Family Nurse Practitioner Program Research Articles

Effectiveness of Screen-Based Simulation as a Strategy to Improve Nurse Practitioner Students' Access to Electronic Health Records in Clinical Education.

Learning to use electronic health records is essential for family nurse practitioner students to inform practice and clinical decision-making. Limited access to electronic health records during clinical training can lead to suboptimal use. Academic programs often rely on healthcare organizations to provide opportunities for students to learn electronic health record skills. However, clinical experiences are highly individualized, and students may not have access to electronic health records. Alternatives are needed to develop this critical competency. This study compared self-reported ratings regarding comfort and access to electronic health record documentation between students who participated in screen-based simulation and students who completed traditional clinical experiences with a preceptor during the last 70 hours of clinical training in one family nurse practitioner program. There was a significant difference in electronic health record access between students who participated in simulated versus traditional clinical experiences (P = .002). There were no significant differences in ratings of comfort using electronic health records between groups. Both groups reported limited access to electronic health records in the first 500 hours of clinical experience. However, students who participated in screen-based simulation reported a quarter-fold increase in electronic health record access during their last 70 hours of clinical training.

The Heart of Cardiovascular Disease in Women

Heart disease is the leading cause of death (LCOD) for both men and women in the United States and kills approximately 1 in every 4 women. 1 Tsao C.W. Aday A.W. Almarzooq Z.I. et al. on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2023 update: a report from the American Heart Association. Circulation. 2023; 147: e93-e621https://doi.org/10.1161/CIR.0000000000001123 Crossref PubMed Scopus (57) Google Scholar Despite widespread dissemination of staggering statistics, focused interventions, and national advocacy campaigns promoting cardiovascular disease (CVD) awareness, it is reported that only 45% to 56% of women identify CVD as the LCOD. 2 Bairey Merz C.N. Andersen H. Sprague E. et al. Knowledge, attitudes, and beliefs regarding cardiovascular disease in women: the Women's Heart Alliance. J Am Coll Cardiol. 2017; 70: 1106-1107https://doi.org/10.1016/j.jacc.2017.07.721 Crossref Scopus (0) Google Scholar Also troubling is the downward trend of women identifying CVD as the LCOD as reported in the 2019 American Heart Association survey in which the percent dropped from 64.8% in 2009 to only 43.7% in 2019. 3 Cushman M. Shay C.M. Howard V.J. et al. Ten-year differences in women's awareness related to coronary heart disease: results of the 2019 American Heart Association National Survey: a special report From the American Heart Association. Circulation. 2021; 143: e239-e248https://doi.org/10.1161/CIR.0000000000000907 Crossref PubMed Scopus (85) Google Scholar Previously excluded from clinical studies that inform best practice guidelines today, women continue to face historically rooted gender inequities resulting in suboptimal screening, inaccurate risk stratification, and a delay in diagnosis and management. 2 Bairey Merz C.N. Andersen H. Sprague E. et al. Knowledge, attitudes, and beliefs regarding cardiovascular disease in women: the Women's Heart Alliance. J Am Coll Cardiol. 2017; 70: 1106-1107https://doi.org/10.1016/j.jacc.2017.07.721 Crossref Scopus (0) Google Scholar ,4 Shaw L.J. Pepine C.J. Xie J. et al. Quality and equitable health care gaps for women: attributions to sex differences in cardiovascular medicine. J Am Coll Cardiol. 2017; 70: 373-388https://doi.org/10.1016/j.jacc.2017.05.051 Crossref PubMed Scopus (69) Google Scholar Women experience gender and sex-mediated risk factors for CVD and are disproportionally affected by traditional risk factors because of physiologic differences. 5 Cho L. Davis M. Elgendy I. et al. Summary of updated recommendations for primary prevention of cardiovascular disease in women: JACC state-of-the-art review. J Am Coll Cardiol. 2020; 75: 2602-2618https://doi.org/10.1016/j.jacc.2020.03.060 Crossref PubMed Scopus (104) Google Scholar Although this is well-documented in the health care literature, nurse practitioners (NPs) and other clinicians report a lack of high-level confidence and comfort in screening women who may be at risk for CVD. 2 Bairey Merz C.N. Andersen H. Sprague E. et al. Knowledge, attitudes, and beliefs regarding cardiovascular disease in women: the Women's Heart Alliance. J Am Coll Cardiol. 2017; 70: 1106-1107https://doi.org/10.1016/j.jacc.2017.07.721 Crossref Scopus (0) Google Scholar ,4 Shaw L.J. Pepine C.J. Xie J. et al. Quality and equitable health care gaps for women: attributions to sex differences in cardiovascular medicine. J Am Coll Cardiol. 2017; 70: 373-388https://doi.org/10.1016/j.jacc.2017.05.051 Crossref PubMed Scopus (69) Google Scholar Catherine Nadeau, DNP, APRN, FNP-BC, CNE, is an assistant professor and concentration director of the Family Nurse Practitioner Program at the University of South Florida in Tampa. Dr Nadeau can be reached at [email protected] Christina Cardy, DNP, APRN, AGACNP-BC, is an assistant professor and concentration director of the Adult Gerontology Acute Care Nurse Practitioner Program at the University of South Florida. Elizabeth Remo, DNP, APRN, FNP-BC, is an assistant professor at the University of South Florida. Anthony W. McGuire, PhD, ACNP-BC, ACNPC, FAHA, is an associate professor at the University of South Florida. Andrea Efre, DNP, APRN, ANP, FNP-C, is an assistant professor at the University of South Florida. Christina Bricker, PhD, APRN, FNP-BC, FAHA, is an associate professor at the University of South Florida.

