Advanced Diagnostic Content in Nurse Practitioner and Physician Assistant Programs

Nurse practitioners' use of diagnostic imaging: A scoping review

AIM

To explore the nature and extent of peer-reviewed literature related to the use of diagnostic imaging by nurse practitioners (NPs) to inform future practice and research.

BACKGROUND

Nurse practitioners undertake advanced assessment, diagnosis, and management of patients, including requesting and interpretation of diagnostic imaging. It is unclear what evidence exists related to the quality use of radiological investigations by NPs in recent years.

DESIGN

A scoping review based on the steps suggested by the Joanna Briggs Institute.

METHODS

A structured review of the databases Medline, CINAHL and Embase was undertaken using the keywords and MESH terms 'nurse practitioner', 'medical imaging', 'diagnostic imaging', 'scan' and 'radiography'. Only English language articles were included, and no date limit was applied. Database review was completed on 30 May 2021.

RESULTS

Eight themes were identified-country and clinical context, requesting diagnostic imaging, performing diagnostic imaging, image-guided interventions, interpreting diagnostic imaging, training education and knowledge, impact on resource usage and comparison with medical practitioners. There were more studies across a greater breadth of clinical specialties and imaging modalities in the United States than in other countries. Nurse practitioner practice is frequently benchmarked against that of medical colleagues. There is a paucity of studies focusing on educational preparation and the lack of relevant university curricula for NPs around diagnostic imaging.

CONCLUSION

There are significant gaps in the evidence outside of the United States across several of the identified themes. Further studies are needed to explore NP access to and use of diagnostic imaging and to understand the barriers and facilitators to this.

RELEVANCE TO CLINICAL PRACTICE

Studies from four countries were included in this review. The evidence suggests that, where studied, nurse practitioners (NPs) can safely and appropriately request and interpret plain x-rays in the emergency and minor injuries setting. Further research is needed to evaluate the educational needs of NPs in relation to diagnostic imaging and their use of advanced imaging techniques, particularly outside of the United States.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Utilizing Supplemental Online Modules for Physician Assistant Student Electrocardiogram Interpretation Training

PURPOSE

The literature suggests that graduating medical and physician assistant (PA) students lack competency in electrocardiogram (ECG) interpretation. This project aimed to determine whether use of perceptual adaptive learning modules (PALMs) would improve PA students' ECG interpretation, alter self-perceptions of their ECG education, or both.

METHODS

PALMs were incorporated into the PA curriculum after lecture-based ECG learning. Students' pretest, posttest, and delayed-posttest scores were then compared. Students' ability to correctly interpret ECGs (accuracy) and the percentage of ECGs accurately interpreted within 15 seconds or less (fluency) also were evaluated. Finally, students' perceptions of PALMs and overall ECG training were assessed.

RESULTS

PALM training improved ECG interpretation accuracy and fluency (p < .0001), as well as delayed-posttest accuracy and fluency (p < .0001). The majority of student respondents felt supplemental training enhanced their learning.

CONCLUSION

These perception results combined with data on ECG interpretation improvement supports continued use of supplemental PALMs in ECG interpretation training.

Using Objective Structured Clinical Examination as a Teaching Tool in a Hybrid Advanced Health Assessment Course

BACKGROUND

Advanced health assessment is a required course in advanced practice RN (APRN) education, essential to providing the foundation for differential diagnosis (DD) skills and the ability to formulate a plan of care.

PROBLEM

Feedback from clinical preceptors revealed that our doctor of nursing practice (DNP) students struggled to make a DD.

APPROACH

This educational quality improvement project collected data from 7 cohorts of DNP students in either the Family Nurse Practitioner or Adult Gerontology Nurse Practitioner program to evaluate their readiness for clinical practicums and to inform necessary curriculum revisions.

OUTCOMES

Data revealed that students' ability to identify 3 DDs correctly during the summative health assessment objective structured clinical examination was inconsistent. Qualitative data revealed students lacked understanding on how to use results from the physical assessment to formulate a DD.

CONCLUSION

The findings of this project corroborate those from the literature that suggest we should teach APRN students DD skills explicitly.

