By: Indira Maurer, DNP, FNP-C

As a new year rolls around, so do the hopes and resolutions for a healthier lifestyle. Patients may come to us for guidance in achieving their goals to shed some weight, eat healthier, and adopt better lifestyle choices. Yet, with all the trending diet plans and exercise programs out there, determining which are the best ones to recommend to our patients can be a daunting task. 

In the last 20 years, obesity rates increased from 30.5% to 41.9% in the United States¹. Obesity affects all races with Black adults having the highest rate of obesity at 49.9%, Hispanic adults at 45.6%, White (non-Hispanic) adults at 41.4%, and Asian adults at 16.1%¹.  The long-term sequelae of obesity include heart disease, stroke, type 2 diabetes, and certain types of cancer; all of which are among the leading causes of preventable, premature death.  In 2019, obesity alone had an estimated cost of 173 billion dollars in the United States¹. 

The question is, how can we make an impact? Let’s talk about exercise! With just 1 in 4 adults meeting physical activity guidelines, there is a great need for education and awareness of physical activity. The current recommendation includes a minimum of 150 minutes per week of moderate-intensity aerobic activity with the incorporation of muscle-strengthening activity at least 2 days per week².  It is important that patients understand that physical activity is anything that gets our body moving and burns calories. Any movement is better than none at all.  It is often helpful to encourage your patients to start slow and work their way up.  Some activities you can recommend include brisk walking (at least 2.5 miles per hour), water aerobics, tennis, and biking slower than 10 miles per hour². 

Let’s shift our focus to nutrition.  Diet is a personal choice that may be influenced by multiple factors such as income, food prices, individual preferences/beliefs, and cultural dietary customs.  It is important that we educate our patients on the need for a well-balanced diet rather than a specific dietary “trend” that may impose demands making it difficult to follow.  A healthy diet should include fruits, vegetables, legumes, nuts, and whole grains³.  It may be helpful to present a visual of the recommended daily intake of the food groups.  For example, fruits and vegetables should make up half of their plate for their meals⁴.  Whole grains should make up one-quarter of their plate.  The remaining quarter is for lean protein. Salt intake should be limited to less than 5 grams per day while sugar intake should not make up more than 10% of the total energy intake for the day³.  Oils should be consumed in moderation with a preference for healthier vegetable oil sources³.  

We have an opportunity to influence and educate our patients on making better choices to improve their overall health.  Nutrition and exercise are important areas where we can start, as these steps ultimately reduce the risk of disease and increase our patients’ general well-being.

References

1. Adult obesity facts. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/data/adult.html. Published May 17, 2022. 
2. American Heart Association recommendations for physical activity in adults and kids. www.heart.org. https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults. Published July 28, 2022. 
3. Healthy diet. World Health Organization. https://www.who.int/news-room/factsheets/detail/healthy-diet. Published April 29, 2020. 
4. Healthy Eating Plate. The Nutrition Source. https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/. Published October 4, 2021.

Full Practice Authority

What Does This Mean for our Patients? 

By: Mona Williams-Gregory, Ph.D., DNP, APRN

In 1965, the role of the NP was created by Loretta Ford. In this fledgling role, she functioned as a pediatric NP in collaboration with a pediatrician. For several years, the role of the NP remained relatively unchanged and ill-defined with physicians acting in supervisory capacities. In 1971, Idaho was the first state to formally recognize the role and the expansive scope of NPs¹. Increasingly since then, the contributions made by NPs have been well documented and are rich in the literature. By 1994, five states had adopted full practice authority for NPs. Since then, full practice authority has been sweeping the US and has been adopted by 26 states, DC, and two US territories¹.

What does full practice authority mean for our patients? Head-to-head studies have compared clinical and quality outcomes of patients cared for by NPs with patients cared for by physicians. Patients cared for by NPs have equivalent, positive clinical outcomes when compared to similar patients cared for by physicians^2,3,4,5,6. When caring for patients, the clinical safety among NPs is equivalent to that of physicians⁶. Care provided by an NP has demonstrated improvement in several clinical indicators. Inpatients cared for by NPs have lower mortality rates³. Outpatients cared for by NPs have fewer ED visits⁵ and fewer hospitalizations^2,5. Overall, the care provided by NPs is associated with lower total healthcare expenditures⁵. Patients cared for by NPs consistently report greater patient satisfaction than when cared for by other health care practitioners⁶. NPs provide superior education and more counseling than any other healthcare provider^4,6. Full practice authority means reduced costs and improved access to quality healthcare services^5,7.

References:

1. Brom, H. M., Salsberry, P. J., & Graham, M. C. (2018). Leveraging health care reform to accelerate nurse practitioner full practice authority. J Am Assoc Nurse Pract, 30(3), 120-130.doi: 1-.1097/JXX.000000000000023

2. Liu, C-F., Hebert, P. L., Douglas, J. H., Neely, E. L., Sulc, C. A., Reddy, A., Sales, A. E., & Wong, E. S. (2020). Outcomes in primary care delivery by nurse practitioners: Utilization, cost and quality of care. Health Services Research, 55(2),1 78-189. doi: 10.1111/1475-6773.13246
3. Gupta, S., Balachandran, M., Bolton, G., Pratt, N., Molloy, J., Paul, E., & Tiruvoipati, R. (2021). Comparison of clinical outcomes between nurse practitioner and registrar-led medical emergency teams: a propensity-matched analysis. Critical Care, 25(117). https://doi.org/10.1186/s13054-021-03534-4
4. Kurtzman, E. T., & Barnow, B. S. (2017). A comparison of nurse practitioners, physician assistants, and primary care physicians’ patterns of practice and quality of care in health centers. Med Care, 55(66), 615-622. doi: 10.1097/MLR.0000000000000689
5. Morgan. P. A., Smith, V. A., Berkowitz, T, Edelman, D., Van Houtven, C., Woolson, S. L., Hendrix, C. C., Everett, C. M., White, B. S., & Jackson, G. L. (2019). Impact of physicians, nurse practitioners, and physician assistants on utilization and costs for complex patients. Health Affairs, 38(6). https://doi.org/10.1377/hlthaff.2019.00014
6. Carranza, A. N., Munoz, P., & Nash, A. J. (2020). Comparing quality of care in medical specialties between nurse practitioners and physicians. J Am Assoc Nurse Pract, 33(3), 184-193. doi: 10.1097/JXX.0000000000000394
7. Dillon, D., & Gary, F. A. (2017). Full practice authority for nurse practitioners. Nursing Administration Quarterly, 41(1), 86-93. https://www.researchgate.net/publication/312009196