bluuebunny/crossref_metadata_2025 huggingface dataset:
Screening, Diagnosis, and Clinical Care for Depression
Authors: Goolsby Mary Jo
Published: May 2005

Depression is an extremely common condition, which usually responds well to prescribed treatment. Many patients have undiagnosed depression or related illnesses. There are a variety of screening tools that can be applied in practice settings. It is recommended that adult patients be screened for depression in practice sites able to coordinate the actual diagnosis and treatment of depression. This column reviews two sets of recommendations specific to the screening, diagnosis, and treatment of depression.

Readers are invited to submit suggestions for future CPG columns and manuscripts reviewing CPGs. NPs interested in contributing to the column are invited to contact the column editor, Dr. Goolsby, to discuss their ideas. JAANP's readership is broad, covering all NP specialties. CPGs applicable to any areas of care can be submitted (from acute care to long term care, from neonatal care to geriatric care).
School‐Based Rural Case Management: A Model to Prevent and Reduce Risk
Authors: Reel Sally J. , Morgan‐Judge Tina , Sue Peros Donna , Abraham Ivo L.
Published: May 2005

Purpose

To describe the development of the School Based Rural Case Management: A Model to Prevent and Reduce Risk in a primary health care academic nursing center practice in West Virginia.

Data Sources

Selected nursing and anthropological literature, regional health planning documents, and case examples.

Conclusions

The model guides identification of health risks and the provision of health service, health education, and support to students, families, and communities.

Implications for Practice

As primary health care services are developed within rural schools, a school‐based case management system assists matching appropriate services to the client, as well as supports program success.
Psychological Distress Among Abused Minority Women With Sexually Transmitted Diseases
Authors: Champion Jane Dimmitt , Shain Rochelle N. , Piper Jeanna , Perdue Sondra T.
Published: May 2005

Purpose

To describe psychological distress among abused minority women with sexually transmitted diseases (STDs) and to identify needs for psychotherapeutic intervention for reduction in abuse, sexual risk behavior and STD.

Data Sources

A controlled randomized trial of the effects of a behavioral intervention on STD recurrence. Eligibility was limited to English speaking Mexican‐American and African‐American women with a current non‐viral STD confirmed by laboratory testing (gonorrhea, chlamydia, syphilis or trichomonas). All eligible women who could be contacted were recruited from public‐health clinics in San Antonio. T‐tests, Chi square and correlation were used to analyze the data.

Conclusions

Women with STD and a history of abuse reported more symptoms of current psychological distress than nonabused women. This psychological distress was present in all dimensions of the SCL‐90‐R, including somatization, obsessive‐compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism. Increased current psychological distress and correlation was found not only for women with reports of sexual abuse but also forms of physical or psychological abuse. The majority of abuse was reportedly experienced during a relationship with a boyfriend or friend/acquaintance.

Implications for Practice

Abused women with STD may benefit from the identification and assessment of abuse history and psychological distress so that appropriate psychological treatment can accompany medical treatment. The prevalence of woman abuse within a population of women with STD mandates the inclusion of violence in STD prevention programs.
Magnet Therapy: What's the Attraction?
Authors: Ratterman Rebecca , Secrest Janet , Norwood Barbara , Ch'ien Anne P.
Published: May 2005

Purpose

To review the current state of the science of magnet therapy with respect to pain management and to view magnet therapy from a nursing perspective.

Data Sources

Extensive review of the world‐wide scientific literature and of scientific peer‐reviewed journals regarding magnet therapy.

Conclusions

Magnet therapy is gaining popularity; however, the scientific evidence to support the success of this therapy is lacking. More scientifically sound studies are needed in order to fully understand the effects that magnets can have on the body and the possible benefits or dangers that could result from their use.

Implications for Practice

Credibility for advanced practice will be established across disciplines as nurses demonstrate their ability to critically evaluate practices. Alternative therapies are accepted and used by many patients today. While magnet therapy is popular, the scientific evidence to support its use is limited, at best. Advanced practice nurses have more effective treatment modalities in their repertoire and are advised to avoid practices for which efficacy is unsupported.
Use of an Insulin Pen by Homeless Patients with Diabetes Mellitus
Authors: Wilk Terry , Mora Pablo F. , Chaney Susan , Shaw Kathleen
Published: May 2005

Purpose

To assess the impact of an insulin delivery system, the NovoPen®, on diabetes treatment for the homeless.

Data Sources

Homeless patients (n=23) with diabetes and using insulin were identified from a registry of patients with diabetes maintained at the Homeless Outreach Medical Services clinical sites. Baseline evaluations included glycosylat‐ed hemoglobin (HbAlc) measurements and a questionnaire about the patient's current treatment practices. Patients were instructed in the use of the NovoPen(r); HbAlc measurements and questionnaires were repeated after 3 and 6 months of participation.

Conclusions

Reductions of HbAlc were observed at 3 and 6 months. The authors concluded that use of the pen improved patient compliance and thus glycemic control.

