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OBJECTIVE The objective of this study was to develop a simple and practical guide for discussing and managing obesity in primary care settings. METHODS This study convened representatives from 12 primary care and obesity specialty organizations for a series of roundtable meetings to discuss the key components of obesity treatment in primary care. Attendees identified the need for a guide for primary care providers that outlined the key steps for discussing obesity with patients and managing their care while recognizing the significant time constraints on such provider/patient encounters. RESULTS Prevailing themes from the roundtable sessions suggested that the key components of addressing obesity in primary care settings are obtaining patient permission, addressing weight bias, providing a diagnosis, and emphasizing shared decision-making. A modified "6A" framework with the steps "Ask," "Assess," "Advise," "Agree," "Assist," and "Arrange" was deemed appropriate to organize the process of weight management in primary care. An algorithm was developed to provide a script for the patient/provider encounter. CONCLUSIONS The expert panel developed a short, accessible, practical, and informative guide for obesity management by primary care clinicians. Efforts are under way to disseminate the guide to primary care providers through the 11 participating organizations that have endorsed it.

The National Organization of Nurse Practitioner Faculties and the American Association of Nurse Practitioners collaborated to develop a document outlining expectations when establishing clinical experiences for nurse practitioner (NP) students. A literature review explored the beliefs of clinical preceptors and NP faculty in relation to the process of the establishment and completion of successful clinical experiences. From the literature, the development of two guidance checklists addressed the expectations and responsibilities of the NP faculty and clinical preceptor during the clinical placement process. In light of challenges to secure clinical sites for NP students, it is imperative that the clinical placement process is standardized and the communicative pathway between the NP faculty and clinical preceptor improved.

Purpose The aim of two national studies was to identify characteristics of nurse practitioners (NPs) who precept and the benefits, incentives, and barriers associated with the NP preceptor role. Methods Stratified randomized sampling was used to invite a representative number of NPs from each state to participate in a 2015 survey and a follow-up survey in 2016. These descriptive, exploratory studies distributed electronic questionnaires to 5000 randomly selected NPs in the 2015 survey and 40,000 NPs in the 2016 survey. Responses from 10.9% (n = 548) and 9.9% (n = 3970), respectively, were analyzed. Conclusions The findings show strong support among our NP colleagues to assist with educating future NPs. Several benefits, barriers, and motivators among stakeholders were identified that need to be considered when working with preceptors. Implications for practice This study provides a basis for understanding the current climate in education when working with clinical preceptors. Many areas become apparent where NP education could enhance the experience for both the student and the preceptor. Educational settings need to consider preceptor time, issues with online learning, and the rise of specialty practices. Offering incentives linked to the most valued, positive aspects of the role and methods to overcome barriers should be explored.

To date, approximately 300,000 families including 700,000 children have been affected by the increased and repeated number of deployments in support of the Global War on Terror in Iraq and Afghanistan since 2001. The purpose of this review is to discuss the impact of these deployments on family members of active duty and reserve/guard personnel. A search of literature across the years of military conflicts reveals waves of studies emerging after World War II, the Vietnam conflict, Desert Storm/Shield, and now the most recent wars. Study designs most frequently include qualitative exploratory, survey methods, and program evaluations. The field is limited by small scale projects, service- and facility-specific samples, and knowledge extracted from related topics. More research is needed to achieve a more comprehensive understanding across the trajectory of the deployment experience for both service personnel and family members as well as long-term outcomes.

Military mothers and their children cope with unique issues when mothers are deployed. In this article, we present mothers' perspectives on how military resources affected them, their children, and their caregivers during deployment. Mothers described beneficial features of military programs such as family readiness groups and behavioral health care, processes such as unit support, and policies on length and timing of deployments. Aspects that were not supportive included inflexibility in family care plans, using personal leave time and funds for transporting children, denial of release to resolve caretaker issues, and limited time for reintegration. We offer recommendations for enhanced support to these families that the military could provide.

