Nurse Practitioner Clinic Research Articles

Incorporating Evidence-Based Practice Learning Activities Throughout Family Nurse Practitioner Clinical Practicum Courses.

Evidence-based practice (EBP) is crucial to high-quality health care, yet nurse practitioner graduates report low levels of confidence in their EBP abilities. This may be because of limited incorporation of EBP learning opportunities outside of foundational course-work. Family nurse practitioner (FNP) program faculty incorporated EBP learning activities across the three-semester clinical year curriculum, and the activities scaffolded in complexity. Initial activities included appraisal and application of clinical practice guidelines to patient case scenarios. Later, students used the seven steps of EBP to present frequently asked patient questions and EBP clinical challenges in their clinical rotations to their peers. This innovative way to thread EBP across the clinical year allowed faculty to continue to evaluate and guide students toward EBP competency. The integration of EBP learning activities across the clinical year is a feasible strategy to further expand FNP student competency in EBP. [J Nurs Educ. 2024;63(X):XXX-XXX.].

The Clinical Nurse Practitioner's Essential Role in Early Diagnosis and Management of Multiple Sclerosis in Europe: A Consensus Report.

Timely diagnosis of multiple sclerosis (MS) is a challenge due to factors such as prompt identification of symptoms and consequent delays in hospital visits and treatment initiation. In part to address this challenge, an expert scientific advisory panel of clinical nurse practitioners (CNPs) from different European nations was convened by Viatris on October 25, 2022, in Amsterdam, the Netherlands. This meeting was an interactive discussion to understand the role of clinical nurse practitioners in MS management. The objectives were to (1) understand the current delays in MS diagnosis from the perspective of expert CNPs; (2) determine the role of the CNP in MS management; and (3) identify the opportunities to improve accessibility, foster collaboration among stakeholders, and promote initiatives to educate people with MS. The recommendations of the panel underline the multidimensional role of CNPs in the management of MS at all stages. Health care stakeholders need to work together to achieve better access to treatment regimens and facilitate outcomes in the management of MS through shared decision-making and follow-ups. Further exploration of the role of CNPs in the management of MS, as well as recommendations for early diagnosis, will help both general practitioners and specialists better manage MS care.

Nurse Practitioner Care Compared with Primary Care or Nephrologist Care in Early CKD.

Early interventions in CKD have been shown to improve health outcomes; however, gaps in access to nephrology care remain common. Nurse practitioners can improve access to care; however, the quality and outcomes of nurse practitioner care for CKD are uncertain. In this propensity score-matched cohort study, patients with CKD meeting criteria for nurse practitioner care were matched 1:1 on their propensity scores for ( 1 ) nurse practitioner care versus primary care alone and ( 2 ) nurse practitioner versus nephrologist care. Processes of care were measured within 1 year after cohort entry, and clinical outcomes were measured over 5 years of follow-up and compared between propensity score-matched groups. A total of 961 (99%) patients from the nurse practitioner clinic were matched on their propensity score to 961 (1%) patients receiving primary care only while 969 (100%) patients from the nurse practitioner clinic were matched to 969 (7%) patients receiving nephrologist care. After matching to patients receiving primary care alone, those receiving nurse practitioner care had greater use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (82% versus 79%; absolute differences [ADs] 3.4% [95% confidence interval, 0.0% to 6.9%]) and statins (75% versus 66%; AD 9.7% [5.8% to 13.6%]), fewer prescriptions of nonsteroidal anti-inflammatory drugs (10% versus 17%; AD -7.2% [-10.4% to -4.2%]), greater eGFR and albuminuria monitoring, and lower rates of all-cause hospitalization (34.1 versus 43.3; rate difference -9.2 [-14.7 to -3.8] per 100 person-years) and all-cause mortality (3.3 versus 6.0; rate difference -2.7 [-3.6 to -1.7] per 100 person-years). When matched to patients receiving nephrologist care, those receiving nurse practitioner care were also more likely to be prescribed angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and statins, with no difference in the risks of experiencing adverse clinical outcomes. Nurse practitioner care for patients with CKD was associated with better guideline-concordant care than primary care alone or nephrologist care, with clinical outcomes that were better than or equivalent to primary care alone and similar to those with care by nephrologists. This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_12_08_CJN0000000000000305.mp3.

