Military medicine
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Advanced practice registered nurses (APRNs) such as clinical nurse specialists and nurse practitioners excel at chronic disease management. Development of an APRN-led heart failure (HF) clinic is an ideal way to manage complex HF patients. However, there are important factors to consider when implementing an APRN-led HF clinic. ⋯ The increasing need for primary care and internal medicine providers supports using APRNs to fill the gap and provide disease management for HF patients. Also, APRNs can impact the overall costs of HF treatment by optimizing postdischarge care and preventing hospitalizations and readmissions. Multiple studies supported implementation of APRN-led HF clinics for disease management to provide complex treatment strategies and comprehensive care to these patients.
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Review
Standardizing Evidence-Based Practice Review Processes Across the Defense Health Agency Enterprise.
The Defense Health Agency (DHA) Campaign Plan identifies Ready Reliable Care (RRC) as one of the eight strategic initiatives. A critical aspect of RRC is standardizing evidence-based practice (EBP) across Military Health System to include training, technology, equipment, and processes. The TriService Nursing Research Program hosted an EBP Summit to address this expectation. ⋯ Strategic recommendations to address the identified gaps are establishing a TriService Clinical Inquiry Working Group for process and product standardization, identifying EBP champions for each DHA market to educate and facilitate EBP review and submission processes, and establishing EBP review forums led by EBP subject matter experts. The authors suggest funding for program development and evaluation.
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The QSEN Institute developed the quality and safety education for nurses (QSEN) competencies for both undergraduate and graduate-prepared nurses to support their development of the knowledge, skills, and attitudes needed to deliver safe, quality care. The purpose of this scoping review was to (1) determine the extent of evidence about the current use of QSEN competencies in graduate nursing curricula and (2) determine the application of the QSEN competencies among graduate-prepared nurses in clinical practice. ⋯ Although the QSEN competencies were adopted for use in graduate curricula and practice settings, there is a wide variation in the actual use and application with limited reporting of outcomes. The graduate QSEN competencies can be leveraged to equip nurses with the knowledge, skills, and attitudes to address quality and safety challenges in any nursing environment including the operational environment in deployed and austere settings. This review provides recommendations to address gaps in research, graduate nursing education, and clinical practice.
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Overweight and obesity trends are on the rise among both civilian and military beneficiaries. The purpose of this narrative review was to evaluate nutrition, behavioral, lifestyle, pharmacotherapy, and alternative approaches to weight management (WM) among adults with a focus toward identifying gaps and evidence-based strategies that could support or enhance current and future WM programming among military adult beneficiaries. ⋯ Reviewers identified several validated tools and techniques to augment and update existing WM programming to improve health and weight outcomes. The review affirmed use of individualized dietary patterns and not a "one-size-fits-all approach" as well as incorporating more comprehensive and team-approached treatments to make the best use of tools and strategies to enhance outcomes.
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Experiences by service members in recent conflicts and training environments illuminate concerns about the possible effects of blast overpressure (BOP) exposure on brain health. Section 734 of the National Defense Authorization Act for Fiscal Year (FY) 2018 (Public Law 115-91) requires that the Secretary of Defense conducts a longitudinal medical study on blast pressure exposure of members of the Armed Forces during combat and training, and the Assistant Secretary of Defense for Health Affairs was assigned responsibility for fulfilling requirements. The study's goal is to improve DoD's understanding of the impact of BOP exposure from weapon systems on service members' brain health and inform policy for risk mitigation, unit readiness, and health care decisions. This article focuses on the activities of the Weapon Systems Line of Inquiry (LOI) and the development of a prototype BOP Tool. ⋯ It is recommended that the DoD revises requirements and policy to improve and standardize safety guidance throughout research, development, testing, and evaluation; acquisition; and training. The validated BOP Tool allows users to generate a scenario to predict BOP exposure and allows service members to modify them during planning for safer training.