Purpose Many military women are being called to separate from their children to go to war. Most previous research has focused upon paternal, rather than, maternal, separation. The purpose of this article is to describe the experience of military mothers and their children during wartime deployments with clinical implications for nurse practitioners (NPs) in military or community settings. Data sources Using grounded theory methods, 37 active duty and reserve component military women participated in a one-time interview. Included were women who deployed for at least 4 months to Iraq or Afghanistan and had at least one child under the age of 12 during the separation. Conclusions Military families present unique challenges for NPs. Mother deployments offer opportunities for intervention and anticipatory guidance across the trajectory of the separation. Military women's emotional and physical health must be supported before, during, and following deployment. Implications for practice NPs are ideally positioned to support military families. During deployment, the NP's focus may shift to care of the children and their caregiver. Before and at reintegration, NPs are in a key position to intervene early for posttraumatic stress and support family readjustment.

Purpose To provide primary care providers with knowledge of unique challenges faced by military families. By understanding how military families cope with military lifestyle and deployment, providers can be more effective in their care of these patients and offer assistance in optimizing their health. Data sources Research articles, World Wide Web search of resources for military families and Department of Defense documents. Conclusions Military families are faced with many challenges and hardships such as frequent geographic relocations, social isolation, periodic deployments and separations, and risk of injury and death. Unique stressors associated with deployment include assumption of single parent role, altered finances, change in social support from family and friends, and concerns for the safety of the service member. Ineffective coping with stressors can manifest both physically and/or psychologically. Implications for practice Healthcare providers should routinely inquire about a patient's possible military affiliation. Military spouses need to be assessed for current stress levels and coping behaviors used in order to provide the most appropriate recommendations and referrals. As healthcare providers, understanding the unique demands of the military lifestyle is necessary to provide effective quality care with optimal health outcomes in this population.

Purpose: The purpose of this descriptive correlational study was to describe the coping behaviors used by Army wives during deployment separation, the perceived effectiveness of the coping behaviors used, and the correlation between the two variables. Data sources: A secondary analysis was conducted to examine coping use and perceived effectiveness, measured by the Jalowiec Coping Scale (JCS), in a sample of 102 Army wives surveyed during deployment separation. Conclusions: The most used coping subscales from the JCS were the optimistic and supportant and the most effective were the supportant and confrontive. The strongest correlations between coping use and effectiveness were found in the supportant subscale, which measures use of support systems (r= 0.77, p < .00), and the confrontive subscale, which includes behaviors of constructive problem solving (r= 0.62, p < .00). The use and effectiveness of individual behaviors are also identified. Implications for practice: Identifying effective and ineffective coping behaviors of spouses of deployed troops can potentially reduce stress and improve well-being. Primary care providers should encourage military spouses to engage in optimistic thinking, seek out spiritual support, talk to others in a similar situation, and participate in physical activity. Disclosure The views expressed are those of the authors and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of the Defense, or the United States government.

garmon bibb s.c., padden d.l. & ferguson w. (2012) Moderators of access and utilization of clinical preventive services in older adults. Journal of Advanced Nursing 68(2), 335–348. Abstract Aim. This paper reports a study exploring the relationships between potential moderators of access and utilization of clinical preventive services in a homogeneous sample of older adults with near universal health coverage. Background. Advancements have occurred in eliminating financial and structural barriers to utilization of clinical preventive services (primary, secondary and tertiary prevention) in most developed countries, but variations in utilization continue. These variations may be attributed to non-social determinants of health moderators that impact utilization in older adults. Methods. Theorized relationships were explored using questions from the United States Behavioral Risk Factor Surveillance System Survey and a homogenous convenience sample of 202 older adults (mean age 84; sd 5·23) with near universal health coverage. Data collected across a 2 year period (2007–2009) were analysed using Chi-square, Mann–Whitney U and Hierarchical Logistic Regression. Findings. Several logistic regression models of personal access (advised to lose weight, high blood pressure, high cholesterol); moderators (gender, perceived health status, BMI ≥ 30 kg/m2); and clinical preventive services utilization (check-up in last 12 months; ever had colonoscopy/sigmoidoscopy) showed statistically significant (P

The purpose of this research was to describe predictors of participation in health-promoting behaviors among military spouses. A total of 105 female spouses of currently deployed active duty military members were surveyed to determine their perceived stress and participation in the health-promoting behaviors of exercise, diet, checkups, substance use/avoidance, social behaviors, stress management/rest, and safety/environmental behaviors. Demographic and deployment information was also collected. Regression analyses showed perceived stress was predictive of several health behaviors including exercise, social behaviors, stress management/rest, and safety/environmental behaviors. Increased perceived stress was associated with decreased participation in these behaviors. Deployment factors predicted only dietary behaviors and stress management/rest. As the minimum anticipated length of the deployment increased, healthy dietary behavior decreased. Likewise, as the number of deployments experienced incre...

