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Title: Addressing the mental health of women after sexual assault: the role of follow-up care
Contributors: Lisa Creelman (author), Lela Zimmer (Thesis advisor), Tracey Day (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Sexual assault is associated with debilitating mental health consequences, such as post-traumatic stress disorder (PTSD) and depression, yet a significant gap exists within the literature around the care needed to address these consequences. As a result, this project seeks to answer the question: In adult women of childbearing age who have experienced a recent sexual assault, can access to post-assault follow-up care within two weeks of the assault decrease the prevalence and severity of PTSD and depression? Eligibility criteria for this literature review included research data published in 2004 or later regarding mental health follow-up care for adult women of childbearing age who have experienced sexual assault. The majority of participants within these primary studies included adult women of childbearing age from large urbanized areas. This review utilized an ecological framework that identified individual, personal relationship, community and societal influences that impact the mental health of women after sexual assault while highlighting multi-level strategies aimed at decreasing the emotional distress experienced by women. Utilizing a trauma informed approach to care that encompasses thorough assessment and action orientated care planning, preferably within two weeks of a sexual assault, was suggested to be important for coping with emotional and psychological trauma. Limitations of this project include the retrospective nature of the studies reviewed and their reliance on participant recall or provider documentation practices. Further research is needed to develop multi-level strategies that improve the mental health of women after sexual assault. --Leaf 2.
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-03-29T17:28:48.238Z

$Promoting exercise in postmenopausal women to decrease osteoporotic fracture risk$

Title: Promoting exercise in postmenopausal women to decrease osteoporotic fracture risk
Contributors: Stephanie Borchert (author), Sylvia Barton (thesis advisor), Rosemary Graham (committee member), University of Northern British Columbia (Degree granting institution)
Abstract: Due to the aging Canadian population, the disease of osteoporosis is becoming increasingly prevalent. Postmenopausal women in particular are at heightened risk for osteoporosis due to their depleting estrogen levels and subsequent declines in bone density. Exercise is recognized as a key preventative measure for osteoporosis progression in this at-risk population. However, there is limited information available to provide insight into how health care providers can promote exercise behaviours which help to maintain the muscle strength and bone health of postmenopausal women and decrease the likelihood of osteoporosis related fractures. Nurse practitioners, as primary care providers, are in an ideal position to provide health promotion for the prevention of osteoporosis in their postmenopausal patients. An integrative literature review was conducted to identify which strategies nurse practitioners within the primary care setting can use to promote exercise behaviours in postmenopausal women in order to reduce their future osteoporotic fracture risk.
Discipline: Nursing-Family Nurse Practitioner
Date added: 2019-03-26T21:03:38.583Z

Title: Nursing interventions in the prevention of febrile seizures
Contributors: Rayleen D. Swansen (author), Eileen Owen-Williams (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Febrile seizures are a common childhood problem occurring in two to five percent of children in Western Europe and the United States with a higher incidence reported in underdeveloped countries. Peak incidence occurs between 14-18 months of age. The author's experience when working with the Inuit population in the Eastern Arctic province of Nunavut suggests a high incidence of febrile seizures in young children although the statistics are not available regarding the incidence and prevalence. Community health nurses working in remote health centres are challenged by the uncertainty of which intervention is the most efficacious when treating these children during or following febrile seizures. This uncertainty results in inconsistent interventions, which creates stress and anxiety in both the community health nurses and parents. Despite their frightening presentation febrile seizures usually present as single benign incidents however, once they occur, recurrence may be as high as 50 percent. Due to a lack of treatment guidelines on the prevention of febrile seizures in remote Nunavut communities interventions are often inconsistent. A systematic review of the literature and guidelines were conducted to respond to the questions of whether increased dosages or prolonged use of pharmacological agents as compared to non-pharmacological interventions are more effective in preventing febrile seizures. Using the Stetler Model of research utilization as a framework to promote change recommendations for guidelines were developed. --P.ii.
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-04-10T22:09:57.643Z

