Body Image Disturbance in Female Adolescents Using Online Learning Platforms: A Concept Analysis

Aim To analyze the concept of body image disturbance in female adolescents using online learning platforms as a phenomenon of interest to nurse practitioners and other health care practitioners. Background With the declaration of the COVID-19 pandemic, the use of online learning platforms as a primary mode of learning has increased exponentially among adolescents. While research is still lacking in this field, the literature on traditional social media suggests that these online learning platforms may negatively influence body image and emotional outcomes. Particularly vulnerable to these outcomes are female adolescents, whose construction of own body image is highly influenced by their self-perceived evaluation from their peers. While the concept of body image disturbance is well defined in adolescent eating disorders, it has not been characterized in the context of online learning platforms. Defining the concept of body image disturbance in this context is crucial for recognizing its occurrence and providing early intervention. Methods The Walker and Avant method of concept analysis was used to analyze the concept. Findings The defining attributes of body image disturbance among female adolescents using online learning platforms are: (1) Viewing a digitally distorted image of oneself and feeling displeasure with the perceived appearance; (2) Self-surveillance of one’s appearance; and (3) Upward comparison of one’s appearance with others and experiencing feelings of inadequacy. Conclusion As COVID-19 continues to disrupt the traditional school experience, nurse practitioners can use the presented scenarios, along with examples of questionnaires noted in this study, to recognize and delineate the occurrence of body image disturbance in female adolescents using online learning platforms. A standardized definition of the concept will enable nurse practitioners to recognize its occurrence and to provide interventions in a timely manner.

Nurse Practitioners and The Use of Antipsychotic Medications in Long Term Care in Ontario, Canada

Introduction: Antipsychotic use in Long-Term Care (LTC) in Ontario, Canada continues to pose a challenge in the care of older adult patients living in these institutions. The dangers and patterns of inappropriate prescribing have been documented frequently. Most of the current literature focuses on dementia and behavioral and psychological symptoms of dementia, the role of prescribers, or on interprofessional interventions with person-centered care to address the behavior. Very little discussion has focused on the role of nurse practitioners and other frontline long-term care staff in the assessment and interactions with residents that may result in prescriptions of antipsychotics. Objectives: The purpose of this population based retrospective study of data from all LTC facilities in Ontario, Canada in 2019-2020 was to determine the extent to which antipsychotic medications were used in and the factors associated with this use. Reflections about the NP role are discussed. Results: The results demonstrate that over thirty percent of residents in LTC continue to receive antipsychotics and those with the responsive behaviours are significantly more likely to be prescribed antipsychotics. Conclusions: The findings identify a potential link between over-burdened front-line staff and increased antipsychotic prescriptions, as well as continued use of antipsychotics in attempts to prevent harm to residents and staff at long-term care homes. Recommendations are made that include changes to legislation that will ensure optimal front-line care and time for care, increased training for front line staff and, in particular, how the role of the nurse practitioner in LTC can be utilized to optimize the appropriate use of antipsychotics, and the support of discontinuing or decreasing the dose of antipsychotics when required.

Emphasizing the Nurse Practitioner Role in Addressing Unique Challenges Associated with Benzodiazepine use among the Elderly

Aim: The aim of this paper is to discuss the use of benzodiazepine medications among the elderly, and the role of a nurse practitioner within this patient population. Background: Benzodiazepines are well known to have a negative impact on the mobility of elderly patients and to contribute to increased falls. These medications also have an impact on elderly patients’ ability to perform activities of daily living and to drive. Nurse practitioners offer holistic care to elderly patients. This includes prescribing medications, monitoring therapy, deprescribing medications and identifying opportunities for safe alternatives to treat a variety of conditions. Methods: This paper presents a narrative review focused on the effect of benzodiazepine medications on the elderly patient population, with an emphasis on the use of benzodiazepines in insomnia. Conclusions: Findings of this review confirm the known risks associated with the use of benzodiazepines in the elderly and that these medications should be carefully considered in ongoing management. The conclusions of this review support the use of nurse practitioners in the enhancement of the healthcare of the elderly through the continuum of assessment, monitoring, deprescribing of benzodiazepine medications when appropriate, as well as opportunities to implement alternative treatments.