Psychometric Testing of a Tool Assessing Nurse Practitioner Clinical Educator Competence

A convenience sample of 137 nurse practitioner (NP) clinical educators completed the Academic Clinical Nurse Educator Skill Acquisition Tool (ACNESAT). NP clinical educators reported extreme confidence (M = 173.57, SD = 4.34) with 40 clinical educator activities, the most confidence with Demonstrates Clinical Expertise (M = 4.56, SD = .554), and the least confidence with Applies Theory to Clinical Practice during Clinical Nursing Education Experiences (M = 4.07, SD = .846). The 40-item tool demonstrated high internal consistency reliability (α = .972).Therefore, the ACNESAT may be used to assess skill acquisition, identify professional development needs, and guide individualized mentoring programs.

Primary Care Nurse Practitioner Clinical Procedural Skills

This online survey study examined the most frequently performed and most important clinical procedural skills (CPSs) and location of CPSs training in a sample of 102 primary care nurse practitioners across a 6 state/jurisdiction region of the United States. Results indicated that 7 CPSs were reported as being performed at least once a week by > 30% of participants, and the same 7 CPSs were reported as very important by > 50% of participants. Results facilitate formation of a list of core CPSs for primary care nurse practitioners for standardization of CPSs curricular requirements.

Optimization of Patient Scheduling in a Hematology Outpatient Setting

BackgroundA sequelae of increased cancer incidence is the need for specialized outpatient care. The purpose of this project was to improve scheduling of multifaceted treatments and care within an outpatient clinic. MethodsA decision support tool was developed within research electronic data capture (REDCap) to improve patient scheduling. ResultsPatients reported satisfaction with access and appointment coordination. Nurse practitioner clinic utilization and new-patient volumes increased. Qualitative themes included ease in facilitating transfer of care. ConclusionsA decision support tool within REDCap was successfully implemented within an outpatient cancer clinic and may be considered for other specialty services.

Providing support and raising awareness of a delicate subject.

Clare Akers, Clinical Nurse Practitioner, University College London Hospitals NHS Foundation Trust, was runner up in the urology nurse of the year category in the BJN Awards 2020.

21 - Pilot Project to Assess Nurse Practitioner Clinic for Adults With Diabetes Without Access to Primary Care

21 - Pilot Project to Assess Nurse Practitioner Clinic for Adults With Diabetes Without Access to Primary Care

Integrated Nurse Practitioner and Pharmacist Post-discharge Heart Failure Clinic: Impact on Patient Outcomes

IntroductionThe American Heart Association recommends implementation of integrated transition of care programs to manage patients following hospitalization for acute decompensated heart failure (ADHF). At our site, a Nurse Practitioner (NP) has been historically responsible for seeing patients post discharge in the Heart Failure Access Clinic (HFAC). Whether the addition of a clinical pharmacy specialist (CPS) to co-manage patients at the HFAC clinic leads to improved outcomes is not known. Therefore, we conducted a pilot study to assess the feasibility and potential benefits of this integrated approach.ObjectiveWe evaluated 30-day heart failure readmission, emergency department (ED) visits, and all-cause mortality in post-discharge patients who were seen in our integrated CPS and NP pilot HFAC clinic. The clinic process and CPS interventions were also assessed.MethodsPatients who were discharged from the hospital for ADHF were eligible for the pilot study if they had at least mild LV systolic dysfunction (LVEF ≤50%). In the integrated HFAC clinic, the NP determined patients’ volume and perfusion status, implemented a flexible diuretic plan, and set parameters for patients contacting the HF team. Responsibility for medication reconciliation, neurohormonal medication education, and dose optimization was shifted to the CPS. Descriptive statistics were used as appropriate.ResultsBetween 11/18/2019 and 3/10/2020, 24 visits were conducted in the integrated clinic. Our patients were predominantly Caucasian (88%), male (96%), and elderly (mean age: 70 ± 12 years). Most patients (75%) had LVEF ≤40%. The 30-day post-discharge readmission rate was 2/24 (8%), while both ED visits and all-cause mortality rates were 0%. Historically, veterans at our NP led HFAC clinic have had a 30-day readmission rate of 15.8% (data from 2019). The average time to appointment was 12 ± 8 days post-discharge with 25% patients seen within 7 days. The mean duration of the CPS visit was 36 minutes; the NP visit was 41 minutes (n=12). The CPS noted medication discrepancies in 14/24 (58%), alerted other providers for medication issue follow-up in 10/24 (42%), and identified HF inappropriate medications in 3/24 (13%). HF medications were titrated by the CPS in 13/24 (54%), and 16/24 (67%) patients were scheduled with CPS for ongoing medication dose titration. One patient (4%) was referred for tobacco treatment.ConclusionsEarly analysis indicates that the integrated HFAC leads to high-quality patient care as evidenced by a very low 30-day hospital readmission rate without ED visits or fatality. These outcomes compare favorably to our institution's 30-day readmission rate observed prior to implementation of this pilot project. Potential benefits of adding a CPS as a provider to our HFAC include medication reconciliation and education, identification of harmful drugs, and timely medication titration. Further analysis is warranted to compare the impact of the integrated HFAC versus standard of care over a longer time frame.

