaccines, live viral vectors, conjugate vaccines, and DNA vaccines. Traditional vaccines are generally expensive to produce and both live vaccines and protein‐based vaccines require special storage conditions. These factors limit the worldwide usefulness of the familiar vaccines of today.

Implications for Practice

Keeping abreast of changes in this rapidly changing technology is necessary for health care providers to fulfill their roles effectively. New protocols that use nasal, vaginal, and intraperitoneal routes as well as subcutaneous injections and skin patches, edible vaccines and time release methods may be preferred depending on factors such as the age, health status, and emotional status of the patient. These advances hold promise for further progress in the development of vaccines that are protective against multiple organisms in more acceptable delivery systems.
Advanced Practice Nurses: A Study of Client Satisfaction
Authors: Bryant Rebecca , Clark Graham Margaret
Published: May 2005

Purpose

To describe the satisfaction of clients with care provided by advanced practice nurses (APNs) in the Wright State University (WSU) Pilot Project. The Pilot Project was created through state legislation that recognized APNs associated with three universities in Ohio for the purpose of granting the APNs title protection, prescriptive authority, and recognition leading to reimbursement.

Data Sources

The Interactional Model of Client Health Behavior (Cox, 1982), which proposes that client characteristics and interactions with health professionals determine health outcomes, served as the framework for this descriptive study. The study measured client (n=506) satisfaction with care delivered by 36 APNs at 26 different practice sites using an adapted Client Satisfaction Tool (CST). The internal consistency of the adapted CST was 0.935.

Conclusions

Client (n=506) satisfaction scores ranged from 28 to 50, with a mean score of 47.15 (SD=4.00). Findings suggest that clients are very satisfied with APNs in the WSU Pilot Project.

Implications for Nursing Practice

Client satisfaction is one indicator used to determine quality of care. Consumer satisfaction benefits the individual client and provides important information for the health care payer. Measuring and reporting client satisfaction with care provided by APNs may increase the visibility and marketability of APNs.
Diagnosing and Treating Alzheimer's Disease: A Practitioner's Overview
Authors: Schumann Lorna , Langbart Cynthia
Published: May 2005

Purpose

To provide an overview of current diagnostic protocols of Alzheimer's disease (AD), screening techniques, tests, and a review of standard and new treatments.

Data Sources

Selected articles from the scientific literature, online sources, and standard texts were examined.

Conclusions

Standard tools, such as the Geriatric Depression Scale, the Mini Mental State Evaluation, and the 7‐Minute Screen, are useful in the primary care setting for screening elderly patients. Other tools, such as the Clinical Dementia Rating (CDR) and the Global Deterioration Scale, are useful for staging and monitoring progression of disease and response to treatment. Clinical diagnostic testing is still in developmental stages, but the hope is to have a reliable and objective diagnostic tool in order to diagnose AD in the earliest stages.

Implications for Practice

The diagnosis and treatment of AD is becoming a more frequent challenge in the primary care office. Clinicians must keep abreast of the rapid changes in new technologies in order to make informed diagnostic and therapeutic decisions.
The Primary Care Nurse Practitioner: Advocate for Self Care
Authors: Thrasher Christine
Published: May 2005

Purpose

To critically analyze the role of the primary care nurse practitioner (NP) as advocate in promoting health through self care.

Data Sources

Selected philosophical and theoretical texts and articles, scientific literature, professional standards, and ethical arguments.

Conclusions

Philosophical reasoning and nursing theory must be used to validate and direct human practice. If self‐care and well‐being are desirable as an end and are defined as a movement toward self‐determination, then the philosophical goal of the NP must be the protection and promotion of self care and autonomy through client advocacy. Implications for Practice The role of the NP must be defined by its philosophy of care rather than by its function. The influence of philosophical reasoning, nursing, and critical social theory impact the ability of the NP to promote self‐care through advocacy. Understanding the lived experience is an essential component of advocacy.
The Master's Portfolio: Validating a Career in Advanced Practice Nursing
Authors: Hayes Eileen , Chandler Genevieve , Merriam Dorothy , Christine King M.
Published: May 2005

Purpose

To describe the process of portfolio development and faculty review that offers graduate credit within a framework of structural empowerment and mentoring for documented educational and clinical accomplishments for family nurse practitioners (FNPs).

Data Sources

Selected literature and examples from one student's portfolio to illustrate the process.

Conclusions

The degree granting process assists certified FNPs to fulfill career aspirations through achieving graduate level education at the University of Massachusetts, Amherst, School of Nursing.