Optimizing Care for Military Women: The Value of the Dual-Certified Family and Women's Health Nurse Practitioner.

The number of women in the military has more than tripled over the past 50 years, increasing from 5% in the 1970s to 17% in 2023, making them essential for global health engagement and military operations. Provider competence and confidence are barriers to the consistent availability of preventive, gynecologic, and reproductive services for women across service locations and duty platforms. The Defense Health Board recommends standardizing services and improving the availability and scope of services for women at every point of care. In direct conflict with these recommendations, however, is a congressional call for a drawdown of medical forces, which creates a need for operationally trained clinicians with a broad skill set including comprehensive care for women. Advanced practice registered nurses, such as family and women's health nurse practitioners, are key assets to fill this gap on military medical health-care teams. At the request of the U.S. Air Force, the Graduate School of Nursing at the Uniformed Services University began offering a Women's Health Nurse Practitioner (WHNP) program in 2014. The WHNP curriculum was layered onto the existing Family Nurse Practitioner program so that Family Nurse Practitioner students receive enhanced education in women's health and WHNP students are prepared to meet the holistic, primary care needs of patients across the lifespan in addition to caring for women with obstetric and urogenital health concerns. This article highlights the value of dual-certified Family Nurse Practitioners and WHNPs in the military health-care system. These Uniformed Services University alumni are uniquely prepared to provide comprehensive primary and specialty care for female warfighters across the lifecycle from stable, well-resourced duty stations to austere, operational settings or deployment platforms.

Guest Editorial: Nurse Practitioners in Emergency Care: The Evidence.

Guest Editorial: Nurse Practitioners in Emergency Care: The Evidence.