Implications for Practice

Patients had improved quality of life after using the pen to administer insulin. Nurse practitioners should recognize quality of life issues when treating patients with chronic diseases. Nurse practitioners who care for homeless diabetes patients can promote better care for this population by educating homeless shelter staff about diabetes and its management.
The Efficacy of Metered‐Dose Inhalers with a Spacer Device in the Pediatric Setting
Authors: Buxton Lance J. , Baldwin Joan H. , Berry Judith A. , Mandleco Barbara L.
Published: May 2005

Purpose

To systematically review the published research and report on the efficacy of using a metereddose inhaler with a spacer (MDI‐S) device in a pediatric setting to treat acute exacerbations of asthma.

Data sources

A literature search was conducted on the CINAHL, Medline, and Cochrane databases; additional searches were made by hand from the reference lists in each study retrieved from databases and from review articles written on the same topic.

Conclusion

This critical appraisal of the research demonstrates the MDI‐S is as effective as the nebulizer, faster in the delivery of medication, and cost‐effective.

Implications for Practice

No significant difference between the MDI‐S and nebulizer in delivering medication in an acute exacerbation of asthma was found in this analysis. The practitioner's choice of delivery methods should reflect the family's preference, the practice situation, and economic considerations.
Cognitive and Motor Symptoms in Dementia: Focus on Dementia with Lewy Bodies
Authors: Schumann Lorna , Lingler Jennifer Hagerty , Kaufer Daniel I.
Published: May 2005

Purpose

To describe the clinical syndrome called dementia with Lewy bodies (DLB) and highlight its common and unique characteristics with respect to diagnosis and management.

Data Sources

Review of the scientific literature including psychiatric literature, reports of clinical trials, and clinical practice guidelines.

Conclusions

DLB is a clinical and histopathologic disease, which is second only to Alzheimer's disease (AD) as a cause of dementia in older adults. The clinical syndrome of DLB includes cognitive and motor deterioration reminiscent of symptoms associated with AD and Parkinson's disease (PD) respectively.

Implications for Practice

The late life intersection of cognitive and motor symptoms can present significant challenges in the primary care setting. Recognizing key features of common neurodegenerative disorders is essential to accurately diagnosing and appropriately treating the growing population of older adults who suffer from AD, PD, and DLB.
Workplace Empowerment, Collaborative Work Relationships, and Job Strain in Nurse Practitioners
Authors: Almost Joan , Spence Laschinger Heather K.
Published: May 2005

Purpose

To test a theoretical model linking nurse practitioners’ (NPs) perceptions of workplace empowerment, collaboration with physicians and managers, and job strain.

Data Sources

A predictive, nonexperimental design was used to test a model in a sample of 63 acute care NPs and 54 primary care NPs working in Ontario, Canada. The Conditions of Work Effectiveness Questionnaire, the Collaborative Behaviour Scale ‐ Parts A (physicians) and B (managers), and the Job Content Questionnaire were used to measure the major study variables.

Conclusions

The results of this study support the proposition that the extent to which NPs have access to information, support, resources, and opportunities in their work environment has an impact on the extent of collaboration with physicians and managers, and ultimately, the degree of job strain experienced in the work setting. Primary care NPs have significantly higher levels of workplace empowerment, collaboration with managers, and lower levels of job strain than acute care NPs.

Implications

These findings will benefit NPs and nursing leaders in their efforts to create empowering work environments that enable NPs to provide excellent quality patient care and achieve organizational outcomes.
CLINICAL PRACTICE GUIDELINES
Authors: Goolsby Mary Jo
Published: May 2005

Gastrointestinal (Gl) bleeding is a commonly encountered primary care clinical challenge. The AGA Medical Position Statement; Evaluation and Management of Occult and Obscure Gastrointestinal Bleeding, reviewed in this month's clinical practice guideline column, summarizes recommendations for the initial diagnostic approach and management for occult bleeding, as well as the subsequent diagnostic and management approach for obscure bleeding. The recommendations have applicability in primary care as nurse practitioners (NPs) assess the cause of occult bleeding and consult with specialists when obscure bleeding occurs.
Health Maintenance Throughout the Life Span for Individuals with Down Syndrome
Authors: Bosch Joni Jacobsen
Published: May 2005

Purpose

To describe the routine health maintenance needs of individuals with Down syndrome who have specialized health needs associated with the multi‐system impact of the diagnosis.

Data Sources

Review of scientific literature including peer‐reviewed articles, books, and online resources.

Conclusion

In addition to the routine health maintenance needs of all persons, those with Down syndrome have specialized needs. Failure to address these specific health maintenance concerns may lead to misdiagnoses and failure to reach the highest level of function possible.

Implications for Practice

Patients with Down syndrome who have legit‐imate, treatable diagnoses may be misdiag‐nosed as having behavior problems or demen‐tia. Failure to identify abnormalities such as cardiac problems or sleep apnea may shorten life and interfere with ability to live life to the fullest.
Carpal Tunnel Syndrome; Current Theory, Treatment, and the Use of B6
Authors: Holm Gregory , Moody Linda E.
Published: May 2005

Purpose

To present the current state of the science of pathophysiology, assessment and treatment of carpal tunnel syndrome, including the use of pyridoxine (B6).

