Committee for assessing progress on implementing the recommendations of the institute of medicine report the future of nursing: leading change, advancing health

www.mobilehealthmap.org 617‐442‐3200 New research shows that mobile health clinics improve health outcomes for hard to reach populations in cost‐effective and culturally competent ways . A Harvard Medical School study determined that for every dollar invested in a mobile health clinic, the US healthcare system saves $30 on average. Mobile health clinics, which offer a range of services from preventive screenings to asthma treatment, leverage their mobility to treat people in the convenience of their own communities. For example, a mobile health clinic in Baltimore, MD, has documented savings of $3,500 per child seen due to reduced asthma‐related hospitalizations. The estimated 2,000 mobile health clinics across the country are providing similarly cost‐effective access to healthcare for a wide range of populations. Many successful mobile health clinics cite their ability to foster trusting relationships. Qualitative research in such mobile health clinics has found that patients value the informal, familiar environment in a convenient location, with staff who “are easy to talk to,” and that the staff’s “marriage of professional and personal discourses” provides patients the space to disclose information themselves. A communications academic argued that mobile health clinics’ unique use of space is important in facilitating these relationships. Mobile health clinics park in the heart of the community in familiar spaces, like shopping centers or bus stations, which lend themselves to the local community atmosphere.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

Background
Although it is widely known that evidence-based practice (EBP) improves healthcare quality, reliability, and patient outcomes as well as reduces variations in care and costs, it is still not the standard of care delivered by practicing clinicians across the globe. Adoption of specific EBP competencies for nurses and advanced practice nurses (APNs) who practice in real-world healthcare settings can assist institutions in achieving high-value, low-cost evidence-based health care.

Aim
The aim of this study was to develop a set of clear EBP competencies for both practicing registered nurses and APNs in clinical settings that can be used by healthcare institutions in their quest to achieve high performing systems that consistently implement and sustain EBP.

Methods
Seven national EBP leaders developed an initial set of competencies for practicing registered nurses and APNs through a consensus building process. Next, a Delphi survey was conducted with 80 EBP mentors across the United States to determine consensus and clarity around the competencies.

Findings
Two rounds of the Delphi survey resulted in total consensus by the EBP mentors, resulting in a final set of 13 competencies for practicing registered nurses and 11 additional competencies for APNs.

Linking Evidence to Action
Incorporation of these competencies into healthcare system expectations, orientations, job descriptions, performance appraisals, and clinical ladder promotion processes could drive higher quality, reliability, and consistency of healthcare as well as reduce costs. Research is now needed to develop valid and reliable tools for assessing these competencies as well as linking them to clinician and patient outcomes.

https://sigmapubs.onlinelibrary.wiley.com/doi/epdf/10.1111/wvn.12021

The Establishment of Evidence-Based Practice Competencies for Practicing Registered Nurses and Advanced Practice Nurses in Real-World Clinical Settings: Proficiencies to Improve Healthcare Quality, Reliability, Patient Outcomes, and Costs

Inevitably, reading is one of the requirements to be undergone. To improve the performance and quality, someone needs to have something new every day. It will suggest you to have more inspirations, then. However, the needs of inspirations will make you searching for some sources. Even from the other people experience, internet, and many books. Books and internet are the recommended media to help you improving your quality and performance.

Primary Care: America's Health in a New Era

Shared decision-making is increasingly advocated as an ideal model of treatment decision-making in the medical encounter. To date, the concept has been rather poorly and loosely defined. This paper attempts to provide greater conceptual clarity about shared treatment decision-making, identify some key characteristics of this model, and discuss measurement issues. The particular decision-making context that we focus on is potentially life threatening illnesses, where there are important decisions to be made at key points in the disease process, and several treatment options exist with different possible outcomes and substantial uncertainty. We suggest as key characteristics of shared decision-making (1) that at least two participants-physician and patient be involved; (2) that both parties share information; (3) that both parties take steps to build a consensus about the preferred treatment; and (4) that an agreement is reached on the treatment to implement. Some challenges to measuring shared decision-making are discussed as well as potential benefits of a shared decision-making model for both physicians and patients.