Title: Diabetes prevention in primary school-age children
Contributors: Angie Fast (author), Vincent Salyers (Thesis advisor), Amy Klepetar (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: The increasing incidence of type 2 diabetes among primary school-age children is a rapidly growing problem throughout the world. This project was designed to explore the research question: in primary school-age children, does an alternative nutritional education intervention reduce the incidence of type 2 diabetes? A review of literature related to nutritional education for this age group yielded three research studies, one systematic review, and two evidence-based practice guidelines to corroborate alternative nutritional education as a means for potentially reducing the incidence of diabetes among school-age children. As part of this project, Pender's Health Promotion Model was examined to determine if it would be a useful framework for implementing an alternative nutritional educational program within the primary school system in an effort to decrease primary school-age onset of type 2 diabetes. Based on findings from this project, there is evidence that an alternative nutritional education intervention does reduce the incidence and risk of type 2 diabetes in primary school-age children. --P. 2.
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-04-10T22:07:42.166Z

Title: Supporting informal caregivers through the dementia journey: a primary care approach
Contributors: Amanda L. McKnight (author), Catharine Schiller (Thesis advisor), University of Northern British Columbia College of Arts, Social, and Health Sciences (Degree granting institution), Helen Bourque (Committee member)
Abstract: Informal caregivers of persons with dementia often experience significant stressors which may result in detrimental physical, psychological, social, and financial consequences. In order for primary care providers to adequately support this burgeoning group of caregivers a greater understanding of their experiences and needs is essential. This literature review seeks to determine how primary care providers can best support informal caregivers of persons with dementia through the dementia journey. Studies were included that examined the needs or experiences of informal caregivers of persons with dementia. Additionally, studies that examined primary care-based interventions aimed at improving the caregiving experience for these individuals were also included. Four themes... .
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-05-15T16:21:59.066Z

Title: Food insecurity in aboriginal women living with HIV/AIDS: evidence-informed health promotion interventions for family nurse practitioner practice
Contributors: Shannon M. Martens (author), Lela Zimmer (Thesis advisor), Khaldoun Aldiabat (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Food insecurity negatively affects HIV/AIDS populations. The purpose of this integrated literature review is to identify evidence-informed health promotion interventions to prevent and treat food insecurity amongst Aboriginal women living with HIV/AIDS in rural and remote British Columbia, Canada. A comprehensive literature search identified 31 pieces of literature for data analysis. The highest priority identified for family nurse practitioner practice was advocacy for healthy public policy: increase social assistance and the Family Bonus, expand the monthly nutritional supplement to include all with HIV/AIDS, and include remote Aboriginal communities in the Nutrition North Canada Program. The next identified priority was community action initiatives including: community hunter, gardening, and kitchen programs, as well as food banks. Finally, on the individual level, interventions included food insecurity assessment, nutritional counselling, micronutrient supplementation, and addressing depression and addictions. Through utilization of these interventions, family nurse practitioners will be enabled to effectively address food insecurity. --Leaf ii.
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-03-29T17:22:26.294Z

Title: Group appointments & lifestyle coaching to reduce complications of type 2 diabetes in primary care settings
Contributors: Natalie Manhard (author), Vincent Salyers (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Type 2 diabetes is a common illness and affects many people. It will afflict approximately 7 million people yearly and reach epidemic proportions by 2025. This project provides an overview of literature from 1998-2008 supporting group medical appointments as a means for overseeing type 2 diabetes care, with an emphasis of self-management and nurse-practitioner coaching in chronic disease management.
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-04-10T22:04:38.203Z

