Journal of the American Association of Nurse Practitioners
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Hypertension in older adults is extremely common. It constitutes the major modifiable risk factor of cardiovascular disease, premature disability, and death. ⋯ Given the high prevalence of older adults with hypertension, nurse practitioners should critically examine the overall benefit of treatment, use of antihypertensive therapies, and BP targets to provide high-quality care to this patient population. The purpose of this article is to outline the evidence surrounding the management of BP in older adults and to offer strategies to reconcile conflicting guideline recommendations.
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J Am Assoc Nurse Pract · Dec 2019
Hypertonic saline versus mannitol for the treatment of increased intracranial pressure in traumatic brain injury.
Increased intracranial pressure (ICP) occurring after traumatic brain injury (TBI) is associated with increased morbidity and mortality. If appropriate treatments are not initiated, brain herniation can occur and lead to death. Previously, the Brain Trauma Foundation recommended mannitol as the first-choice hyperosmolar agent. However, in 2016, they retracted this recommendation, citing a lack of sufficient supporting evidence. Current research shows that hypertonic saline (HTS) also decreases ICP. ⋯ Evidence demonstrates HTS to be as effective as mannitol for ICP reduction. Further research in a large multicenter clinical trial is needed to compare these two agents for superiority in the management of increased ICP. Providers should consider the properties of each agent, adverse effects, and potential benefits when selecting a hyperosmotic agent.
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J Am Assoc Nurse Pract · Mar 2019
Can telemedicine improve triage and patient satisfaction in urgent care settings?
Urgent care centers (UCCs) frequently experience long wait times, overcrowding, and patient dissatisfaction. According to recent studies in the emergency care setting, utilization of telemedicine during patient triage has demonstrated reduction in patient wait time and improvement in patient satisfaction. Implementation of telemedicine in urgent care settings may make triage faster and more efficient and lead to similar improvements in wait time and patient satisfaction. Finally, there is potential for telemedicine to improve working conditions for providers and staff of UCCs.
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Teaching models provide a systemic framework for didactic and clinical teaching. The One-Minute Preceptor (OMP) is one teaching model, providing five microskills to organize a learning experience for students in the clinical environment. This review aims to integrate the literature on the OMP model by highlighting potential use for nurse practitioners while identifying directions for future research. ⋯ The OMP model has the potential to overcome clinicians' barriers to precepting nurse practitioner students. Future research may evaluate the use of this model specific to nurse practitioner preceptors and students, perceived time benefits in clinical teaching, overall improvement in clinical teaching, and use in interprofessional precepting.
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J Am Assoc Nurse Pract · Jun 2018
Food and Drug Administration upscheduling of hydrocodone and the effects on nurse practitioner pain management practices.
In 2013, the Advisory Committee of the Food and Drug Administration determined hydrocodone combination medications (HCMs) needed tighter regulation due to high abuse potential; they recommended upscheduling HCMs from Schedule III to II. The purpose of this study was to examine the effect of upscheduling of HCMs on pain management practices of advanced practiced registered nurses (APRNs) in Oklahoma. ⋯ Upscheduling of HCMs has had a severe impact on APRNs, affecting their prescribing practices and leading to increased referrals. They noted limited treatment options, increased health care costs, and decreased access to care. The APRNs understand the problem of prescription opioid abuse, diversion, and misuse. A consensus model could standardize the regulatory process for APRNs, increase interstate mobility for practice, and increase access to APRN care nationwide.