This study examined the relationships between stress, coping, general well-being, and sociodemographic characteristics using Lazarus and Folkman’s theory of stress and coping. A descriptive correlational design was used. The sample consisted of 105 female spouses of currently deployed active duty military members. Instruments included the Perceived Stress Scale, the Jalowiec Coping Scale, and the RAND-36. Perceived stress was the best predictor of both mental and physical well-being, accounting for 51.7% and 25.4% of the variance, respectively. Evasive and optimistic coping contributed an additional 1.9 % and 4.3%, respectively, to the variance in mental well-being. Differences in coping use were found among rank groups, those who grew up in a military family, and those with a previous deployment separation. Nurses are in an ideal position to identify military spouses at risk and provide education on effective coping behaviors shown to positively affect well-being during deployment separation.

The results reported in this article are from a larger descriptive study examining the health literacy rates in active duty military personnel receiving health care within a culture of universal access. The purpose of this article is to describe the health literacy skills among a sample of active duty military personnel with comparison to the national population. Data were collected using the shortened version of the Test of Functional Health Literacy in Adults (S-TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine (REALM) in a convenience sample of 155 active duty subjects at a major military hospital from January 2007 through May 2007. Results indicate that military personnel have adequate health literacy skills although variations were noted on the basis of health training and race/ethnicity. Although the S-TOFHLA was found to be a practical tool for assessing health literacy in a high-tempo health care setting, additional reliability and validity testing is needed.

Background. The burden of cardiovascular disease (CVD) is increasing in low-to-middle income countries. We examined how socioeconomic and demographic characteristics may be associated with CVD risk factors and healthcare access in such countries.Methods. We extracted data from the World Health Organization’s STEPwise approach to surveillance 2002 cross-sectional dataset from Pohnpei, Federated States of Micronesia (FSM). We used these data to estimate associations for socioeconomic position (education, income, and employment) and demographics (age, sex, and urban/rural) with CVD risk factors and with healthcare access, among a sample of 1638 adults (25–64 years).Results. In general, we found significantly higher proportions of daily tobacco use among men than women and respondents reporting primary-level education (12 years). Results also revealed significant positive associations between paid employment and waist circumference and systolic blood pressure. Healthcare access did not differ significantly by socioeconomic position. Women reported significantly higher mean waist circumference than men.Conclusion. Our results suggest that socioeconomic position and demographic characteristics impact CVD risk factors and healthcare access in FSM. This understanding may help decision-makers tailor population-level policies and programs. The 2002 Pohnpei data provides a baseline; subsequent population health surveillance data might define trends.

Background The burden of cardiovascular disease (CVD) is increasing in low-to-middle income countries (LMIC). Although strong evidence for inverse associations between socioeconomic position and health outcomes in high-income countries exists, less is known about LMIC. Understanding country-level differences is critical to tailoring effective population health policy and interventions. We examined the association of socioeconomic position and demographic characteristics in determining CVD risk factors among adults living in Pohnpei, Federated States of Micronesia. Methods We used data from the cross-sectional World Health Organization’s STEPwise approach to surveillance 2002 Pohnpei dataset and logistic regression analyses to examine the association of socioeconomic position (education, income, employment) and demographics (age, sex) with selected behavioral and anthropometric CVD risk factors. The study sample consisted of 1638 adults (642 men, 996 women; 25–64 years). Results In general, we found that higher education (≥13 years) was associated with lower odds for daily tobacco use (odds ratio [OR]: 0.46, confidence interval [CI]: 0.29–0.75, p = 0.004) and low physical activity (OR: 0.55, CI: 0.34–0.87, p = 0.027). Men had over three times the odds of daily tobacco use than women (OR: 3.18, CI: 2.29–4.43, p $10,000 was associated with over twice the odds of high blood pressure (BP) (OR: 2.24, CI: 1.43–3.51, p = 0.003), versus lower-income (

