Adult-gerontology Primary Care Research Articles

Unfolding Case Studies: Improving Nurse Practitioner Students’ Self-Efficacy

Faculty use evaluative methods to assess students’ mastery of nurse practitioner competencies but seldom assess students’ self-efficacy. Self-efficacy is one’s belief that an activity can be competently performed, consequently having a positive impact on clinical performance. Graduating students may not feel confident in their ability to manage patients who require frequent treatment changes necessary to manage acute illness and exacerbation of chronic disease. Nurse practitioner students enrolled in their last adult-gerontology primary care didactic course were invited to participate in a study assessing their self-efficacy after completing a mandatory unfolding case study assignment. The participants demonstrated increased self-efficacy in several domains.

Adult-Gerontology Nurse Practitioners: A Discussion of Scope and Expertise

Adult-gerontology primary care nurse practitioners (NPs) deliver longitudinal primary care in outpatient settings from adolescence to older adulthood, and adult-gerontology acute care NPs provide care to critically ill adults and older adults. Family NP programs vastly outnumber adult-gerontology NP programs nationwide, despite a rapidly aging population. This report discusses the differences in education and scope of practice of adult-gerontology primary care NPs, adult-gerontology acute care NPs, and family NPs and highlights the crucial and unique assets adult-gerontology NPs bring to any health care system or practice. Differences in competencies, certification examinations, and practice settings are discussed in depth.

Pandemic response: The identification of alternative clinical hours to ensure advanced practice nursing students meet program requirements.

The coronavirus (COVID-19) pandemic resulted in the abrupt withdrawal of clinical sites for advanced practice nursing students which worsened an already challenging placement process. Few studies to date have analyzed the use of alternative clinical practice experiences used to facilitate the completion of program requirements by advanced practice nursing students beyond direct hour requirements. The faculty team from one university decided to track and analyze their use of alternative clinical practice experiences for advanced practice nursing students actively enrolled during the first semester of the pandemic. The team collated student alternative hour entries within the clinical courses for review and statistical analysis. Data included input from advanced practice nursing students in family, pediatric primary care, adult gerontology primary care, adult gerontology acute care nurse practitioner concentrations, and nursing education, doctor of nursing practice, and nurse anesthesia programs. A total of 569 advanced practice nursing students participated in 15 distinct alternative clinical activities. There was a significant effect of students' program concentration on total number of virtual case study hours logged, F (6, 562) = 9.45, p < .0001, and a significant effect of students' program concentration on total number of continuing education hours logged, F (6, 562) = 7.79, p < .0001. Results can inform the use of concentration-specific alternative activities for advanced practice nursing students to address gaps in clinical experiences.

Understanding Trauma-Informed Care in the PALTC Setting

Understanding Trauma-Informed Care in the PALTC Setting

Learning From My “Lived Experience” With the Health Care System

Learning From My “Lived Experience” With the Health Care System

Simulating Treating in Place in Long-Term Care: Interprofessional Team Care Video Case for Nurse Practitioners

As a means of enhancing clinical simulation opportunities for adult-gerontology nurse practitioner students, a series of video simulations were created for use for nurse practitioner education. With funding through the Health Resources and Service Administration (HRSA) Advanced Nursing Education Workforce grant and partnering with nurse practitioner clinical educators from Optum Health Care, a video simulation focused on the concept of treating an older veteran within a long-term care facility rather than transferring to the acute care setting was developed. The case Treating in Place: Nurse Practitioner-Led Team Management of a Long-Term Care Patient Video involved a nurse practitioner collaborating with a physician, a registered nurse, a social worker, and a family member. The interactive simulation video was developed using the eLearning authoring tool H5P to create learning experiences for students that can be used either in face-to-face classroom experiences or embedded in learning management systems. H5P is a web-based authoring tool that helps faculty build interactive course content. H5P activities provide instant feedback to students, allowing them to self-assess their understanding of the dynamic video simulation case. A faculty handbook that describes the case scenario with the interactive questions and suggested discussion questions is available. The adult-gerontology primary care nurse practitioner competencies addressed for this case are identified in the faculty handbook. These videos have been widely disseminated and are being included in nurse practitioner curriculum across the country. A QR code with access to direct viewing of the video will be included in the presentation.

