JoAnne M. Saxe

Meeting a primary care challenge in the United States: chronic illness care

Leading health care experts in the United States have stated that the greatest primary care challenge today is meeting the complex needs of patients with chronic illness/long-term conditions or impairment. To address this challenge, there is a need for health care system redesign that requires a multidisciplinary team approach, including active participation from professional nurses. In particular, it is essential for advanced practice nurses to provide leadership in health systems design for which they are specifically trained and experienced. In this article, the primary care challenge related to chronic illness care management is addressed. Future implications for community-based, chronic illness care delivery and the education of future health care providers with a focus on advanced practice nurses will also be discussed.

Shared faculty governance: A decision-making framework for evaluating the DNP

The concept of shared governance was used to frame the dialogue and decision-making process around the Doctor of Nursing Practice (DNP) at a leading School of Nursing. This article reports the process used to support dialogue around the DNP so that an informed decision could be made. The shared governance process promoted reflective conversation within the entire faculty and, in the end, supported the decision-making related to the DNP.

Adult Immunization Update

Prevention of various communicable diseases through the induction of artificial immunity via immunobiologics (live virus vaccines*, live bacteria vaccines, detoxified toxins, inactivated virus or bacteria vaccines, and immune globulins [beyond the scope of discussion]) has repeatedly proven to be a beneficial health protection strategy. Because occupational health nurses are often in a strategic position to design and implement health protection programs, such as immunization programs, it is crucial to have current information for orchestrating such an important endeavor. Thus, this immunization update includes a discussion on: • The basis for the widespread delivery of common adult immunizations. • The recent initiatives influencing the direction of immunization programs. • A framework for assuring safe and effective immunization delivery in the adult population. • A brief review of the indications, dosage, adverse effects, contraindications, and special considerations for common adult immunizations. • A concise presentation of newly approved vaccines

Risk profile screening

The recovery period following hospitalization for a CHD event is an ideal time to assess a patient for risk factors and to offer intervention. Frequently, the nurse is the single source of such care and has opportunity to educate the patient and offer suggestions for life-style modifications that can reduce the recurrence of CHD events. This article describes modifiable risk factors and methods of assessment, cites sources for management and general health screening method, that can provide a comprehensive assessment of health risks. Gender or ethnic-specific issues, have been highlighted. A very brief mention of age-specific risk factors is included.