CHANGING AGING MYTHS AND READINESS FOR INTERPROFESSIONAL EDUCATION IN FAMILY NURSE PRACTITIONER STUDENTS

Abstract The preparation of Family Nurse Practitioner (FNP) students caring for the older adult population is inadequate. The design was a quasi-experimental pilot study (N = 30) to assess change in myths about aging and readiness for interprofessional education (IPE) in FNP students near graduation. The Woolf Aging Quiz (WAQ) containing 24 true-false myths about older adults, and the Readiness for Interprofessional Learning Scale (RIPLS) containing 19 items rated on a 5-point Likert scale (high score indicates more readiness), were completed at baseline and post-intervention. The intervention consisted of 4-weeks of education on normal aging, agism, age friendly healthcare, and IPE using online weekly brief video presentations and peer discussion. Thirty FNP students, mean age 43.5 years, 80.6% (N = 25) female, 19.4% (N = 6) male. A paired t-test showed no significant pre-post difference in the WAQ (t = -1.388, p < .05). McNemar crosstab analysis of the WAQ items indicated 14 aging myths where students chose the wrong answer pre and post intervention. In addition, the RIPLS showed no significant change (t = .793, p < .05) from pre-intervention (mean = 35.87) to post-intervention (mean = 34.42). FNP students near graduation held strong ageist beliefs, reflected in the WAQ, and were unprepared for IPE. Both of these results were resistant to change. The data suggests that FNP programs need to address aging and IPE content earlier and provide students with exposure to older adults that addresses myths about aging affords both theoretical and practical opportunities for interprofessional learning.

Addressing telehealth education in a family nurse practitioner program through simulation-based learning.

Telehealth usage increased because of the COVID-19 pandemic. Health care agencies responded by increasing existing platforms and implementing new telehealth platforms. Despite the demand, health care providers may have had little training in the telehealth care delivery model in the workplace or embedded in school. Based on educational theory, evidence, and best practice, the authors crafted a learning module that focused on telehealth medical skills followed by a summative standardized patient simulation. This article describes the development, implementation, and evaluation of the learning module and the summative simulation assessment. The learning module and the simulation provided a teaching strategy that resulted in an objective measurement of student clinical performance, which may be elusive in a traditional face-to-face practicum. Additionally, the simulation-based learning resulted in increased student satisfaction with simulation and increased self-confidence to apply the information in the clinical setting.

Guest Editorial: AAENP Releases Position Statement: The Role of Nurse Practitioners in Emergency Medical Services.

Recently, there has been a national discussion about nurse practitioners (NPs) working within emergency medical services (EMS). The National Association of EMS Physicians, the Society for Emergency Medicine Physician Assistants (SEMPA), and most recently, the American Academy of Emergency Nurse Practitioners (AAENP) have all issued position statements on this issue (AAENP, 2022; SEMPA, 2021; Wright et al., 2021). The joint mission should be centered around high-quality patient care, a multidisciplinary team, and elevating the level of NP practice available in the prehospital and interfacility settings. NPs working in prehospital roles can add value to rural, suburban, and urban environments. In rural America, providing adequate EMS response creates challenges for ambulance providers (National Rural Health Association, 2018). Urban EMS programs are already utilizing NPs as a potential solution to augment care delivery within the EMS system in various roles (Sanko et al., 2020). However, NPs face regulatory challenges, limiting or prohibiting more active involvement in the EMS system. According to the American Association of Nurse Practitioners (AANP), NPs in full practice authority states are more likely to practice in rural and underserved areas (AANP, 2022). To enable NPs to contribute more to prehospital care, national health care practice models and state regulators must consider rule changes that strengthen the utilization of NPs in EMS systems. NPs with appropriate training are in an ideal space to support rural EMS systems. In addition, there are barriers to NPs working in EMS leadership roles. One of the most significant barriers is the National Registry of Emergency Medical Technicians (NREMT, 2019) requirement that all paramedics and advanced emergency medical technicians have a physician medical director. This rule becomes problematic in some of the most rural areas of the country that struggle to find medical direction. Although medical directors trained in EMS fellowships may be ideal, the physician-only language written in NREMT's guidelines marginalizes rural health care and prevents qualified NPs from participating in certain levels of medical direction. AAENP (2022) believes that “NPs are uniquely positioned to provide and direct care of the patient within a multidisciplinary EMS system. The AAENP supports utilization of NPs in EMS to the full extent of their licensure, education, and scope of practice based on state and agency regulations.” —Wesley D. Davis, DNP, ENP-C, FNP-C, AGACNP-BC, CEN, FAANP, FAEN Family and Emergency Nurse Practitioner Program Coordinator and Assistant Professor, College of Nursing University of South Alabama Mobile, Alabama —Chivas Guillote, DNP, ENP, FNP, AGACNP, LP Vice President of Clinical Services Harris County Emergency Corps Houston, Texas Guest Editors

Factors Influencing Virtual Synchronous Site Visits in a Family Nurse Practitioner Program.