Title: Effectiveness of physical activity interventions in primary care settings: an integrative litterature review
Contributors: George Wood (author), Linda Van Pelt (Thesis advisor), Jennifer Beaveridge (Thesis advisor), University of Northern British Columbia College of Arts, Social, and Health Sciences (Degree granting institution), Barbara Nielsen (Committee member)
Abstract: Physical inactivity and sedentary lifestyle is a significant problem affecting the overall health of Canadian adults, causing a substantial financial burden on healthcare. Primary care settings are an important component of a multifaceted approach to address this problem. Physical activity (PA) health benefits to improve population health are substantial, but initiating PA health promotion in primary care settings remains a challenge. Primary care providers need effective PA intervention clinical tools to succeed in fulfilling a key role in promoting PA. This integrative literature review explores extant evidence related to PA interventions’ effectiveness. Background knowledge of primary care, health promotion, and PA interventions’ content is presented along with an overview of relevant information on PA. A comprehensive search revealed 13 research articles for analysis. Key findings include evidence on the effectiveness of PA interventions and their components, as well as on the patients and providers’ characteristics associated with increased efficacy. ...
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-05-15T21:02:28.039Z

Title: Reducing barriers to accessing primary care for individuals with severe mental illness: examining characteristics of Canadian nurse practitioner practice
Contributors: Damen DeLeenheer (author), Martha MacLeod (Thesis advisor), Linda Van Pelt (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Individuals with severe mental illness experience reduced access to appropriate and timely primary care. This reduced access has been linked to various barriers and may negatively affect health outcomes. The purpose of this project is to identify the characteristics of nurse practitioner (NP) practice that may reduce the most common barriers to accessing primary care encountered by individuals with severe mental illness. (SMI). The most common barriers to access can be broadly described by three themes and include suboptimal therapeutic relationships, complex service delivery, and stigma. A systematic review of the literature indicated that NPs possess a number of practice characteristics that help overcome barriers to accessing primary care. These characteristics can be described as collaborative practice, a holistic approach, and flexible practice formats. NP practice characteristics have the potential to reduce barriers to care for individuals with SMI and improve access to primary care. --Leaf ii.
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-04-10T22:06:08.65Z

Title: Complementary and alternative therapies: supporting the woman with inadquate milk production
Contributors: Eunice Finch (author), Lela Zimmer (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: While the benefits of breastfeeding are well established, and high initiation rates indicate that women recognize these benefits and wish to provide their infants with the healthiest beginnings, duration rates indicate that women are having difficulty overcoming challenges in the early weeks of breastfeeding. Studies indicate that early breastfeeding cessation is correlated with perceived or actual inadequate milk supply (Lewallen et al., 2006). While the traditional management of insufficient supply during breastfeeding has involved breastfeeding support with particular attention to effectiveness of maternal and infant position, milk transfer, and frequency of feeds, some women may not see improvement in supply from traditional measures. Breastfeeding websites, parenting books, and review articles by breastfeeding professionals suggest the use of complementary and alternative therapies such as acupuncture, herbal medicines, relaxation therapy, aromatherapy, and homeopathy to increase milk supply, however little clinical evidence exists to support the use of such therapies. This literature review summarizes the available data in research and grey literature regarding the use of acupuncture and herbal medicine in managing insufficient milk supply. The majority of evidence supporting the use of acupuncture and herbal medicine in the breastfeeding woman is qualitative and quasi-experimental, with few randomized controlled trials supporting the safety and efficacy of these treatments for increasing milk production in the lactating woman. The role of the nurse practitioner in supporting patients using complementary and alternative therapies is discussed. --Leaf 2.
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-04-10T22:07:41.31Z