Interactive e-Learning Electrocardiogram Module: Increasing Confidence and Interpretation Ability Among Family Nurse Practitioner Students

Electrocardiogram (ECG) interpretation is a skill that family nurse practitioners (FNPs) use almost daily in primary care. One way to teach ECG interpretation in a flexible way is through e-learning modules. The purpose of this study was to evaluate the confidence and ability of ECG interpretation in FNP students who completed a series of e-learning modules. Student confidence and ability to correctly identify ECGs increased after completing the series (p < .0001). Adding self-paced modules such as this one into an FNP curriculum will likely be invaluable for students' future clinical careers.

The growing need to provide training in clinical procedures in family nurse practitioner educational programs

ABSTRACT

Family nurse practitioners (FNPs) have a plethora of employment options upon graduation. Besides primary care, many are working in nontraditional settings such as urgent care, emergency departments, retail health, and specialty practices. In many of these settings, practitioners are required to perform procedures. However, more information is needed on the type of settings in which recent FNP graduates are working, the procedures being performed in these settings, and the perceptions of graduates of how prepared they felt to perform these procedures. Family nurse practitioners who completed an FNP program within the previous five years and who attended the 2019 AANP National Conference were invited to participate in a survey to assess their preparation in clinical procedures. Results revealed that more than half of the 198 respondents reported doing incision and drainage of abscesses and laceration repair. Respondents were divided on how they first learned to perform the procedures, with 47% stating that a preceptor demonstrated procedures to them during a clinical practicum experience, 42% stating that they learned on the job after graduation, and 43% reported that their FNP program provided training or simulation activities related to procedures. More than a quarter of respondents reported that they took a class on procedures. In all, 61% reported that they did not feel adequately prepared to perform procedures on graduation. Results indicated that colleges of nursing should ensure that FNP students have opportunities to master the procedures that are frequently performed by FNPs.

Is it time for the 4th P in nurse practitioner education? Physical assessment, pharmacology, pathophysiology, and procedures: A systematic review

BACKGROUND AND PURPOSE

Nurse practitioners (NPs) perform diagnostic and clinical procedure skills in the acute, specialty, urgent, and primary care settings. Nurse practitioners surveyed on readiness for practice report a lack of confidence and education preparation for performing selected advanced diagnostic and skills. As NPs gain independent, full practice scope, it is imperative advanced diagnostic and procedure skills used in practice are taught in nurse practitioner curriculum. The purpose of this review is to document a systematic review of the literature, answering the following question: Among primary care NPs, does current program curriculum align with current procedures and skills in theclinical setting?

METHODS

PubMed, Cochrane, Scopus, CINAHL, and Embase were searched between inception and 2018 using the search terms "advanced practice nursing, clinical competence, diagnostic techniques or procedures, and primary health care." Following the preferred reporting items for systematic reviews and meta-analysis guidelines, nine articles were included in the synthesis.

CONCLUSION

There is scant research regarding NP educational preparation of skills and procedures. Study findings indicate that programs are not teaching all the procedures deemed important. Education should promote improved congruence between the skills and procedures taught in program curricula and those used in clinical practice.

IMPLICATIONS FOR PRACTICE

It is critical to complete an education practice survey measuring skill and procedure preparation and competency at graduation. Survey results will determine whether skill and procedure guidelines are indicated for NP education. A recommendation may include minimal skills and procedure for all nurse practitioner curricula.

Characteristics of Effective Continuing Medical Education for Physician Assistants and Nurse Practitioners in Hospital Medicine

PURPOSE

The purpose of this study was to describe participant characteristics and effective teaching methods at a national continuing medical education (CME) conference on hospital medicine for physician assistants (PAs) and nurse practitioners (NPs).

METHODS

In this cross-sectional study, participants provided demographic information and teaching effectiveness scores for each presentation. Associations between teaching effectiveness score and presentation characteristics were determined.

RESULTS

In total, 163 of 253 participants (64.4%) completed evaluations of 28 presentations. Many of the participants were younger than 50 years (69.0%), had practiced for fewer than 5 years (41.5%), and worked in nonacademic settings (76.7%). Teaching effectiveness scores were significantly associated with the use of clinical cases (perfect scores for 68.8% of presentations with clinical cases vs. 59.8% without; P = .04).

CONCLUSION

Many PAs and NPs at an HM CME conference were early-career clinicians working in nonacademic settings. Presenters at CME conferences in hospital medicine should consider using clinical cases to improve their teaching effectiveness among PA and NP learners.