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mrlongkgraves · 6 years

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Nurse practitioners can make a difference patient by patient

As indicated by recent research studies, patients made more than 1 billion visits to nurse practitioners last year, according to Joyce Martha Knestrick, PhD, C-FNP, APRN, FAANP.

The research also indicates NPs are educated and well-trained to provide patients and families access to high-quality, cost-effective primary healthcare services.

Joyce Martha Knestrick, APRN

Knestrick talked with us about best practices when caring for families in the community and the resulting positive outcomes.

She is the president of the American Association of Nurse Practitioners. With 25 years of experience, she currently practices as a family nurse practitioner at Wheeling Health Right in Wheeling, W.Va.

What are best practices when caring for families in the community?

Nurse practitioners’ model of care focuses on the patient, family and community. To put the patient as the center of care, there needs to be involvement of the patient and family, which sometimes involves members of the community. They all bring personal knowledge and information to the treatment plan equation.

Involving the family can help patients find the right care for their needs, preferences and current circumstances.

Recently, a patient was discharged from the hospital to home. The patient’s daughter had her own health problems and although she lived nearby, she was not able to care for her mother.

The patient lived alone in an isolated area and in an older home with multiple stairs. She came to her follow-up appointment to see her nurse practitioner, and although normally meticulous about her appearance, her hygiene was poor and she had lost weight.

The NP talked with the patient and the niece who brought her to the appointment and discovered the family had not been involved in the discharge plan. The patient was unable to climb the 12 steps to the bathroom where the shower was located.

A new plan was made with the patient, niece and daughter via telephone, and community services were used to help keep the patient at home and healthy. This example shows when patients and families are partners in planning and making decisions about their healthcare, outcomes are improved.

What positive outcomes can nurses expect to achieve when implementing best practices and including the whole family in the process?

By implementing best practices, nurse practitioners can expect to understand the role of the family, the family dynamics and the impact of the family (and their decision-making) on the patient’s care.

Because I am from rural mid-Appalachia, it is important that I understand the cultural norms within the community and that I deliver culturally sensitive care to my patients. My research has focused on aspects of caring for the population and provides me and other providers insight into ways to work with patients.

An example is the practice of smoking. Many women in my study continue to smoke despite the education and media regarding the effects of smoking. The women revealed many reasons for smoking, including a sense of having control over something in their lives.

When I work with patients on smoking cessation, I ask them what is important to them in relation to smoking and quitting smoking. If the number of cigarettes they smoke a day is all they have control over, taking that away may do more harm than good. Then I try to find other ways for the women to feel in control.

In addition, my involvement in research on access to care in Appalachia was the impetus for my former practice partner and I to start a nurse practitioner-run clinic. This clinic provided the culturally sensitive, patient-centered care the residents of the community were seeking.

Access to care improved and patient outcomes improved. Since the practice was part of the community, families and the community were empowered to help make the clinic successful.

For instance, a child and his parents came in to see the NP because he was experiencing frequent asthma exacerbations. Because the NP cared for the family, she knew one of the parents regularly smoked cigarettes. The NP assessed the situation and discovered the parent was smoking inside the home, and the more problems the child had, the more anxiety the parent reported. Because of his increased anxiety, he smoked even more cigarettes.

The NP worked with the parents and the child [to make] changes in the environment and centered the care around the child. The parent stopped smoking inside the home and the child experienced fewer exacerbations.

What educational tools do you use to improve family education in this process?

At the American Association of Nurse Practitioners, we have a CE Center with information regarding various diseases that includes treatment and patient and family education. Depending on the problem or illness, NPs can go to various sources and evidence for a particular issue. In addition, patients and families can go to NPFinder.com to find an NP in their geographical area.

What words of wisdom can you share with nurse practitioners who are considering the specialty of family practice?

The family nurse practitioner’s role in a community setting can be both challenging and rewarding. Patients come to primary care with complex issues, and the nurse practitioner has to be prepared to make difficult and complex diagnoses and treatment plans with the patient as the center of care.

Keeping the family in the plan of care whenever it’s possible and knowing the resources available in the community are essential in a family primary care practice. Keeping abreast of the current evidence to work with patients and families is necessary to produce good patient outcomes.

Another crucial aspect to the process is educating the patient and the family about health promotion and prevention practices at home.

I have been in practice for more than 25 years, and now I see my patients’ children and grandchildren. I am most satisfied in my role when I know that I have improved my patients’ quality of life and have had a positive impact on the family.

How can nurse practitioners in family practice get involved in improving family practice through community involvement, research and legislation?

The American Association of Nurse Practitioners offers information to members in the areas of practice, education, research, advocacy and leadership. Joining the association gives members in family practice opportunities for continuing education to keep current and provide best practices for their patients.

