Using standardized patients (SP) presenting with a specific complaint has been a mainstay in health care education. Increased use of technology has facilitated the move of instruction from the on-campus classroom to distance learning for many nurse practitioner programs. Using interactive case studies provides distance learners SP encounters. This technologically facilitated encounter gives the distance learner the opportunity for integrative thinking and development of problem solving and clinical reasoning skills.
Chronic low back pain (CLBP) is a primary care condition that overflows into the emergency department (ED). No ED-specific practice guideline exists for the management of patients with CLBP in the ED setting. Back pain is a common chief complaint, with cases of CLBP making up to 50% of the patients seen with back pain in an urban, freestanding ED affiliated with a multicampus health system in the Midwest where 25% of patients live below the poverty line and 21.8% do not have primary care. Kolcaba's Theory of Comfort guides the implementation of an evidence-based practice application project. The Guideline for the Evidence-Informed Primary Care Management of Low Back Pain from the National Guideline Clearinghouse is introduced. Interprofessional collaboration for immediate referrals was implemented. The plan-do-study-act model was applied with descriptive analysis of the data. Reflective of established specific aims of the project, there was increased (1) support for the use of evidence-based practice guideline among the ED providers and staff, (2) use of evidence-based practices, (3) connection of patients to community resources, (4) evidence-based education for patients, and (5) overall satisfaction with pain management. The effectiveness of the application of this primary care guideline in the ED opens the way both for region-wide application of the guidelines and for the introduction of other primary care practice guidelines for patients who present to the ED with other chronic conditions.
Utilization of NPs to facilitate triage and treatment of the outpatient neurosurgical spine patient is a sustainable patient-centered care delivery model that leads to improvements in access and ensures exceptional quality outcomes.
Background and Purpose:
Physical inactivity after stroke stymies motor recovery, perpetuates further deconditioning, and contributes to a high long-term risk of cardiac events and recurrent stroke. This study used stakeholder input to develop a cardiac rehabilitation program specific to stroke.
Methods:
An exploratory qualitative study was performed consisting of separate focus groups of stroke survivors, caregivers, rehabilitation clinicians, nurse practitioners along with individual physician interviews. Two experienced researchers in qualitative research methodology independently identified themes, patterns, and issues prioritized by participants.
Results:
Four major themes emerged: safety, individualization of the cardiac rehabilitation program, return to function and living at highest potential, and need to maintain prolonged activity. Major components identified in developing the cardiac rehabilitation program included: Individualized stroke survivor education pertaining to fall prevention, safe aerobic exercise and learning how to live well after stroke (e.g., fitness, nutrition, chronic disease management, etc.); Exercise/stress testing prior to aerobic exercise; Determine when to begin cardiac rehabilitation post stroke (e.g., readiness, needs, resources, benefit, etc.), individualize approach and timing after holistic assessment; Education/training of cardiac rehabilitation professionals regarding best care practices for stroke survivors; Interdisciplinary approach to assure safety and continuum of care; Referral programs for IADLs, driving, sexual function, etc.; Motivational interviewing to overcome barriers with inclusion of peer mentoring/coaching; Discharge to cost effective community programs or a sustainable home program.
Conclusions:
Addressing safety concerns along with the creation of an individualized cardiac rehabilitation program that enables stroke survivors to achieve and maintain their highest level of function long-term are fundamental components. Partnering with the major stakeholders and incorporating a coordinated interdisciplinary approach are crucial to the creation of a feasible and cost effective cardiac rehabilitation program for stroke survivors.
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