Taylor, Pamela H. PhD, APRN; Coulter, Katherine J. DNP, APRNEditor(s): Alexander, Susan DNP, ANP-BC, ADM-BC Author Information

Family Nurse Practitioner Students and Diagnostic Readiness Tests: Performances and Perceptions.

Nursing schools use diagnostic readiness tests (DRTs) to prepare family nurse practitioner (FNP) graduates to pass certification exams, but overall effectiveness estimates of DRTs are scant in the nursing literature. This pilot investigation used statistical analysis and Likert attitude scales with a convenience sample of FNP students to 1) discover any correlations between score results of two DRTs and 2) elicit test-takers' perceptions of their effectiveness. Perceptions of effectiveness were sometimes less positive than statistical indicators of test effectiveness. Disconnects between effectiveness and student perceptions need further study to guarantee optimal employment of DRTs in FNP program curricula.

Nutrition Education in Primary Care Adult and Family Nurse Practitioner Programs.

Educating and training clinicians to deliver nutrition interventions is critical to improve population health. However, the adequacy of nutrition education within primary care adult and family nurse practitioner (ANP/FNP) curricula has not been addressed. The purpose of this study was to describe faculty perceptions of nutrition education in ANP/FNP programs. We used a cross-sectional design to gather data on nutrition education. The survey was administered to a convenience sample of faculty from the United States. Our response rate was 47.8% (N = 49). The mean ± SD hours of nutrition education was 14.4 ± 14.6. One-fourth of schools reported that their students received at least 25 hours of nutrition education. Most participants thought it was very or extremely important (75.6%) that their students become more educated about nutrition. There is a need and desire for more nutrition education within nursing graduate curricula. Novel strategies to implement nutrition education in nurse practitioner curriculum are needed.

The impact of telehealth objective structured clinical evaluations in intraprofessional nursing education: A mixed methods study

BackgroundTelehealth is an expanding modality of providing care. In 2018, the National Organization of Nurse Practitioner Faculties (NONPF) released a white paper encouraging the inclusion of telehealth into nurse practitioner education. It is important for nursing students to gain experience with telehealth so that they are prepared to provide care via telehealth. ObjectivesThe purpose of this project was to evaluate the impact of incorporating telehealth simulation into objective structured clinical examinations (OSCEs) in the family nurse practitioner (FNP) and bachelor of science in nursing (BSN) programs. SettingThis study was conducted at a public, liberal arts university in a rural area of the Southeast United States. ParticipantsThe FNP and BSN students participated in this study. The FNP program is a hybrid master's degree program, which has a two-year plan of study. The BSN program is a traditional campus-based program, which includes two years of upper-division nursing courses. MethodsThis mixed-methods study included a pre- and post-survey design utilizing both quantitative and qualitative measures to evaluate undergraduate and graduate nursing students understanding of and comfort with telehealth and their perceptions of a simulated intradisciplinary telehealth OCSE experience. ResultsStudents' telehealth knowledge, skills, and confidence were improved after the telehealth OSCE experience. Directed content analysis of the responses revealed three themes: increased knowledge of telehealth, technical difficulties, and teamwork/communication. ConclusionsIt is beneficial for both undergraduate and family nurse practitioner students to have exposure to telehealth in their respective curriculums.

Incorporating a Mindfulness Program in a Graduate Family Nurse Practitioner Program.

Mindfulness-based stress reduction (MBSR) activities have been shown to have psychological benefits. Studies have identified increased perceived levels of stress in graduate students; however, this is not specific to graduate nursing students. There is very little data on the use of MBSR as a nonpharmacologic tool to decrease stress levels in graduate nurse practitioner students. Therefore, the purpose of this study was to determine if the implementation of MBSR improves the overall perceived stress of graduate nursing students. The pilot MBSR program covered topics such as different forms of mindfulness meditation practice, mindful awareness during yoga postures, and mindfulness during stressful situations. Perceived stress scores mean for the sample (n = 25) was elevated at 26 (+4) indicating moderate stress prior to the MBSR training and significantly decreased post 14-week MBSR training (+6) (p < .05). This finding suggests that the MBSR activities have contributed to the overall reduction in stress in these students. The graduate family nurse practitioner students are now familiar with the benefits of MBSR and can share this practice with their patients. Having this skill as a part of their clinical tool kit and practice will allow them to apply this to patient care and subsequently provide holistic care.

