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Practice Nurses (practice + nurse)
Kinds of Practice Nurses Terms modified by Practice Nurses Selected AbstractsPatient Problems, Advanced Practice Nurse (APN) Interventions, Time and Contacts Among Five Patient GroupsJOURNAL OF NURSING SCHOLARSHIP, Issue 1 2003Dorothy Brooten Purpose: To describe patient problems and APN interventions in each of five clinical trials and to establish links among patient problems, APN interventions, APN time and number of contacts, patient outcomes, and health care costs. Design and Methods: Analysis of 333 interaction logs created by APNs during five randomized controlled trials: (a) very low birthweight infants (n=39); (b) women with unplanned cesarean birth (n=61), (c) high-risk pregnancy (n=44), and (d) hysterectomy (n=53); and (e) elders with cardiac medical and surgical diagnoses (n=139). Logs containing recordings of all APN interactions with participants, APN time and type of patient contact were content analyzed with the smallest phrase or sentence representing a "unit." These units were then classified using the Omaha Classification System to determine patient problems and APN interventions. Groups were compared concerning total amount of APN time, number of contacts per patient, and mean length of time per APN contact. All studies were conducted in the United States. Findings: Groups with greater mean APN time and contacts per patient had greater improvements in patients' outcomes and greater health care cost savings. Of the 150,131 APN interventions, surveillance was the predominant APN function in all five patient groups. Health teaching, guidance, and counseling was the second most frequent category of APN intervention in four of the five groups. In all five groups, treatments and procedures accounted for < 1% of total APN interventions. Distribution of patient problems (N=150,131) differed across groups reflecting the health care problems common to the group. Conclusions: Dose of APN time and contacts makes a difference in improving patient outcomes and reducing health care costs. Skills needed by APNs in providing transitional care include well-developed skills in assessing, teaching, counseling, communicating, collaborating, knowing health behaviors, negotiating systems, and having condition-specific knowledge about different patient problems. [source] Obesity in Youth: Implications for the Advanced Practice Nurse in Primary CareJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 8 2004C-ANP, Diane Berry PhD Purpose To discuss the advanced practice nurse's diagnosis and management of obesity in youth in primary care. Data Sources Review of current scientific literature, practice guidelines, and a case study. Conclusions Obesity in youth is difficult to manage. Recent research suggests a genetic and environmental etiology associated with impaired glucose tolerance, type 2 diabetes, hypertension, hyperlipidemia, and hypertriglyceridemia. Nutrition education, increasing physical activity, decreasing sedentary behaviors, and behavioral modification have been used with varying success. Management is directed at healthy lifestyle behavior change for youth and their families. Implications for Practice If obesity, impaired glucose tolerance, hypertension, hypercholesterolemia, and hypertriglyceridemia are left untreated, youth may develop type 2 diabetes and coronary artery disease later in life and suffer early morbidity and mortality. [source] Embracing the Role of the Advanced Practice Nurse in the Perinatal SettingNURSING FOR WOMENS HEALTH, Issue 3 2006Natalie Lyn Wolf BSN First page of article [source] The Invisibility of Advanced Practice Nurses in Popular MagazinesJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2001Susan L. Norwood EdD PURPOSE To determine the image portrayed in the media of nurses and particularly nurse practitioners (NPs) compared with other health care providers. DATA SOURCES An analysis of advertisements and articles in popular magazines aimed at female, male, and gender-neutral audiences was conducted between 12/99 and 06/00. Relationships between target audience and content of advertisements and articles, as well as portrayal of health care providers were also explored. CONCLUSIONS A review of 100 consecutive advertisements for health-related products and 96 consecutive health-related articles in popular magazines revealed that the media continues to overwhelmingly depict and promote physicians as the source of health care and health-related advice. IMPLICATIONS FOR PRACTICE Because when there are few references to a group, such as NPs, it is reasonable to assume group members have little influence, standing, and authority, NPs should be concerned about the implications of these findings. Strategies for increasing the visibility of NPs as credible and valuable members of the health care team are shared. [source] Perspectives on Psychiatric Consultation Liaison Nursing Psychiatric-Mental Health,Advanced Practice Nurses: Transforming Nursing PracticePERSPECTIVES IN PSYCHIATRIC CARE, Issue 2 2008Catherine Broom MN First page of article [source] Practice nurses' role and knowledge about diabetes management within rural and remote Australian general practicesEUROPEAN DIABETES NURSING, Issue 2 2010District Nurse, MRCNA, R Livingston RN Abstract Background: The increasing prevalence of diabetes and obesity represents a significant disease burden in Australia. Practice nurses (PNs) play an important role in diabetes education and management. Aim: To explore PNs' roles, knowledge and beliefs about diabetes education and management in rural and remote general practice in Australia. Method: Exploratory study undertaken in three phases: 1) Pilot study to test the performance of the questionnaire; 2) One-shot cross-sectional survey using self-complete questionnaires; 3) Individual interviews. Results: Ten PNs completed the pilot test; the draft questionnaire was deemed appropriate to the study purpose. Then, 65 questionnaires were distributed to PNs and 21 responded. Fourteen respondents had worked in the role <5 years, and most PNs attended