Implications for Practice

The portfolio process affords practicing FNPs not only the opportunity to acquire an advanced degree but a framework for examining and validating a career. For the student in this exemplar, it was a “significant, introspective, satisfying learning experience,” a rare opportunity in a busy professional life.
The Role of Exercise in the African‐American Woman with Type 2 Diabetes Mellitus: Application of the Health Belief Model
Authors: Koch Julie
Published: May 2005

Purpose

To determine whether aging African‐American women with a diagnosis of type 2 diabetes mellitus who maintain a regular exercise regimen possess different health beliefs and benefit from greater glycemic control than those who do not exercise regularly.

Data Sources

A 32‐item health belief model diabetes scale was administered to a convenience sample of 31 African‐American women with type 2 diabetes.

Conclusions

A group t‐test identified statistically significant differences between “exercisers” and “nonexercisers” in perceived benefits and barriers to exercise and glycemic control.

Implications for Practice

Findings may be utilized in the development of diabetic educational programs and compliance‐ enhancing treatment interventions that focus on the barriers and benefits of diabetes self‐management.
Challenges of Outcomes Research for Nurse Practitioners
Authors: Breslin Eileen , Burns Margaret , Moores Patricia
Published: May 2005

Purpose

To describe the numerous methodological challenges nurse practitioners (NPs) face in designing and conducting outcomes research and provide practical tips to implement an outcomes study within an institution.

Data Sources

Review of world wide scientific literature on outcomes research.

Conclusions

Nurse practitioners must be aware of the challenges of conducting outcomes research. Challenges associated with variable definition, designing outcomes studies, use of data sets, and instrument development and selection must be understood prior to undertaking an outcome study

Implications for Practice

Valuable studies have laid a foundation for evidence of quality care provision by NPs. Now is the time to measure patient outcomes of the NP care longitudinally over significant periods of time.
INFECTIOUS DISEASES OF REFUGEES AND IMMIGRANTS
Authors: Kemp Charles , Roberts Amy
Published: May 2005

This series is based on the Infectious Diseases section of the web site Refugee Health ∼ Immigrant Health, available on the World Wide Web at http://www.baylor.edu/~Charles_Kemp/refugee_health.htm. The site was developed through a contract with the Texas Department of Health as part of an ongoing effort to improve the health of refugees and immigrants.
Efficacy of Raloxifene for Treatment of Menopause: A Systematic Review
Authors: Boyack Mark , Lookinland Sandra , Chasson Susan
Published: May 2005

Purpose

To critically appraise recent randomized controlled trials (RCT) of raloxifene and its effects on the long‐term consequences of menopause.

Data Sources

All RCTs of greater than six months duration in post‐menopausal women found in MEDLINE through July 2000.

Conclusions

Raloxifene lowered lipids, but estrogen had a more beneficial effect on HDL and fibrinolytic markers. Raloxifene had a more beneficial effect on triglycerides, inflammatory and thrombogenic markers. Compared to placebo, raloxifene reduced vertebral fractures but had a similar although lesser effect on bone mineral density and markers of bone turnover than estrogen. Estrogen receptor positive breast cancer was reduced by 90% with no increase in the incidence of endometrial cancer with raloxifene. The most serious side effect of raloxifene was an increased incidence of deep vein thromboses and pulmonary emboli.

Implications

Raloxifene has been shown to be beneficial using cardiovascular and osteoporosis endpoints in studies of short duration. More RCTs of longer duration with comparisons to other traditional treatments are needed before raloxifene becomes the treatment of choice.
Addressing Use of Herbal Medicine in the Primary Care Setting
Authors: Egan Colleen D.
Published: May 2005

Purpose

To critically evaluate existing approaches to the integration of allopathic and complementary and alternative medicine (CAM) and develop a middle ground approach to addressing use of herbal medicine and other forms of CAM in the primary care setting.

Data Sources

Extensive review of scientific literature and Internet sources supported by legal, philosophical, and ethical arguments.

Conclusions

A review of medical literature indicates that a growing number of people perceive both allopathic and CAM to be valued aspects of health care. Whether we agree with this perception or not, ethical, legal, clinical, and social considerations dictate that we assist patients in their efforts to derive benefit from use of CAM while helping them to minimize risks. Yet the current approach to addressing CAM in primary care is “don't ask, don't tell,” with approaches to filling this clinical void ranging from “just say no” to CAM use, to allopathic practitioners who also are CAM practitioners.

Implications for Practice

It is possible to occupy the middle ground, neither rejecting nor embracing CAM, but recognizing its significant impact on health care. In order to do this safely, clinicians need to be informed about herbs and other CAM practices, document thoroughly the informed consent and decision‐making process, and monitor patients carefully for adverse effects.
Promoting Health Among Perimenopausal Women through Diet and Exercise
Authors: Lange‐Collett Jennifer , Schumann Lorna
Published: May 2005

Purpose

To review the literature related to health promotion during the perimenopausal years and suggest methods for integrating those changes into the lifestyles of women in primary care.