A multimorbidity nurse practitioner-led clinic: Evaluation of health outcomes

BackgroundHealthcare services for people living with multiple chronic diseases have traditionally been organised around each condition, an approach which is neither resource-efficient nor convenient or effective for patients. The integrated nurse practitioner service reported here was developed to optimise patient experience and outcomes within a chronic disease self-management framework. AimTo evaluate patient outcomes following attendance at an integrated chronic disease nurse practitioner clinic for multimorbidity. MethodsA prospective service evaluation of adults with any combination of chronic kidney disease, diabetes and/or heart failure between June 2014 and December 2017. Demographic and clinical outcomes at entry and after 12 months of clinic attendance were collected from health records of all patients (n = 162); a subgroup also completed health-related quality of life and self-efficacy measures at entry and 12 months follow-up (n = 106). FindingsPatients attending the clinic had complex needs and poor health-related quality of life. Despite the complexity of their health problems, as a cohort blood pressure was well-controlled and self-efficacy for chronic disease management was relatively high. Over the first 12 months of integrated nurse practitioner care, there were large improvements in physical aspects of health-related quality of life and many patients achieved reductions in body mass index. Use of hospital inpatient and emergency services also decreased. DiscussionNurse practitioner-led services have the potential to reduce treatment burden and deliver integrated chronic disease management. ConclusionsThe multimorbidity clinic has improved health outcomes in this patient cohort and offers a model for enhanced primary care.

Cost Analysis of a Multidisciplinary Vascular Anomaly Clinic.

Multidisciplinary vascular anomaly clinics (VACs) offer important value to pediatric patients with complex vascular anomalies whose care overlaps specialties. These clinics are labor intensive and costly to operate since providers see fewer patients compared to their individual specialty clinic. Our North American tertiary care institution's VAC specialists include a pediatric otolaryngologist, pediatric surgeon, pediatric plastic surgeon, pediatric dermatologist, and interventional radiologist. To assess financial feasibility, we conducted a cost analysis of our VACs comprised of 2 half-day multidisciplinary physician attended clinics (5 specialists at our main campus and 2 specialists at a satellite clinic) and a half-day nurse practitioner clinic. Assessment of net revenue based on net collections for clinic, professional, operative, hospital setting, and facility charges generated during 12 consecutive monthly VACs beginning July 1, 2015. Expense calculations included provider and staff salaries, benefits, supply costs, and clinic leasing costs. There were 469 clinic visits, of which 202 were new patient evaluations. Sixty-eight patients underwent 93 procedures under general anesthesia, including procedures performed by our interventional radiologist, most commonly sclerotherapy or embolization (n = 37), surgical interventions including endoscopy (n = 36), or laser procedures (n = 20). Three patients were admitted. Fifty-seven patients received a new diagnosis different from that for which they were referred. Gross revenue was $1 810 525, and net revenue was 42.5%, or $783 152. Expenses totaled $453 415 for a net positive revenue of $329 737. When including direct downstream revenue, particularly from operative procedures, our VAC program operates on a net positive margin, making the program financially feasible.