Impact of Simulated Electronic Health Records on Informatics Competency of Students in Informatics Course.

ObjectivesNursing has embraced online education to increase its workforce while providing flexible advanced education to nurse professionals. Faculty use virtual simulation and other adaptive learning technologies to enhance learning efficiency and student outcomes in online courses. The purpose of this study was to assess the impact of simulated Electronic Health Records (EHRs) on informatics competency in a graduate online informatics course.MethodsA two-group independent measures study design was adopted to assess students’ perception of a simulated EHR while comparing differences in informatics competencies between an intervention group and a control group. A simulated EHR assignment was provided to students in the intervention group, and a paper assignment was provided to those in the control group. The informatics competency of the students was measured using the Self-Assessment of Informatics Competency Scale for Health Professionals (SICS).ResultsStudents who were enrolled in a family nurse practitioner program in fall of 2019 participated in this study (n = 39). The students expressed positive perceptions of a simulated EHR experience. The SICS results indicated that students in the intervention (simulated EHR) group showed higher informatics competency than those in the control group.ConclusionsThe positive results of this study support incorporating simulated EHR exercises in online courses. Higher informatics competency in the intervention group implies that the use of simulated EHR facilitated learning of complicated informatics concepts.

Meeting FNP students' and faculty clinical needs: Two perspectives.

Appropriate clinical practice sites with skilled preceptors are the backbone of family nurse practitioner (FNP) students' education. Faculty are also in need of practice sites to stay abreast of current clinical practice and maintain clinical hours for certification. The purpose of this article is to relate the process of developing a practice model to meet the needs of the FNP student and faculty. Academia and student life professionals collaborated to use an existing student health center on campus as an education site with an FNP nursing faculty member as a preceptor. This qualitative descriptive study presents reflections of the experience from the student perspective. Three main themes were identified: independence, confidence, and trust. Lessons learned from the faculty perspective are also reviewed. Benefits of the project ultimately outweighed barriers. The interdepartmental precepted practice experience completed its fourth successful year and maintains support through the university's student life division. The model may provide strategies, particularly for FNP programs and faculty in smaller universities, to increase and diversify clinical experiences and provide a faculty practice site.

Well-being Content in Nurse Practitioner Curricula: Facilitators and Barriers

The challenges and stressors of primary care require nurse practitioners to balance patient demands with their own health and well-being. Academic institutions have a responsibility to promote health and well-being among all students, with the goal of their continuing these activities after graduation. Results of this project describe the current state of well-being content integration in the curriculum of a hybrid family nurse practitioner program and identify potential barriers and facilitators of curriculum refinement. Findings provide direction regarding the next steps required to implement well-being content into didactic and workplace learning environments of primary care programs.

Beyond Discussion: Implementing Multimodal Learning in a Nurse Practitioner Program.

End-of-program feedback from students reflected a decreased level of active engagement and retention in learning at a public university in the upper Midwest of the United States. Results prompted educators to explore integration of multimodal instruction within the postlicensure family nurse practitioner program. A graduate program faculty work group was created to review and revise the curriculum. Through the utilization of national organization standards, implementation of evidence-based best practices, and a shared vision, a small group of nurse faculty was able to complete significant improvement in the graduate curriculum within a single academic year.

Screening, brief intervention, and referral to treatment training for family nurse practitioner students.