Data Sources

Selected research articles, texts, websites, per‐sonal communications with experts, and the authors’ own clinical experience.

Conclusions

Much is yet to be learned about carpal tunnel syndrome. While the basic treatment of NSAIDs and nighttime splints seems universally accepted, much controversy remains. The use of vitamin B6 as a treatment is one such controversy requiring further investigation.

Implications for Practice

Current treatment for carpal tunnel syndrome should include NSAIDs, nighttime splinting, ergonomic workstation review, and vitamin B6 200mg per day.
Evaluation of a Rape Protocol; A Five Year Follow‐up with Nurse Managers
Authors: Lewis Carol M. , DiNitto Diana , Nelson Terri Spahr , Just Mary Margaret , Campbell‐Ruggaard Julie
Published: May 2005

Purpose

To evaluate the use and effectiveness of a pro‐tocol developed for emergency nurses and other medical personnel to use with survivors of sexual assault. The Ohio Department of Health (ODH) Protocol for the Treatment of Adult Sexual Assault Survivors was developed by a multi‐disciplinary team in 1991–92 as a written guide to provide comprehensive, standardized, non‐judgmental, and equitabletreatment for survivors. In 1993, this 118‐page manual was sent to all Ohio hospitals. In 1994, a follow‐up video and training guide were also delivered. In 1997, Victims Rights Advocacy, a non‐profit agency in Ohio, and the Center for Social Work Research at The University of Texas at Austin collaboratively conducted an evaluation of the utilization and effectiveness of this protocol at Ohio hospitals.

Data Sources

Emergency departments at Ohio hospitals were asked to complete a mailed survey regarding their policies and procedures for treating sexual assault patients. Telephone calls were made to the hospi‐tals that did not return a survey, and site visits were conducted at 20 hospitals in diverse areasof Ohio.

Conclusions

Overall, respondents concurred that hospitals can benefit from using a standardized protocol, such as the ODH Protocol, for treating victims of sexual assault. Survey participants also indicated that training is needed on several topics, especially testifying in court, cultural awareness, and the needs of special populations, such as male, gay, lesbian, and bisexual survivors. In addition, findings indicate that survivors need more follow‐up services, and written information about these services should be provided to them.

Implications for Practice

Nurse practitioners can improve the treatment of sexual assault survivors in their communities through a variety of actions, such as gathering information about available protocols and training opportunities for personnel, and becoming familiar with resources that can help victims.
When Did You Last Talk With Your Legislators?
Authors: Towers Jan
Published: May 2005

January 2003 marked the beginning of the 108th Congress. If you have not yet spoken with your federal legislators about nurse practitioners (NPs), now is the time to do so. As legislators begin introducing new bills for this session of Congress, it will be important for NPs to inform their legislators about problems and issues facing them and their patients that need to be addressed.

If you have never talked with your legislators, you will want to make an appointment the next time he or she comes home. Most legislators have offices in a centrally located town in their district or, in the case of senators, in the capital and in the larger metropolitan areas of the stat represent. A call to “Telephone Information” should help you to locate their offices and local phone numbers. If you have difficulty finding them, the League of Women Voters or your local Republican and Democratic headquarters should have the information you need. If you have visited your legislator, let them know that you have spoken before and that you would like to talk again. If you had a previous successful interaction the legislator may remember you with pleasure and will want to meet with you again.

If possible, when visiting your congressperson, take a group of NPs with you. Be sure to let the staff know that you are a constituent. Legislators are elected to represent the people in their electoral district in government. As a result, they are particularly interested in the concerns of the population responsible for putting them in office.
Onychomycosis: Current Treatment Options
Authors: Jones Ellen Davis
Published: May 2005

Purpose

To describe current evidence regarding the treatment of clients with onychomycosis who have one or more chronic illnesses.

Data Sources

Current review of research articles, standard pharmaceutical texts, and case studies.

Conclusions

Onychomycosis is often considered only as a cosmetic diagnosis. Treatment is based on factors such as the client's willingness to pay for expensive therapy and the ability to physically comply with daily regimens; however, treatment of Onychomycosis in clients with chronic illnesses including diabetes and peripheral vascular disease should be strongly encouraged. For these clients, Onychomycosis is not just a cosmetic diagnosis because it has the potential to decrease mobility and blood flow to the affected digits if left untreated.

Implications for Practice

The primary care clinician's successful management of client's with chronic illnesses such as diabetes and peripheral vascular disease should include the treatment of onychomycosis. Recognizing the best treatment is a crucial decision.
Assessing Physical Activity in Adolescents: Common Activities of Children in 6th–8th Grades
Authors: Harrell Joanne S. , Pearce Patricia F. , Markland Ella Trivett , Wilson Kristina , Bradley Chyrise B. , McMurray Robert G.
Published: May 2005

Objectives

To provide data for physical activity assessment in practice by describing the leisure time activ‐ities of adolescents and determining if the activities and the metabolic equivalents (MET levels) of those activities differ for boys and girls.

