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Improving human papilloma virus vaccination rates among adolescents.

The human papilloma virus (HPV) is the leading cause of cervical cancer worldwide and is responsible for genital warts and five other types of cancers. The HPV vaccine was introduced in 2006 and demonstrated to be safe and more effective than expected, yet adolescent rates of immunization in the United States remain low. Adolescent HPV vaccine rates were below the national average, and effective vaccine recommendation strategies were not used at an urban pediatric primary care office in southern Florida. The percentage of HPV vaccine rates in this primary care office were measured among adolescents ages 13-17 years using data obtained from Florida's state vaccine registry before implementation of the intervention, after the intervention, and monthly over a 90-day period. Interventions aimed to improve vaccine rates included implementing an HPV protocol consisting of education on providing a strong bundled recommendation, appointing a vaccine champion, implementing standing vaccine orders, and educational materials. The vaccine rates among adolescents increased by 11% for the initial dose, 7% for the second dose, and 6% for the vaccine completion rate. Chi-square test demonstrated statistical significance, for the initial vaccine. A nurse practitioner-led application of an evidenced-based HPV vaccine protocol positively affected the care of adolescents in this primary care setting.

Nurse practitioner educational preparation and confidence related to managing antipsychotic medications and associated drug-induced movement disorders.

Antipsychotic medications (APMs) have been used to treat multiple psychiatric disorders for decades. The conditions to use these medications have expanded from primarily psychotic disorders to Food and Drug Administration-approved uses as first-line mood stabilizers in bipolar disorder and adjunctive pharmacotherapy in unipolar depression. Antipsychotic medications can have serious side effects, including drug-induced movement disorders (DIMDs). Nurse practitioners (NPs) in non-psychiatric-mental health specialties are increasingly managing psychotropic medication regimes. There is a void in peer-reviewed literature capturing the scope of NPs managing APMs, such as whether they received training to prescribe and manage risks of APM, and if so, what type (e.g., continuing education, attending conferences, consulting), and their confidence assessing and managing DIMDs. To describe the scope of NP management, knowledge, and confidence related to APMs and associated risks of DIMDs. Nonexperimental, descriptive, cross-sectional survey. Participants ( n = 400) recruited through a professional association membership portal. Nearly two-thirds of participants reported managing APMs (64%) and receiving training to prescribe and manage risks of APMs (63%). More than half (54%) reported they received training to do so in their NP education program. Thirty-five percent of participants indicated they were either completely (6%) or fairly (29%) confident, whereas most (65%) endorsed being somewhat (26%), slightly (20%), or not (19%) confident in assessing and managing DIMDs. Opportunities exist to broaden NP education in managing APMs and associated risks of DIMDs.

Opportunities to improve high-risk behavior screenings during well-child examinations.

Nurse practitioners serve an essential role in the completion of age-appropriate adolescent high-risk behavior screenings including tobacco/nicotine, alcohol, illicit drug use, and sexual activity during well-child examinations (WCEs). Midwestern adolescents demonstrate a suboptimal rate of engaging in annual preventative medical visits in comparison to national data. This mixed-methods quality improvement pilot sought to evaluate health care providers' beliefs, general clinic processes, and the overall quality of WCEs among adolescents aged 11-17 years in two midwestern primary care clinics. Quantitative data were obtained through queried reports and manual electronic health record chart audits. Qualitative data were obtained through focus group interviews. Interventional strategies included providing education to key stakeholders regarding data analysis findings indicating process deficiencies regarding adolescent WCEs. Project members championed integration of advanced practice nurses as leaders of change within urban, multisite tertiary health care systems. Results demonstrate that the lack of standardized assessment during an adolescent WCE can lead to fragmentation of high-risk behavior screenings. This quality improvement pilot demonstrates the need for nurse practitioners to be at the forefront of interprofessional committees advancing the implementation of evidence-based guidelines and practice improvement initiatives. Standardization of high-risk behavior screening as part of the WCE in adolescence provides the foundation for health promotion and chronic disease prevention spanning into adulthood.

Young adults with congenital heart disease heading to college: Are college health centers and providers prepared?

An estimated 1.4 million adults in the United States have congenital heart disease (CHD). As this population grows and many pursue postsecondary education, these adults' health care needs and concerns should be at the forefront for providers, particularly nurse practitioners, at college health centers. To understand how college health centers and providers identify and manage the care of students with chronic conditions to further support their health care transition, with a focus on students with CHD. Qualitative key informant interviews were performed with providers at five college health centers to understand the processes in place and the challenges health care providers on college campuses face when caring for students with CHD. Most of the college health centers did not have formalized processes in place to care for these students. Although many felt that they had the capabilities in their health centers to manage these students' maintenance/preventive care needs, fewer felt comfortable with their urgent or emergent care needs. The onus was often on students or parents/guardians to initiate these transitions. This study highlights some challenges to providing care to students with chronic conditions like CHD. More collaborative relationships with specialists may be critical to ensuring that all the care needs of chronic disease students are met on college campuses. Nurse practitioners, who often staff these clinics, are well positioned to support this transition onto campuses and lead the development of processes to identify these students, ease care management transitions, and ensure easy provider communication that allow students with chronic diseases to thrive on campus.

Medications for opioid use disorder: An interactive educational program developed for the nurse practitioner curriculum.

Opioid overdose deaths remain a major public health concern in the United States and led to the recent changes in regulations that allow nurse practitioners (NPs) to prescribe buprenorphine without the previously required Drug Addiction Treatment Act waiver. Previously, waiver requirements included 24 hours of opioid use disorder (OUD) and medications for OUD (MOUD) training. Although this training is no longer required, NPs need education related to providing nonstigmatizing care to individuals with OUD and safe MOUD prescribing practices. A combination of online didactic modules, in-person simulation activities, and experiential learning was provided to psychiatric mental health NP (PMHNP) and family NP (FNP) students enrolled in a Doctor of Nursing Practice (DNP) program. OUD was presented through a chronic care lens to normalize treatment and decrease stigma, and harm reduction principles were included to increase safe prescribing of MOUD. Fifty-six students completed the didactic training, 51 students participated in the simulation, and 11 students completed shadowing experiences with an experienced MOUD provider. Psychiatric mental health NP and FNP graduates of this DNP program have the knowledge and skills to provide MOUD to individuals struggling with OUD, thus potentially increasing access to care and decreasing overdose deaths.