An integrated chronic disease nurse practitioner clinic: Service model description and patient profile

BackgroundOne common cluster of chronic conditions — chronic kidney disease, diabetes mellitus and heart failure — places a significant burden on the Australian healthcare system. In combination, these conditions complicate treatment, increase rates of hospitalisation and carry a poorer prognosis for survival. Current health services are organised around single conditions, making coordination of care more difficult and adding complexity to patients’ lives. AimsTo describe an integrated model of care provided by nurse practitioners for patients with multiple chronic diseases. MethodsA prospective, longitudinal study of patients with two or three chronic diseases attending a community-based nurse practitioner clinic. On entry to the clinic demographic and clinical data were collected from patients and health records (n=121). At six months a subgroup (n=70) also reported their satisfaction with the clinic. FindingsOver 18 months the clinic provided 925 appointments to patients aged between 27–90 years. Most (79.2%) had chronic kidney disease as one of their diagnoses. At baseline, blood pressure and glycosylated haemoglobin targets were achieved by 66.4% and 83.2% respectively, although only 7.1% had a healthy-range body mass index. After six months of attendance, there was high overall patient satisfaction with the new service (98.7%). DiscussionNurse practitioners can reform healthcare delivery through innovative person-centred models of care, breaking down the siloes of treatment for chronic disease. ConclusionIn the current and growing context of multi-morbid chronic health conditions, integration of care within and across organisations is required to meet future health care demands.

A descriptive model for a multidisciplinary unit for colorectal and pelvic malformations

IntroductionPatients with anorectal malformations (ARM), Hirschsprung disease (HD), and colonic motility disorders often require care from specialists across a variety of fields, including colorectal surgery, urology, gynecology, and GI motility. We sought to describe the process of creating a collaborative process for the care of these complex patients. MethodsWe developed a model of a devoted center for these conditions that includes physicians, psychologists, social workers, nurses, and advanced practice nurses. Our weekly planning strategy includes a meeting with representatives of all specialties to review all patients prior to evaluation in our multidisciplinary clinic, followed by combined exams under anesthesia or surgical intervention as needed. ResultsThere are 31 people working directly in the Center at present. From the Center's start in 2014 until 2017, 1258 patients were cared for from all 50 United States and 62 countries. 360 patients had an ARM (110 had a cloacal malformation, 11 had cloacal exstrophy), 223 presented with HD, 71 had a spinal malformation or injury causing neurogenic bowel, 321 had severe functional constipation or colonic dysmotility, and 162 had other diagnoses including familial polyposis, Crohn's disease, or ulcerative colitis. We have had 170 multidisciplinary meetings, 170 multispecialty outpatient, and 52 nurse practitioner clinics. In our bowel management program we have seen a total of 514 patients in 36 sessions. ConclusionThis is the first report describing the design of a multidisciplinary team approach for patients with colorectal and complex pelvic malformations. We found that approaching these patients in a collaborative way allows for combined medical and surgical decisions with many providers simultaneously, facilitates therapy, and can potentially improve patient outcomes. We hope that this model will help establish new-devoted centers in other locations to encourage centralized care for these rare malformations. Level of evidenceIV.

A New Approach for Solving an Old Problem in Nurse Practitioner Clinical Education

Abstract Increasing enrollment in nurse practitioner programs to meet the current demand for primary care providers is a major focus of schools of nursing across the United States. Competition with other schools for clinical sites and a labor-intensive 1:1 preceptor/student education model limit the number of sites available for educational experiences. This article explains some of the barriers to obtaining clinical sites and how 1 school changed clinical education.