diabetes education programmes in their workplace. A minority (40%) used diabetes management guidelines regularly. Most knew obesity to be the most common risk factor for diabetes but only 50% knew that glycosylated haemoglobin indicates blood glucose levels over the preceding three months. Self-reported competency to assess patients' self-care practices and medication management practices varied. Conclusion: PNs' diabetes management was self-reported; their knowledge varied and their perceived benefits of diabetes education differed from those of patients. Copyright © 2010 FEND [source] Enhancing primary health care services for adults with intellectual disabilitiesJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 3 2005C. A. Melville Abstract Background Primary health care teams have an important part to play in addressing the health inequalities and high levels of unmet health needs experienced by people with intellectual disabilities (ID). Practice nurses have an expanding role within primary health care teams. However, no previous studies have measured their attitudes, knowledge, training needs, and self-efficacy in their work with people with ID. Methods All practice nurses working in a defined area were identified. A purpose-designed questionnaire to measure nurse attitudes, knowledge, training needs and self-efficacy was developed and piloted. All practice nurses were then invited to participate. Data from completed questionnaires were entered onto PC and analysed. Results Of a total of 292 practice nurses 201 (69%) participated. Whilst 89% (n = 179) of participants reported having infrequent contact, 25% (n = 50) reported a growing workload with people with ID. Only 8% (n = 16) had ever received any training in communicating with people with ID. A knowledge gap regarding the health needs of people with ID was identified. Eighty-six per cent reported having experienced specific difficulties during previous appointments, and only 23% thought they had sufficient case note information at appointments, but 68% did not modify the duration of their appointments with people with ID. Conversely, responses demonstrated that practice nurses have a high level of experience and qualification in general nursing, have positive attitudes to working with people with ID, and high self-efficacy scores were identified for work with people with ID. The practice nurses viewed ID to be a high priority area for future training. Conclusions Primary health care teams have a key role in tackling the unmet health needs of people with ID. Whilst this project has identified factors that may impact on the accessibility of services, it has also identified practice nurses as having positive attitudes and high self-efficacy scores in their work with people with ID. This indicates that they should be targeted for specific training in this area, which may make an important contribution in enhancing future accessibility of primary health care services for people with ID. [source] PHC RIS: Practice nurses , Enhancing primary health care services in rural AustraliaAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 2 2009Sara Howard No abstract is available for this article. [source] Brief interventions: good in theory but weak in practiceDRUG AND ALCOHOL REVIEW, Issue 1 2004Professor ANN M. ROCHE Director Abstract A substantial body of research evidence has accumulated in support of the efficacy of brief interventions for a number of alcohol and drug-related problem areas, most notably alcohol and tobacco. This evidence has been used to exhort a range of professional groups such as general practitioners (GPs), and more recently emergency department hospital staff to engage in brief interventions. Internationally, however, these secondary prevention efforts have largely failed. Why have these proven interventions not been embraced by frontline workers? This is a little-asked question as efforts to press-gang unwilling professionals to take up the cudgel continue. This paper examines the characteristics of brief interventions and their principal delivery agents and explores reasons for the failure to move from efficacy to effectiveness. Given the prevention potential that rests with brief intervention, these are crucial questions to address. A key feature of brief intervention delivery also examined is the role of GPs versus the less well-explored option of the practice nurse. It will be proposed that perhaps we have the right vehicle but the wrong driver and that until closer scrutiny is made of this issue efforts in this key prevention area will continue to fail to achieve optimum results. [source] Opportunistic screening for Chlamydia in general practice: the experience of health professionalsHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2003Elizabeth Perkins Abstract Chlamydia trachomatis is the most common curable bacterial sexually transmitted infection in the UK. The infection is asymptomatic in up to 70% of women, and if untreated, can lead to pelvic inflammatory disease, ectopic pregnancy and infertility. Chlamydial infection can be diagnosed using urine testing and is easily treated with antibiotics. In 1999, the UK Department of Health funded a pilot opportunistic Chlamydia screening programme in two health authorities. All sexually active women between the ages of 16 and 24 years attending general practices and other healthcare settings, such as family planning clinics, antenatal clinics and genito-urinary medicine services, were offered the opportunity to be screened for Chlamydia, regardless of the purpose of their visit. This evaluation was funded to assess the feasibility and acceptability of opportunistic screening. The evaluation was conducted using both qualitative and quantitative methods. The present paper describes findings from the qualitative evaluation study arising from the health professionals' experience of opportunistic screening in general practice. Receptionists were central to the opportunistic screening model in general practice and it was this aspect of the model that raised most concerns. Whilst general practitioners reported that the