Data Sources

The study was conducted in five middle schools in three rural counties in North Carolina. Subjectswere 1,211 6th, 7th, and 8th graders aged 11–14 (mean 12.2) years. Half (52.5%) were girls. The sample was 64% white, 24% African‐American and 12% other races.

Results

The top five activities of boys were football, basketball, bicycling, running, and baseball; the top five activities of girls were talking, running, walking, bicycling, and dancing. The average MET was 5.3 for boys and 4.3 for girls (p=0.000). By grade levels, 6th graders had an average MET of 4.9 and the MET of 8th graders was 4.5 (p<0.05). Older youth, girls, and children of parents with more education reported significantly more sedentary activities than the other youth.

Implications for Practice

Physical activity is an integral component of overall health. Once activities and activity levels are known, current practices can be aug‐mented or changed to accommodate improved understanding of physical activity. Because an active lifestyle is important in preventing obesity and other chronic conditions and for general health, nurse practitioners (NPs) should ask adolescents about their common activities and encourage them to continue the more vigorous activities and reduce time spent in sedentary pursuits. Prescriptive physical activity can be included for primary, secondary, or even tertiary prevention, thus crossing all levels of NP practice.
Health Risk Behaviors in Smoking and Non‐Smoking Young Women
Authors: Kelley Frances J. , Thomas Sue Ann , Friedmann Erika
Published: May 2005

Purpose

To compare the health, health risk behaviors and stress levels of college female smokers and non‐smokers.

Data Sources

Forty‐one college women, ages 18–21 years, participated in an interview and completed a health survey and the Derogatis Stress Profile.

Conclusions

The smokers perceived themselves to be more overweight (Chi square, p= <.001). Smokers used more marijuana (Chi square, p= <.003) and had higher scores on depression {t (39) = 2.29, p= .028}, hostility {t (39) = 2.562, p= .014} and perceived quality of health {t (39) = 2.72, p= .01}. In the interview, smokers identified social situations involving alcohol as the time they would most likely smoke. Smokers did not smoke when ill and all were interested in quitting. The non‐smoking women support smoking cessation for their peers.

Implications for Practice

College alcohol and substance use prevention and treatment programs should address tobacco cessation. The majority of college women are not smokers and could be resources to encourage smoking cessation among their peers. Smoking cessation at this age has dramatic implications for futurehealth.
National Guideline Clearinghouse Guideline Synthses and Comparisons
Authors: Goolsby Mabry Jo
Published: May 2005

As the number of clinical practice guidelines relevant to clinical practice continues to grow, nurse practitioners may find it confusing to choose from two or more guidelines on the same or similar topics. The National Guideline Clearinghouse provides two resources to assist clinicians in comparing multiple guidelines on similar topics: guideline syntheses and guideline comparisons. This column describes the features of these two resources, using examples from guidelines on acute pharyngitis.
The Importance of Screening, Assessing, and Managing Urinary Incontinence in Primary Care
Authors: Gray Mikel
Published: May 2005

Purpose

To present evidence that routine screening for urinary incontinence is justified because it is a clinically relevant and prevalent disorder that responds to treatment, resulting in improved outcomes for many patients managed by the nurse practitioner (NP).

Data Source

Selected scientific literature.

Conclusions

The prevalence of urinary incontinence and success of treatment options justify routine screening, individualized assessment, and treatment.

Implications for Practice

Routine screening for urinary incontinence by NPs is uncommon. Based on the relative risk, the potential success of treatment and improved quality‐of‐life outcomes after treat‐ment, NPs should regularly screen and assess for incontinence.
Lichen Sclerosus of the Vulva in Women: Assessment, Diagnosis, and Management for the Nurse Practitioner
Authors: Edwards Quannetta Tucker , Saunders‐Goldson Sherri
Published: May 2005

Purpose

To describe the etiology, clinical manifestations, assessment, and management of vulvar lichen sclerosus (LS) in women.

Data Sources

Selected research and clinical articles in professional journals and online websites, peer review, educational technical bulletin from professional organization and the authors’ professional clinical experiences.

Conclusions

Vulvar LS can manifest with varied symptoms that may mimic other common vulvar disorders such as infections. Careful assessment of the vulva and biopsy of any suspicious skin changes are needed for diagnosis and management of vulvar LS. Treatment with high‐potency topical corticosteroids may alleviate uncomfortable symptoms and reduce physical changes. Follow‐up management is essential to check for progressing problems such as introital stenosis and to assess for skin changes that may indicate vulvar squamous cell carcinoma.

Implications for Practice

Accurate diagnosis and successful management of vulvar LS requires thorough assessment of the genitalia, knowledge of the disorder and appropriate treatment and follow‐up management.
Practice Methods Among Nurse Practitioners Treating Depressed Women
Authors: Groh Carla J. , Hoes M. Linda
Published: May 2005

Objective

To determine practice methods and beliefs about degree of competence in the assessment, diagnosis, and treatment of depressive symp‐toms in women by nurse practitioners (NPs).