Title: Collaborating with palliative care teams to provide end of life care for patients with heart failure
Contributors: Melanie Starzyk (author), Shannon Freeman (thesis advisor), University of Northern British Columbia College of Arts, Social, and Health Sciences (Degree granting institution), Fiona Hutchison (committee member)
Abstract: Advanced heart failure (HF) can be difficult for nurse practitioners (NPs) to manage in primary care due to the unpredictable nature of the condition. Further, barriers that patients with HF experience in regards to receiving end of life (EOL) care hinder NP collaboration with palliative care teams. The goal of the project is to answer: How can NPs working in a primary care setting collaborate with palliative care teams to provide patients who have HF with EOL care? A literature search was conducted using the Cumulative Index of Nursing and Allied Health, PubMed Medline, PsychInfo, Social Work Abstracts and the National Guideline Clearinghouse electronic databases. Evidence was also gathered using backward and forward reference searching, and highly relevant grey literature from the BC Heart Failure Network. The Canadian Interprofessional Health Collaborative (CIHC) framework was used to describe the theoretical underpinnings of this paper by outlining the factors involved to achieve interprofessional collaboration. There were 33 articles retrieved during the literature search to inform how NPs can collaborate with palliative care teams for patients with HF at EOL. There were no articles that answered the research question directly. Instead, barriers and issues for patients with HF receiving EOL care were identified in the findings. Nurse practitioners can collaborate with palliative care teams by addressing the barriers to EOL care for patients with HF that relates to communication, leadership, role clarification, team functioning, and conflict resolution. Nurse practitioners should be encouraged to collaborate with palliative care teams to improve accessibility to palliative care for patients with HF at EOL. Future research is needed to directly inform how collaboration can occur with palliative teams to provide patients who have HF with EOL care.
Discipline: Nursing-Family Nurse Practitioner
Date added: 2019-04-15T20:32:06.053Z

Title: Considering the use of motivational interviewing for nurse practitioner practice with Aboriginal clients
Contributors: Colleen Isaiah (author), Lyle Grant (Thesis advisor), Sylvia Barton (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: The purpose of this scholarly project was to explore how motivational interviewing (MI) as a behaviour change intervention may be used with Aboriginal clients by nurse practitioners (NPs) in primary health care settings. Four systematic peer-reviewed articles with meta-analyses were located through a literature search of 11 databases, annotated, and evaluated for empirical evidence supporting its use in clinical practice by health care professionals. Four themes relevant to the application of MI by NPs were identified across the four articles: dose of MI, target behaviours, practitioner training in MI, and the essential components of MI. Project findings provide support for the use of MI with Aboriginal clients, in order to influence health behvioural change. It is proposed, that based on a potential theoretical fit between MI and Aboriginal concepts of health, such as interconnectedness, balance, and respect. Aboriginal clients might be more receptive of an intervention that is flexible enough to incorporate an Aboriginal worldview. The project concludes with a discussion of the implications MI has for nurse practitioner practice.
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-04-10T22:03:42.951Z

Title: Nurse practitioner use of a family centered care approach to manage childhood obesity in the primary health care setting
Contributors: Colleen Patenaude (author), Martha MacLeod (Thesis advisor), Linda Van Pelt (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Childhood obesity rates are rising at an alarming rate. Obesity has a negative impact on health and well being as well as social development. Obese children have a higher incidence of morbidity and mortality. Current clinical practice guidelines recommend practitioners use a family centered approach to managing childhood obesity. The purpose of this project is to examine the use of a family centered care (FCC) approach in managing childhood obesity in the primary health care setting and determine how best to incorporate it into managing childhood obesity in nurse practitioner (NP) practice. The principles of FCC are reviewed. NP use of existing nursing models such as the McGill model of nursing for guidance in incorporating family centered care into practice is examined and discussed. The research obtained during the literature review indicates using a FCC approach to disease management is effective and can be achieved in the primary health care setting. As a result of the findings, a five step approach to assessing and managing childhood obesity is recommended for NPs practicing in the primary health care setting. --Leaf ii.
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-04-10T22:05:16.282Z

Title: Effects of primary prevention on early childhood caries in Canadian First Nations children ages 0-4 years
Contributors: Shirley Nixon (author), Heather Correale (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Early childhood caries (ECC) in Canadian First Nations (FN) children is at disproportionately high levels compared to the national average. Current literature suggests a paradigm shift in approach to the causes and management of ECC can significantly decrease these levels. The purpose of this paper is to critically analyze the question 'For Canadian First Nations children, ages 0-4, could the introduction of primary disease prevention and self management reduce levels of ECC compared with the present model of care?'
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-04-10T22:09:12.003Z

