Journal of the American Academy of Nurse Practitioners (J AM ACAD NURSE PRAC)

Publications in this journal

• Article: Practice implications for preventing population vulnerability related to vitamin D status

  Andrea Collins
  Journal of the American Academy of Nurse Practitioners 01/2013;
• Article: Pediatric overweight or obesity: does the label really matter?

  Julee Waldrop, Laurie Anne Ferguson
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  ABSTRACT: To discuss the issue of early identification of overweight and obesity in infants and young children and provide some clinical recommendations based on the current evidence and the World Health Organization's (WHO) newly released guidelines for growth and development. Comparison of the growth charts from the WHO and the Centers for Disease Control as well as current literature. Although healthcare providers and the general public recognize overweight and obesity as serious problems, there is still disagreement on what constitutes obesity in infants and young children and when and how to intervene. More research on interventions and outcomes is particularly needed. The primary care provider deals with the sequelae of obesity on a daily basis. Some recommendations are provided for nurse practitioners who care for infants and children based on current evidence and expert opinion.
  Journal of the American Academy of Nurse Practitioners 06/2008; 20(5):251-8.
• Article: Patient satisfaction with nurse practitioner care in emergency departments in Canada.

  Christine Thrasher, Rebecca Purc-Stephenson
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  ABSTRACT: To measure patient satisfaction with care delivered by nurse practitioners (NPs) in emergency departments (EDs) in Canada using a psychometrically valid survey. All patients who received care from an NP in six participating EDs in Ontario province over a 1-week period were asked to complete a self-administered patient satisfaction survey designed specifically to assess satisfaction with NP care in EDs. One hundred and thirteen patients completed the survey. Principal components analysis of the survey revealed three factors or subscales: Attentiveness, Comprehensive care, and Role clarity. Scores on the three subscales indicated that patients were satisfied with Attentiveness (M = 3.72, SD = 0.38) and Comprehensive care (M = 3.52, SD = 0.49) and had a moderate understanding of Role clarity (M = 2.99, SD = 0.66). Participants with higher income levels reported higher levels of satisfaction with the attentiveness they received, whereas patients with previous experience with an NP reported higher levels of satisfaction with the comprehensive care they received. There was no appreciable increase in patient satisfaction with the NP based on age, gender, education, or health status. These findings indicate that attentiveness, comprehensive care, and role clarity are reflected by the NP in emergency healthcare settings as indicated by the patient's responses to the survey. This study supports that meeting expectations is a critical component of patient satisfaction.
  Journal of the American Academy of Nurse Practitioners 06/2008; 20(5):231-7.
• Article: Characterizing nurse practitioner practice by sampling patient encounters: an APRNet study.

  Terry Deshefy-Longhi, Martha K Swartz, Margaret Grey
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  ABSTRACT: The purpose of this study was to characterize nurse practitioners' (NPs') practice by using reports of patient encounters to more accurately reflect practice patterns than has been previously performed. This study was part of a larger primary care practice survey by a consortium of 20 practice-based research networks (PBRNs). Therefore, comparisons, when appropriate, were also made between this network of NPs (Advanced Practice Registered Nurse Network, APRNet) and the other 19 physician-run research networks. A descriptive survey was developed by the 20 PBRN consortium under grants from the Agency for Healthcare Research and Quality. The consortium's goal was to collect primary care data over a 6-month period and to document and compare primary care practice in the United States. The data were collected immediately following members' encounters with patients rather than from billing spreadsheets. Nineteen PBRNs may have had NPs in the practices that comprised their networks. However, the data from these NPs were collected under the study ID numbers of the physician owners of each practice. APRNet, therefore, was the sole research network comprised exclusively of NPs who collected and reported data under their own study ID numbers. Acute health problems comprised 45% of all episodes treated by NPs compared to 30% of episodes for exacerbations of chronic conditions and 24.5% for nonillness and health promotion visits. In addition, our findings suggest that NPs provide counseling in 84% (vs. 61% for physicians) of their primary care visits, regardless of the reason for visit, and the type of counseling varies by the type of NP. Despite many studies on the comparability and outcomes of NP practice, the need to identify, clarify, and document the practices of NPs in primary care settings remains. The present survey provides an important and useful first step in providing a systematic way to characterize these practices through a survey of APRNs immediately following their patient encounters.
  Journal of the American Academy of Nurse Practitioners 06/2008; 20(5):281-7.
• Article: Trust of nurse practitioners and physicians among African Americans with hypertension.