Data Sources

A survey about the diagnosis and treatment of depressive symptoms in women was mailed to 3,000 NPs randomly selected from the mem‐bership of the American Academy of Nurse Practitioners. Family, adult, women's and gerontological NPs were included; 1,647 surveys were returned (55%).

Conclusions

Assessment and treatment protocols used by NPs were consistent with the AHCPR guidelines and similar to the protocols used by psychiatrists and non‐psychiatric physicians, yet only 65% believed their education had adequately prepared them to assess/diagnose depression and only 52% believed they had been adequately prepared to treat depression.

Implications for Practice

Findings suggest areas for improvement in the formal education and continuing education of NPs.
Screening, Diagnosis, and Monitoring of Hepatic Injury
Authors: Goolsby Mary Jo
Published: May 2005

Although prophylactic vaccines and a better screened blood supply have contributed to a decreased incidence of viral hepatitis, liver injury remains a common problem. It is important that nurse practitioners know which patients are at risk for hepatic injury, when and how to screen for hepatic injury, and how to monitor patients diagnosed with hepatic damage. The National Academy of Clinical Biochemistry guidelines related to hepatic injury provide a framework for the screening, diagnosis, and monitoring of hepatic injury resulting from a variety of causes.
Obesity as a Confounding Health Factor Among Women With Mobility Impairment
Authors: Sharts‐Hopko Nancy C. , Sullivan Maureen P.
Published: May 2005

Purpose

To examine the relationships between self‐reported height and weight and factors associated with disabilities that impair mobility among adult women.

Data Sources

Survey data were gathered from a convenience sample of 83 women with disabilities at community events targeting the disabled population. Height, weight, and factors associated with their disabilities were reported on a demographic questionnaire. Body mass index (BMI) was estimated using a conversion table and the self‐reported height and weight of each participant.

Conclusions

The average self‐reported weight was 168.3 lb. Only 38% of the women fell into the normal range on estimated BMI, but 62% of the women fell into the categories of overweight or obese. The incidence of overweight and obesity exceeded that reported for the general population of women in a national sample X2= 6.48, p= 03, 2 df). Self‐reported weight was positively correlated with the number of comorbidities reported by the women (r= .419, p < .0001).

Implications

The issue of obesity is an important problem facing women with disabilities. Women who have mobility limitations need to be weighed periodically, and strategies should be devised for weight management, including both dietary plans and appropriate exercise regimens given their limitations.
Abnormal Cervical Cytology: New Names, Familiar Smears
Authors: Carulli Denise Trower
Published: May 2005

Purpose

To discuss the newest 2001 changes in The Bethesda System of cervical cytology classification and management guidelines for abnormal Pap smears.

Data Sources

Extensive review of scientific literature and consensus guidelines.

Conclusions

Decision making about abnormal cervical cytology can be frustrating and controversial. It is imperative that nurse practitioners understand and practice the appropriate management protocol for cytological abnormalities.

Implications For Practice

Alarmingly, many providers are unsure of management guidelines for abnormal cervical cytology. The information in this article offers providers a clear protocol for cervical cytology classification to facilitate the confident management of abnormal Pap smears.
Case Study of Hip Fracture in an Older Person
Authors: Hayes Karen S. , Steinke Elaine E. , Heilman Annette
Published: May 2005

Purpose

To discuss proximal femoral (hip) fractures as the leading cause of hospitalization for injuries among older persons, using a case example that illustrates not only the orthopedic injury but also how an older person's chronic problems complicate the acute event.

Data Sources

Extensive review of scientific literature on the conditions discussed, supplemented by the case study.

Conclusions

Hip fractures in older adults can present multiple challenges to care when complicated by preexisting or coexisting conditions. This case of an older man with a hip frac‐ture emphasizes the resuscitation priorities for the patient found after a “long lie” and the impact of chronic alcoholism and mal‐nutrition, which lead to serious complica‐tions.

Implications for Practice

Careful physical and psychosocial assessment is important for determining the pre‐senting problem and comorbid conditions. Priorities for postoperative management of hip fracture and its complications guide the nurse practitioner through the successful return of the patient to the community.
Factor V Leiden and Venous Thromboembolism: Risk Associated With Hormone Replacement Therapy
Authors: Park Brandon Dee , Lookinland Sandra , Beckstrand Renea L. , Chasson Susan
Published: May 2005

Purpose

To determine the risk‐benefit ratio of hormone replacement therapy (HRT) and the cost‐effectiveness of screening in perimenopausal and postmenopausal women who are carriers of factor V Leiden, as well as to provide evidence‐based clinical recommendations for the primary care provider.

Data Sources

Databases searched included EMBASE, BIOSIS, MEDLINE, CINAHL, PubMed, SciSearch, and the Cochrane Database. Two reviewers extracted, reviewed, and concurred upon relevant evidence identified in the data‐bases.

Results

Results confirmed that all women have a higher risk for the development of venous thrombosis while on HRT. The presence of a genetic mutation, such as factor V Leiden, in combination with HRT dramatically increased an individual's chance for developing venous thrombi.

