bluuebunny/crossref_metadata_2025_split huggingface dataset:
Legislative Issues Impacting On The Practice Of The South African Nurse Practitioner
Authors: Geyer Nelouise , Naude Susan , Sithole Gladys 
Published: May 2005

PurposeTo 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 SourcesStatutes and laws of the government of South Africa; published professional guidelines; authors’ experiences.ConclusionsThe 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 PracticeSome 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

PurposeTo describe the components of the female athlete triad, including definitions and clinical criteria for diagnosis, methods of screening, and treatment options.Data SourcesSelected scientific literature; standard diagnostic guidelines.ConclusionsThe 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 PracticePrimary 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

PurposeTo 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 SourcesCase report, scientific literature, diagnostic evidence.ConclusionsCoarctation 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 PracticePrimary 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

PurposeTo determine the frequency with which Black women with type 2 diabetes receive routine primary health care screening for cancer and diabetes complications.Data SourcesPilot study data from a convenience sample of 21 Black women (mean age 46.8 years) with type 2 diabetes.ConclusionsCancer 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 PracticeThis 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

PurposeTo provide an overview of the Children's Health Insurance Program (CHIP), along with implications for practice as it applies to nurse practitioners.Data SourcesExtensive review of the on‐line and published literature on CHIP.ConclusionsCongress 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 PracticeAlthough 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

PurposeTo 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 SourcesFederal regulations pertaining to herbal products, current research literature, and anecdotal and consumer reports.ConclusionsCurrent 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 PracticeClinical 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

PurposeTo 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 SourcesUtilizing 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.ConclusionsWomen, 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 PracticeIdentifying 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

PurposeTo 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 SourcesSelected clinical guidelines, clinical articles, and research studies.ConclusionsAsthma 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 PracticeStandards 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

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

PurposeTo present a framework for nurse practitioners (NPs) who wish to engage in outcomes research.Data SourceReview of scientific literature on the design of outcomes research.ConclusionThe 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 PracticePractical 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

PurposeTo 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 SourcesReview of the current scientific literature on exercise adherence and the Stages of change model.ConclusionsMiddle‐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 PracticeNurse 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

PurposeTo 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 SourcesVerbatim 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.ConclusionsThe 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

PurposeTo 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 SourcesA descriptive study including 135 older adults living in a continuing care retirement community.ConclusionsThe 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 PracticeWith 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

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

PurposeTo 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 SourcesUsing 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.ConclusionsThe 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 PracticeManagement 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

PurposeTo 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 SourcesA convenience sample of 216 women recruited from church sites in Las Vegas completed self‐administered questionnaires.ConclusionsThe 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 PracticeThe 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

PurposeThis exploratory study described the prenatal care experience in the public and private arena from the perceptions of childbearing women using interpretive interactionism.Data SourcesA 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.ConclusionsFive 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 PracticeControversy 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.
Preventing Pediatric Obesity: Assessment and Management in the Primary Care Setting
Authors: Schumann Lorna , Nichols Mary R. , Livingston Dora 
Published: May 2005

PurposeTo review the literature on and discuss the role of the primary care provider in assessing and managing overweight children before they become obese.Data SourcesSelected research, national guidelines and recommendations, and the professional experience of the authors.ConclusionsThe 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 PracticePediatric 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.