involvement of receptionists saved them time, the receptionists themselves were sometimes drawn into discussions for which they felt ill equipped and unsuitably located. This research suggests that a call,recall national screening programme would provide a better model to undertake Chlamydia screening in general practice. The advantages of this model are threefold. First, each individual within the target age range can receive information about Chlamydia through the post. Secondly, the test and more detailed information can be managed by a practice nurse in a private and confidential setting. Thirdly, individuals are not repeatedly offered the test when visiting the surgery. [source] The advanced practice nurse,nephrologist care model: Effect on patient outcomes and hemodialysis unit team satisfactionHEMODIALYSIS INTERNATIONAL, Issue 3 2004Lori Harwood Abstract The tertiary care nurse practitioner/clinical nurse specialist (NP/CNS) is an advanced practice nurse with a relatively new role within the health-care system. It is stated that care provided by the NP/CNS is cost-effective and of high quality but little research exists to document these outcomes in an acute-care setting. The clinical coverage pattern by nephrologists and NP/CNS of a hemodialysis unit in a large academic center allowed such a study. Two NP/CNS plus a nephrologist followed two of three hemodialysis treatment shifts per day; only a nephrologist followed the third shift. The influence of this care pattern of patients was examined using a cross-sectional review of outcomes such as adequacy of delivered dialysis, anemia management, phosphate control, hospitalizations, etc. In addition, the level of satisfaction of the dialysis team and perceptions of care delivered with the care models was assessed. The care model staff-to-patient-number ratio was similar in both groups (1:27 for NP/CNS plus nephrologist; 1:29 for nephrologist alone). Patient demographics were similar in both groups but the NP/CNS,nephrologist group had patients with more comorbidities. No statistically significant (p < 0.05) differences existed between the groups in patient laboratory data, adherence to standards, medications, inter- and intradialytic blood pressure, achievement of target postdialysis weights, and hospitalizations or emergency room visits. Significantly more adjustments were made to target weights and medications and more investigations were ordered by the NP/CNS,nephrologist team. Team satisfaction and perceptions of care delivery were higher with the NP/CNS,nephrologist model. It is concluded that the NP/CNS,nephrologist care model may increase the efficiency of the care provided by nephrologists to chronic hemodialysis patients. The model may also be a solution to the problem of providing nephrologic care to an ever-growing hemodialysis population. [source] Effectiveness of general practice nurse interventions in cardiac risk factor reduction among adultsINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 3 2007Elizabeth Halcomb RN BN(Hons) Grad Cert. Abstract Background, Cardiovascular disease is the leading cause of death for adults in Australia. In recent years there has been a shift in health service delivery from institutional to community-based care for chronic conditions, including cardiovascular disease. The general practice setting is seen to offer greater flexibility, higher levels of efficiency and more client focused healthcare delivery than is possible in the acute care sector. It has been suggested that practice nurses represent a useful adjunct to current models of cardiovascular disease management. To date, significant descriptive research has been conducted exploring the demographics, roles, educational needs and issues facing practice nurses. However, there is a need to evaluate the effectiveness of practice nurse interventions in terms of patient outcomes, clinician satisfaction and cost-effectiveness. Objectives, This review seeks to present the best available evidence regarding the efficacy of general practice nurse interventions for cardiac risk factor reduction in healthy adults, as well as those with established cardiovascular disease or known cardiac risk factors. Search Strategy, A systematic literature search was performed using Medline (1966 , 2005), CINAHL (1982 ,2005), Cochrane Controlled Trials Register (Issue 4, 2005) and the Joanna Briggs Institute Evidence Library. In addition, the reference lists of retrieved papers, conference proceedings and the Internet, were scrutinised for additional trials. Selection Criteria, This review considered any English language randomised trials that investigated interventions conducted by the practice nurse for cardiovascular disease management or reduction of cardiac risk factors. Interventions conducted by specialist cardiac nurses in general practice were excluded. Outcomes measured included blood pressure, smoking cessation, total cholesterol, exercise, body weight/body mass index and cost-effectiveness. Results, Eighteen trials, reported in 33 papers, were included in the review. Ten trials investigated multifaceted interventions, while the remaining eight trials reported targeted interventions. Of the trials that reported multifaceted interventions, three trials investigated risk reduction in those with established cardiovascular disease, four trials focused on those with known cardiovascular disease risk factors and three trials included the general community. The eight trials which examined the efficacy of targeted interventions focused upon dietary intake (two trials), smoking cessation (three trials), weight reduction (one trial) and physical activity (two trials). The effect of both the multifaceted and targeted interventions on patient outcomes was variable. However, both the multifaceted and targeted interventions demonstrated similar outcome trends for specific variables. Improvements were demonstrated by most studies in blood pressure, cholesterol level, dietary intake and physical activity. The variation in outcome measures and contradictory findings between some studies makes it difficult to draw definitive