  Ramona Benkert, Rosalind Peters, Nutrena Tate, Ellen Dinardo
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  ABSTRACT: To examine correlates of low-income African Americans' level of trust in healthcare providers. Specific aims were to (a) describe the levels and correlations of trust, mistrust, and satisfaction; (b) compare trust scores by provider type (nurse practitioner [NP] and medical doctor) and clinic type (nurse-managed clinic [NMC] and joint-managed clinic [JMC]); and (c) examine the relationship of patient and provider demographic factors (e.g., race concordance) with trust in the provider. This descriptive cross-sectional study was conducted with 145 low-income African Americans (51% women, 49% men; mean age = 49.4 years). All participants were enrolled in a larger study that examined the effect of psychosocial variables on hypertension outcomes. Participants completed three questionnaires: Trust in Provider Scale, Cultural Mistrust Inventory, and the Michigan Academic Consortium Patient Satisfaction tool. Chart audits were performed to collect clinical data. Trust and satisfaction were moderately high, M = 3.9 (0.56), M = 4.1 (0.57), respectively, on the 5-point scales, and cultural mistrust was in the moderate range, M = 3.9 (0.79), on a 7-point scale. No significant differences in mistrust, t(142) =-1.43, p = .155, or satisfaction, t(142) = 0.716, p = .475, were noted by provider type. Trust was significantly higher for patients seen by NPs, t(142) = 2.57, p = .011. Additionally, patients seen in the NMC reported significantly higher levels of trust than those seen in the JMC, t(143) = 3.62, p < .001. Race concordance between provider and patient did not change these findings. Low-income African American patients have experienced unequal and discriminatory treatment, which can result in a cultural mistrust of providers; yet, providers in this study were able to engender high trust and satisfaction among these respondents. Still, the sociocultural effects of race concordance require further exploration to better understand the impact on trust in the patient-provider relationship. Finally, the high levels of trust in the NMC may offer a promising solution to the health disparities of African Americans; yet, more research is needed.
  Journal of the American Academy of Nurse Practitioners 06/2008; 20(5):273-80.
• Article: The prevalence and pattern of gastroesophageal reflux symptoms in perimenopausal and menopausal women.

  Mary Infantino
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  ABSTRACT: To determine the prevalence and describe the pattern of gastroesophageal reflux disease (GERD) symptoms in premenopausal-, perimenopausal-, and menopausal-age women. Three tools were used to collect data: the Menopause Rating Scale, a standardized, self-administered 11-item scale that assesses the presence of menopausal symptoms and their impact on quality of life; the Gastrointestinal Symptom Rating Scale, a standardized, self-administered 15-question survey that inquires about both lower and upper gastrointestinal (GI) symptoms; and the Reflux Disease Questionnaire (RDQ), a self-administered 14-question survey currently being evaluated in the United States as a specific diagnostic tool for GERD that specifically addresses upper GI symptoms of discomfort. Additionally, GERD were correlated with vasomotor, vaginal, genitourinary, and other menopausal symptoms using multiple regression analysis to assess the relationships between GERD and menopausal symptoms. Approximately 497 women between the ages of 25 and 60 years completed the surveys. The prevalence of GERD symptoms was high in this sample. Almost 42% of perimenopausal and 47% of menopausal participants complained of upper GI symptoms. Although perimenopausal and menopausal women had higher percentages of GERD diagnosis as compared to premenopausal women, 80% of the perimenopausal and menopausal groups had never been diagnosed with an upper GI disorder. A post hoc analysis of RDQ results demonstrated that patients with menopause had significantly more upper GI discomfort. Overall, this study found that menopausal women were 2.9 times more likely to have GERD symptoms. These findings are strongly suggestive of a hormonal link between perimenopausal and menopausal states and increasing GERD symptoms. Women of all ages should be screened for symptoms of GERD, especially in the perimenopausal and menopausal population of women because diagnosis of GERD is often not made or misdiagnosed. The impact on the quality of life of women experiencing GERD symptoms cannot be underestimated.
  Journal of the American Academy of Nurse Practitioners 06/2008; 20(5):266-72.
• Article: Against the grain: an overview of celiac disease.

