Women With High-Risk Pregnancies, Problems, and APN Interventions

Purpose To (a) describe women’s prenatal and postpartum problems and advanced practice nurses (APN) interventions; and (b) determine if problems and APN interventions differed by women’s medical diagnosis (diabetes, hypertension, preterm labor). Design and Methods Content analysis of 85 interaction logs created by APNs during a randomized clinical trial in which half of physician-provided prenatal care was substituted with APN-provided prenatal care in the women’s homes. Patients’ problems and APN interventions were classified with the Omaha Classification System. Findings A total of 212,835 health problems and 212,835 APN interventions were identified. The dominant antenatal problems were physiologic (59.2%) and health-related behaviors (33.3%); postpartum were physiologic (44.0%) and psychosocial problems (31.6%). Antenatally, women with diabetes had significantly more health-related behavior problems; women with preterm labor had more physiologic problems. APN surveillance interventions predominated antenatally (65.6%) and postpartum (66.0%), followed by health teaching, guidance, and counseling both antenatally (25.4%) and postpartum (28.1 %). Women with chronic hypertension required significantly more case-management interventions. Conclusions The categories of women’s problems were largely similar across medical diagnostic groups. Interventions to address women’s problems ranged from assessing maternal and fetal physiologic states to teaching interpersonal relationships and self-care management to assisting with transportation and housing. Data show the range of APN knowledge and skills needed to improve maternal and infant outcomes and ultimately reduce healthcare costs in women with high-risk pregnancies

Certification and education as determinants of nurse practitioner scope of practice: An investigation of the rules and regulations defining NP scope of practice in the United States

Purpose and background: In 2008, a consortium of advanced practice nursing organizations authored the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education. The document\u27s aim is to provide guidance for states to adopt uniformity in the regulation of advanced practice registered nurse roles. Despite a target date to complete that work by 2015, there remains an extensive amount of variation in how states define the scope of practice (SOP) for nurse practitioners (NPs). Data sources: Based on the National Council of State Boards of Nursing online database, state (N = 51 [includes the District of Columbia]) NP practice acts and/or rules and regulations documents were examined for language describing SOP for NPs consistent with the language of the advanced practice registered nurse (APRN) Consensus Model. Conclusions: Results indicated that 18 states and the District of Columbia (37%) had specific regulations defining NP SOP by certification and/or educational preparation while 23 (45%) did not. The remaining nine states (18%) had SOP regulations that were interpreted as being ambiguous in relation to certification and/or educational preparation. Implications for practice: The findings suggest much work is needed to ensure NP SOP accurately reflects NP board-certification and graduate educational preparation

Certification And Education As Determinants Of Nurse Practitioner Scope Of Practice: An Investigation Of The Rules And Regulations Defining Np Scope Of Practice In The United States

Purpose and background: In 2008, a consortium of advanced practice nursing organizations authored the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education. The document\u27s aim is to provide guidance for states to adopt uniformity in the regulation of advanced practice registered nurse roles. Despite a target date to complete that work by 2015, there remains an extensive amount of variation in how states define the scope of practice (SOP) for nurse practitioners (NPs). Data sources: Based on the National Council of State Boards of Nursing online database, state (N = 51 [includes the District of Columbia]) NP practice acts and/or rules and regulations documents were examined for language describing SOP for NPs consistent with the language of the advanced practice registered nurse (APRN) Consensus Model. Conclusions: Results indicated that 18 states and the District of Columbia (37%) had specific regulations defining NP SOP by certification and/or educational preparation while 23 (45%) did not. The remaining nine states (18%) had SOP regulations that were interpreted as being ambiguous in relation to certification and/or educational preparation. Implications for practice: The findings suggest much work is needed to ensure NP SOP accurately reflects NP board-certification and graduate educational preparation

The Impact Of Nurse Practitioner Regulations On Population Access To Care

Background: By 2025, experts estimate a significant shortage of primary care providers in the United States, and expansion of the nurse practitioner (NP) workforce may reduce this burden. However, barriers imposed by state NP regulations could reduce access to primary care. Purpose: The objectives of this study were to examine the association between three levels of NP state practice regulation (independent, minimum restrictive, and most restrictive) and the proportion of the population with a greater than 30-min travel time to a primary care provider using geocoding. Methods: Logistic regression models were conducted to calculate the adjusted odds of having a greater than 30-min drive time. Findings: Compared with the most restrictive NP states, states with independent practice had 19.2% lower odds (p =.001) of a greater than 30-min drive to the closest primary care provider. Discussion: Allowing NPs full autonomy to practice may be a relatively simple policy mechanism for states to improve access to primary care

Willingness of Older Adults From Culturally Diverse Populations to Participate in COVID-19 Related Treatment Trials and Associated Factors

This survey study aimed to assess the willingness of culturally diverse older adults to participate in COVID-19 research. The majority of the 276 participants were women (81%, n  = 223) and Black/African American (62%, n  = 172) or White Hispanic (20%, n  = 56). A key finding from the survey was less than 1 of 10 respondents would be likely to participate in COVID-19 related research if given the opportunity. There were no differences observed by gender, race or ethnicity. Implications of these findings are considered. These study findings indicate continued effort and better messaging strategies are required to increase awareness that COVID-19 related research needs to include culturally diverse older adults to ensure vaccines and treatments are efficacious in different populations