Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States. It's estimated that more than 13 million U.S. adults have COPD, and as many as 24 million have evidence of impaired lung function, suggesting that COPD is underdiagnosed. Even when patients receive optimal COPD therapy, they periodically experience exacerbations, which reduce lung function and quality of life, increase risk of death from COPD, and account for the majority of costs related to COPD treatment. This article, the second in a two-part series on COPD, outlines current guidelines and evidence-based recommendations for identifying, assessing, and managing COPD exacerbations (the first article in the series, "An Evidence-Based Approach to COPD," March 2012, focused on the management of stable COPD in the outpatient setting).

Problem/Background: The ability to accurately diagnose patients based on symptom profiles is a vital yet challenging skill that Nurse Practitioners (NPs) undertake frequently. Purpose: This integrative literature review highlights a variety of evidence based, practical educational strategies that foster the development of diagnostic reasoning. Methods: An integrative literature review was conducted in order to identify original research focusing on diagnostic reasoning educational interventions. Results: Eighteen primary sources met inclusion and exclusion criteria. Results are synthesized in terms of sample and setting, methodological features, interventions, and outcomes. Interventions broadly fit into five educational themes: testing strategies, cognitive biases, simulation programs, course formats, and instructional approaches. Discussion: Interventions are simple and can be implemented in multiple educational settings. Future research should occur in populations of NP students. Validated, easy-to-use measurement tools as well as more precise diagnostic reasoning concept development should occur.

Background: Telemedicine facilitates access to care that is both efficacious and highly satisfactory to patients. As primary health care providers, nurse practitioners (NPs) need to be educated to deliver health care within various settings. With the rapid expansion of telemedicine, NP educational authorities have charged educators to address essential telemedicine-based competencies. Purpose: Innovative approaches to integrating telemedicine competencies into NP curricula have yet to be established in nursing education. Methods: Multifocal curricular changes were integrated into an NP clinical course. Students engaged in self-directed learning modules and multiple simulation training sessions and rotated through telemedicine clinical practicums. Results: Experiences were perceived as realistic and complementary, learning meaningful, and applicability broad and farreaching. Telemedicine-focused simulation training sessions were viewed as highly satisfactory, and students were confident in simulation-derived learning. Conclusions: Nursing educators should integrate multimodal telemedicine experiences into curricula, addressing multiple learning phases through experientially designed simulation trainings.