Data Sources

Selected scientific literature and guidelines for exercise programs.

Conclusions

The transition into perimenopause presents an opportunity for addressing health promotion issues, such as diet and exercise. As a woman senses perimenopausal changes, health awareness emerges. Such personal insight motivates the woman to implement lifestyle changes.

Implications for Practice

Considering the average women will spend approximately one third of her life past menopause, a concerted effort is needed to ensure her well‐being. Diet and exercise represent two modifiable areas of concern for perimenopausal women. Dietary selections of phytoestrogens, calcium, fiber and fat along with exercises plans are relatively simple interventions to begin the process of change.
A Profile of Nurse Practitioners in Emergency Care Settings
Authors: Cole Frank L. , Ramirez Elda
Published: May 2005

Purpose

To determine characteristics of nurse practitioners (NPs) who provide emergency care.

Data Sources

Descriptive cross‐sectional study of a convenience sample of 113 NPs in emergency care obtained from the online Resource Directory of Nurse Practitioners in Emergency Care.

Conclusions

The majority of NPs in emergency care worked in facilities that were located in urban/suburban areas, were responsible for providing care in both the main emergency department and fast track area, held a Master of Science degree in nursing, obtained their education as a family nurse practitioner, and were certified as an NP by a national certifying agency. They were experienced registered nurses before becoming an NP but were relatively new to the NP role.

Implications

The results of this study provide information about characteristics of NPs who provide emergency care.
Utilization and Scope of Practice of Nurse Practitioners and Physician Assistants in Montana
Authors: Larsson Laura S. , Zulkowski Karen
Published: May 2005

Purpose

To explore the licensing, certification, governance and education requirements of nurse practitioners (NPs) and physician assistants (PAs) in the state of Montana. Services provided and privileges retained in employment were also analyzed.

Data Sources

This was a descriptive study using a survey of rural hospital administrators (N=34).

Conclusions

Survey results show that 92.5% of PAs in Montana meet their supervision requirement by a telephone contact provision outlined by the state board of medicine. In contrast, 54.2% of NPs, who are autonomous by legal definition, have a telephone supervision requirement imposed on them by their employers.

Implications for Practice

These findings have implications for the current and prospective professionals and the businesses for which they work. Nurse practitioners and their professional organizations need to consider the implications these findings have on the professional image and marketability of all NPs.
Infectious Diseases of Refugees and Immigrants: Hookworm
Authors: Roberts Amy , Kemp Charles
Published: May 2005

This series is based on the Infectious Diseases section of the web site Refugee Health ∼ Immigrant Health, available on the World Wide Web at http://www.baylor.edu/~Charles_Kemp/refugee_health.htm. The site was developed through a contract with the Texas Department of Health as part of an ongoing effort to improve the health of refugees and immigrants.
Early Recognition of Marfan's Syndrome
Authors: Schumann Lorna , Amado Juan A. , Thomas Debera J.
Published: May 2005

Purpose

To describe the classical features of Marfan's syndrome to help nurse practitioners (NPs) diagnose it in the early stages of progression and perhaps prevent many of its deleterious effects.

Data Sources

Selected research‐based articles in the scientific literature and classic medical texts.

Conclusions

The cause of Marfan's syndrome is unknown, but studies have linked it with a disorder of chromosome 15. It is a degenerative connective tissue disorder that affects the musculoskeletal, ocular, integumentary, respiratory, and neurologic systems. The most lethal effect is on the cardiovascular system causing dissecting aortic aneurysms.

Implications for Practice

Early diagnosis is essential for a positive course of management. Marfan's syndrome can have fatal consequences and is often underdiagnosed and misdiagnosed.
Gaining Insight into Age‐Related Macular Degeneration
Authors: Frock Terri L.
Published: May 2005

Purpose/objective

To enhance nurse practitioner (NP) recognition of clients with age‐related macular degeneration (AMD) based on history and physical examination findings, to encourage prompt initial referral of these clients to an ophthalmologist for a treatment evaluation, and to acquaint NPs with low vision rehabilitation services.

Data sources

Government documents, professional association practice guidelines, original research articles, journal articles, and Internet resources.

Conclusions

Age‐related macular degeneration is a common, chronic vision‐threatening condition necessitating prompt recognition and professional evaluation. If not recognized early, AMD can lead to low vision and a diminished quality of life for the elderly client.