Using the PEPPA Framework to Develop and Implement a Nurse Practitioner Role Within Canada’s National Ballet School

Aim: To outline the successful development and implementation of a nurse practitioner role within a professional ballet school. Background: Nurse practitioners are well integrated into primary and acute care in Ontario, yet the role within schools and private athletic institutions is not well documented. Canada’s National Ballet School is a professional ballet school with a combination of day students and those living in residences. Students complete both dance training and academics at the School. The physical and mental health of students was identified as a key priority by the school, leading to the development of an integrated health and wellness program. To facilitate more timely access to healthcare and provide an opportunity for collaboration and consultation within the school, a plan to implement a nurse practitioner role into the school was developed. Methods: In order to develop and implement the role of the nurse practitioner within the institution, the participatory, evidence-based, patient-focused process for advanced practice nursing role development, implementation, and evaluation (PEPPA) framework was used. The first seven steps of the PEPPA framework were applied in this project. Findings: The PEPPA framework allowed for us to identify key barriers and facilitators for the role implementation and successfully implement the nurse practitioner role. While the initial plan was for a slower implementation, the COVID-19 pandemic highlighted the need for a nurse practitioner in the institution more urgently. Conclusion: The PEPPA framework provided us with an organized process for developing and implementing the nurse practitioner role at Canada’s National Ballet School.

Theory of the Evolution of Nurse Practitioner Practice

Aim: To determine the nurse practitioner's perception of scope of practice and understanding of changes to practice over time. Background: A great deal of research about nurse practitioners has been conducted related to such things as role clarity, transition, or preparedness to practice and job satisfaction. Conceptual models of nurse practitioner practice have been developed to highlight practice processes, interprofessional relationships and more. However, none of this literature addresses nurse practitioner's perception of scope of practice, the impact of their changing practice experiences and how the understanding of their practice changes over time. Methods: This grounded theory study was undertaken in Ontario, Canada, with interviews of primary health care nurse practitioners which resulted in the Theory of the Evolution of Nurse Practitioner Practice. Conclusion: Within this theory, scope of practice is defined as nurse practitioners working to their maximum potential. There are both intrinsic and extrinsic elements which render maximum practice potential a fluid and changing state.

Case presentation of Safe and Effective Use of Medical Cannabis in the Elderly

Introduction: The therapeutic benefits of medical cannabis have been demonstrated for a number of chronic conditions impacting the elderly population, such as pain management, and as alternatives to antipsychotic and opioid interventions, as well as end of life treatments. However, this therapeutic intervention has not become part of routine care for seniors living in long-term care facilities because of reduced public acceptance and stigma. The aim of this paper was to present case studies outlining the effective use of medical cannabis to treat elderly patients with a variety of medical conditions and symptoms such as: post traumatic stress disorder, pain, anxiety, delusions, as well as palliative care. Cannabis was also used to taper antipsychotic medications, and for managing those in palliative care. Case Presentation: Three cases highlighting the use of medical cannabis are described, from the perspective of a nurse practitioner-led interdisciplinary team approach. Management and Outcome: Using a variety of combinations of medical cannabis (cannabidiol and delta-9-tetrahydrocannabinol) in oral formulations, the long-term care facility has achieved a dramatic reduction in the use of antipsychotic medications. Medical cannabis has shown alleviation of many symptoms such as: pain, dyspnea, agitation, fatigue, weakness, loss of appetite, nausea, vomiting, and twitching. Positive results were noted in several palliative care patients who received medical cannabis for pain and symptom management. Conclusion: As an adjunct therapy for managing post traumatic stress disorder and other conditions, medical cannabis has been effective in reducing symptoms and for improving the patients’ overall quality of life. Continued evaluation into the long effectiveness of medical cannabis provided to individuals over the age of 65 years is suggested. This nurse practitioner-led therapeutic intervention highlights the potential health benefits of medical cannabis and has clinical implications for practice and education.

I Have Never Felt so Novice: Using Narrative Reflection to Explore the Transition from Expert RN to Novice NP Student

Aim: To explore the experiences of nurse practitioner students moving from expert registered nurses to novice nurse practitioner program students. Background: Moving from registered nurse to nurse practitioner can be a time filled with mixed emotions, lack of confidence, adaptation, and competency development. Learning about and navigating the advanced practice nursing role can be challenging. Students in the nurse practitioner program are encouraged to engage in regular reflective writing to foster role development and learning. This paper aims to reflectively explore the experiences of transition from registered nurse to nurse practitioner student. Methods: Inspired by Benner’s Novice to Expert Theory and Carper’s ways of knowing, the authors personally reflected on their transition experiences during NP schooling and then collectively developed a composite reflection of the shared experience. From this exercise common themes were identified. Conclusion: This unique reflective paper identified common themes in the experience of transitioning to the student role. Potential areas for future research-based exploration of the nurse practitioner student experience were identified. By understanding these experiences, students can be better prepared in advance and faculty can design both formal and informal support measures to better support the student experience.