Nurse practitioners information needs and information seeking: Implications for practice and education

This report is an exploratory study of the information needs and information seeking in a sample of nurse practitioners (NPs) approved to practice in North Carolina. A search and review of relevant literature revealed no studies on this topic. In this study, NPs report their most frequent information needs relate to drug therapy, diagnosis, and other therapy. Their most frequently used information resources are physicians, drug reference manuals, and textbooks. They most frequently confer with physicians on diagnosis and other therapy and other NPs on psychosocial issues

Evaluation of the patient with hand pain and numbness: Carpal tunnel syndrome (CTS)

Carpal tunnel syndrome (CTS) is one of the most common neuropathies associated with nerve entrapment. It occurs most frequently between the ages of 40 and 60 and affects women three times more often than men.1 Approximately 80% of patients are older than 40. The most common symptom is pain, but this often is accompanied by numbness, tingling, and sometimes a burning sensation. It is the presence of these accompanying symptoms that often complicates what might be a simple problem in clinical diagnosis and treatment of this condition

The correlates and predictive validity of HIV risk groups among drug users in a community-based sample: Methodological findings from a multi-site cluster analysis

Outreach and intervention with out-of-treatment drug users in their natural communities has been a major part of our national HIV-prevention strategy for over a decade. Intervention design and evaluation is complicated because this population has heterogeneous patterns of HIV risk behaviors. The objectives of this paper are to: (a) empirically identify the major HIV risk groups; (b) examine how these risk groups are related to demographics, interactions with others, risk behaviors, and community (site); and (c) evaluate the predictive validity of these risk groups in terms of future risk behaviors. Exploratory cluster analysis of a sample of 4445 out-of-treatment drug users from the national data set identified eight main risk subgroups that could explain over 99% of the variance in the 20 baseline indices of HIV risk. We labeled these risk groups: Primary Crack Users (29.2%), Cocaine and Sexual Risk (12.8%), High Poly Risk Type 2 (0.3%), Poly Drug and Sex Risk (10.9%), Primary Needle Users (24.1%), High Poly Risk Type 1 (1.4%), High Frequency Needle Users (19.8%), and High Risk Needle Users (1.6%). Risk group membership was highly related to HIV characteristics (testing, sero-status), demographics (gender, race, age, education), status (marital, housing, employment, and criminal justice), prior target populations (needle users, crack users, pattern of sexual partners), and geography (site). Risk group membership explained 63% of the joint distribution of the original 20 HIV risk behaviors 6 months later (ranging from 0.03 to 37.2% of the variance individual indices). These analyses were replicated with both another 25% sample from the national data set and an independent sample collected from a new site. These findings suggest HIV interventions could probably be more effective if they targeted specific subgroups and that evaluations would be more sensitive if they consider community and sub-populations when evaluating these interventions

Outcomes of Integrated Assertive Community Treatment for Homeless Consumers with Co-occurring Disorders

The objective of this research was to evaluate the impact of Integrated Assertive Community Treatment (I-ACT) on psychiatric symptoms, drug use, housing status, and service utilization. A single-group repeated measures evaluation of outcome indicators at intake, 6 months, and 12 months examined changes over time with 555 respondents receiving outpatient treatment. While 555 received baseline interviews, figures vary on follow-up sample sizes and are listed as they are discussed in the paper. The study was implemented by a community treatment provider. The primary analyses used in this study were repeated measures ANOVA and the Friedman's two-way analysis test. Significant reductions in substance use (F(1.69, 553.02) = 94.30, p < .01) and psychiatric symptoms (F(1.98, 299.19) = 43.73, p = .0001) were found from baseline to 6 months and changes were sustained from the 6- to 12-month follow-up points. Similar results were found in housing status with the number of participants in stable housing rising significantly. Utilization of substance use and psychiatric treatment declined significantly across all three follow-up points, and physical health service use remained unchanged. I-ACT has demonstrated efficacy through controlled research studies, and this evaluation extends on these findings to demonstrate that I-ACT is effective in community service provision settings in reducing substance use and psychiatric symptoms. Further, the reduction in service use found across follow-up points indicates cost containment