  Suzanne Martin
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  ABSTRACT: To review the epidemiology, pathophysiology, clinical presentation, diagnosis, and management of celiac disease (CD). Review of literature using Pub Med and Access Medicine. The following search terms were used: celiac disease, malabsorption syndromes, diarrhea, and gluten-free diet (GFD). There was no limitation placed on publication year. Only articles written in English were included. CD is a chronic systemic autoimmune disorder triggered in genetically susceptible individuals by the ingestion of gluten proteins (wheat, barley, and rye). CD often presents atypically, and diagnosis delays are common. Currently, the only effective treatment for CD is strict adherence to a GFD. This is a difficult diet to comprehend and follow. Adherence to a GFD requires ongoing education and support from a multidisciplinary healthcare team, support groups, family, and friends. Once considered a rare disease of childhood, CD is now recognized as a common disorder that can occur at any age. Clinicians need to be cognizant of risk factors, clinical manifestations, conditions, and complications associated with CD in order to make a timely diagnosis, ameliorate symptoms, and minimize disease complications.
  Journal of the American Academy of Nurse Practitioners 06/2008; 20(5):243-50.
• Article: Overweight and obesity in nurses, advanced practice nurses, and nurse educators.

  Sally K Miller, Patricia T Alpert, Chad L Cross
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  ABSTRACT: To quantify the incidence of overweight and obesity in nursing professionals and assess nurses' knowledge of obesity and associated health risks. A mailed survey to 4980 randomly selected registered nurses from one state in each of six geographic regions. Response rate was 15.5% (n= 760). Descriptive statistics were calculated for continuous variables; categorical variables were summarized with frequency counts. The grand mean body mass index (BMI) of nurses surveyed was 27.2. Almost 54% were overweight or obese. Fifty-three percent of these nurses report that they are overweight but lack the motivation to make lifestyle changes. Forty percent are unable to lose weight despite healthy diet and exercise habits. Only 26% of respondents use BMI to make clinical judgments of overweight and obesity. Although 93% of nurses acknowledge that overweight and obesity are diagnoses requiring intervention, 76% do not pursue the topic with overweight and obese patients. Many nurses provide weight-related health information to the public. These data suggest that they may benefit from continuing education on obesity and its risks. Because 76% of nurses do not pursue the topic of obesity with patients, they may benefit from education on pursuing sensitive topics during a professional encounter. Nurse practitioners may play a key role in the education of both patients and registered nurses.
  Journal of the American Academy of Nurse Practitioners 06/2008; 20(5):259-65.
• Article: The role of gastroesophageal reflux disease in asthma.

  Sandra Huggins
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  ABSTRACT: To emphasize the relationship between gastroesophageal reflux disease (GERD) and asthma symptoms or exacerbations. Selective review of the scientific literature. Although studies in recent years have offered insight into the relationship between GERD and asthma symptoms, many nurse practitioners (NPs) fail to recognize atypical GERD symptoms, which may explain difficult-to-treat asthma and exacerbation. It has become evident that patients suffering from persistent asthma display an increased prevalence of GERD. While there are increasing constraints that limit the provider-patient interaction time, it is imperative that NPs develop keen assessment skills to effectively diagnose and treat asthma symptoms that are a product of GERD. Awareness of the asthma-GERD relationship allows NPs to quickly obtain pertinent information and successfully determine how to efficiently treat symptomatic asthmatic patients.
  Journal of the American Academy of Nurse Practitioners 06/2008; 20(5):238-42.
• Article: Predisposing factors to phlebitis in patients with peripheral intravenous catheters: a descriptive study.

  Esin Uslusoy, Samiye Mete
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  ABSTRACT: The purpose of this study was to investigate the predisposing factors in the development of phlebitis in peripheral intravenous (IV) catheterization sites in patients treated with a variety of IV infusion solutions and drugs. Systematic observation of 568 IV sites inserted for fluid infusion and drug administration in 355 patients in the Department of General Surgery of a University Hospital in Turkey. A data collection tool was based on standards established by the Infusion Nurses Society. Patients' infusion sites were monitored every 24 h during treatment and for 48 h after discontinuation of the IV. In contrast to the usual findings in the literature, the authors found that infusion through an infusion pump and insertion of catheters in the veins around the elbow increased the risk of phlebitis. Also, the number of times infusions were started led to an increased rate of phlebitis. However, conflicting results were obtained about the relation between phlebitis, gender, and catheter size. Phlebitis causes sepsis, pain, additional diagnostic investigations, and treatments, and may lead to increased duration of hospitalization, patient's stress level, and financial burden, as well as increasing staff workload. Advanced practice nurses need to be aware of the factors that increase the likelihood of phlebitis and take appropriate measures to prevent it.
  Journal of the American Academy of Nurse Practitioners 05/2008; 20(4):172-80.
• Article: Empowering your patients in the fight against methicillin-resistant Staphylococcus aureus.

