Standardizing Strep Throat Documentation in a Pediatric Outpatient Setting During COVID-19: A Quality Improvement Pilot ProjectClinicians’ nonadherence to the 2012 Infectious Diseases Society of America’s group A streptococcal (GAS) pharyngitis guidelines leads to unnecessary in-person clinic visits, unnecessary use of bacterial testing, and inappropriate antibiotic prescriptions. Quality improvement methodology was used during nurse telephone triage at an outpatient pediatric clinic to standardize nurse documentation to align with the GAS guidelines. This pilot project’s standardization resulted in improved communication among clinicians and decreased unnecessary resource and antibiotic use despite encountering barriers related to COVID-19.
Virtual Skills Training Format for Teaching Intrauterine Contraception Insertion During Coronavirus Disease 2019The coronavirus disease 2019 pandemic resulted in the curtailment of face-to-face clinical skills training in 2020. To meet Title X workforce needs, the National Clinical Training Center for Family Planning transitioned onsite intrauterine contraception training to a virtual format using online didactic material and livestreamed training and telementoring. Videos demonstrated the placement and removal of intrauterine contraceptives, and all necessary supplies were shipped directly to participants.
COVID-19 Telemedicine and Vaccination at an Urban Safety Net HIV Medicine ClinicIn response to the emerging coronavirus disease 2019 (COVID-19) pandemic in March 2020, the Owen Clinic at UC San Diego Health scaled up telemedicine to ensure the continuity of human immunodeficiency virus primary care. A group of nurse practitioners, physicians, and a physician assistant developed a dedicated COVID-19 telemedicine clinic to provide virtual health care services to patients with or at risk for severe acute respiratory syndrome coronavirus 2 infection. This effort contributed to successful health outcomes for the clinic’s 476 patients diagnosed with COVID-19.
Acquired Tracheomegaly in Critically Ill Patients With COVID-19: A Literature ReviewTracheomegaly is defined as an abnormally dilated trachea and is seen in patients requiring long-standing mechanical ventilation and/or significant hyperinflation of their endotracheal or tracheostomy tube cuffs can occur in adults with severe COVID-19. Tracheomegaly is linked with inadequate nutrition, pneumonia, diabetes, hypotension, steroids, and protracted mechanical ventilation, which are common in COVID-19 patients. Findings include cuff leaks that necessitate cuff overinflation to maintain adequate tidal volumes.
A Pandemic, Not a PanaceaAs the dust settles in the wake of the biggest public health crisis in a century, I’ve wondered why governors and legislatures in states without nurse practitioner (NP) full practice authority (FPA) didn’t permanently lift restrictions on NP scope of practice. At least 21 of the remaining 24 supervisory states—through executive order, legislative action, or both—temporarily removed some scope of practice barriers during their declared state of emergency or to a specified date beyond it.
Acute Myocardial Infarction From Embolized Left Ventricular Thrombus in Coronavirus Disease 2019A 44-year-old man with a late presentation of coronavirus disease 2019 (COVID-19) pneumonia developed a left ventricular apical thrombus resulting in an asymptomatic anterior myocardial infarction due to extensive thrombosis of the left anterior descending artery. There are increasing reports of thrombotic complications in patients infected with COVID-19. This case highlights the risk of thrombotic events caused by severe acute respiratory syndrome-related corona virus-2 and the associated challenges in management.
Evaluating the Effectiveness of BREATHE for Nurse Practitioners During COVID PandemicThe current health care system incorporates multidimensional strategies of improving patients’ care experiences, promoting the health of populations, and reducing per capita cost of health care. These strategies include reducing readmission rates by keeping patients in the community and out of the skilled nursing facilities. Unfortunately, patients’ outcomes were severely threatened during the coronavirus disease 2019 pandemic due to staff burnout. This project evaluates the effectiveness of the BREATHE program on the perceived stress level of nurse practitioners during the coronavirus disease 2019 pandemic.
Home Use Guidance for Aerosol-Generating Procedures During the Coronavirus Disease 2019 PandemicFrom the early days of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, there were concerns that nebulizers used for the treatment of respiratory diseases as aerosol-generating devices could enhance the transmission of SARS-CoV-2. However, given the absence of any compelling data showing that nebulized treatments increase the risk of SARS-CoV-2 infection, it is unnecessary for community-dwelling patients with respiratory diseases to alter their current therapies, including nebulized treatments, to prevent symptom exacerbations.