conclusions. Conclusions, While interventions to reduce cardiovascular disease risk factors have produced variable results, they offer significant potential to assist patients in modifying their personal risk profile and should be developed. The public health importance of these changes is dependant upon the sustainability of the change and its effect on the health outcomes of these individuals. Further well-designed research is required to establish the effectiveness of practice nurse interventions for cardiovascular disease management and risk factor reduction in terms of patient outcomes and cost-effectiveness. [source] Psychopharmacological and electroconvulsive treatment of anxiety and depression in the elderlyJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2000W. A. Heffern MN The pharmacotherapeutics of antianxiety and antidepressant medication in the elderly is reviewed, and the benefits and risks of electroconvulsive therapy (ECT) are discussed. Physiological changes in normal ageing are described, and the pharmacodynamic and pharmacokinetic implications are addressed. Finally, the role of the advanced practice nurse (mental health/psychiatry) is discussed in terms of accountability, collaboration, and the development of empirical knowledge to enhance quality patient care. [source] Anemia and its impact on function in nursing home residents: What do we know?JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 1 2010CRNP Assistant Professor, Valerie K. Sabol PhD Purpose: To provide the advanced practice nurse (APN) information on the prevalence and causes of anemia in elderly nursing home (NH) residents, in order to affect diagnostic and management strategies that may help improve physical function and mobility outcomes. Data Sources: Literature review of current peer-reviewed research articles. Conclusions: In the United States, the prevalence of anemia increases with advancing age, and are reported to be much higher among older NH residents than among community-dwelling older adults. Causes of anemia among the elderly are often multifactorial. Older individuals with anemia, including mild anemia and even low normal level, have demonstrated lower muscle strength, physical function, mobility, and increased morbidity and mortality outcomes. Implications for Practice: Given the potentially significant relationship between anemia and physical performance outcomes among NH residents, gaining a better understanding will help guide future evidence-based care by allowing the APN an opportunity to tailor both medical and restorative care interventions. Because anemia is a potentially modifiable condition, intervention may preserve, limit, or reverse functional impairment and/or disablement, and allow for maximal functional independence. [source] Alcohol dependence and depression: Advance practice nurse interventionsJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 7 2006PMHNP (Psychiatric Mental Health Nurse Practitioner), Tracey L. Fowler RN Abstract Purpose: To identify alcohol dependence, depression, and their comorbidity as common health problems in the United States. To emphasize advance practice nurse (APN) interventions including screening, treatment, and outcome evaluations for individuals and their families suffering with alcohol dependence and depression. Data sources: Scientific literature on alcohol dependence, depression, and their comorbidity as well as general systems theory. Conclusions: APNs have the opportunity to successfully intervene with individuals and their family with alcohol dependence, depression, and their comorbidity. These complex health conditions need to be screened for, treated, and evaluated to ensure positive outcomes for the individual and their family system. Implications for practice: APNs are in an excellent position to intervene at every contact with the individual and family with alcohol dependence and depression. Interventions aimed at the individual and family system are detailed in order to assist the individual and family to optimal health. [source] Adolescent Obesity: Current Trends in Identification and ManagementJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 11 2004M. Anette Hagarty RN Purpose To discuss the prevalence, identification, and clinical manifestations of adolescent obesity for the advanced practice nurse in primary care. Data Sources Selected research and clinical articles. Conclusions Adolescent obesity has been historically attributed to inappropriate diet and exercise; however, recent research also attributes adolescent obesity to genetic factors and metabolic dysfunction. If left untreated, adolescent obesity may result in the metabolic complications of dyslipidemia, hypertension, cardiovascular disease, and early onset of type 2 diabetes. Implications for Practice Practitioners should focus on using the new body mass index (BMI) national guidelines for early identification of obesity. Essential to the management of this condition are education, parental involvement, behavior modification, and psychological support. [source] Periodontal Disease: Diagnosis and ManagementJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2000Elaine Embrack Ridgeway RN ABSTRACT Approximately 50% of all adults in the United States have some form of gingivitis, and 80% have experienced some degree of periodontitis. Despite the use of fluoride, a critical element in the prevention of periodontal disease, many children and adults still suffer needlessly from this "silent" destroyer of the gum tissue and its underlying bone structures. This article highlights the prevalence, pathophysiology, classifications, health risk factors and clinical management of clients with periodontal diseases. Regardless of the health care setting, the advanced practice nurse plays a critical role in the prevention, early diagnosis and intervention of periodontal disease. [source] ,Can you take a student this morning?' Maximising effective teaching by practice nursesMEDICAL EDUCATION, Issue 5 2009Pat Smith Objectives, Little is known about the contribution nurses make to medical student learning. This study set out to explore