Teaching opens new doors

There’s a crisis in nursing. For some time now we've known about the shortage of nurses; however, we've been paying less attention to another crisis: the shortage of nurse educators. According to the National League for Nursing (NLN), approximately 1,390 budgeted, vacant, full-time faculty positions exist nationwide. Since 2002, the vacancy rate in baccalaureate and higher degree programs has increased 32% (soaring to a 7.9% vacancy rate) and 10% for associate degree programs (growing to a 5.6% vacancy rate).1 The faculty shortage has profoundly impacted the general nursing shortage. Without nurse educators, our ability to reverse the shortage of practicing nurses is severely compromised. Therefore, it's timely to undertake a discussion of the educator shortage's origins, the benefits of becoming a nurse educator, and the types of career development opportunities that are available

Wanted: More men in nursing

Nursing is one of the world's most diverse occupations. It offers a variety of workplace settings, client populations, and healthcare specialties. Challenging and rewarding careers exist in direct patient care, administration, education, and advanced practice nursing, to name a few. Workforce demand is usually high, and with some retooling or additional education, nurses can develop expertise in other areas of the profession. One might think that the focus on helping people, the autonomy, the opportunity for career advancement, and the opportunity to work in a variety of geographic areas would be attractive to men across the nation, but that doesn't seem to be the case. Traditionally, nursing has been and continues to be a female-dominated profession. Some feel that nursing should remain a "female" profession, but the fact is, to meet rising healthcare demands, we'll need to recruit and retain more men

Advanced practice nursing: Conceptual issues

The issue of defining advanced practice nursing roles is increasingly a subject of national discussion and debate. Central to this discussion has been the issue of merging nurse practitioner (NP) and clinical nurse specialist (CNS) roles and the tendency for the term "nurse practitioner" to replace that of "clinical nurse specialist" in denotation of these roles. The authors note the lack of any attempt to use a broader conceptual approach in these discussions. In this article, the development of each role is reviewed, and the strengths and weaknesses of each role in current practice and education are evaluated. The authors conclude that inadequate justification exists for continuing both roles, but that the answer is not in simply replacing the CNS with the NP. Ongoing careful and thoughtful dialogue should be used to guide the merging of these two roles

Integrated Recovery Management Model for Ex-Offenders With Co-Occurring Mental Health and Substance Use Disorders and High Rates of HIV Risk Behaviors

This paper provides outcomes from an evaluation of a federally funded program combining HIV prevention services with an integrated mental health and substance abuse treatment program to a population of primarily African American ex-offenders living with, or at high risk for contracting HIV in Memphis, Tennessee. During the 5-year evaluation, data were collected from 426 individuals during baseline and 6-month follow-up interviews. A subset of participants (n = 341) completed both interviews. Results suggest that the program was successful in reducing substance use and mental health symptoms but had mixed effects on HIV risk behaviors. These findings are important for refining efforts to use an integrated services approach to decrease (a) the effects of substance use and mental health disorders, (b) the disproportionate impact of criminal justice system involvement, and (c) the HIV infection rate in African American ex-offenders in treatment

Evaluation of a Faith-Based Culturally Relevant Program for African American Substance Users at Risk for HIV in the Southern United States

Objective: This article provides an evaluation of a federally funded faith-based program that serves African Americans who use heroin and cocaine and are at risk for HIV/AIDS in Nashville, Tennessee. Methods: Data were collected from 163 individuals at baseline and 6- and 12-month follow-up interviews. A subset of participants (n = 51) completed all three interviews. Results: Results suggested that this culturally relevant set of interventions was successful in reducing substance use and HIV/AIDS risk behaviors. The program was able to show data that supported the efficacy of a faith-based approach emphasizing spirituality rather than directive, aggressive, authoritarian, or coercive counseling techniques. Discussion: The model is important to the continued development of culturally relevant interventions that are vital to decreasing the disproportionate rates of HIV/AIDS within the African American community

Patterns of HIV risk and alcohol use among African-American crack abusers

Although the association between heavy alcohol use and HIV risk has been studied in treatment populations, we know little about patterns of alcohol use and HIV risk among out-of-treatment African-American drug users. This study examines the extent to which alcohol use affects HIV risk in a sample of 495 African-American crack users who did not inject drugs. We present differences between levels of alcohol and crack use with regard to sexual practices (including sex while impaired), number of partners, frequency of sexual activity, and condom use. The findings suggest an intimate relationship between alcohol use, crack use, and sexual risks for HIV infection. Respondents who reported frequent use (15–30 days in the last 30 days) of alcohol, crack, or both displayed significantly greater risk than those who reported less than frequent use