  Christine K Tisinger
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  ABSTRACT: To provide patient teaching points for primary care management and control of methicillin-resistant Staphylococcus aureus (MRSA) through application of the latest research regarding transmission of this bacteria. Case reports, scientific literature, and the recommendations of expert professional groups. MRSA is a well studied yet continually evolving superbug. There is a paucity of literature regarding detailed home management and containment of MRSA. This review acknowledges the critical importance of patient education regarding MRSA infections and empowers patients with knowledge that can positively impact treatment outcomes. Awareness of transmission modes and recognition of sources for relapse of infectious states can curb the spread of MRSA in the community.
  Journal of the American Academy of Nurse Practitioners 05/2008; 20(4):204-11.
• Article: Obtaining a thorough sleep history and routinely screening for obstructive sleep apnea.

  Jamie Lamm, Jane Poeschel, Sheila Smith
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  ABSTRACT: To present a clinical case study of obstructive sleep apnea (OSA) and discuss a potential correlation between OSA, unexplained distal pain symptoms, and pyschoemotional concerns. A review of the scientific literature was performed on OSA using the Cumulative Index of Nursing and Allied Health Literature and MEDLINE. OSA is potentially life threatening and can have serious consequences to a patient's health. Many of the obvious signs of OSA occur at night, and the symptoms of OSA may correspond to a variety of other diseases. Clinicians should recognize a possible correlation between OSA and unexplained distal pain symptoms as well as psychoemotional concerns. These clinically associated conditions may be less apparent but may dramatically affect quality of life. By improving recognition and treatment of OSA, morbidity and mortality can be reduced and quality of life can be improved for patients and their families. It is imperative that clinicians are attentive and take detailed histories to recognize the clinical signs and symptoms of OSA, paying more attention to the less obvious symptomatology that may be significantly impacting quality of life.
  Journal of the American Academy of Nurse Practitioners 05/2008; 20(4):225-9.
• Article: Mindfulness-based stress reduction: a literature review and clinician's guide.

  Sharon Praissman
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  ABSTRACT: To provide nurse practitioners (NPs) with clinical research about Mindfulness-Based Stress Reduction (MBSR) and demonstrate its usefulness for reducing stress in a variety of populations. A literature review was conducted using the following databases: EBSCO, Cinahl, Pschyline, and Medline. English language articles published between 2000 and 2006 in peer-reviewed journals were reviewed. Search terms "mindfulness,"meditation," and "stress" were used. Additional information was obtained through select, reputable Internet sites. MBSR is an effective treatment for reducing stress and anxiety that accompanies daily life and chronic illness. MBSR is also therapeutic for healthcare providers, enhancing their interactions with patients. No negative side effects from MBSR have been documented. MBSR is a safe, effective, integrative approach for reducing stress. Patients and healthcare providers experiencing stress or stress-related symptoms benefit from MBSR programs. NPs can safely and effectively use this intervention in a variety of patient populations.
  Journal of the American Academy of Nurse Practitioners 05/2008; 20(4):212-6.
• Article: One voice.

  Patricia Clinton
  Journal of the American Academy of Nurse Practitioners 05/2008; 20(4):171.
• Article: Guidelines update on the prevention of heart disease in women.

  Meriam F Caboral, Wilma V King, Mary J Goolsby
  Journal of the American Academy of Nurse Practitioners 05/2008; 20(4):191-3.
• Article: Clinical practice algorithms: medication management to reduce fall risk in the elderly-part 4, anticoagulants, anticonvulsants, anticholinergics/bladder relaxants, and antipsychotics.

  Tatjana Bulat, Steven Charles Castle, Michelle Rutledge, Patricia Quigley
  Journal of the American Academy of Nurse Practitioners 05/2008; 20(4):181-90.
• Article: Family-centered collaborative negotiation: a model for facilitating behavior change in primary care.