the nature of practice nurse teaching during the general practice clerkship and to investigate ways in which the teacher and learner (the practice nurse and the medical student) can be best supported to maximise learning. Methods, Mixed focus groups were conducted with general practitioner educational supervisors and practice nurses. Further focus groups were conducted with students on completion of clerkships. Results, There is wide variation in the delivery, organisation and expectations of practice nurse teaching. Although there is some evidence of a passive learning experience, the learning dynamic and the student,nurse relationship are regarded highly. Conclusions, Time spent with practice nurses is an important part of the clerkship in general practice. The nature of the practice nurse,medical student relationship differs from that of the educational supervisor,medical student relationship and can be built upon to maximise learning during the clerkship. The experience for the practice nurse, medical student and supervisor can be enhanced through formal preparation for delivering teaching. [source] Preparing for Prescriptive Privileges: A Standard for the Psychiatric-Mental Health PreceptorshipPERSPECTIVES IN PSYCHIATRIC CARE, Issue 3 2004Ann Hales PhD TOPIC. Establishing a standard for preparation for prescriptive authority for advanced practice psychiatric nurses. PURPOSE. To outline a best practice standard for the clinical and prescriptive authority preceptorship. SOURCES. NACNS and NONPF competencies and practice guidelines. CONCLUSIONS. The authors recommend a clinical preceptorship with planned faculty monitoring, clinical logs, case studies, and group supervision to prepare the psychiatric-mental health advanced practice nurse to serve within the expanded prescribing role. [source] Physical activity advice in the primary care setting: results of a population study in New ZealandAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2006Karen Croteau Objectives: To determine the prevalence of physical activity advice, including the Green Prescription (a physical activity scripting scheme), given in the primary care setting, and the characteristics of New Zealanders who receive such advice. Method: Questions from a 2003 national postal survey (n=8,291), ,Obstacles to Action', were examined. The survey was designed to identify population segments to target for physical activity interventions. Binary logistic regression was used to examine independent factors associated with receiving a physician or practice nurse recommendation to increase physical activity and receiving a Green Prescription. Results: Overall, 13.3% of the sample reported receiving physical activity advice while 3.0% reported receiving a Green Prescription from their general practitioner or practice nurse in the last year. Those more likely to receive physical activity advice were Maori or Pacific, overweight or obese, sedentary, or suffering chronic disease. Results were similar for Green Prescription advice. When controlling for these and other demographics, physical inactivity was not related to the odds of receiving a Green Prescription. Conclusions: One out of every eight New Zealanders reported being given general physical activity advice in the primary care setting. While the physically inactive but otherwise healthy were not specifically targeted, the Green Prescription was more likely to be given on the basis of existing chronic conditions related to physical inactivity and other high-risk populations. Implications: Primary care settings provide an important opportunity to promote physical activity for New Zealand adults. While those most at risk are more likely to receive such advice, there are many more that may benefit. [source] Increasing practice nurse access to alcohol trainingDRUG AND ALCOHOL REVIEW, Issue 3 2002ANN DEEHAN Abstract Policy makers have repeatedly placed emphasis on the role of primary care in screening for at-risk alcohol consumption and delivering public health messages to the general population. Research has pointed to primary care staff holding negative attitudes towards alcohol misusing patients. Training has traditionally been seen as the key to increasing the capacity of the medical field to engage with alcohol misusing patients but little work has been undertaken to examine the potential barriers to training take up. Consequently, the aim of this study was to explore the willingness of practice nurses to be trained in alcohol screening and brief intervention, and whether identifiable barriers to training exist and how they may be overcome. All practice nurses (n = 82) in an outer London (UK) Health Authority Area were twice mailed an invitation to an alcohol training seminar and a telephone invitation was made to all of those who did not reply to the mailings. Those who did not attend (n = 66) were contacted to take part in a short structured telephone interview ,89% (59/66) were contacted successfully and interviewed. Respondents were experienced in primary care and viewed health promotional activity as a valid part of their role. Few had undertaken previous alcohol training and as a group they were highly active in attending training events with training undertaken tending to be related directly to perceived practice needs and priorities: thus this group could not be characterized as unwilling to be trained. Barriers to training at alcohol events were found to be either personal or work-related, with most nurses interested in receiving further training or information. These data imply that the ways in which training is organized and delivered require sensitivity to identifiable barriers if it is to reach and effect changing practice among practice nurses successfully. A range of possibilities are identified as alternative approaches to the provision of elective training events which may be more acceptable to the target population of health-care staff. [source] The social causes of inequality in epilepsy and developing a rehabilitation strategy: A U.K.