Conclusion/Implications

Based on the findings of the studies reviewed, it is recommended that women wishing to initiate HRT be thoroughly screened for known risk factors of thrombosis. If risk factors are identified, genetic testing for factor V Leiden may be warranted.
Spiritual‐Care Process and Content: Lessons Learned From the ECHO Project
Authors: Graham Julia B. , Brush Barbara L. , Andrew Reverend Maureen
Published: May 2005

Purpose

To describe the process and content of spiritual caregiving delivered by a minister to 18 homeless male addicts in recovery and to determine whether and how advanced practice nurses can integrate similar counseling into practice.

Data Sources

Notes from the minister's clinical sessions with individuals in the study sample were analyzed to identify the procedures used in spiritual counseling and the overall content of the interactions. Results were then reviewed in light of the literature on the nurse's role in spiritual caregiving to determine realistic implications for practice.

Implications for Practice

Advanced practice nurses are currently mandated to integrate spiritual care into clinical practice as part of their holistic‐practice model. Although theoretically sound, in practice, the time‐dependent and specialized nature of spiritual caregiving may be more appropriately and effectively delivered by ministers as part of the primary care team when time, personal, and other constraints exist.
2001–2002 AANP National Nurse Practitioner Practice Site Survey
Authors: Goolsby Mary Jo
Published: May 2005

Between October 2001 and February 2002, AANP implemented the National NP Practice Site Survey. The purpose of the survey was to describe the general U.S. NP workforce, including the percentage of NPs working in primary care and their settings. Data were collected from over 39,000 NPs of all specialties. Based on the survey, a description of the U.S. NP Workforce was developed. For instance, according to the survey, the average NP is female (95%) and 47 years old. She has been in practice for 8.6 years, is a family NP (35%), and is involved in direct patient practice. This report includes detail on the respondents' clinical specialization, age, years of practice, and type of practice.
Sleep‐Disordered Breathing in Patients With Heart Failure: Pathophysiology, Assessment, and Management
Authors: Spieker Evelyn D. , Motzer Sandra Adams
Published: May 2005

Purpose

To provide clinicians in primary care settings information on the effects of sleep‐disordered breathing in patients with heart failure (HF). Assessment and screening tools, as well as management considerations, are presented.

Data Sources

Review of the scientific literature of the past 10 years, along with classic studies and Internet sources.

Conclusions

HF is an increasingly prevalent problem with a high degree of associated sleep‐disordered breathing. There are two broad categories of sleep‐disordered breathing: obstructive sleep apnea and central sleep apnea/Cheyne‐Stokes breathing. Both of these occur on a continuum of mild hypopnea to severe apnea with hypoxia. Sleep apneas are particularly harmful to patients with HF and, if left untreated, may adversely affect their prognosis. Yet sleep apnea is not routinely screened for in this population.

Implications for Practice

Given the serious consequences of untreated sleep‐disordered breathing, there is sound justification to screen for sleep apnea in all patients with HF. Subsequent treatment of those patients with sleep apnea can significantly improve their quality of life and can decrease their mortality.
Nurse Practitioner Self‐Confidence and Attitudes Regarding Managed Care
Authors: Hayes Eileen F.
Published: May 2005

Purpose

To examine the relationship between nurse practitioner (NP) perceived self‐confidence in performing managed care tasks and NP attitudes toward managed care.

Data Sources

A random sample of NPs‐members of the Massachusetts Coalition of Nurse Practitioners‐completed a demographic survey, responded to questions measuring self‐confidence in performing managed care tasks and attitudes toward managed care, and wrote about their managed care experi‐ences.

Conclusions

NPs were only moderately confident in performing managed care tasks and had mostly negative attitudes toward managed care. They reported intense frustration related to prescriptive coverage and referrals to specialty services, potential trust issues between providers and patients, and ethical and legal dilemmas in tailoring plans of care to fit the patient's insurance. The NPs' written comments indicate a need for more in‐depth exploration of NP attitudes toward managed care.

Implications for Practice and Education

Continuing education in selected managed care competencies, better education of NP students, and promotion of organizational cultures that support interdisciplinary teamwork as well as population‐ and evidence‐based practice may help NPs to embrace the promise of managed care and to offer solutions to its problems.
Improving Access—An Innovative Model
Authors: Geyer Nelouise
Published: May 2005

Purpose

To present a model of health care delivery in South Africa that made health care services accessible and affordable to members of the community who do not have medical insurance.

Data Sources

Statutes and laws governing the practice of health care professionals in South Africa, published professional guidelines, local research data, and the author's experience of the model of health care delivery.

Conclusions

The innovative and visionary approach of a few health care professionals has established a model of health care delivery specifically suited to their community's needs. This model of service delivery has provided an affordable and accessible health service to members of the local community, who have indicated their satisfaction with the service.

