LEADER 06353nam 2200517 450 001 9910717369403321 005 20221025031126.0 035 $a(CKB)3710000000362746 035 $a(NjHacI)993710000000362746 035 $a(OCoLC)904080846$z(OCoLC)1117845740 035 $a(EXLCZ)993710000000362746 100 $a20221025d2013 uy 0 101 0 $aeng 135 $aur||||||||||| 181 $ctxt$2rdacontent 182 $cc$2rdamedia 183 $acr$2rdacarrier 200 10$aEffects of nurse-managed protocols in the outpatient management of adults with chronic conditions /$fRyan J. Shaw [and five others] 210 1$aWashington, District of Columbia :$cDepartment of Veterans Affairs (US),$d[2013] 210 4$dİ2013 215 $a1 online resource (iii, 88 pages) $cillustrations (some color) 225 1 $aEvidence-based synthesis program 300 $a"Evidence-based synthesis program." 300 $a"August 2013." 320 $aIncludes bibliographical references. 330 3 $aMedical management of chronic illness consumes 75 percent of every health care dollar spent in the United States, and the provision of economical, accessible, and high-quality chronic disease care is a continuing concern across health care settings. Type 2 diabetes, hypertension, hyperlipidemia, and congestive heart failure are prime examples of common chronic diseases that cause substantial morbidity and mortality and require long-term medical management and support.^For each of these disease conditions, the majority of care occurs in outpatient settings where well-established clinical practice guidelines can be used to guide treatment decisions.^Despite the availability of these guidelines, practice recommendations often are not implemented which contributes to suboptimal clinical outcomes.^The shortage of primary care clinicians in outpatient care settings has been identified as a barrier to the provision of comprehensive chronic disease care and provides an impetus to develop and test strategies for expanding the roles and responsibilities of other members of the interdisciplinary team to help meet the continually increasing need for chronic disease care.^In an effort to serve more Veterans and improve the quality and efficiency of chronic disease care,^the Department of Veterans Affairs (VA) is implementing Patient Aligned Care Teams (PACTs)--a model of primary care transformation that builds on other widely disseminated efforts such as the chronic care model.^VA PACTs are adaptations of the patient-centered medical home, which includes the following core principles: wide-ranging, team-based care; patient-centered orientation toward the whole person; care that is coordinated across all elements of the health care system and the patient's community; enhanced access to care that uses alternative methods of communication; and a systems-based approach to quality and safety. VA PACT clinical teams may include nurses (registered nurses [RNs] or licensed practical nurses [LPNs]) as well as primary care providers, clinical pharmacists, behavioral health specialists, and clinic facilitators.^An organizing principle for these care teams is to utilize personnel at the highest level of their skill set.^The Institute of Medicine has recommended the expansion of nurses' roles and responsibilities to allow them to practice to the full extent of their education and training.^Reports of the contributions of nurses in improving access and quality of care for patients with selected chronic conditions by using detailed structured protocols developed by or through consultation with physicians began in the late 1960s.^There is now robust evidence supporting the effectiveness of nurses in providing patient education about chronic disease treatment, self-care management, and secondary prevention strategies as well as the ability of nurse practitioners (NPs) to provide effective and cost-effective primary care.^As the largest segment of the health care workforce, nurses are ideally suited to collaborate with other professionals in meeting the increasing demand for chronic care.^Nurses are experienced and accustomed to working in multidisciplinary teams and, with clearly defined clinical protocols and additional training, safely practice beyond their usual scope of practice and may well be able to order relevant diagnostic tests, adjust routine medication regimens, and appropriately refer complicated or unstable patients for further medical evaluation. The VA is in the process of developing protocols and policies expanding the nurse's role as a member of PACT teams.^A protocol contains a series of actions in accordance with current clinical guidelines or standards of practice that are implemented by nurses to manage a patient's condition.^At the VA, there is emerging interest in allowing nurses to practice in an expanded role that includes medication initiation or titration under guidelines of protocols.^The lack of certainty regarding outcomes associated with the use of clinical protocols by non-NP nurses in expanded roles led the VA to commission this evidence synthesis. We thus synthesized the current literature to describe the effects of nurse-managed protocols for the outpatient management of adults with high-impact, chronic conditions such as type 2 diabetes, hypertension, hyperlipidemia, and congestive heart failure (CHF). 410 0$aEvidence-based synthesis program (Series) 606 $aNurses$zUnited States 606 $aChronic diseases$xNursing 606 $aAmbulatory medical care$zUnited States 607 $aUnited States$2fast 615 0$aNurses 615 0$aChronic diseases$xNursing. 615 0$aAmbulatory medical care 676 $a331.126 700 $aShaw$b Ryan J.$01353452 712 02$aUnited States.$bDepartment of Veterans Affairs.$bHealth Services Research and Development Service, 712 02$aQuality Enhancement Research Initiative (U.S.) 712 02$aDurham VA Medical Center.$bEvidence-based Synthesis Program Center. 712 02$aEvidence-based Synthesis Program (U.S.) 801 0$bNjHacI 801 1$bNjHacl 906 $aBOOK 912 $a9910717369403321 996 $aEffects of nurse-managed protocols in the outpatient management of adults with chronic conditions$93254399 997 $aUNINA LEADER 02068oam 2200469 450 001 9910807832003321 005 20240131141500.0 010 $a1-4166-1570-9 010 $a1-299-44782-1 010 $a1-4166-1569-5 035 $a(OCoLC)872658115 035 $a(MiFhGG)GVRL6UJC 035 $a(EXLCZ)992550000001018482 100 $a20130207d2013 uy 0 101 0 $aeng 135 $aurun|---uuuua 181 $ctxt 182 $cc 183 $acr 200 10$aEssential questions $eopening doors to student understanding /$fJay McTighe, Grant Wiggins 210 $aAlexandria, Va. $cASCD$dc2013 210 1$aAlexandria, Virginia :$cASCD,$d2013. 215 $a1 online resource (viii, 119 pages) 225 0 $aGale eBooks 300 $aDescription based upon print version of record. 311 $a1-4166-1505-9 320 $aIncludes bibliographical references and index. 327 $aCover Page; Title Page; Copyright; Table of Contents; Chapter 1. What Makes a Question Essential?; Chapter 2. Why Use Essential Questions?; Chapter 3. How Do We Design Essential Questions?; Chapter 4. How Do We Use Essential Questions?; Chapter 5. How Do We Address Implementation Challenges and Special Cases?; Chapter 6. How Do We Establish a Culture of Inquiry in Classrooms?; Chapter 7. How Do We Use Essential Questions Beyond the Classroom?; References; Appendix: Annotated Bibliography; Index; About the Authors; Related ASCD Resources 330 $aThis book from the authors of Understanding by Design explores how to design and frame essential questions that prompt students to think deeply and create a more stimulating environment for learning. 606 $aQuestioning 606 $aInquiry-based learning 615 0$aQuestioning. 615 0$aInquiry-based learning. 676 $a371.3/7 700 $aMcTighe$b Jay$01605395 702 $aWiggins$b Grant P.$f1950- 801 0$bMiFhGG 801 1$bMiFhGG 906 $aBOOK 912 $a9910807832003321 996 $aEssential questions$93931800 997 $aUNINA LEADER 00973cam0-2200313 --450 001 9911016379503321 005 20250804091135.0 010 $a978-88-282-1482-3 100 $a20250804d2024----kmuy0itay5050 ba 101 1 $aita$ceng 102 $aIT 105 $aa 001yy 200 1 $a<>climb$eEverest 1996: cronaca di un salvataggio impossibile$fAnatolij Bukreev con G. 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