As patients grow older, the incidence of sexual dysfunction increases while sexual activity decreases. Multiple factors contribute to sexual problems, and older age compounds and complicates those factors. Although sexual activity can diminish with age, it helps to acknowledge that more than half of older adults are sexually active. Further, the majority of men and women over the age of 65 report an interest in sex. This chapter helps the practitioners to: define sexuality and sexual dysfunction; distinguish differences in impotence and erectile dysfunction; explain the hormonal changes in aging adult women; apply principles of interdisciplinary collaboration to clinical practice; and identify risk factors genito-pelvic pain/penetration disorder, orgasmic disorder and female sexual interest/arousal disorder. It also helps to recommend evidence-based practice interventions to older adults suffering from reproductive changes; establish a differential for erectile dysfunction in the aging male; and explain options for medical management and treatment of erectile dysfunction.
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Clinical epidemiology is considered a basic science of medical practice that informs diagnostic, prognostic and therapeutic clinical decisions related to individual healthcare. Healthcare epidemiology broadens the scope of clinical epidemiology to include various types of healthcare settings not limited to the acute care setting. It is a more comprehensive term to use to designate epidemiology of clinical care in both acute and primary care settings. This chapter provides an overview of healthcare epidemiology, inclusive of clinical infectious hospital-acquired infections, and the basis of health care epidemiologic data in evidence-based healthcare. Healthcare epidemiologists are expert clinicians who provide information and education in areas such as but not limited to infectious diseases, infection control and prevention principles, antibiotic stewardship, occupational health and safety, and prevention of hospital- or healthcare-acquired infections or health conditions, along with regulatory compliance guidance.
- Go to chapter: Transcultural Service-Learning: Preparing Nurses to Meet the Needs of Rural Indigenous Communities
The greatest concentration of people in the United States (U.S.) live in large urban areas or suburban communities located next to metropolitan cities; yet there are many rurally isolated communities. Rural nursing practices, especially in rural areas within the western U.S., typically includes the care of American Indian and Alaska Natives (
AI/ AN) peoples who reside on or near rurally isolated reservation communities. Effective nursing practice with AI/ ANpeoples requires more than the knowledge and skills developed from generic evidence-based practice models. It also requires cultural consciousness in the mindful application of evidence-based practice. This chapter focuses on cultural immersion service learning ( CISL). It describes the inclusion of a CISLexperience within a required undergraduate nursing course facilitated prelicensure nursing students’ understanding of culturally conscious care and why the practice of cultural consciousness is an essential element of nursing practice toward the reduction of healthcare disparities seen among rural communities.
This chapter describes checklists that summarize recommendations for reporting treatment, observational, diagnostic, and prognostic studies, as well as systematic reviews and meta-analyses. This checklists were developed by organizations and work groups who specialize in research methodology and are public access. Use of evidence-based checklists with recommendations for appropriate reporting of research studies can enhance the information available to systematic reviewers who rate the quality of evidence. The CONsolidated Standards of Reporting Trials (CONSORT) Statement 2010 for reporting clinical trials enables readers to understand a trial’s design, analysis, and interpretation, and assess the validity of the study’s results. The STAndards for Reporting of Diagnostic Accuracy (STARD) initiative for reporting diagnostic validity studies aims to improve the accuracy of reported research design elements, sampling methods, and data analyses in diagnostic studies. Successful use of checklists presupposes an understanding of experimental research designs, and the threats to the validity of causal inferences.
This chapter focuses on the most common systems that rehabilitation systematic review (SR) and guideline development (GD) groups use to evaluate evidence from clinical trials and form clinical practice recommendations. Use of evidence rating and practice GD systems is essential to implementing evidence-based practice (EBP). Evidence rating and practice GD systems can also be used proactively to improve the development of future evidence by helping researchers to proactively select research design elements that best minimize validity threats in clinical trials. The Institute of Medicine (IOM) has published standards for conducting SRs and developing practice guidelines that have had broad influence on all health care fields and disciplines. Grades of Recommendation, Assessment, Development, and Evaluation Work Group (GRADE) pro computer software is available to facilitate SR and GD. In general, the GRADE system provides a more detailed process for generating usable practice recommendations.
This chapter provides updated information on hormone therapy, menopause, and osteoporosis that reflects evidence-based practice generated through analysis of the emerging data from the Women’s Health Initiative and other research. Menopause is the landmark event of the climacteric, the 10- to 15-year period, beginning at about 40, when women’s bodies are changing and preparing for cessation of menses. A woman is considered menopausal when 1 year (12 months) has elapsed since her last menstrual period. The chapter discusses etiology, history, physical examination, laboratory testing, differential diagnosis, treatment, complications and risks, consultation and referral, and follow-up for hormone therapy, menopause, atrophic vaginitis, and osteoporosis.
