Joanne M. Pohl

Quality and safety education for advanced nursing practice

The Quality and Safety Education for Nurses (QSEN) project is a national initiative to transform nursing education to integrate quality and safety competencies. This article describes a two-year process to generate educational objectives related to quality and safety competency development in graduate programs that prepare advanced practice nurses in clinical roles. Knowledge, skills, and attitudes for each of 6 competencies are proposed to stimulate development of teaching strategies in programs preparing the next generation of advanced practice nurses.

The influence of developmental life stage on quality of life in survivors of prostate cancer and their partners

IntroductionAlthough prostate cancer is prevalent, little information is available on how it affects couples’ quality of life (QOL) according to their age cohort. The purpose of this study was to examine how quality of life, self-efficacy and appraisal of the illness experience vary among men with prostate cancer and their partners according to age cohort: middle age (50–64); young-old (65–74); and old-old (75–84). Using an Adult Developmental and Family Stress framework, this study focuses on how normative (developmental stage) and non-normative stressors (prostate cancer) may affect a couples ability to adapt.MethodsA descriptive, comparative design was used to examine age-related differences in quality of life and selected psychosocial variables in 69 men with prostate cancer and their spouses. Cross-sectional data were obtained using standardized instruments with adequate reliability and validity. ANCOVA and MANCOVA were used to determine differences among age groups.ResultsFindings indicated that patients who were ages 65–74 had better QOL and higher self-efficacy than patients ages 50–64 and less negative appraisal of illness than the other two groups. Spouses ages 50–64 reported the most distress related to sexual changes in their husbands. Spouses in both the middle age and old-old group had more bother related to hormone therapy than the young-old spouses.Implications for cancer survivorsFindings suggest that interventions should be tailored to dyads’ developmental life stage. Younger and older prostate cancer survivors and their partners may benefit from tailored interventions designed to improve their quality of life and confidence in managing their treatment outcomes during the survivorship period.

Personal influencing factors associated with Pap smear testing and cervical cancer

Pap smear is a screening test that detects abnormal cells before they advance to cancer. Unfortunately, not all women obtain routine screening. The method used was a qualitative study exploring personal influences regarding Pap smears. Face-to-face interviews with 7 low-income African American women who do and do not obtain Pap smears (between 21 and 37 years of age) were conducted at a health department about their social influence, previous health care experience, and cognitive appraisal regarding Pap smears and cervical cancer. Women were found to be socially influenced by their family and their physician. Previous health care experience with the Pap and pelvic was perceived as negative. Cognitively, Pap smears were believed to test for sexually transmitted diseases, including HIV, and the women also felt that if one took good care of oneself it reduced the risk for cervical cancer. It was concluded that exploring beliefs associated with Pap smears and perceptions of vulnerability to cervical cancer and giving correct information and counseling may increase Pap smear screening in women.

Advance directives: a guide for patient discussions.

Advance care planning is an important part of preventive health care. The patient planning for future health care decisions should explore life and treatment goals, reflecting on personal values and beliefs. This article discusses how clinicians can assist patients in the primary care setting. A four-step advance care planning process includes presenting the topic, facilitating a discussion, completing and documenting the advance directive, and reviewing and updating documents.

Predictors of participation in a smoking cessation intervention group among low-income women

The predictors of participation in a smoking cessation group among low-income women were examined. Fifty smokers were recruited from a Midwestern community primary care setting serving an uninsured, underinsured, and Medicaid population. Participants completed a questionnaire before the intervention, and eleven women chose to participate in the 6-week sessions. There were few differences between the control group (nonparticipants) and the intervention group. The intervention group had significantly higher intention-to-quit scores. Logistic regression analysis was used to predict group membership with age, self-efficacy, optimism, social support, nicotine dependence, intention-to-quit, and other smokers in the home as the predictor variables. The only two significant predictors of participation in the cessation intervention were self-efficacy and intention-to-quit smoking. The higher the intention-to-quit score and the lower the self-efficacy score (the belief that one can be successful in not smoking); the more likely these women were to participate in the group intervention. Results are discussed in terms of their clinical relevance as well as future research in the area.

The Safety Net: Academic Nurse-Managed Centers’ Role

This article reports on a study conducted in 2001 that examined the role of four schools of nursing (SONs) in Michigan and their challenges in serving the safety net population through primary care nurse-managed centers (NMCs). The NMCs are described and compared to community health centers (CHCs) in terms of patient mix, funding sources, and contributions SONs make as a substitute resource for federal funding to the NMCs. NMCs are frequently invisible providers in the health system, yet they serve high-need populations. Similarities and differences between NMCs and CHCs are discussed as well as the unique challenges faced by NMCs and their SONs as the result of policies that sometimes limit NMCs ability to serve safety net populations.

