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Objectives To identify classes of individuals presenting to the ED for suspected ACS who shared similar symptoms and clinical characteristics. Background Describing symptom clusters in undiagnosed patients with suspected ACS is a novel and clinically relevant approach, reflecting real-world emergency department evaluation procedures Methods Symptoms were measured using a validated 13-item symptom checklist. Latent class analysis was used to describe symptom clusters. Results The sample of 874 was 37% female with a mean age of 59.9 years. Four symptom classes were identified: Heavy Symptom Burden (Class 1), Chest Symptoms and Shortness of Breath (Class 2), Chest Symptoms Only (Class 3), and Weary (Class 4). Patients with ACS were more likely to cluster in Classes 2 and 3. Women and younger patients were more likely to group in Class 1. Conclusions Further research is needed to determine the value of symptom clusters in the ED triage and management of suspected ACS.

BACKGROUND Skin cancer is the most common cancer; survival of the most serious skin cancer, malignant melanoma, depends on early detection. Early detection relies on accessibility to clinical skin examination (CSE). Primary care nurse practitioners (PCNPs) are well-positioned to conduct CSE; however, they require further education on CSE and have time constraints for continuing education. A digital intervention grounded in microlearning is a promising approach to deliver new information over a brief timespan. OBJECTIVE To develop and explore the feasibility of implementing a 1-week online video intervention with content on CSE skills (defined as melanoma risk assessment, head-to-toe skin examination and pigmented lesion assessment) for PCNPs. Specific aims were 1) to develop three theory-based, brief skin cancer videos containing content on CSE and were suitable for online delivery to PNCPs and 2) to determine intervention enrollment, retention and adherence, and acceptability and usability of the intervention. Aim 1 focused on content validity, integration of the videos and surveys into Research Electronic Data Capture (REDCap) for digital delivery. Aim 2 focused on feasiblity testing. METHODS For Aim 1, the principal investigator (PI) created storyboards for videos that ¬addressed each CSE skill. A dermatology expert panel reviewed the storyboards and videos for relevance, comprehension, and clarity assessed using a Content Validity Index (CVI). The panel evaluated usability of delivery of the video intervention by REDCap and Vimeo using Brooke’s System Usability Scale (SUS) and technical video production using Beaudin’s Quality Evaluation of Video. Vimeo, which is an online platform and community developed to create, upload and share videos.[1] For Aim 2, the videos were delivered to a sample of 10 PCNPs recruited statewide. Enrollment and retention rates were based on metrics from previous studies of CSE in the literature, and intervention adherence. Usability and acceptability were assessed using the SUS and the Attitudes toward Web-based Continuing Learning survey (AWCL). RESULTS CVI scores indicated relevance and clarity for each video (M range 3.79 to 4; 4, high relevance). The integration of REDCap and Vimeo was rated usable (SUS = 95; 0-100, worst to best). The digital delivery of the videos was exceptional on all five technical items (M = 5, poor [1] to exceptional [5]). Of the 22 PCNPs recruited, 12 were enrolled (35%) and 10 (83%) were retained in the study. Intervention adherence was ≥ 50%. Participants rated the usability as “better” (M = 85.8, SD = 10.6; better=70-90) and favorably ranked acceptability of AWCL’s constructs of perceived usefulness (M = 5.26 SD =0.08, strongly agree = 7)), perceived ease of use (M = 5.40 SD =0.41), behavior (M = 5.53 SD =0.12) and affection (M = 5.77 SD =0.04). CONCLUSIONS The video intervention was feasible to deliver to PCNPs using an online, microlearning approach. The findings provide support for using the videos for an intervention in a future pilot randomized trial targeting behavioral CSE outcomes in PCNPs and other primary care providers.

Background: Rural areas face health care workforce shortages. Nursing students seeking rural employment require instruction and clinical experience in using telehealth to work in health care teams. Method: An innovative telehealth consultation simulation paired nurse practitioner (NP) students with prelicensure baccalaureate nursing degree (BSN) students. The simulation aimed to enhance NP student proficiency and confidence in telehealth consultation skills and to foster professional role development through exposure to telehealth nursing roles for RNs and NPs. On-campus BSN students assumed the role of the RN in a rural clinic and consulted with off-campus NP students using telehealth technology in the care of a standardized patient. Results: Participants demonstrated level-appropriate proficiency and reported confidence in telehealth consultation and favorable attitudes toward intraprofessional communication. Conclusion: An intraprofessional educational model allowing BSN and NP students to develop telehealth consultation skills successfully addressed a gap in preparing nursing students to meet rural health care workforce needs. [ J Nurs Educ . 2020;59(5):274–277.]

Nurses worldwide provide support to patients who are living with chronic illnesses. As pressures related to cost and access to care increase, technology-enabled self-management interventions will become increasingly common. This patient-focused framework can guide nursing practice using technology that prioritizes patient needs.