Alcohol and substance-related disorders affect individuals throughout the global community. It is important that nurse practitioners understand the use of screening, brief intervention, and referral to treatment (SBIRT) in recognizing these disorders before development of chronic disease conditions. The SBIRT curriculum was adapted and integrated in a family nurse practitioner program. After completion of the curriculum in the didactic setting, students used what they learned in a clinical setting. Following the experience, students reflected on the encounters leading to increased awareness of personal feelings. Students were able to use their training in patient encounters and identified a variety of thoughts and feelings about working with patients who screened positive for overuse of alcohol or substances. The SBIRT is an important component of the education of nurse practitioners. It is through timely screening and intervention that conditions can be addressed early in substance use disorder. It is important for students to be aware of personal thoughts and feelings when working with this population.

Using Objective Structured Clinical Examination as a Teaching Tool in a Hybrid Advanced Health Assessment Course.

Advanced health assessment is a required course in advanced practice RN (APRN) education, essential to providing the foundation for differential diagnosis (DD) skills and the ability to formulate a plan of care. Feedback from clinical preceptors revealed that our doctor of nursing practice (DNP) students struggled to make a DD. This educational quality improvement project collected data from 7 cohorts of DNP students in either the Family Nurse Practitioner or Adult Gerontology Nurse Practitioner program to evaluate their readiness for clinical practicums and to inform necessary curriculum revisions. Data revealed that students' ability to identify 3 DDs correctly during the summative health assessment objective structured clinical examination was inconsistent. Qualitative data revealed students lacked understanding on how to use results from the physical assessment to formulate a DD. The findings of this project corroborate those from the literature that suggest we should teach APRN students DD skills explicitly.

Developing and Implementing the Family Nurse Practitioner Role in Eswatini: Implications for Education, Practice, and Policy.

Introduction:Eswatini, a small, largely rural country in Southern Africa, has a high burden of morbidity/mortality in the setting of a critical shortage of human resources for health. To help achieve universal access to healthcare across the lifespan, the advanced practice family nurse practitioner (FNP) role was proposed and is in the process of being implemented.Methods/Approach:The PEPPA framework (Participatory, Evidence-based, Patient focused Process for Advanced practice nursing) illustrates the steps in the process of developing and implementing the FNP role in a country. These steps include: determining the need for the role, deciding on a model of care, developing/implementing the curriculum, relevant policies, and scope of practice (SOP), and integrating the role into relevant nursing regulations and Ministry of Health (MOH) guidelines and documents.Outcomes:The assessment has been completed, a locally tailored competency-based FNP curriculum has been developed, revised, and implemented, the FNP SOP has been approved and MOH guidelines are being updated to reflect current evidence-based practice and to integrate the FNP role. Continuous cycles of improvement/revision were needed to adapt the curriculum and SOP to meet local needs. Clinical placements were challenging since this is a new health cadre, but most challenges were overcome and many resulted in important opportunities for interdisciplinary collaboration.Summary:Outcomes from this quality improvement initiative demonstrate that it is feasible to develop and implement a locally responsive, competency-based FNP program in a low resource setting and enroll students, despite time and financial constraints. Adapting the curriculum and SOP from western countries can provide a foundation for program development but revision to assure that the program is responsive to local context is then needed. There is general acceptance of the role among Eswatini communities and professional stakeholders with emphasis on the need for FNP graduates to be clinically competent and able to function independently. Policy work related to deploying new graduates is ongoing.

Using Simulation to Prepare for Clinicals in Front-Loaded FNP Curricula

BackgroundTransitioning from a Master of Science degree to a Doctorate of Nursing Practice degree in a Family Nurse Practitioner program presents a challenge in course sequencing. If DNP coursework is placed after concurrent clinical and didactic courses, students will encounter situations in clinical that they have not studied in the didactic arena (increasing preceptor burden) and complete their clinicals a year before graduation. We adopted a front-loaded course sequence, placing didactic management courses before the start of clinical courses. However, students would now be exposed to didactic management content a year before beginning clinical. MethodsTo enhance readiness for clinicals, we implemented a program, “Conquering Clinical,” which included a full day of simulation that reviewed four scenarios frequently encountered in primary care. ResultsThe students reported feeling both more confident and more competent in conducting a primary care encounter. ConclusionA preclinical preparation program is beneficial to both students and preceptors.