  Diane O Tyler, Sharon D Horner
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  ABSTRACT: To describe a parent-child-based model that melds a family-centered interaction approach, Touchpoints, with brief negotiation strategies (an adaptation of motivational interviewing) to address health risks in children. An application of the model for addressing childhood overweight in the primary care setting is presented. Selected research, theoretical, and clinical articles; national recommendations and guidelines; and a clinical case. Lifestyle health behaviors are learned and reinforced within the family; thus, changes to promote child health require family involvement. Interventions that engage parents and support parent-child relationships, while enhancing motivation and the abilities to change behavior, are recommended. Primary care is an appropriate setting for addressing lifestyle health behaviors. A collaborative partnership, rather than a prescriptive manner, is advocated for primary care providers when working to facilitate health-promoting behavior.
  Journal of the American Academy of Nurse Practitioners 05/2008; 20(4):194-203.
• Article: Sodium dietary restriction, knowledge, beliefs, and decision-making behavior of older females.

  Sharon L Sheahan, Becky Fields
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  ABSTRACT: The purposes of this qualitative/descriptive study were to (a) explore experiences and decision-making behaviors associated with adoption of a sodium-restricted diet (SRD) among older women with hypertension or heart failure and (b) identify healthcare system and contextual factors that facilitate or impede adherence to SRD. Participants were 33 single older women, aged 65-98 years, residing in three congregate living facilities in the high-risk "coronary valley" area of the United States. A semistructured interview format was employed with three focus groups. The audio-taped transcribed data were content analyzed for themes by the researchers with the assistance of ATLAS.Ti computer software. Predominant themes were lack of SRD education by healthcare providers, a desire for more information about sodium, including the use of alternative herbal seasonings, and large-print informational materials. Eating alone with no motivation to cook and share meals was a contextual barrier to healthy nutrition. To prevent costly hospitalizations and rehospitalization from nonadherence to SRD, clinicians need to provide more structured SRD education supplemented with printed brochures. Exploring the client's nutritional social setting may improve SRD adherence.
  Journal of the American Academy of Nurse Practitioners 05/2008; 20(4):217-24.
• Article: Implications of the biology of weight regulation and obesity on the treatment of obesity.

  Ann Bellar, Patricia A Jarosz, David Bellar
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  ABSTRACT: The purposes of this article are to provide a brief review of the complex biology of weight regulation and obesity, to explain some of the effects of diet and exercise on the biology of weight regulation and obesity, and to propose a coherent way to assess and treat people related to weight and obesity. Scientific publications, clinical guidelines, and government sources. Obesity is a complex problem requiring an understanding of how interventions interact with the biology of weight regulation in people who are obese. Promoting health in obese people requires a focus on improving insulin sensitivity. Helping individuals maintain normal weight throughout life is important in order to keep the long- and short-term weight signals in balance and reflective of true energy requirements. Exercise is associated with loss of total and abdominal adipose tissue and improved insulin sensitivity. Diets inducing gradual weight loss are less likely to stimulate appetite. Diets should include antioxidants to neutralize the increase in free radical production associated with obesity and exercise. Other interventions in the treatment of obesity may include treating sleep deficits and the dysregulated endocannabinoid system.
  Journal of the American Academy of Nurse Practitioners 04/2008; 20(3):128-35.
• Article: Cost-efficient treatment for uninsured or underinsured patients with hypertension, depression, diabetes mellitus, insomnia, and gastroesophageal reflux.

  Karlen E Luthy, Neil E Peterson, Joey Wilkinson
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  ABSTRACT: As the number of uninsured and underinsured patients in the United States continues to rise, savvy nurse practitioners (NPs) must balance quality of care with cost of drugs. This article reviews evidence-based treatments in light of prescribing the most cost-efficient medications. Searches of electronic databases including MEDLINE, MEDLINEPlus, EBSCO, PubMed, CINAHL, Clinical Pharmacology, Biomedical Reference Collection--Basic, Health Source--Consumer Edition, Health Source--Nursing/Academic Edition, Ovid, and the Cochrane Library Online. As the role of NP continues to evolve, it is important for NPs to establish themselves as economically conscious healthcare providers, striking a delicate balance between providing quality and cost-efficient care. An NP's familiarity with cost-efficient treatment options for common diagnoses such as hypertension, depression, diabetes mellitus, insomnia, and gastroesophageal reflux disorders can help ease the economic burden uninsured and underinsured patients endure, especially with respect to prescription drugs, and improve compliance with medication regimens. NPs should acquire knowledge on how to best treat uninsured or underinsured patients in the most cost-efficient manner. Knowledge of prescription drug cost is one tool an NP can use to encourage patient compliance, improving the overall health of uninsured or underinsured individuals.
  Journal of the American Academy of Nurse Practitioners 04/2008; 20(3):136-43.