-based analysisEPILEPSIA, Issue 10 2009Leone Ridsdale Summary A rehabilitation approach has been adopted for many long-term neurologic conditions, but not for epilepsy. The disabilities associated with epilepsy are cognitive, psychological, and social, which are not as readily identified by medical doctors as are physical disabilities. A rehabilitation approach moves the emphasis from a medically driven process to a focus on the personal, social, and physical context of long-term illness. It is suggested that a missed opportunity for education and support for self-management occurs after diagnosis. This results in disadvantage to those whose educational level and knowledge of epilepsy are low. People who do not achieve epilepsy control may then experience higher levels of psychological distress, and a negative cycle of loss of self-efficacy, poor epilepsy control, social disadvantage, and disability. Rehabilitation services have benefited communities surrounding centers of excellence. Not so in epilepsy. Despite centers of excellence, areas with deprivation have higher than national average levels of patients reporting a seizure in the prior year, and higher emergency hospital admissions. Specialists working in partnership with general practitioners (GPs) and practice nurses can do more to increase participation and reduce distress for people with epilepsy. When available, GPs and nurses with special interest in epilepsy promote integrated services. Primary,secondary networks are likely to be more effective in preventing downward drift. This requires evaluation. [source] Effectiveness of general practice nurse interventions in cardiac risk factor reduction among adultsINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 3 2007Elizabeth Halcomb RN BN(Hons) Grad Cert. Abstract Background, Cardiovascular disease is the leading cause of death for adults in Australia. In recent years there has been a shift in health service delivery from institutional to community-based care for chronic conditions, including cardiovascular disease. The general practice setting is seen to offer greater flexibility, higher levels of efficiency and more client focused healthcare delivery than is possible in the acute care sector. It has been suggested that practice nurses represent a useful adjunct to current models of cardiovascular disease management. To date, significant descriptive research has been conducted exploring the demographics, roles, educational needs and issues facing practice nurses. However, there is a need to evaluate the effectiveness of practice nurse interventions in terms of patient outcomes, clinician satisfaction and cost-effectiveness. Objectives, This review seeks to present the best available evidence regarding the efficacy of general practice nurse interventions for cardiac risk factor reduction in healthy adults, as well as those with established cardiovascular disease or known cardiac risk factors. Search Strategy, A systematic literature search was performed using Medline (1966 , 2005), CINAHL (1982 ,2005), Cochrane Controlled Trials Register (Issue 4, 2005) and the Joanna Briggs Institute Evidence Library. In addition, the reference lists of retrieved papers, conference proceedings and the Internet, were scrutinised for additional trials. Selection Criteria, This review considered any English language randomised trials that investigated interventions conducted by the practice nurse for cardiovascular disease management or reduction of cardiac risk factors. Interventions conducted by specialist cardiac nurses in general practice were excluded. Outcomes measured included blood pressure, smoking cessation, total cholesterol, exercise, body weight/body mass index and cost-effectiveness. Results, Eighteen trials, reported in 33 papers, were included in the review. Ten trials investigated multifaceted interventions, while the remaining eight trials reported targeted interventions. Of the trials that reported multifaceted interventions, three trials investigated risk reduction in those with established cardiovascular disease, four trials focused on those with known cardiovascular disease risk factors and three trials included the general community. The eight trials which examined the efficacy of targeted interventions focused upon dietary intake (two trials), smoking cessation (three trials), weight reduction (one trial) and physical activity (two trials). The effect of both the multifaceted and targeted interventions on patient outcomes was variable. However, both the multifaceted and targeted interventions demonstrated similar outcome trends for specific variables. Improvements were demonstrated by most studies in blood pressure, cholesterol level, dietary intake and physical activity. The variation in outcome measures and contradictory findings between some studies makes it difficult to draw definitive conclusions. Conclusions, While interventions to reduce cardiovascular disease risk factors have produced variable results, they offer significant potential to assist patients in modifying their personal risk profile and should be developed. The public health importance of these changes is dependant upon the sustainability of the change and its effect on the health outcomes of these individuals. Further well-designed research is required to establish the effectiveness of practice nurse interventions for cardiovascular disease management and risk factor reduction in terms of patient outcomes and cost-effectiveness. [source] The social world of Australian practice nurses and the influence of medical dominance: An analysis of the literatureINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 6 2009FRCNA, Grad Cert Ed (Tert Teach), Jane Mills RN In Australia, the number of practice nurses is growing at a rapid rate. On the nursing landscape, this group of nurses stand out because of their relationship with the Australian Government who both fund them, and concern themselves with their continuing professional development. This paper provides a construction of the social world of Australian practice nurses, identifying stakeholders in the business of practice nursing. Literature produced by the various social world segments is analysed for the