Shared Decision-making in the Medical Encounter: What Does It Mean? (Or, It Takes at Least Two to Tango)

This descriptive survey assessed the perception of evidence-based practice (EBP) among nurses in the United States. Although evidence-based healthcare results in improved patient outcomes and reduced costs, nurses do not consistently implement evidence-based best practices. A descriptive survey was conducted with a random sample of 1015 RNs who are members of the American Nurses Association. Although nurses believe in evidence-based care, barriers remain prevalent, including resistance from colleagues, nurse leaders, and managers. Differences existed in responses of nurses from Magnet® versus non-Magnet institutions as well as nurses with master's versus nonmaster's degrees. Nurse leaders and educators must provide learning opportunities regarding EBP and facilitate supportive cultures to achieve the Institute of Medicine's 2020 goal that 90% of clinical decisions be evidence-based.

/pdf/the-state-of-evidence-based-practice-in-us-nurses-critical-17iw8qteul.pdf

The State of Evidence-Based Practice in US Nurses: Critical Implications for Nurse Leaders and Educators

BACKGROUND Estimates of the relative contributions of physicians, physician assistants (PAs), and nurse practitioners (NPs) toward rural primary care are needed to inform workforce planning activities aimed at reducing rural primary shortages. OBJECTIVES For each provider group, this study quantifies the average weekly number of outpatient primary care visits and the types of services provided within and beyond the outpatient setting. METHODS A randomly drawn sample of 788 physicians, 601 PAs, and 918 NPs with rural addresses in 13 US states responded to a mailed questionnaire that measured reported weekly outpatient visits and scope of services provided within and beyond the outpatient setting. Analysis of variance and χ(2) testing were used to test for bivariate associations. Multivariate regression was used to model average weekly outpatient volume adjusting for provider sociodemographics and geographical location. RESULTS Compared with physicians, average weekly outpatient visit quantity was 8% lower for PAs and 25% lower for NPs (P<0.001). After multivariate adjustment, this gap became negligible for PAs (P=0.56) and decreased to 10% for NPs (P<0.001). Compared with PAs and NPs, primary care physicians were more likely to provide services beyond the outpatient setting, including hospital care, emergency care, childbirth attending deliveries, and after-hours call coverage (all P<0.001). CONCLUSIONS Although our findings suggest that a greater reliance on PAs and NPs in rural primary settings would have a minor impact on outpatient practice volume, this shift might reduce the availability of services that have more often been traditionally provided by rural primary care physicians beyond the outpatient clinic setting.

The contribution of physicians, physician assistants, and nurse practitioners toward rural primary care: findings from a 13-state survey.

https://www.jenonline.org/article/S0099-1767(07)00344-3/pdf

Factors Influencing the Decision to Use Nurse Practitioners in the Emergency Department

For decades, nurse practitioners (NPs) have faced a myriad of difficulties as they attempted to provide comprehensive patient care, including pharmacologic therapies. NPs have also struggled to remove constraints on their ability to practice to the full extent of their potential. Intensive legislati

Prescriptive authority and barriers to NP practice.

Purpose: To understand nurse practitioners' (NPs) decisions about whether to obtain prescriptive authority for controlled substances, to describe NPs' experiences with providing or prescribing controlled substances, and to describe the relationship between perceived autonomy and prescriptive authority for controlled substances.

Design and Methods: Twelve focus groups were conducted with approximately 100 NPs who attended continuing education conferences. Discussions were audiotaped and transcribed verbatim. Grounded theory approaches were used for data collection and analysis.

Findings: A core category of Letting go and taking hold characterized Washington State NPs' experience of the transition to prescribing schedule II–IV medications. Three dimensions of the NPs' transition were Resisting change, Ambivalent about change, and Embracing change.

Conclusions: The core category, Letting go and taking hold, indicated how transition to a new scope of practice extended beyond successful passage of legislation, the importance of examining the nature of professional transition that accompanies successful legislative change, and role development as an ongoing process throughout one's career in response to changes in scope of practice. NPs need preparation for a new scope of practice long before legislation actually passes. Revealing and examining this process can facilitate the goal of achieving fully autonomous NP practice.

Louise Kaplan

Papers

The State of Evidence-Based Practice in US Nurses: Critical Implications for Nurse Leaders and Educators

The contribution of physicians, physician assistants, and nurse practitioners toward rural primary care: findings from a 13-state survey.

Factors Influencing the Decision to Use Nurse Practitioners in the Emergency Department

Prescriptive authority and barriers to NP practice.

The Transition of Nurse Practitioners to Changes in Prescriptive Authority