Implications for practice

Even though NPs have a limited role in the treatment of AMD, they are in an instrumental position as a primary care providers to screen for this disease chiefly by: (a) adherence to eye examinations intervals, (b) recognition of risk factors, (c) use of the Amsler grid, (d) awareness of psychosocial dimensions, (e) making appropriate referrals, and (f) advocating low vision rehabilitation services.
Outcomes of a Community‐Based Three‐Year Breast and Cervical Cancer Screening Program for Medically Underserved, Low Income Women
Authors: Schulz Marcia A. , Ludwick Ruth , Cukr Penelope L. , Kelly Dennis
Published: May 2005

Purpose

To evaluate a community level three‐year breast and cervical cancer screening program for medically underserved, low income women.

Data Sources

Descriptive data on 128 women gathered from five semiannual screening programs held between 1995 and 1997 were analyzed.

Conclusions

Poor and medically under served women often face barriers that may discourage or prevent screening activity and measures for early detection of breast and cervical cancer. Besides success in recruiting women to the program, community collaborative partnerships were established that continue to sustain this program.

Implications for Practice

The results from this project provide an example of how advance practice nurses (APNs) can demonstrate meaningful and competitive health care services for underserved women and how APNs can actively evaluate programs they offer that affect the health practices of communities in need.
Assisted Living Facilities as a Site for NP Practice
Authors: Wink Diane M. , Holcomb Lygia Owen
Published: May 2005

Purpose

To describe what an assisted living facility (ALF) is, who resides in ALFs, and the benefits of nurse practitioner (NP) practice in an ALF for the client, facility, NP, and practice.

Data Sources

Selected scientific literature, legal and regulatory guidelines, consumer information and guidelines, Internet sites, and the authors'experiences.

Conclusions

Assisted living facilities are nonmedical residential settings grounded in a philosophy of providing residents with choice, autonomy, privacy, independence, dignity, and respect in a housing environment as homelike as possible. Nationally, ALFs vary considerably by size, services provided, and regulations imposed by states.

Implications for Practice

Assisted living facilities are now a popular choice for individuals who desire assistance with selected activities of daily living (ADL) while maintaining maximum independence. They are becoming an excellent site for the provision of in‐home primary care in order to facilitate aging in place.
Nuts and Bolts of NP Practice in Assisted Living Facilities
Authors: Holcomb Lygia Owen , Wink Diane M.
Published: May 2005

Purpose

To describe the practical issues associated with setting up a nurse practitioner (NP) practice in an assisted living facility (ALF), including record keeping, maintaining communication, and scheduling and coordination issues.

Data Sources

Selected scientific literature, legal and regulatory guidelines, and the authors’ experiences.

Conclusions

Initiating a NP practice in an ALF can be a rewarding experience, but it will not be without its own unique challenges. Procedures that maintain excellent communication between the NP, the home practice site, the resident and family, the ALF facility, and other services required by the needs of the resident take time and effort to establish but are worth the extra effort.

Implications for Practice

Nurse practitioners who establish a practice in an ALF need to be familiar with state regulations, facility procedures and culture, and the needs of elders who are aging in place and integrate all that into their office practice sites in order to be successful.
Chronic Cough: Evaluation and Management
Authors: Schumann Lorna , Madler Billie Jo
Published: May 2005

Purpose

To inform the nurse practitioner of the common causes of chronic cough, to educate how each cause can be identified, and to suggest treatment options for the most common causes.

Data Source

Selected research and review articles from professional journals.

Conclusion

Chronic cough is a common presenting complaint in the primary care setting. Although at first the symptom may seem simple, the etiology, diagnosis, and treatment of chronic cough can be challenging. Furthermore, without proper identification of the cause, effective treatment most likely will not be obtained.

Implications for Practice

By familiarizing oneself with this topic, nurse practitioners will feel confident in treating chronic cough.
Doctorial Dissertations On Nurse Practitioners: 1970–2000
Authors: Hooker Roderick S. , Mayo Helen G.
Published: May 2005

Purpose

To understand more about the nurse practitioner (NP) profession, a study was undertaken of the dissertation literature.

Data Sources

A search of Dissertation Abstracts Online yielded 134 dissertations that included NPs in the title or abstract and were awarded between 1970 and 2000.

Conclusions

Most of the degrees are either PhD (61%) or EdD (27%). State‐based universities produced the most degrees (70%) and six universities accounted for one‐fourth of the degrees. The topics of NP‐focused dissertations are wide ranging and include history, medical economics and managed care, NP education and professional role, and clinical and behavioral research.

Implications for Practice

This dataset provides an important source of information for research on the NP profession.