influence of medical dominance on the role, image, power and politics of practice nurses. [source] Benefits and limitations of nurses taking on aspects of the clinical role of doctors in primary care: integrative literature reviewJOURNAL OF ADVANCED NURSING, Issue 8 2010Claire RashidArticle first published online: 2 JUL 2010 rashid c. (2010) Benefits and limitations of nurses taking on aspects of the clinical role of doctors in primary care: integrative literature review. Journal of Advanced Nursing,66(8), 1658,1670. Abstract Aim., This paper presents an integrative literature review of studies exploring the benefits and limitations of the recent expansion of the clinical role of nurses working in general practice in the United Kingdom. Background., Similar clinical outcomes and high levels of satisfaction with consultations undertaken by nurse practitioners compared to general practitioners in primary care have been reported in a Cochrane review [Cochrane Database of Systematic Reviews (2004) vol. 5, p. CD001271]. Since then, nurse consultations have increased considerably as general practitioners have delegated part of their clinical workload to other general practice nurses. However, whether all general practice nurses can fulfil this extended role remains open to question. Method., An integrative review was performed. Nine electronic databases were searched. UK studies were included if they were published after the previous Cochrane review, i.e. between 2004 and 2009. Results., Eight studies were identified, most using qualitative methodology. The evidence suggested that the changes in nurses' role have been predominantly driven by the perceived increase in workload arising from the new general practitioner contract. Delegating work to nurses provided a means of organizing workload within a practice without necessarily allowing patient choice. Patients generally thought that all general practice nurses would be able to deal with simple conditions, but they would prefer to consult with a general practitioner if they thought it necessary. There were concerns about nurses' knowledge base, particularly in diagnostics and therapeutics, and their levels of training and competence in roles formerly undertaken by general practitioners. Conclusion., There have been few studies in this key area of healthcare policy. There is a need for better training and support for nurses undertaking roles in consultation and for patients' views to be better represented. [source] Current approaches to obesity management in UK Primary Care: the Counterweight ProgrammeJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 3 2004The Counterweight Project Team Abstract Background/Aims Primary care is expected to develop strategies to manage obese patients as part of coronary heart disease and diabetes national service frameworks. Little is known about current management practices for obesity in this setting. The aim of this study is to examine current approaches to obesity management in UK primary care and to identify potential gaps in care. Method A total of 141 general practitioners (GPs) and 66 practice nurses (PNs) from 40 primary care practices participated in structured interviews to examine clinician self-reported approaches to obesity management. Medical records were also reviewed for 100 randomly selected obese patients from each practice [body mass index (BMI) ,30 kg m,2, n = 4000] to review rates of diet counselling, dietetic or obesity centre referrals, and use of anti-obesity medication. Computerized medical records for the total practice population (n = 206 341, 18,75 years) were searched to examine the proportion of patients with a weight/BMI ever recorded. Results Eighty-three per cent of GPs and 97% of PNs reported that they would raise weight as an issue with obese patients (P < 0.01). Few GPs (15%) reported spending up to 10 min in a consultation discussing weight-related issues, compared with PNs (76%; P < 0.001). Over 18 months, practice-based diet counselling (20%), dietetic (4%) and obesity centre (1%) referrals, and any anti-obesity medication (2%) were recorded. BMI was recorded for 64.2% of patients and apparent prevalence of obesity was less than expected. Conclusion Obesity is under-recognized in primary care even in these 40 practices with an interest in weight management. Weight management appears to be based on brief opportunistic intervention undertaken mainly by PNs. While clinicians report the use of external sources of support, few patients are referred, with practice-based counselling being the most common intervention. [source] Enhancing primary health care services for adults with intellectual disabilitiesJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 3 2005C. A. Melville Abstract Background Primary health care teams have an important part to play in addressing the health inequalities and high levels of unmet health needs experienced by people with intellectual disabilities (ID). Practice nurses have an expanding role within primary health care teams. However, no previous studies have measured their attitudes, knowledge, training needs, and self-efficacy in their work with people with ID. Methods All practice nurses working in a defined area were identified. A purpose-designed questionnaire to measure nurse attitudes, knowledge, training needs and self-efficacy was developed and piloted. All practice nurses were then invited to participate. Data from completed questionnaires were entered onto PC and analysed. Results Of a total of 292 practice nurses 201 (69%) participated. Whilst 89% (n = 179) of participants reported having infrequent contact, 25% (n = 50) reported a growing workload with people with ID. Only 8% (n = 16) had ever received any training in communicating with people with ID. A knowledge gap regarding the health needs of people with ID was identified. Eighty-six per cent reported having experienced specific difficulties during previous appointments, and only 23% thought they had sufficient case note information at appointments, but 68% did not modify the duration of their appointments with people with ID. Conversely, responses