• A Brief Educational Intervention to Enhance Nurse Practitioners' Knowledge, Attitudes and Skin Cancer Counseling Behaviors

      Loescher, Lois J.; Goodman, Hope Ann; Loescher, Lois J.; Pacheco, Christy; Anderson, Chrys (The University of Arizona., 2016)
      Background: Skin cancer is the most common form of cancer in the United States and is a public health concern. There are over 5 million new cases of keratinocyte skin cancer (KC) (previously known as non-melanoma skin cancer) and over 65,000 new cases of melanoma annually in the United States. Skin cancer is highly preventable, although prevention methods are not commonly practiced. Nurse practitioners have a key role in educating and encouraging patients to practice skin cancer prevention methods. Purpose/Aims: The purpose of this project was to determine whether a brief educational video can improve nurse practitioner knowledge, attitudes, and behaviors regarding skin cancer and skin cancer prevention counseling. Methods: A single subject pre-test post-test design guided this project. Participants completed an online pretest assessing skin cancer knowledge, attitudes, and behaviors. Following the pretest participants were given access to the video intervention. The intervention included information about skin cancer and published guidelines about skin cancer prevention counseling. Changes in knowledge, attitudes, and behaviors and satisfaction with the intervention were assessed through a post-test. Results: A total of 30 eligible Arizona nurse practitioners completed both the pretest and posttest surveys. There was a statistically significant increase (p=.000) in knowledge from 64.17% on the pretest to 87.5% on the posttest. Attitudes about skin cancer and skin cancer counseling were fair on the pretest and significantly improved (p=.000) on the posttest. On the pretest, nurse practitioners had poor attitudes regarding skin cancer prevention counseling practice behaviors. These attitudes favorably increased (p=.009) on the posttest. Self-reported practice behaviors also improved significantly following the intervention (p=.000). Participants' attitudes regarding the intervention were generally favorable. Conclusions: A brief educational intervention offered online to nurse practitioners is highly effective for improving their knowledge, attitudes, and behaviors regarding skin cancer and skin cancer prevention counseling. The intervention is feasible to administer and is acceptable to nurse practitioners.
    • Proposed Addition of Acute Care Nurse Practitioners in Observation Units: Identifying the Stage of Change of Staff Cohorts at Banner Desert Medical Center

      Buchner, Brian; Lohmann, Kacey; Buchner, Brian; Shea, Kimberly; Carlisle, Heather (The University of Arizona., 2017)
      Because of the expense associated with hospital admissions, the use of observation status has grown. One of the most consistently measured outcomes in observation is the patient length of stay (LOS). Research supports the positive impact that nurse practitioners (NP) have on LOS when added to other service lines that could be applied to observation. Banner Desert Medical Center (BDMC) is currently attempting to decrease their observation LOS. Adding acute care nurse practitioners (ACNP) to the care delivery model is a potential intervention. The purpose of this project was to develop an executive summary to inform staff of current evidence that supports the addition of ACNPs to observation. Then, via a survey, the project aimed to determine the level of staff support by identifying the Transtheoretical Model of Change (TTM) Stage of Change and to recommend appropriate stage-matched interventions for staff based on TTM processes of change. The 10 Likert scale survey questions were adapted from two validated TTM surveys. The final question asked for the pros and cons of the intervention to determine the Decisional Balance (DB). The registered nurse (RN) cohort demonstrated consistently strong support for the proposed intervention with an average mean response of 6.57 on affirmative questions and a correspondingly low average mean of 2.2 on negative questions. When compared to the RN cohort, the physician cohort had lower mean responses with an average of 4.29 on every affirmative, a higher average mean response of 3.85 on the negatively worded questions. The DB for RNs was 19 pros to two cons. The DB for physicians was eight cons to three pros. These finding reflect that nurses are in the Preparation Stage of Change and are ready to move forward with adding ACNPs. An appropriate stage-matched intervention for registered nurses would be the development of change teams. In contrast, the physician cohort is in the Precontemplation stage and is not ready to proceed with adding ACNPs. Appropriate stage-matched interventions for physicians would include facilitating consciousness-raising activities such as an open forum to communicating information about the proposed change and to explore concerns and questions regarding the intervention.
    • Use of Standards of Care by Nurse Practitioners in Providing Care to Adolescents with Asthma at an Academic Nurse-Managed Primary Care Clinic

      May, Kathleen; Thal, Wendy Renee; May, Kathleen; Velasquez, Donna; Andersen, Susan (The University of Arizona., 2010)
      Asthma is a chronic disease that affects 8.4 million children in the United States (American Lung Association [ALA], 2007). Adolescents with asthma need tailored management of their care with attention given to particular developmental concerns. Standards of care, such as the National Heart, Lung, Blood Institute [NHLBI] 2007 asthma guidelines (NHLBI, 2007), exist to guide patient care and in this case, also address specific adolescent needs. Advanced practice nurses should incorporate "national standards of care as a framework for managing patient care" (American Association of Nurse Practitioners [AANP], 2007, p. 2). There is a lack of research about nurse practitioner use of standards of care, especially in caring for adolescents with asthma.The purpose of this practice inquiry was to explore patterns of practice and perceptions of practice by the nurse practitioners who care for adolescents with asthma, and to evaluate the current patterns of practice in comparison with national standards for providing care to adolescents with asthma at the Larry Combest Community Health Wellness Center [LCCHWC]. The design for this practice inquiry was descriptive retrospective, using mixed methods for process evaluation of a program through description of nurse practitioner practice at an academic nurse-managed primary care clinic.The nurse practitioners addressed all components of the process of care recommended by the AANP (2007), which includes assessment, diagnosis, development and implementation of a treatment plan, and evaluation of the patient status. However, despite comments about the importance of using evidence based practice in the form of guidelines, results from health records review indicate that nurse practitioners have not fully integrated the NHLBI 2007 asthma guidelines into providing care to adolescents with asthma. This study establishes a baseline measure of adoption of the NHLBI 2007 asthma guidelines by nurse practitioners at this clinic site. The results of this study may ultimately contribute to nurse practitioners' awareness of use of standards of care and improved quality of care for adolescents with asthma.