The Journal for Nurse Practitioners

Erratum

2010-03-01

The location of the Mayo Clinic was incorrect in the article “Chronic Disease Prevention Across the Lifespan” in the January 2010 issue of JNP, p. 22. The correct location is Rochester, MN. JNP regrets the error

Erratum

2010-03-01

The credentials for an author of the article “Prescribing Competencies for Advanced Practice Registered Nurses” in the February issue of JNP were incorrect. They should have been Tracy Klein, MS, RN, FNP-BC, FAANP. JNP regrets the error.

NPs Continue to Be Under the Physician Microscope

Marilyn W. Edmunds — 2010-03-01

One of my colleagues sent me an article recently from the Journal for Clinical Epidemiology. In it, a familiar title caught my eye: “A Landmark Randomized Health Care Trial: The Burlington Trial of the Nurse Practitioner.” Another article by a similar title was published in 1974 in the New England Journal of Medicine by Walter O. Spitzer just as the nurse practitioner (NP) role was expanding in the United States. Spitzer was a leader in outcomes research; this was one of the first NP outcome studies published and certainly one of the most methodologically rigorous. Spitzer continued to be an international leader in evaluation research for many years and was part of the strong physician research group associated with McMaster University in Canada.

Cultural Changes

Marsha Siegel — 2010-03-01

I recently experienced an “a-ha” moment at a meeting where Ed O'Neil, PhD, director of the Center for the Health Professions at the University of California-San Francisco, was addressing health care reform issues. He pointed out that above all, nursing in general needs to reform how it thinks about itself. He further noted that, for nurse practitioners (NPs), no regulatory changes will matter until there is a cultural change. “WOW!” was my initial thought, but as the next 24 hours passed, I started wondering what he meant; in what way is a “cultural” change needed? I did not see him again to ask, but really, this was an issue that I needed to think about for myself.

News

2010-03-01

In December, The U.S. Food and Drug Administration (FDA) approved the first generic versions of Aricept (donepezil hydrochloride) orally disintegrating tablets. Donepezil hydrochloride is indicated for the treatment of dementia related to Alzheimer disease (AD). “Generics offer greater access to health care for all Americans,” said Gary Buehler, director of the FDA's Office of Generic Drugs. “Health care professionals and consumers can be assured that FDA-approved generic drugs have met the same rigorous standards as the brand-name drug and are the same as the branded in dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use.”

The Pros and Cons of Mandated Collaboration

Carolyn Buppert — 2010-03-01

The following seven states have no legal requirements for physician involvement in nurse practitioner (NP) practice: Alaska, Idaho, Maine, New Hampshire, New Mexico, Oregon, and Washington. (In Maine, an NP must practice under physician supervision for 24 months, but after that may practice without mandated physician involvement. In Utah, NPs need a physician collaborator only to prescribe controlled medications. Sometimes people include the District of Columbia in the list of states without mandatory collaboration. The District's code says, “Generally, advanced practice registered nurses shall carry out acts of advanced registered nursing in collaboration with a licensed physician or osteopath.” Nothing need be filed with the board of nursing.

Accurate Use of Prostate-Specific Antigen in Determining Risk of Prostate Cancer

Michelle A. Angie — 2010-03-01

Abstract: Measuring the level of prostate-specific antigen (PSA) in serum is used as a screening tool for prostate cancer. As more research results on improving the specificity and sensitivity of PSA testing become available, primary care providers will be provided with other methods to indicate when a urology referral is needed. The belief that the normal range is 0 to 4 ng/mL has not been supported by research. Multiple factors such as age, medication, and inflammatory processes can affect PSA level. Risk factors increase the patient's probability of developing prostate cancer. With no standard screening recommendations for prostate cancer, the provider has a greater responsibility to interpret results properly. Implications for practice are discussed.

The Journal for Nurse Practitioners Continuing Education Credit Application

2010-03-01

Facilitating Successful Aging: Encouraging Older Adults to Be Physically Active

Amanda Adams-Fryatt — 2010-03-01

Abstract: Participation in regular physical activity has the potential to change the way we age. Evidence indicates that engaging in regular physical activity can provide dramatic physical, mental, and social benefits to older adults and decrease overall any-cause mortality. For older adults, the focus changes, and beside the promotion of health, maintenance of independent living becomes paramount. Nurse practitioners (NPs) must counsel older adults on the benefits of physical activity. The Stages of Change theory can be used to encourage older adults to change sedentary behavior and become more active.

Complementary Therapies in Osteoporosis

Darlene Higgs, Cathy Kessenich — 2010-03-01

Abstract: Osteoporosis is a disorder characterized by brittle, fragile bones. It results from unbalanced bone metabolism and often leads to bone fractures and, consequently, a decreased quality of life. It is complex in pathology and requires multifactorial management and treatment. It is imperative that nurse practitioners (NPs) maintain current best-practice knowledge to appropriately manage and treat this increasingly prevalent and debilitating disease. This article provides a review of information regarding recent evidence for pharmacological and supplemental therapies in osteoporosis, including strontium ranelate, genistein, and vitamin K.

Should a Written Collaborative Practice Agreement with a Physician Be Required for Nurse Practitioner Practice?

Barbara Resnick, Sandra Nettina — 2010-03-01

Barbara Resnick, PhD, FAAN, FAANP, is a professor of nursing and adjunct professor in the Department of Epidemiology and Preventive Medicine at the University of Maryland in Baltimore. She received her PhD from the University of Maryland and her MS in nursing from the University of Pennsylvania. Her research focus has been on motivation of older adults, particularly regarding performance of functional activities and exercise. She has authored over 100 manuscripts, numerous book chapters on both clinical and research topics relevant to the care of older adults, and, recently, a book on restorative care nursing.