Serious Mental Illness in Post-Acute and Long-Term Care:Building Knowledge, Sharing Care

Serious Mental Illness in Post-Acute and Long-Term Care:Building Knowledge, Sharing Care

Interdisciplinary Care: Together We Can Do Something Wonderful

Interdisciplinary Care: Together We Can Do Something Wonderful

There Is No Place Like Assisted Living: Can the Setting Evolve While Staying True to Itself?

There Is No Place Like Assisted Living: Can the Setting Evolve While Staying True to Itself?

Use of Long-Term Care Facilities for Primary Care Nurse Practitioner Students.

Family and adult-gerontology primary care nurse practitioner (NP) students must obtain patient clinical hours caring for older adults. Primary care occurs in a variety of settings, including long-term care (LTC) facilities. Anecdotal reports indicate that faculty in some primary NP academic programs do not recognize the robust primary care opportunities that exist in LTC settings. This article describes a professional nursing organization's process of researching the appropriateness of designating LTC clinical hours as allowable primary care clinical experiences for NP students. The NP serves as an integral member of the LTC team, providing the same elements of primary care provided in traditional ambulatory care settings. Older adults receiving primary care in LTC settings have a variety of health care needs, including assessment and management of acute and chronic conditions. A position statement was developed for primary care NP students and endorsed by 22 professional organizations and NP programs. [J Nurs Educ. 2021;60(2):99-102.].

In the time of COVID….

JAANP Fellow Dr. Leslie-Faith Morritt Taub, NYU Adult-Gerontology Primary Care Program Director, describes the emotional, political, and social impact of COVID-19 on one graduating cohort of nurse practitioner (NP) students at New York University and one incoming cohort of students. Through the lens of a seasoned professor she describes the changes to her teaching methods because she leads these students through the course work and clinical work required to take on the role of the NP in the midst of a global pandemic in the heart of New York City.

Teaching Nurse Practitioner Students About Polypharmacy Through a Lived Experience

Polypharmacy (typically defined as the concomitant use of 5 or more medications) affects 40-50% of older adults in the U.S., and is associated with geriatric syndromes, a higher risk of medication non-adherence, and adverse drug events. Medication non-adherence is a common frustrating clinical issue for clinicians who provide care for older adult patients. Simultaneously, patients often find medication regimens to be complicated and confusing. This may contribute to medication non-adherence, which may further lead to adverse drug events and/or negative health outcomes. The more medications a patient is taking, the higher the risk for non-adherence. Thirty-eight students enrolled in an adult-gerontology primary care nurse practitioner program were given a bag of five mock medications that are commonly prescribed for older adults. Students were instructed to follow the directions on each of the bottles for approximately one month. A private messaging system was available for students if refills were needed or if they had questions about their medications. A debriefing session for this month-long, ungraded simulation was held, at which time students returned medication bottles. Pill counts were not analyzed, but all returned bottles contained mock medications. Approximately 52.6% of students estimated adhering to the medication regimen 0-24% of the time, whereas 26.3% reported an adherence rate of 25-50%. The most commonly cited barrier to adherence (55.3%) was “forgetfulness”. Nearly all students (89.5%) reported that the exercise “very much” increased their awareness of challenges patients face when managing medications, and 97% cited an increased awareness of ways to improve medication adherence.

Are Nurse Practitioner Students Learning About Medicare Fraud?

Are Nurse Practitioner Students Learning About Medicare Fraud?