African-American Women Who Smoke Crack Cocaine: Sexual Trauma and the Mother-Daughter Relationship

This study evolved from previous writings that linked sexual abuse to the quality of the mother-daughter relationship. The purpose of this investigation was to examine the mother-daughter relationship among African-American women who abuse crack cocaine by comparing three different groups: women who have not experienced incest but have experienced sexual abuse; women who have experienced incest; and women who have not experienced sexual abuse. A convenience sample of 64 African-American women was used, 35 of whom were in drug abuse treatment and 29 of whom were abusing crack cocaine. Using analysis of variance studies, significant differences were found between the three groups in terms of the mother-daughter relationship. Differences were also found between the group that experienced incest and the group that experienced nonincestuous sexual abuse in terms of the amount of abuse and first age of abuse. This preliminary investigation indicates the need for further study of specific populations in this area--most notably, African-American women who abuse crack cocaine.

Faculty practice: What do the data show? Findings from the NONPF Faculty Practice Survey

Abstract This article reports on the findings of the NONPF (National Organization of Nurse Practitioner Faculties) Faculty Practice Survey regarding promotion and tenure. Relevant issues related to tenure for practicing faculty are identified and discussed. Faculty practice has become an increasingly important and complex issue for academic institutions in relation to promotion and tenure. The purpose of this article is to examine the role and patterns of practice among tenured and nontenured faculty in academic nursing institutions and the variables associated with faculty promotion and tenure in these institutions. Method: A survey was mailed to the membership of the National Organization of Nurse Practitioner Faculties to examine the differences between practicing faculty who were tenured and those who were nontenured and to identify predictors of tenure. A 50% response rate (N = 452) was obtained. Findings indicate that only 37% of the practicing faculty were tenured, and more than half (51%) reported that practice was not considered in promotion and tenure decisions at their institutions. The predictors of tenure included practice being considered in promotion and tenure and support for practice at the school of nursing level. Data on reasons faculty practice are also presented. Recommendations for including practice in promotion and tenure guidelines are discussed as well as the ramifications of administrative support for practice. Nurs Outlook 2002;50:238-246.

A partnership model for implementing electronic health records in resource-limited primary care settings: experiences from two nurse-managed health centers

OBJECTIVE To present a partnership-based and community-oriented approach designed to ease provider anxiety and facilitate the implementation of electronic health records (EHR) in resource-limited primary care settings. MATERIALS AND METHODS The approach, referred to as partnership model, was developed and iteratively refined through the research teams previous work on implementing health information technology (HIT) in over 30 safety net practices. This paper uses two case studies to illustrate how the model was applied to help two nurse-managed health centers (NMHC), a particularly vulnerable primary care setting, implement EHR and get prepared to meet the meaningful use criteria. RESULTS The strong focus of the model on continuous quality improvement led to eventual implementation success at both sites, despite difficulties encountered during the initial stages of the project. DISCUSSION There has been a lack of research, particularly in resource-limited primary care settings, on strategies for abating provider anxiety and preparing them to manage complex changes associated with EHR uptake. The partnership model described in this paper may provide useful insights into the work shepherded by HIT regional extension centers dedicated to supporting resource-limited communities disproportionally affected by EHR adoption barriers. CONCLUSION NMHC, similar to other primary care settings, are often poorly resourced, understaffed, and lack the necessary expertise to deploy EHR and integrate its use into their day-to-day practice. This study demonstrates that implementation of EHR, a prerequisite to meaningful use, can be successfully achieved in this setting, and partnership efforts extending far beyond the initial software deployment stage may be the key.

Measuring Quality in Nurse‐Managed Centers Using HEDIS Measures

&NA; Nurse‐managed centers (NMCs) provide viable options for primary healthcare and contribute substantially to filling access gaps for vulnerable populations. The purposes of this paper are to (a) describe a pilot application and adaptation of eight Health Plan Employer Data and Information Set (HEDIS) measures to six NMCs, (b) report the findings from the quality assessments, and (c) compare findings to national HEDIS data. The eight quality assessment areas are asthma, cervical cancer screening, childhood immunizations, depression, diabetes, hypertension, mammography screening, and smoking cessation. The NMCs achieved or exceeded HEDIS 50th percentile levels in a number of important clinical areas, but did not attain the 50th percentile level in others. Thus, HEDIS measures are relevant for the assessment of care quality and provide useful data for quality improvement in NMCs.