Antihistamines for Postacute Sequelae of SARS-CoV-2 InfectionPostacute sequelae of SARS-CoV2 (PASC) infection is an emerging global health crisis, variably affecting millions worldwide. PASC has no established treatment. We describe 2 cases of PASC in response to opportune administration of over-the-counter antihistamines, with significant improvement in symptoms and ability to perform activities of daily living. Future studies are warranted to understand the potential role of histamine in the pathogenesis of PASC and explore the clinical benefits of antihistamines in the treatment of PASC.
Use of Integrative Treatment Methods by Individuals With COVID-19This study was conducted to examine the use of integrative treatment methods by individuals with COVID-19 using Pender’s health promotion model. During the analysis of the themes, we observed that individuals’ decisions to start integrative treatment were affected by uncertainty related to COVID-19, desire to recover and strengthen immunity, and thinking that there would be permanent damage due to the disease. Integrative treatment methods were frequently used by individuals who had COVID-19, and these methods were primarily based on non–evidence-based information sources and not disclosed to health care professionals.
Save Your Life and Others' COVID-19 VaccineThank you for your leadership in serving as Editor-in-Chief for The Journal for Nurse Practitioners, a premier national and international journal dedicated to nursing profession, health care profession, and patient care. I applaud your leadership in your column on “COVID-19 Vaccine—Your Ethical Responsibility” (J Nurse Pract. 2021;17:1157-1158) and THANK YOU! This is an unprecedented time during which the coronavirus disease 2019 pandemic infiltrates all lives globally and a call for health care practitioners including nurses, physicians, pharmacists, and all other health care providers to step up, dedicate our roles in health care, serve our patients safely and effectively, and protect the community.
A Buprenorphine Program Evaluation Before and During the COVID-19 PandemicThis project evaluated the service delivery (ie, attendance rate) of a buprenorphine management treatment program and compared patient recovery-related information between service methods. This was a medical record review and cross-sectional comparison of pre–COVID-19 vs post onset of COVID-19 data. In the sample of 28 adults, mean attendance rates did not differ significantly before (99.46%) vs during the pandemic (96.13%; t = 1.92, P = .07). Patient participation in therapy before and during the pandemic did differ significantly (χ2 = 1.98, P = .03).
Access to Care: End-to-End Digital Response for COVID-19 Care DeliveryThe coronavirus disease 2019 pandemic disrupted health care, requiring organizational leaders to act quickly to manage the health-related concerns of individuals and communities. The ability to offer a variety of digitally enabled telehealth services with 24/7 access to nurse practitioners and physician assistants allowed us to care for patients in their homes. It reduced the spread of the virus, protected our employees from further disease spread, and provided early interventions to those in need.
A Case Study of Pancytopenia During the Novel 2019 Coronavirus PandemicPatients with pancytopenia may present as either clinically stable or unstable. Although there are many common causes of pancytopenia, a new cause that has been recently documented in patient case studies is the novel 2019 coronavirus. Nurse practitioners in all practice environments need to be able to identify pancytopenia, be aware of the associated complications and emergencies, and provide appropriate intervention including a hematology consult.
Recognizing the Clinical Sequelae of COVID-19 in Adults: COVID-19 Long-HaulersAs the numbers of acute severe acute respiratory syndrome coronavirus 2 infections continue to rise, we are learning that symptoms do not resolve quickly in all patients. Although why some patients experience persistent symptoms is not clear, these individuals suffer. Long-hauler is the term that is associated with these persistent symptoms, and this review of the literature provides information to nurse practitioners working in primary care about symptoms, risk factors, and resources for disease management.
The Lived Experience of COVID-19This qualitative study examined the essence of living with coronavirus disease 2019 (COVID-19). We used a phenomenological research design and interviewed 14 individuals ages 18 and older during the first wave of the COVID-19 pandemic. Data analysis using Colaizzi’s method for analysis revealed 2 overarching themes—physical experiences and psychologic/emotional experiences—and 8 subthemes that identify concerns that affect quality of life. The findings provide insights for nurses and health care providers on the experiences of living with COVID-19.
Misinformation During COVID: How Should Nurse Practitioners Respond?Misinformation has been plaguing health care for centuries. The rise of social media has allowed misinformation to flourish and spread at unprecedented rates. The COVID-19 pandemic has highlighted the need for nurse practitioners to understand misinformation and methods to address this issue. Professional medical organizations have called on social media companies to quell the spread of misinformation. Research on how to best address antivaccine misinformation and other forms of misinformation can help nurse practitioners address misinformation on social media and at the bedside.