AANP also is involved in research and provides opportunities for member engagement. NPs can learn how to advocate for patients and the profession in our advocacy center, and our fellows give member access to experts in caring for families.

In addition, the association has specialty practice groups for NPs to discuss current practice trends and, of course, our conferences provide continuing education and networking opportunities.

For more information visit AANP.org. Patients and families might also benefit by visiting the association’s patient-focused site, WeChooseNPs.org.

Take these courses related to nurse practitioners:

Advanced Practice Nurse Pharmacology (25 contact hrs) This course will help advanced practice nurses meet the new ANCC 25-contact hour pharmacology requirement for re-certification beginning Jan. 1, 2014. Written and rigorously peer reviewed by pharmacists and advanced practice nurses, this course features a wide range of medical conditions and the medications associated with them. Chapter topics include hypertension, diuretics, GI, critical care, sexually transmitted diseases, asthma, oncology, non-opioid analgesics, diabetes, weight loss, mental health conditions such as anxiety, bipolar disorder, depression and much more. The chapters highlight clinical uses, dosing, interactions and adverse effects for the common medications used in your practice. APN tips are featured throughout the chapters to help you in your prescribing practices.

Complementary and Alternative Medicine Online Certificate Program (11 contact hrs) A tremendous amount of information has been published about complementary and alternative medicine over the past 10 to 15 years. Because the evidence about complementary and alternative therapies is constantly changing, while we provide information on these therapies, we have chosen to make use of key resources by providing them as links in this certificate program. In doing so, we are challenging you to be an active learner by answering questions and solving problems so that you may better counsel your patients on the safe and appropriate use of these therapies as the literature and evidence evolves.

Obesity Management (12 contact hrs) Data from the National Institute of Diabetes and Digestive and Kidney Diseases indicates that more than two thirds of U.S. adults are overweight (33.1%) or obese (35.7%) with an additional 6% classified as extremely obese. Nearly one third (31.8 %) of youths ages 2 to 19 are overweight or obese. The American Medical Association voted in June 2013 to declare obesity a disease in hopes of improving treatment efforts for management of this growing public health problem. Multiple tools are available to assist healthcare providers in counseling patients toward healthier eating and exercise patterns, yet due to limited time they have not accessed and arranged them into tools that they can use to improve outcomes for their patients.

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gshguide · 6 years

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Psychiatric Nurse Practitioner Opportunities — Telecare

Family nurse practitioners (FNP) are advanced follow registered nurses who work autonomously or in collaboration with different healthcare professionals to ship family-centered care. Given the fairly broad nature of the household” patient inhabitants focus, FNPs offer a variety of healthcare companies that revolve across the household unit; from health promotion and illness prevention to direct care and counseling throughout the lifespan.

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mrlongkgraves · 6 years

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Kids don’t just grow out of their mental health issues

One in five adolescents in the U.S. suffers from developmental, mental or behavioral health illnesses, according to the National Association of Pediatric Nurse Practitioners.

To avoid serious, adverse outcomes, it is crucial these illnesses be detected early by pediatric nurse practitioners and pediatric-focused APRNs and pediatric nurses.

Dawn Garzon Maaks, CPNP

Dawn Garzon Maaks, PhD, CPNP-PC, PMHS, FAANP, president of NAPNAP, shared with us about what the organization is doing to help children with mental health issues and support those who provide care to affected youth and their families.

Garzon Maaks is a professor at the College of Nursing at Washington State University in Vancouver. She also is a fellow of the American Association of Nurse Practitioners and an advocate for advanced practice pediatric-focused nurses.

Q: Self-harm and bullying are concerning issues in adolescent mental health. How do pediatric nurse practitioners screen for them and help parents become more aware?

All children get bullied at least once and, unfortunately, many see bullying as something that just happens. Sustained bullying can cause traumatic stress and may be considered an adverse childhood experience.

This non-trivial bullying is hard to detect. Often survivors do not report what is happening because they are afraid they will get into trouble or the bully will actually escalate their behavior.

Bullying and self-harm are much more common now than in past generations. Technology keeps us socially interconnected no matter where we are.

Research tells us social media and technology use that is excessive or inappropriate actually increases the risk of anxiety and stress. Self-harm is usually not a suicidal behavior but rather a symptom of overwhelming mental pain.

Pediatric nurse practitioners and other APRNs who care for our youth must talk about these issues as part of routine anticipatory guidance. We have to ensure we do good skin and mental health assessments as part of wellness care or any time symptoms have the potential to be stress related.

Parents need to learn that bullying is not a rite of passage and that self-injury and risk-taking can be subtle.

Q: What other adolescent mental health issues should pediatric care practitioners be aware of and what resources are available to them?

We need to assess for adverse childhood experiences and all children, especially those older than 11, must be screened for anxiety and depression. Suicide is the second leading cause of death for people 10 to 24 years of age and, in some states like Utah, it is the leading cause of death. We lose thousands of children each year to suicide.