Implications for Practice

Economic and legal barriers to accessible and affordable health care services can be overcome to ensure that health care is available to the whole population. The nurse practitioner has an important role to play in making health care affordable and accessible to the community.
Migraine Headaches
Authors: Goolsby Mary Jo
Published: May 2005

Migraine headaches are the source of significant disability for many individuals and their management can present a considerable clinical challenge. The American Academy of Family Physicians (AAFP) and American College of Physicians ‐ American Society of Internal Medicine (ACP‐ASIM) “Pharmacologic Management of Acute Attacks of Migraine and Prevention of Migraine Headaches,” provides a succinct, evidence‐based resource for primary care nurse practitioners. In addition to reviewing this clinical practice guideline, this column describes related supporting documents.
A Review of Ludwig's Angina for Nurse Practitioners
Authors: Winters Sandra
Published: May 2005

Purpose

To discuss the causative factors, clinical course, and current treatment modalities for Ludwig's angina, a submandibular cellulitis, and to raise nurse practitioners' (NPs') awareness of this condition.

Data Sources

Recent clinical articles, research, case studies, and medical texts.

Conclusions

Ludwig's angina may be fatal. Early diagnosis, aggressive antibiotic therapy, and management involving a multidisciplinary team approach are imperative for the patient to progress without complications.

Implications for Practice

Education and awareness are crucial for successful diagnosis of and management of treatment for Ludwig's angina. Although NPs have a limited role in the treatment of Ludwig's angina, their ability to recognize the signs and symptoms will prompt emergency care and treatment and facilitate better outcomes for their clients.
A Comparison of Student Outcomes Following Problem‐Based Learning Instruction Versus Traditional Lecture Learning in a Graduate Pharmacology Course
Authors: Miller Sally K.
Published: May 2005

Purpose

To determine if there would be a difference in students' performance and level of satisfaction when taught pharmacology in a problem‐based learning format as compared to traditional lecture format.

Data Sources

Control (n = 12) and experimental (n = 10) group means for middle‐of‐term examina‐tions, final examinations, end‐of‐course numerical averages, and numerical scores of satisfaction were analyzed with at test for statistically significant differences.

Conclusions

There was no significant difference between groups for any of the items measured, suggesting that problem‐based learning and traditional lecture format may be equally effective course delivery methods. Replication with a larger sample is recom‐mended.

Implications

The small sample size precludes generalizing results to the entire population, but outcomes of this pilot study suggest that problem‐based learning may be at least as effective as traditional lecture and should be explored in larger studies.
A Comparison Study of the Utilization of National Cholesterol Education Program Guidelines by Cardiology and Internal Medicine Practices: Implications for the Advanced Practice Nurse
Authors: Patel Lopa , Abriam‐Yago Katherine , Harkins Elizabeth Ann
Published: May 2005

Purpose

To determine whether patients with hypercho‐lesterolemia were being treated according to the updated 2001 National Cholesterol Education Program (NCEP) clinical guide‐lines and whether a difference existed between internists and cardiologists in the implementation of these guidelines.

Data Sources

This retrospective study used data obtained from a review of 200 patient charts that were compared with the NCEP guidelines.

Conclusions

Results indicated that 67% of internal medicine patients and 71% of cardiology patients who qualified for pharmaceutical treatment received prescriptions for cholesterol‐lowering medications. The difference between internal medicine and cardiology physicians was not statistically significant.

Implications for Practice

Like physicians, nurse practitioners should become familiar with and utilize the updated guidelines as standards of practice to promote and improve patient outcomes over the life span.
Diagnosis And Treatment Of Hypertension In Children And Adolescents
Authors: Peters Rosalind M. , Flack John M.
Published: May 2005

Purpose

To provide nurse practitioners (NPs) with updated information regarding the etiology, diagnosis,and treatment of childhood hypertension.

Data Sources

Extensive review of the scientific literature regarding hypertension, including the latest NIH recommendations.

Conclusions

Hypertension affects more than 350,000 American children. While the majority of hypertension in early childhood occurs from secondary causes, the incidence of essential hypertension in later childhood and adolescence is rising, raising concerns as elevated pressures in childhood “track” into adulthood. Early detection and treatment of elevated childhood pressures represent important steps in reducing long‐term cardiovascular risk.

Implications for Practice

NPs must be able to accurately differentiate between primary and secondary hypertension in childhood. Secondary hypertension requires prompt diagnosis and treatment, and controlling primary childhood hypertension has life‐long implications. Given the familial predispo‐sition to hypertension, it is important for adult NPs to be aware of the risks faced by children of hypertensive patients.
Interstitial Cystitis
Authors: Newsome Grace
Published: May 2005

Purpose

To describe the pathophysiology, assessment, diagnosis, and management of interstitial cystitis.

Data Sources

Selected professional publications and presentations.

Conclusions

Interstitial cystitis (1C) is a chronic and disabling condition. Symptoms include urinary frequency and urgency, pain, dyspareunia, and nocturia. It occurs primarily in women. Onset is predominately in adulthood although 1C does occur in childhood. Bladder wall defects, auto‐immune disorder, viral and/or bacterial infection, toxin exposure, pelvic floor dysfunction and inflammatory response are possible causes. Diagnosis is by history, physical examination, laboratory tests, and cystoscopic examination. The management of interstitial cystitis includes dietary changes, antihistamines, tri‐cyclic antidepressants, oral and intravesicle glu‐cosaminoglycans, hydrodistention, pain management and emotional support.