Book review: Not What the Doctor Ordered (3rd Ed.) by Jeffrey C. Bauer

Taub, Leslie-Faith Morritt PhD, ANP-C, GNP-BC (Clinical Associate Professor /Director Adult-Gerontology Primary Care Nurse Practitioner Program-NYU Meyers)1 Author Information

Caring Collaborative Beyond Our Borders

Caring Collaborative Beyond Our Borders

PROGRESSIVE CARE OF AN AGING WOMAN: INTERACTIVE VIDEO SIMULATION CASES SPANNING 15 YEARS

As a means of enhancing experiential educational opportunities for adult-gerontology nurse practitioner students who are prepared to manage the complex care of older adults, interactive simulation videos were developed using the eLearning authoring tool H5P to create learning experiences for students that can be used either in face to face classroom experiences or embedded in learning management systems. H5P is a web-based authoring tool that helps faculty build interactive course content. H5P activities provide instant feedback to students, allowing them to self-assess their understanding of the dynamic video simulation case. With funding through the Health Resources and Service Administration Advanced Nursing Education Workforce grant, four video simulation cases were developed that address emerging chronic care conditions in an older women who aged 15 years presenting initially with signs of hypothyroidism, progressed to early frailty, through moderate dementia and eventually along with her daughter face end of life health care issues. Partnering with the university instructional design experts, nurse practitioner faculty created questions that were inserted throughout the video as a means of keeping students engaged in problem-solving and decision making. A faculty handbook that described the case scenario with the interactive questions with suggested discussion questions was developed for each video simulation. The adult-gerontology primary care nurse practitioner competencies addressed in each case are identified in the handbook. Recommendations for the interactive question format will be presented and QR codes with access to direct viewing of the videos will be presented on the poster.

Improving Care for Patients with Dementia: What to Do Before, During, and After a Transition

Improving Care for Patients with Dementia: What to Do Before, During, and After a Transition

Shared Learning for Better Outcomes

Shared Learning for Better Outcomes

Dental and Nurse Practitioner Student Attitudes About Collaboration Before and After Interprofessional Clinical Experiences.

The aim of this study was to investigate the effect that an interprofessional clinical experience (IPCE) had on dental and adult-gerontology primary care nurse practitioner (NP) students' attitudes towards health care collaboration. A survey study was conducted with dental and NP students before and after completing IPCE rotations in a dental clinic and a tertiary care setting in the 2016-17 academic year. All dental students (N=159) and all NP students enrolled in the adult-gerontology primary care program (N=37) participated in the IPCE. Students were asked to complete the Readiness for Interprofessional Learning Scale (RIPLS) survey anonymously prior to and immediately after the experience. All 37 NP students completed both pretest and posttest, for a 100% response rate on both. Among the dental students, 120 completed the pretest, for a 75% response rate, and 106 completed the posttest, for a 67% response rate. The results showed a significant increase in total RIPLS score for both the dental and NP students following the experience (p<0.001). Attitudes about teamwork and collaboration and about roles and responsibilities improved for both the dental and NP students (p<0.001) following the IPCE. There was a difference between dental students' and NP students' teamwork and collaboration subscale scores before IPCE (p=0.006), but it diminished after the intervention (p=0.09). These results suggest the IPCE succeeded in building positive attitudes about interprofessional collaboration between dental and NP students. Clinical rotations should be considered to enhance the scope of students' experiences with interprofessional patient care.

058 Nurse Practitioner Practices for Discussing and Treating Genitourinary Syndrome of Menopause

Symptomatic genitourinary syndrome of menopause (GSM) is prevalent in the postmenopausal population and can cause significant pain, dryness, vulvar irritation, vaginal burning and itching, dyspareunia, dysuria, and recurrent urinary tract infections (UTIs). To determine how Nurse Practitioners (NPs) identify, discuss, and treat symptoms of GSM in postmenopausal women (PMW). The NPInfluence panel was used to invite NPs to participate in an online survey from the American Association of Nurse Practitioners. To participate, NPs (certified in family, women’s health, adult, adult-gerontology primary care, or gerontology and/or practice in a site focused on similar disciplines) had to provide direct patient care ≥20 hours per week in an outpatient setting, and likely to see PMW. Survey topics included criteria for vaginal screening exams, timing and practices for initiating conversations about vaginal/vulvar symptoms, language used when discussing GSM symptoms, and treatment and referral practices for the common GSM symptoms of dyspareunia/vulvovaginal atrophy (VVA), and recurrent UTIs.