Nurse-Guided Completion of the BASDAI Questionnaire in Ankylosing Spondylitis Patients with Low Literacy

2010-03-01

Abstract: The objective of this study was to assess nurse-guided patient completion of the Bath Ankylosing Spondylitis Activity Index (BASDAI). Between April and June 2008, all consecutive patients diagnosed with ankylosing spondylitis in a university clinic who were over 18 years old were enrolled in this study. Demographic data and socioeconomic status were collected by a questionnaire. First, the BASDAI forms were completed by the patient (self-report). The forms were completed again by the patient, this time with the guidance of an experienced study nurse (nurse-guided). If the absolute value of difference of self-reported and nurse-guided BASDAI was $ 1 cm (the minimum clinically important difference), these patients were defined as discordant. One hundred sixty-two patients (101 male, 62%; 61 female, 38%); mean age 35.6 years (standard deviation [SD] 11.4); and with a mean disease duration of 12.7 years (SD 7.8), were enrolled in the study. Mean BASDAI scores were no different between self-reported (3.07, SD 2.31) and nurse-guided (2.89, SD 2.31) scores. Thirty-eight patients (23.4%) had discordant results. Comparing the discordant to non-discordant patients, the discordant patients had more active disease (53% versus 27%, P = 0.004); were older (39 years, SD 11, versus 34 years, SD 11, P = 0.029); were more frequently female (58% versus 32%, P = 0.003); had # 8 years' education (55% versus 22%, P < 0.001); and read the newspaper less (24% versus 50%, P = 0.005), respectively. After logistic regression analysis, the main factors explaining the discordance were: length of education, 3.1 (range 1.21–7.88); age, 1.19 (range 0.97–1.46); and frequency of newspaper reading, 2.63 (0.96–7.18). The BASDAI should be carefully evaluated in older patients with low literacy, and nurse-guided questionnaire completion may be an alternative approach in this subgroup.

Older Adult Relocation: Considerations for Nurse Practitioners

Joseph Kirst, Sue Peck — 2010-03-01

Abstract: The projected trends of the senior and baby-boomer population represent a projected demographic change that is nothing short of astounding. The nation's older adult population will continue to swell and, by 2035, will make up approximately 18% to 23% of the total population, nearly doubling this current age segment. With this significant and inevitable shift in demographics, individual, family, and community needs will increase proportionally. Nurse practitioners in primary care settings need to be cognizant of these trends and provide proactive assessments and health promotion advice to older patients and their families.

Nurse Practitioners' Knowledge, Attitudes, and Clinical Practices Regarding Treatment of Tobacco Use and Dependence

2010-03-01

Abstract: This article describes knowledge, attitudes, and clinical practices regarding treatment of tobacco use and dependence reported by nurse practitioners (NPs) interested in learning about evidence-based practices. Researchers analyzed baseline data from 193 licensed NPs prior to participating in Providers Practice Prevention: Treating Tobacco Use and Dependence. Results revealed domains where participants practiced in accordance with clinical practice guidelines and some areas where additional education and support may be necessary. NPs have a tremendous opportunity to reduce tobacco-related morbidity and mortality by addressing tobacco use, making it vitally important to support their implementation of evidence-based strategies.

Cholinesterase Inhibitors and Alzheimer Disease

Maren S. Mayhew — 2010-03-01

Dementia is a very common problem, and Alzheimer disease (AD) is the most common cause of dementia. More than 24 million people in the world have dementia, and the number is rising as the population ages. AD is a terrible disease that causes impaired cognition and function in the patient and much suffering on the part of the caregivers. It is the fifth leading cause of death in the United States.

Advance Beneficiary Notices of Non-Coverage Modifiers

Jan DiSantostefano — 2010-03-01

Effective April 1, 2010, two HCPCS level 2 modifiers have been updated to distinguish between voluntary and required uses of liability notices:

Diagnosing Premenstrual Syndrome

Kimberly Raines — 2010-03-01

Premenstrual symptoms are common among menstruating women, with approximately 75% reporting some discomfort with their cycles. However, an estimated 10% of women experience premenstrual syndrome (PMS), which is characterized by symptoms severe enough to interfere with daily life. While PMS can have a devastating impact on the quality of a woman's life and work, this complex disorder is poorly understood and can be challenging to diagnose. Nurse practitioners (NPs), regardless of practice specialty, are more likely than not to see patients suffering from PMS.

Determinants of Health: A Framework for Advanced Health Assessment

Scharalda Jeanfreau, Demetrius Porche, O. Danny Lee — 2010-03-01

Implementation of Health Information Technology

2010-03-01

Many practices already use some form of health information technology (HIT) or electronic health records (EHRs). If your practice does not use this technology now, you probably have had conversations about what it would take to implement an HIT or EHR system. Many believe that the proliferation and comprehensive use of HIT across all health care provider groups will significantly increase the quality of health care delivered in this country. In fact, in its analysis of budget options for Congress, the Congressional Budget Office (CBO) suggested that health IT would “improve the information available to clinicians at the time of treatment by encouraging the use of evidence-based medicine and by helping physicians manage patients with complex, chronic conditions.” The report also states that HIT can reduce costs by “reducing the number of inappropriate tests and procedures, reducing paperwork and administrative overhead, and decreasing the number of adverse events resulting from medical errors” (Budget Options. Health Care Congressional Budget Office. Vol. 1, option 46, p. 88). But did you know that Congress and others in the federal government may play a role in helping you to have access to HIT?

Health Policy

Sandy Wilbanks, Sandra Wilbanks — 2010-03-01

Sleep Disorders in Children

Sandy Wilbanks, Sandra Wilbanks — 2010-03-01