demonstrated that practice nurses have a high level of experience and qualification in general nursing, have positive attitudes to working with people with ID, and high self-efficacy scores were identified for work with people with ID. The practice nurses viewed ID to be a high priority area for future training. Conclusions Primary health care teams have a key role in tackling the unmet health needs of people with ID. Whilst this project has identified factors that may impact on the accessibility of services, it has also identified practice nurses as having positive attitudes and high self-efficacy scores in their work with people with ID. This indicates that they should be targeted for specific training in this area, which may make an important contribution in enhancing future accessibility of primary health care services for people with ID. [source] Validation of the Professional Practice Environment Scale in Australian General PracticeJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2010BN(Hons), Elizabeth J. Halcomb RN, FRCNA Abstract Purpose: To validate the Professional Practice Environment Scale (PPE) in Australian general practice. Methods: The PPE was modified slightly for appropriateness for the practice setting and administered to a sample of 342 Australian general practice nurses via an online survey tool. The factor structure of the 38-item PPE was examined using principal components analysis with Varimax rotation. Findings: An eight-factor solution accounted for 71.6% of the variance. Low factor loading (<0.3) or cross-component loadings were detected in eight items. A comparison of Cronbach's alpha values demonstrated little change in the deletion of eight items from four of the eight related components. Conclusions: Findings demonstrated that a 30-item version of the PPE was reliable and valid for use to assess the professional practice environment of nurses working in Australian general practice. Clinical Relevance: A tool to measure the professional practice environment in general practice is important as it will assist in monitoring the impact of the work environment on the recruitment, retention, and satisfaction of nurses in this setting. [source] Women With High-Risk Pregnancies, Problems, and APN InterventionsJOURNAL OF NURSING SCHOLARSHIP, Issue 4 2007Dorothy Brooten Purpose: To (a) describe women's prenatal and postpartum problems and advanced practice nurses (APN) interventions; and (b) determine if problems and APN interventions differed by women's medical diagnosis (diabetes, hypertension, preterm labor). Design and Methods: Content analysis of 85 interaction logs created by APNs during a randomized clinical trial in which half of physician-provided prenatal care was substituted with APN-provided prenatal care in the women's homes. Patients' problems and APN interventions were classified with the Omaha Classification System. Findings: A total of 212,835 health problems and 212,835 APN interventions were identified. The dominant antenatal problems were physiologic (59.2%) and health-related behaviors (33.3%); postpartum were physiologic (44.0%) and psychosocial problems (31.6%). Antenatally, women with diabetes had significantly more health-related behavior problems; women with preterm labor had more physiologic problems. APN surveillance interventions predominated antenatally (65.6%) and postpartum (66.0%), followed by health teaching, guidance, and counseling both antenatally (25.4%) and postpartum (28.1%). Women with chronic hypertension required significantly more case-management interventions. Conclusions: The categories of women's problems were largely similar across medical diagnostic groups. Interventions to address women's problems ranged from assessing maternal and fetal physiologic states to teaching interpersonal relationships and self-care management to assisting with transportation and housing. Data show the range of APN knowledge and skills needed to improve maternal and infant outcomes and ultimately reduce healthcare costs in women with high-risk pregnancies. [source] Prevalence of cardiovascular disease and risk factors in a type 2 diabetic population of the North Catalonia diabetes studyJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2009DNS (Diabetes Nurse Specialist & Clinical Researcher), Jeronimo Jurado RN Abstract Purpose: The purpose of the study was to evaluate the prevalence of cardiovascular disease (CVD), cardiovascular risk factors (CVRFs), and their control in patients with type 2 diabetes mellitus (T2DM) at primary care settings from the North Catalonia Diabetes Study (NCDS). Data sources: In this multicentre cross-sectional descriptive study, data were collected from a random sample of 307 patients with T2DM. The prevalence of CVD, CVRF, metabolic syndrome (MS), coronary heart disease (CHD) risk at 10 years (Framingham Point Scores), and CVRF control was evaluated. MS and lipid profiles were established according to Adult Treatment Panel III criteria. Conclusions: CVD prevalence was 22.0% (CHD: 18.9% and peripheral ischemia: 4.5%) and more frequent in men. The prevalence of selected CVRF was: hypertension: 74.5%; dyslipidemia: 77.7%; smoking: 14.9%; obesity 44.9%, and familial CVD: 38.4%. Three or more CVRFs, including T2DM, were observed in 91.3%. MS prevalence was 68.7%. Framingham score was 10.0%, higher in men than in women. CVD prevalence was related to: age, number of CVRFs, duration of diabetes, familial history of CVD, waist circumference, hypertension, lipid profile, kidney disease, and Framingham score, but not to MS by itself. Correct lipid profiles and blood pressure were only observed in 18.9% and 24.0%, respectively, whereas platelet aggregation inhibitors were only recorded in 16.1% of the patient cohort. MS presence was not an independent risk factor of CVD in our study. Implications for practice: The high prevalence of CVD and an inadequate control of CVRF, which were apparent in the NCDS population, would suggest that advanced practice nurses should consider incorporating specific cardiovascular assessment in their routine care of persons with T2DM. [source] | ||||||||||