To provide primary care providers with knowledge of unique challenges faced by military families. By understanding how military families cope with military lifestyle and deployment, providers can be more effective in their care of these patients and offer assistance in optimizing their health.Research articles, World Wide Web search of resources for military families and Department of Defense documents.Military families are faced with many challenges and hardships such as frequent geographic relocations, social isolation, periodic deployments and separations, and risk of injury and death. Unique stressors associated with deployment include assumption of single parent role, altered finances, change in social support from family and friends, and concerns for the safety of the service member. Ineffective coping with stressors can manifest both physically and/or psychologically.Healthcare providers should routinely inquire about a patient's possible military affiliation. Military spouses need to be assessed for current stress levels and coping behaviors used in order to provide the most appropriate recommendations and referrals. As healthcare providers, understanding the unique demands of the military lifestyle is necessary to provide effective quality care with optimal health outcomes in this population.

Many military women are being called to separate from their children to go to war. Most previous research has focused upon paternal, rather than, maternal, separation. The purpose of this article is to describe the experience of military mothers and their children during wartime deployments with clinical implications for nurse practitioners (NPs) in military or community settings.Using grounded theory methods, 37 active duty and reserve component military women participated in a one-time interview. Included were women who deployed for at least 4 months to Iraq or Afghanistan and had at least one child under the age of 12 during the separation.Military families present unique challenges for NPs. Mother deployments offer opportunities for intervention and anticipatory guidance across the trajectory of the separation. Military women's emotional and physical health must be supported before, during, and following deployment.NPs are ideally positioned to support military families. During deployment, the NP's focus may shift to care of the children and their caregiver. Before and at reintegration, NPs are in a key position to intervene early for posttraumatic stress and support family readjustment.

The purpose of this study was to understand the factors influencing the health promoting behaviors (HPBs) of military spouses. Pender's Health Promotion Model provided the theoretical framework guiding this study. One hundred twelve female spouses were surveyed regarding their perceived health status, perceived stress, self-efficacy, social support, and participation in HPBs. Perceived health status, self-efficacy, social support, and HPBs were positively related, whereas perceived stress was negatively related. Hierarchical multiple regression analysis showed perceived stress and social support to be predictive of an overall health promoting lifestyle (HPLPII), with the full model explaining 49.7% of the variance.

At least one third of the US population suffers from limited health literacy, which has been linked to poorer health status, higher costs, and individuals who are socioeconomically disadvantaged. However, research and the development of theoretical frameworks to study health literacy have only recently begun to occur. The purpose of this article is to describe theoretical frameworks that have either been used or may be used to guide health literacy research and to identify implications for nursing research and practice related to an adaptation of a health literacy framework developed specifically for conducting research in populations with universal access to healthcare.

The objective of this descriptive study was to determine whether Army family nurse practitioners perceive themselves as competent in providing trauma care. Using an adaptation of trauma competency outcomes from various trauma courses, all Army family nurse practitioners were asked to evaluate self-perceived level of trauma competence and self-perceived importance of trauma skills. Results (n = 96) indicate a general agreement that all skills identified in the questionnaire were important in the management of a trauma patient. The respondents considered themselves trained/somewhat competent or higher in 50% of the skills identified. Mann-Whitney U analysis was used to compare various groups within the sample. Significant differences on self-perceived competency were noted with intensive care/emergency room, Advanced Trauma Life Support, and deployment experience. Trauma Nursing Core Course experience was not significant to self-perceived trauma competency. Findings support the need for additional trauma training, such as Advanced Trauma Life Support and hands-on trauma experience.

Clinical education is critically important because competency in practice ultimately will determine the future of advanced practice nursing. Skills taught in Health Assessment, the first in a series of clinical courses, exposed students to tools that form the basis on which other competencies are built. The availability of standardized patients, people who participate in enacting a simulated but seemingly "real life" clinical encounter in a realistic clinical setting for the benefit of student learning and/or evaluation, made this instructional development project possible. The underlying assumption of this project was that clinical advanced practice nursing student education is enhanced by using an authentic clinical environment, known as a simulation center, with standardized patients and by using one or more evaluation techniques with multiple evaluators (i.e., peer, self, faculty, standardized patient). The student clinical experience was expected to improve and overall learning to increase by this method. This improvement was reflected at the end-of-course evaluations and in the quality of the final videotaped physical examination, which was superior to previous years. Student and faculty satisfaction with this teaching-learning process exceeded all expectations.