COVID-19 Management in PediatricsCoronavirus disease 2019 (COVID-19) is a deadly global pandemic, with scientific efforts improving our understanding of this novel coronavirus. No proven disease-specific therapies exist, although 2 vaccines have been recently approved by the United States Food and Drug Administration under emergency use authorization, and several others are in development or phase III clinical trial testing. COVID-19 presents in greater severity in the medically fragile, obese, elderly, and socially disadvantaged, and children in general are less affected.
Management of Diabetes During a Dual PandemicThe dual pandemics of coronavirus disease-19 (COVID-19) and diabetes among patients are associated with 2- to 3-times higher intensive care admissions and higher mortality rates. Whether sheltering at home, quarantined with a positive COVID-19 test, or hospitalized, the person living with diabetes needs special considerations for successful management. Having diabetes and being COVID-19–positive increases the risk of poor outcomes and death. Providers need to give anticipatory pharmacologic guidance to patients with diabetes during COVID-19 lockdown.
Transition of Nurse Practitioner Faculty Practice and Student Clinicals to Telehealth: Response to the COVID-19 PandemicThe COVID-19 pandemic forced the US health care system to evaluate alternative care delivery strategies to reduce the risk of coronavirus transmission to patients and health care providers. Telehealth modalities are a safe and effective alternative to face-to-face visits for primary and psychiatric care. Federal policy makers approved changes to telehealth reimbursement coverage and allowed flexibility of location for patients and providers. This article describes the transition of patient visits to telehealth by nurse practitioner faculty at an academic medical center to maintain continuity of care of underserved patient populations.
Telehealth Palliative Care Needs Rounds During a PandemicOlder people living in care homes deserve access to specialist palliative care in their last months of life, and this has never been more important than during a global pandemic. Palliative Care Needs Rounds facilitated by nurse practitioners are cost-effective, reduce avoidable hospital transfers, improve quality of death and dying, and increase the capacity of staff to recognize and plan for care for dying residents in care homes. Conducting Palliative Care Needs Rounds via telehealth increases access to specialist palliative care while reducing the risk of coronavirus disease 2019 transmission.
Letter to the EditorIn response to the article by Diez-Sampedro et al, “COVID-19 and Advanced Practice Registered Nurses: Frontline Update,”1 published in the September 2020 edition of The Journal for Nurse Practitioners, the authors provide factors that advanced practice registered nurses (APRNs) have been challenged with during the coronavirus disease 2019 (COVID-19) pandemic. They also deliver a synopsis of the essential clinical information health care providers should be knowledgeable of regarding the COVID-19 pandemic (eg, symptoms, testing, treatment challenges, patient education).
What Happened to Person-Centered Care? Observations During the COVID-19 PandemicWhat happened to person-centered care (PCC)? With the advent of the coronavirus disease 2019 and the hysteria about infection rates, we as health care providers seem to have lost our ability to provide PCC. Some facilities may bar significant others (spouses and partners) from waiting rooms, examination rooms, and testing scenarios. Why does this make sense? The significant other spends 24/7 with the patient; thus, the infection risk is probably no greater, allowing the significant other to remain.
Telehealth Billing for Nurse Practitioners During COVID-19: Policy UpdatesTelehealth is a growing valuable strategy to assist patients accessing needed care when unable to get to a health care setting for one of several reasons. During the coronavirus disease 2019 (COVID-19) pandemic of 2020, many health care practices were forced to implement telehealth services to meet patient and practice needs. In 2020, several temporary waivers, exceptions, and telehealth policy changes emerged across the nation. Many telehealth policies are state or federal specific. This report provides a general overview of essential telehealth policies and legislative updates along with resources and websites to guide and support nurse practitioners with contemporary regulations regarding telehealth billing.
An Assessment of Distress Levels of Patients Undergoing Lung Cancer Treatment and Surveillance During the COVID-19 PandemicThe purpose of this quality improvement initiative was to identify anxious/distressed lung cancer patients and address their mental health needs directly related to the COVID-19. A total of 441 patients were screened utilizing a national distress thermometer. 47% were counseled by the NP, 32% sent for referral to the social worker. Patients reported reasons for distress as fear of delaying testing, contracting the virus and changes in their lifestyle. We found that screening all patients during the pandemic, yielded a higher than normal percentage of patients who were in need of some level of mental health services.