Title: Nurse practitioners: improving coronary heart disease management in South Asian Canadians
Contributors: Navineet Sahota (author), Davina Banner-Lukaris (Thesis advisor), Susan Johnson (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Coronary heart disease rates are much higher amongst South Asian Canadians than any other Canadian ethnic group. This project asks the question, How will a nurse practitioner implement culturally sensitive coronary heart disease interventions to improve the health outcomes of the South Asian population? To respond to this research question, a literature review and analysis of studies describing various research data, as well as perceptions among the South Asian community, was completed. Evidence suggests that the South Asian population has a genetic tendency to coronary heart disease. More importantly, there are environmental, dietary, and lifestyle factors that might also contribute to this higher incidence. South Asians are underutilizing the traditional health service. Research indicates that health services and treatments are not culturally relevant. Madeline Leininger's theoretical framework, which advocates for the theory of Culture Care Diversity and Universality, is utilized to examine the literature and used to prepare culturally sensitive coronary heart disease interventions for the South Asian population. In this paper, it is argued that implementation of culturally sensitive coronary heart disease interventions delivered by a nurse practitioner can positively influence the management and the outcome of coronary heart disease in the South Asian population. --P. ii.
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-04-10T22:03:41.403Z

Title: Clinical encounters in Canada's northern territories: implications for nurse practitioners working with aboriginal women to promote sexual health
Contributors: Michelle R. Wolsky (author), Martha MacLeod (Thesis advisor), Janet Baillies (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: In Canada's northern territories, nurse practitioners (NPs) play a significant role in the delivery of health care and are often the first and only point of contact as primary health care providers for Aboriginal women. As such, NPs are uniquely situated to work with Aboriginal women in northern communities to address the greater health inequities, incidences of communicable and chronic disease in ways that account for locally specific historical, geographic, economic, social, and cultural contexts. However, it is increasingly evident that clinical encounters between NPs and Aboriginal women in the north are not resulting in improved sexual health outcomes. The intent of this review was to explore the factors influencing why sexual health outcomes for Aboriginal women are not improving. A review of Nursing and Aboriginal peoples' health literature revealed that, while broader colonial contexts inform Aboriginal women's health, there are concrete structural and interpersonal factors that most directly impact clinical encounters. These include how health services are delivered to Aboriginal peoples in Canada, the health policies that govern the delivery of health care to Aboriginal women, and NP clinical practice issues in the north. These factors come together to inform how relationships between NPs and Aboriginal women can and does evolve in clinical settings. What is evident from this review is the importance of NPs becoming aware of the historical complexities and post colonial processes that impact Aboriginal women's health. This awareness will allow NPs to work collaboratively with Aboriginal women to address those mechanisms of delivery, policies, and cultural attitudes that can act as barriers for accessing health care. It is through working collaboratively with Aboriginal women to improve clinical encounters that changes in sexual health outcomes will occur. --P. iii.
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-04-10T22:08:46.266Z

Title: Primary care considerations of miscarriage management
Contributors: Shandalin Marks (author), Lela Zimmer (Thesis advisor), Connie Lapadat (Thesis advisor), University of Northern British Columbia College of Arts, Social, and Health Sciences (Degree granting institution), Victoria Stafford (Committee member)
Abstract: Nearly 1 in 4 women experiencing a miscarriage during their child bearing years. This, coupled with the fact that many health care providers are communicating to these women that this is an insignificant event, has left many women feeling empty and even traumatized. As a result, the research is shows that these women are presenting with clinically high levels of anxiety and depression post miscarriage. Focusing on this, an investigation was undertaken to look at what the existing primary care approaches are to care are for women in their 20s and 30s who are experiencing depression and anxiety after a miscarriage. Using the Cochrane Collaboration method of reviewing, a systematic approach was taken to examine the literature pertaining to the investigation... .
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-05-15T16:21:58.189Z