While many children and adolescents have normal and healthy developmental processes, approximately 6.1 million children and adolescents between the ages of 12-17 years needed treatment for substance-related or addictive disorders between the years of 2015-2019, yet only 5 million of these children and adolescents received treatment. Their use of addictive substances intensify the development of comorbid mental health disorders, developmental delays and problems with everyday functioning all of which affects their ability to contribute to society as the emerge into adulthood. Appropriate screening and early identification are critical in order to institute evidence-based practice (
EBP) approaches for children and adolescents who use addictive substances. This approach includes early detection and treatment of behavioral issues that may affect children and adolescents. This chapter describes the assessment and management of substance abuse and addiction.
There is little doubt that evidence-based principles have changed the way we think about clinical practice. However, there are challenges to clinical decision making that evidence alone cannot answer. Challenges include realities such as research populations not reflecting “real-world” application, inconsistent adherence to evidence-based principles within clinical practices, sophisticated decision rules overshadowing clinical experience, and gaps in care that impact outcomes. This article attempts first to demonstrate caveats of using and interpreting evidence-based principles and, second, to illustrate common evidence-based concepts which many clinicians misunderstand. These include the cascade effect, common risk difference measures, and predictive values.Source:
Advanced Practice Psychiatric Nursing, 3rd Edition:Integrating Psychotherapy, Psychopharmacology, and Complementary and Alternative Approaches Across the Life Span
Psychiatric-mental health advanced practice registered nurses (
PMH-APRNs) are like water: they are flexible, they are fluid, and they go where they are needed. Deinstitutionalization of psychiatric patients resulted in not only more community-based treatment, but also new and expanded outpatient roles for psychiatric nurses. The third edition of Advanced Practice Psychiatric Nursing meets the practice standards developed by the American Psychiatric Nurses Association, the International Society of Psychiatric-Mental Health Nurses, and the American Nurses Association, which require all PMH-APRNsto have skills in psychotherapy, psychopharmacology, and holistic assessment. Each chapter reflects not only state-of-the-art knowledge, but decades of clinical wisdom. The book is divided into five sections: Section I provides an overview of the theoretical and evidence base for practice and an exploration of the concept of shared decision-making and reaching concordance between clinicians and clients. Section II explores the foundations necessary for the practitioner to implement integrated practice and discusses the synergistic effects of integrating practice concepts. This includes chapters presenting the overviews of psychotherapy, psychopharmacology, and complementary and alternative approaches in the context of the stages of treatment. A new chapter focuses on legal and ethical issues in treatment. Section III applies the information from previous chapters and focuses on integrative management of specific syndromes. The chapters discuss mood disorders, anxiety-related disorders, psychotic symptoms, sleep disturbances, disordered eating, disordered cognition, impulse control, disordered attention, self-directed injury, and other-directed violence. Section IV covers aspects of managing substance misuse, medical problems, pregnancy, telehealth, and forensic issues that often co-occur with psychiatric syndromes. A new chapter focuses on care for sexual and gender minority patients. Section V covers the importance of maintaining competence and quality in clinical practice. The section includes a new chapter on self-care among PMH-APRNsthat focuses on resilience in practitioners, and the final chapter focuses on the global perspectives and the future of psychiatric-mental health advanced practice nursing.
- Go to chapter: Achieving the Quadruple Aim in Healthcare With Evidence-Based Practice: A Necessary Leadership Strategy for Improving Quality, Safety, Patient Outcomes, and Cost Reductions
Achieving the Quadruple Aim in Healthcare With Evidence-Based Practice: A Necessary Leadership Strategy for Improving Quality, Safety, Patient Outcomes, and Cost Reductions
Evidence-based practice (
EBP) is a seven-step problem-solving approach to the delivery of healthcare that integrates the best evidence from well-designed studies with a clinician’s expertise and the values/preferences of the patient/family. This chapter discusses the importance of EBPin achieving the quadruple aim in healthcare, describes the current state of EBPin healthcare, including EBPcompetencies, identifies the barriers and facilitators of EBP, and discusses the key leadership strategies to ignite and sustain EBPin healthcare. It briefly describes EBPcompetencies for practicing registered nurses and advanced practice nurses in real-world clinical settings. Leaders must first understand that EBPis the direct pathway to achieve the quadruple aim in healthcare and be willing to invest in it knowing that healthcare quality and safety will be enhanced, population health outcomes will improve, healthcare costs will diminish, and clinician job satisfaction will increase as EBPdiffuses throughout the organization.