Implications for Practice

Nurse practitioners need to be knowledgeable about the occurrence and debilitating effect of IC. Inclusion of IC into the differential diagnoses related to urgency, frequency, and abdominal pain will help assure the timely and effective diagnosis and management of this unusual disease.
Myasthenia Gravis: Diagnosis and Treatment
Authors: Armstrong Shannon Mortensen , Schumann Lorna
Published: May 2005

Purpose

To provide information about myasthenia gravis (MG), including pathophysiology, differential diagnosis, treatments, diagnostic work up, patient teaching, and diagnostic algorithms for ptosis and weakness related to MG.

Data

Clinical and research journal articles, medical textbooks, and a patient with MG.

Conclusions

Myasthenia Gravis is a very complex disease with many different signs and symptoms, which may be quite noticeable or vague. The presenting symptoms of ptosis and/or diplopia should cause the clinician to consider a work‐up for MG.

Implications for Practice

Because of the low incidence MG (1 in 10,000) has in the U.S., a delay in diagnosis of one to two years is not uncommon. It is vital to diagnose this disease and begin treatment as soon as possible to decrease the signs and symptoms.
Cognitive Function Assessment in Individuals at Risk for Alzheimer's Disease
Authors: Cotter Valerie T. , Clark Christopher M. , Karlawish Jason H.T.
Published: May 2005

Purpose

To describe brief assessments of functional performance and cognition to detect Alzheimer's disease (AD) and depression in older adults for the primary care provider.

Data Sources

Review of the literature.

Conclusions

It is important for the clinician to interview both the patient and a knowledgeable informant to assess changes in the patients’ functioning in daily life tasks and to administer brief screening tests to detect cognitive impairment and depression in older adults. Several suggested instruments for use in the primary care setting are included.

Implications for Practice

Standardized assessments of functional performance and brief cognitive tests identify individuals with clinically meaningful cognitive impairment and provide baseline measurement against which to compare future assessments.
Using the Nursing Interventions Classification to Describe the Work of the Nurse Practitioner
Authors: Haugsdal Cindy S. , Scherb Cindy A.
Published: May 2005

Purpose

To extend the specialty use research based on the Iowa Intervention Project using the Nursing Interventions Classification (NIC) and identify and the 20 most prevalent inter‐ventions described by practicing nurse practitioners (NPs).

Data Sources

A descriptive survey using a mailed question‐naire was sent to 1,190 NPs with prescriptive authority in Minnesota. Results are based on 414 (37%) useable responses.

Conclusions

Of the 486 NIC interventions on the questionnaire, NPs reported using an average of 120 at least once per month. The 20 most frequently selected were reported by 71%‐90% of respondents as being used at least once per month. Four core interventions (documentation, telephone consultation, teaching: prescribed medication, and emotional support) were common to NPs in all specialties.

Implications for Practice

Common medical coding does not reflect the nursing aspects of NP practice. As NPs attempt to define what is different about NP practice, the use of a standardized nursing language such as the NIC may facilitate this process. One clarification that needs to be made with regard to the NIC in future research with NPs is the distinction between prescribing and performing the interventions.
Motivating Health: Strategies for the Nurse Practitioner
Authors: Duran Lynne S.
Published: May 2005

Purpose

To provide the nurse practitioner (NP) with a practical prescription for acquiring expertise in health behavior change using integrated principles from the transtheoretical model of change and motivational interviewing.

Data Sources

Extensive literature review of current theory and research on health behavior change.

Conclusion

Expertise in motivating health behavior change is essential to effective health promotion and to the NP role.

Implications for Practice

Lifestyle choices are principal contributors to the leading causes of death and most chronic diseases in the United States. Traditional health behavior interventions are often ineffective in motivating and sustaining lifestyle change.
Diabetes Medical Nutrition Therapy: Practical Tips to Improve Outcomes
Authors: Daly Anne , Warshaw Hope , Pastors Joyce Green , Franz Marion J. , Arnold Marilynn
Published: May 2005

Purpose

To describe the evolving and expanding role of nurse practitioners (NPs) in providing diabetes medical nutrition therapy (MNT) as the United States faces epidemics of diabetes and obesity.

Data Sources

Scientific literature and reports from the public health, diabetes, and nutrition fields.

Conclusions

Although clinically effective for both prevention and treatment of diabetes, MNT is often underutilized. The majority of people with diabetes are cared for by primary care providers; the role of NPs as primary care providers is evolving and expanding. NPs are recognized as leaders who creatively adapt to the rapidly changing health care delivery system.

Implications for Practice

NPs can serve as role models by presenting accurate, basic nutrition messages, referring patients to registered dietitians for MNT, reinforcing nutrition and the importance of lifestyle change as primary treatments for their disease, and following up on their patients' progress with nutrition interventions.