Michelle T. Renaud

Telehealth: preparing advanced practice nurses to address healthcare needs in rural and underserved populations.

Abstract Healthcare is being confronted with questions on how to deliver quality, affordable, and timely care to patients, especially those in rural areas, in systems already burdened by the lack of providers. Advanced Practice Registered Nurses (APRNs) have been challenged to lead this movement in providing care to these populations through the use of technologies, specifically telehealth. Unfortunately, APRNs have limited exposure to telehealth during their educational experience, thereby limiting their understanding and comfort with telehealth. To address this problem, a telehealth program was developed at a large university that prepares Doctor of Nursing Practice (DNP) APRN students. The telehealth program, embedded into the DNP curriculum, consisted of a simulation workshop, practice immersion, and written project. This program was well received by students, making them aware of the benefits and barriers to the implementation of telehealth as a care delivery modality. Telehealth was embraced as students implemented the program in their own practices.

Use of the parenting stress index in mothers of preterm infants.

PURPOSEThis report describes parenting stress experienced by mothers of preterm infants following hospital discharge. SUBJECTSTwenty-nine mothers and their preterm infants were included in the analysis. DESIGN AND METHODSThe study was conducted using a descriptive and exploratory single group design. The analysis included 29 mothers of preterm infants, mean gestational age 33.14 weeks, mean postnatal age 78.59 days, 6 to 10 weeks after discharge. Mothers were administered the Parenting Stress Index (PSI), a 101-item questionnaire that includes a total score and Parent and Child Domains. It also includes the following 13 scales: Adaptability, Acceptability, Demandingness, Mood, Distractibility/Hyperactivity, Reinforces Parent, Depression, Attachment, Restriction of Role, Sense of Competence, Social Isolation, Relationship with Spouse, and Parent Health. PRINCIPAL RESULTSA high rate of missing items was noted on the PSI. In particular, missing items occurred predominantly in the Child Domain. By following guidelines for scoring the PSI when items are missing, summary scores were calculated for 16 of the 29 participants. Total scores demonstrate the stress experienced by parents of preterm infants. Parent Domain scores were comparable with normative samples; however, Child Domain scores were above the 50th percentile for all child scales. CONCLUSIONSMothers of preterm infants experience stress that is largely attributable to the particular characteristics of low gestation infants. The PSI may provide insight into parenting stress; however, future research should examine missing items more closely.

Effects of Discontinuing Cover Gowns on a Postpartal Ward upon Cord Colonization of the Newborn

To determine if the incidence of bacterial cord colonization in neonates increased when cover gowns were discontinued on a postpartal ward, a study was conducted. All infants who were admitted to and discharged from the well infant nursery at an Army medical center in Denver, Colorado, were cultured at the umbilicus at the time of admission and at discharge. The control group (N = 74) continued to gown as usual; the experimental group (N = 50) did not wear gowns, Visitors in both groups received the same instructions regarding handwashing. For all organisms, the control group demonstrated 80% colonization of infants who were negative on admission, and the experimental group demonstrated a colonization rate of 62%. When the chi square is applied, these data are statistically significant for P= 0.02 and P= 0.05. The experimental group had less colonization than the control group.

Educating Advanced Practice Nurses in Using Social Media in Rural Health Care

Health care in the United States is facing a crisis in providing access to quality care for those in underserved and rural regions. Advanced practice nurses are at the forefront of addressing such issues, through modalities such as health care technology. Many nursing education programs are seeking strategies for better educating students on technology utilization. Health care technology includes electronic health records, telemedicine, and clinical decision support systems. However, little focus has been placed on the role of social media in health care. This paper describes an educational workshop using standardized patients and hands-on experiences to introduce advanced practice nurses in a Doctor of Nursing Practice program to the role of social media in addressing issues inherent in the delivery of rural health care. The students explore innovative approaches for utilizing social media for patient and caregiver support as well as identify online resources that assist providers in a rural setting.

Preparing emotionally intelligent doctor of nursing practice leaders.

The Institute of Medicine (IOM) identified the need for interdisciplinary teams that collaborate, communicate, and integrate care across settings to improve health care delivery. Focusing on innovative strategies that address leadership skills in graduate nursing education could have an effect on interdisciplinary partnerships, transformation of patient care, and new styles of leadership to change current practice models. In response to the IOM guidelines, we incorporated emotional intelligence as a component in our Doctor of Nursing Practice (DNP) leadership curriculum. This article describes a new action-oriented leadership model that prepares the DNP graduate for leadership roles to serve the public and the nursing discipline during a time of radical changes in health care. Behavioral profile, nontraditional readings, and online discussions form the basis of the model. The principles and strategies in this article can be applied to nursing education in multiple arenas, at both the undergraduate and graduate settings.

Routine hearing screening in primary care for adult populations using distortion product Otoacoustic Emissions testing.

Purpose: The purpose of this study was to determine the prevalence of undiagnosed hearing loss in adults in two busy primary care rural health centers. Data sources: Using Otoacoustic Emissions (OAE) testing, participants were screened for hearing loss by trained personnel. Participants were those who presented to the primary care provider with complaints other than hearing loss or ear problems. Conclusion: Of the 86 participants, 48.8% were found to have failed OAE testing, indicating some type of undiagnosed hearing loss. The average age of the participants was 49.27 years, yet nearly half had hearing loss. This finding makes hearing screening in the adult population, other than the elderly, an important issue. Implications for practice: Hearing loss affects over 40% of the adult population. Undiagnosed and untreated hearing loss can be associated with depression, decreased social activities, and low self‐esteem. The project identified the need for routine hearing screening and thus may become the foundation for the development and implementation of a hearing‐screening program for primary care. The primary care nurse practitioner needs to incorporate hearing screening into the exam for early identification and for proper referral.

research and studiesEffects of Discontinuing Cover Gowns on a Postpartal Ward upon Cord Colonization of the Newborn

To determine if the incidence of bacterial cord colonization in neonates increased when cover gowns were discontinued on a postpartal ward, a study was conducted. All infants who were admitted to and discharged from the well infant nursery at an Army medical center in Denver, Colorado, were cultured at the umbilicus at the time of admission and at discharge. The control group (N = 74) continued to gown as usual; the experimental group (N = 50) did not wear gowns, Visitors in both groups received the same instructions regarding handwashing. For all organisms, the control group demonstrated 80% colonization of infants who were negative on admission, and the experimental group demonstrated a colonization rate of 62%. When the chi square is applied, these data are statistically significant for P= 0.02 and P= 0.05. The experimental group had less colonization than the control group.