Of course, substance abuse is another critical issue that must be screened for. Unfortunately, just telling young people to say no doesn’t work.

NAPNAP’s Developmental Behavioral and Mental Health special interest group has an amazing website full of provider resources on a wealth of mental health issues, and they have a great resource for parents on how to raise a healthy teenager.

Other good sources for more information include the Substance Abuse and Mental Health Administration’s Adverse Childhood Experiences website and the National Institute on Drug Abuse’s adolescent substance abuse screening page.

Q: How do you recommend pediatric nurse practitioners screen for these issues in adolescent patients?

Children ages 11 and older should be screened annually for depression and substance use. I personally recommend including anxiety screening as part of wellness care, given the increase in anxiety rates.

The Developmental Behavioral and Mental Health special interest group’s resources listed previously are great and include links to a number of screening tools for each condition. From ADHD to eating disorders to anxiety and autism, these passionate advocates have valuable references for anyone looking for pediatric developmental, behavioral or mental health information.

It is best to use standardized tools that really get to significant symptoms and not over identify or under identify issues. Of course, it helps to separate older children from their parents, if they are willing to do so, to maintain confidentiality and remove the fear of getting into trouble.

Q: What are some intervention strategies for at-risk adolescents, namely, those who have been bullied, have performed acts of self-harm or have attempted suicide?

The most important thing is to perform good quality wellness care. When we do expedited older child and adolescent well visits, we miss many of the subtle signs that tell us kids are struggling.

I like to ask kids if anyone has ever made them feel unsafe. It is an open-ended question that lets them steer the conversation.

Look at your patients’ skin! Of course, you should preserve modesty, but if you do not get them into underwear and robe, you will never notice wounds hidden under bulky clothing.

Suicidal ideation is real. It is important to ask your patients if they have ever thought of harming themselves or others.

If they say yes, ask open-ended questions to find out when this occurred. If recent, ask if it consisted of only thoughts or if there was a plan involved.

The key is to have in place how you will refer out, if needed, prior to finding a child in crisis. We prepare for how we will deal with a medical emergency in practice. It is equally important to think about how we will deal with a mental health emergency.

Q: As an organization, what is NAPNAP doing to educate their members about adolescent mental health?

We have our NAPNAP Partners for Vulnerable Youth that is in its second year of dealing with the issue of child trafficking. Our aim is to educate providers about human trafficking and give them resources on how to help these kids.

Our Developmental Behavioral and Mental Health special interest group is passionate and engaged, and our Adolescent Health Care and School-based Health Services special interest groups provide members with resources and opportunities to network and address these and other critical issues.

We support the pediatric primary care mental health specialist role and published an official statement on pediatric mental health and violence in September.

We have members who serve as content experts to federal and professional organizations who seek, like us, to keep kids healthy in body and mind.

Each year our national conference includes several behavioral and mental health sessions or mini-tracks. We invite pediatric nurse practitioners, FNPs and other providers to join us for our next conference March 7-10, 2019, in New Orleans.

Providers can find behavioral and mental health education on our online education system or at our specialty symposia hosted in the summer and fall. Clinical practice resources also can be found in our For Providers channel.

Take these courses on adolescents’ mental health issues!

Self-Injury (1 contact hr) The North American Nursing Diagnosis Association defines self-mutilation as the \\”deliberate self-injurious behavior causing tissue damage with the intent of causing nonfatal injury to attain relief of tension.\\” Self-injurious behavior can have serious consequences for the person and elicit feelings of helplessness from caregivers. This module will provide the knowledge to dispel the mystery and promote effective treatment for people who engage in self-injurious behavior. It informs readers about the disease, causes, assessment and treatments.

Helping Children Who Are Being Teased and Bullied (1 contact hr) Surveys have shown that about 20% to 28% of American youths (middle school and high school age) report being bullied. Research studies have shown that those who are chronically teased or bullied can suffer short- and long-term psychological consequences and physical problems. This educational activity will help you to distinguish between being teased and bullied and to present effective strategies to help youths, families, and school personnel prevent or respond to harsh teasing or bullying.

Sorting Out Mood Disorders in Children and Adolescents (1 contact hr) This continuing education module highlights mood disorders (also called affective disorders) that are diagnosed in childhood and adolescence. Bipolar and depressive disorders, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition:DSM-5 are discussed, including disruptive mood dysregulation disorder, which appeared for the first time in the DSM-5. Identifying and diagnosing childhood mood disorders requires special knowledge and skill. Children and adolescents with mood disorders present differently than adults with mood disorders. Mental health professionals who work with children must possess a child-centric understanding of mood disorders to identify problems, provide proper treatment, or refer to the appropriate discipline.

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