J Am Acad Nurse Prac
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J Am Acad Nurse Prac · Jun 2005
Tandem practice model: a model for physician-nurse practitioner collaboration in a specialty practice, neurosurgery.
To describe the benefits of a physician-nurse practitioner (NP) collaborative practice model, specifically that of a tandem practice model, using a neurosurgeon and a primary care NP in the clinic and inpatient setting. ⋯ Patients seen in a specialty practice, particularly that of neurosurgery, often have little understanding of their problem and may be frightened or confused because of their perceptions of the unknown. Providing care to such specialized patient populations in a constantly changing healthcare environment may prove demanding to the specialist. The introduction of a primary care NP into such specialty settings offers patients, their families, consultants, and staff members an additional resource for evaluation, intervention, education, and communication, improving the continuity and comprehensiveness of care to challenging patient populations. This model is an option for physician specialists interested in augmenting their practice and provides further resources for meeting the holistic needs of selected patient populations regardless of the setting.
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J Am Acad Nurse Prac · Feb 2005
Moral problems and distress among nurse practitioners in primary care.
To identify the ethical issues nurse practitioners (NPs) encounter in primary care, examine the types of moral problems that arise related to those issues, and determine the level of distress NPs experience. ⋯ More research is needed to clearly understand ethical issues and moral problems for NPs in primary care, how NPs identify and manage problems, and the effects on NPs and patients.
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To provide the primary care provider (PCP) with a review of the clinical presentation, aggravating factors, and basic options for treatment of atopic dermatitis (AD). ⋯ The PCP can manage AD in most patients by prescribing avoidance measures, good skin care, antihistamines, and conservative topical medications. Patients with more severe disease may require aggressive therapies such as phototherapy, balneo-phototherapy, or systemic agents.
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J Am Acad Nurse Prac · Aug 2004
Comparative StudyNurse practitioners' and physicians' care activities and clinical outcomes with an inpatient geriatric population.
Less is known about nurse practitioners' (NPs') effectiveness in acute care than about their effectiveness in outpatient settings. This study investigated care activities and clinical outcomes for hospitalized geriatric patients treated by NPs compared with those treated by intern and resident physicians. ⋯ NPs provide effective care to hospitalized geriatric patients, particularly to those who are older and sicker.
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J Am Acad Nurse Prac · Jun 2004
ReviewNondaily hormonal contraception: considerations in contraceptive choice and patient counseling.
To review currently available choices for non-daily hormonal contraception, considering efficacy, safety, patient counseling issues, and appropriate patient selection. ⋯ Despite the efficacy of OCs, missed pills are quite common and contribute to unintended pregnancy. Many women in all population categories would benefit from the convenience and reliability of nondaily hormonal contraceptives. The highest efficacy rates with typical use are associated with agents that require minimal user participation (i.e., Depo-Provera, Mirena). Compared to daily regimens, all nondaily options offer increased convenience and may contribute to improved patient adherence. However, barriers to use may exist. Patient fears regarding use of hormones can be minimized by discussing the long-term safety of hormonal contraceptives. (The data are predominantly derived from Depo-Provera and OCs because these agents have been available in the United States and in the rest of the world for much longer than the newer nondaily options.) Patient counseling and appropriate expectations regarding changes in menstrual pattern have been demonstrated to further enhance patient adherence to therapy. Finally, patient lifestyle preferences must be considered. The finding that many women are comfortable with or even prefer amenorrhea, which is associated with options such as Depo-Provera, highlights how important it is for clinicians to avoid making assumptions about a patient's contraceptive preferences. Rather, clinicians and patients should exchange information through an open dialogue. For the majority of patients, nondaily hormonal contraceptives should be considered and offered as first-line options.