Title: The influence of osteoporosis education and bone mineral density testing on calcium intake and exercise in young postmenopausal women
Contributors: Sherry Preston (author), Lela Zimmer (Thesis advisor), Heather Correale (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: For postmenopausal women osteoporosis and fracture are a major threat to functional independence and quality of life that has the potential to precipitate the end of life. Calcium, vitamin D and exercise have been shown to increase bone density, reduce falls and prevent fractures. Studies have shown that personal knowledge of bone density has a positive influence on treatment interventions in postmenopausal women yet studies considering the personal knowledge of bone mineral density (BMD) testing on osteoporosis preventative behaviours (OPBs) are less clear. This paper evaluated the influence of education and knowing person knowledge of BMD testing on calcium intake and exercise of young postmenopausal women between the ages of 50-65 years of age. --P. 2.
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-04-10T22:08:39.303Z

Title: The role of nurse practitioners in outreach services and facilitating access for marginalized adult women in British Columbia
Contributors: Jamie L. Tourond (author), Kathy Banks (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Studies show that marginalized adult women experience significant barriers in the process of gaining access to health care in British Columbia. Their needs and risk factors have been studied extensively and much attention has been given to the ways in which the significant inequalities experienced by these women can be addressed. The purpose of this integrative literature review is to understand the role of Nurse Practitioners (NPs) working in outreach services in British Columbia, and to examine ways in which NPs can better facilitate access to health care for marginalized adult women with high-risk lifestyles. Due to the dearth of research on NPs in these practice settings, a review of the health literature was undertaken to identify research that examines the current barriers encountered by marginalized adult women, and the way in which outreach centers might serve as an entry point for access to health care. A rigorous literature search method revealed 18 articles, which were considered appropriate for analysis. The key findings identified the individual and structural barriers to health care access for marginalized women, and emphasized the significant role of outreach centers in facilitating access to health services. The role of NPs in outreach centers is examined by way of a feminist lens, one that is informed by the life experiences of these marginalized women in order to formulate an appropriate, person-centered treatment plan. Nurse Practitioners can facilitate access to health care for marginalized women by fostering a harm reduction philosophy in their practice, by establishing therapeutic relationships with women to overcome the fear and mistrust they have around the health care system and its providers, and by incorporating a person-centered approach to caring for women. Implications for research and education are discussed. --Leaf ii.
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-03-29T17:24:54.853Z

Title: Secondary prevention strategies for increasing physical activity in adults less than 80 years of age with coronary heart disease: what is the evidence for utilization of the transtheoretical model?
Contributors: Sara J. E. Pape-Salmon (author), Eileen Owen-Williams (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Coronary heart disease is a major cause of illness and death in Western countries. Coronary heart disease is associated with significant costs to the patient, society, and the health care system. Patients with coronary heart disease are a priority population for disease management primary health care providers are encouraged to focus on patients with coronary heart disease. Secondary prevention of major cardiovascular disease is recognized as a key component of a cost-effective public health strategy to reduce the rising burden of this disease. A sedentary lifestyle has been identified as an independent modifiable risk factor for coronary heart disease. Effective strategies for increasing physical activity in individuals with coronary heart disease have been acknowledged as successful secondary prevention interventions. This project is a systematic review of the literature to determine whether utilization of individualized behavioural counseling based on the Transtheoretical Model to increase physical activity in adults with coronary heart disease is effective. Systematic review of the literature provided evidence that supports the utilization of the Transtheoretical Model to understand predictors of physical activity, and its use in counseling approaches to increase physical activity in aduults with coronary heart disease or modifiable risk factors for coronary heart disease.
Discipline: Nursing-Family Nurse Practitioner
Date added: 2017-04-10T22:16:19.682Z

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