Abstract NS2: A Rapid Care Evaluation Transient Ischemic Attack Clinic by Nurse Practitioners

Background: Prompt evaluation and management of patients having a transient ischemic attack (TIA) with the ABCD2 triage score has been shown to decrease the risk of stroke and potentially life-long disability. However, creating an organized, well-coordinated approach that provides rapid access for patients is a challenge at many high-volume stroke centers. Purpose: We sought to determine the feasibility of a nurse practitioner (NP)-led Rapid Access Care Execution for Transient Ischemic Attack (RACE-TIA) Clinic as part of an Outpatient Stroke Nurse Practitioner Clinic. Methods: Our RACE-TIA Clinic Algorithm uses ABCD2 score triaging, and outlines the care process for TIA patients who present either through the Emergency Department (ED), Outpatient Clinic or via telephone triage. Patients with possible TIA are triaged using the ABCD2 tool. Those who present to the ED are evaluated by a member of the Acute Stroke Team and patients with a score ≥ 3 remain in the ED Clinical Decision Unit (CDU) for evaluation. Patients with a score < 3 are scheduled in the RACE-TIA Clinic staffed by two stroke-trained NPs. Referrals to the RACE-TIA clinic from the electronic medical record (EMR) referral or the dedicated phone line are triaged by a registered nurse who was trained to complete the ABCD2 scoring. All appointments are scheduled within 24-48 hours of receiving a referral. Results: Since initiating the RACE-TIA Clinic Algorithm in January 2017 a total of 20 patients were seen as outpatients for TIA evaluation. Six patients were directly referred to the RACE-TIA Clinic for acute TIA evaluation and of those, 5 were referred from the ED and 1 from a primary care office. Another 14 patients were scheduled for follow-up after having an initial TIA evaluation at either an outside hospital (3), the ED (2), ED CDU (3) or after inpatient hospitalization (6). The average time from referral to clinic visit was 34 hours. Conclusion: Our NP-led RACE-TIA Clinic has successfully evaluated patients with low risk TIA in the outpatient setting in a timely way and also provided close follow-up for high risk TIA patients after the acute evaluation without expanding or duplicating existing resources.

Combining Forces: Nurse Practitioner and Clinical Pharmacist Led Heart Failure Clinic and its Impact on Titration Rates and Hospital Readmission

Aim: This was an initial evaluation of a novel heart failure (HF) nurse practitioner (NP)-led titration clinic augmented by a clinical pharmacist to facilitate titration of guideline-recommended therapy and education in an outpatient clinic setting.

Choosing Wisely: A Quality Improvement Initiative to Decrease Unnecessary Preoperative Testing

Dartmouth-Hitchcock Medical Center is a rural, academic medical center in the northeastern United States; its General Internal Medicine (GIM) division performs about 900 low and intermediate surgical risk preoperative evaluations...

Perceptions of Family Nurse Practitioner Clinical Preceptors About Usefulness of Onsite Clinical Site Visits.

Clinical site visits are important for evaluating graduate nursing students' clinical success. This descriptive study surveyed family nurse practitioner preceptors' perceptions of modalities for conducting site visits. Results indicated that preceptors believe faculty should make at least 1 face-to-face site visit to observe a student during the semester. No preference for telephone or mobile technology for conducting site visits was identified. The study provides important considerations when designing guidelines for faculty site visits.

Implementing the Flipped Classroom to Enhance Nurse Practitioner Clinical Decision-Making in the Care of the Pediatric Asthma Patient

Abstract Pediatric asthma, while prevalent in primary care, relies heavily on the clinical decision-making process for diagnosis and management because of the common lack of observable symptoms on physical exam. The process of active learning through the “flipped classroom” has been shown to help engage students in the learning process. This pedagogy was implemented in a nurse practitioner course to improve clinical decision-making in the care of the pediatric asthma patient. A description of this method is described along with student feedback, methods of evaluation, and strategies for success.

In the Palm of Your Hand – Normalizing the Use of Mobile Technology for Nurse Practitioner Education and Clinical Practice

The use of mobile devices by nurse practitioners (NPs) to meet an evolving technological landscape is expanding rapidly. A longitudinal study of the ways NP students "normalize" the use of mobile devices in clinical education was completed. This study used researcher-designed survey tools, including sociodemographic questions, and the numerical picture was augmented and interpreted in light of the textual data in the form of selected interviews. Data indicate that mobile technology is normalized in the social realm but still developing in the clinical realm. Progress is hindered by non-modelling by faculty, inconsistent healthcare policy and lack of understanding of the affordances available through this technology. Overall, mobile technology is utilized and normalized in practice; this in turn has influenced their ability to prepare students for practice. Data presented can assist educators and clinicians alike in developing a more fulsome understanding on how to appropriately incorporate mobile technology into education and practice.