University of Northern British Columbia. Nursing-Family Nurse Practitioner

Depression during the perimenopausal transition is a significant concern for women’s mental health and quality of life. Hormone Replacement Therapy (HRT), traditionally used to manage vasomotor and genitourinary symptoms of menopause, has also been investigated for its potential to alleviate depressive symptoms associated with hormonal fluctuations. This integrative literature review examined the impact of HRT on depression in perimenopausal women by analyzing articles published between 2014 and 2025, reflecting the most recent evidence following shifts in clinical practice post-Women’s Health Initiative. A comprehensive search strategy using Medline (Ovid), CINAHL (EBSCO), PsycINFO (EBSCO), and Google Scholar was employed, utilizing Medical Subject Headings (MeSH) and keywords. Six primary studies met inclusion criteria and were critically appraised and synthesized. Key themes arising out of the studies were the timing of HRT initiation, individual variability in depressive symptom response, and methodological heterogeneity across studies. Findings suggest that HRT, particularly transdermal estradiol, may be effective in reducing depressive symptoms when initiated during early perimenopause. However, inconsistencies in study design, outcome measures, and population definitions highlight the need for more standardized, high-quality research. These findings have implications for nurse practitioners and other primary care providers who play a critical role in screening, education, and patient-centered decision-making in the management of menopausal mental health.

Background: Hypertension affects 1.28 billion individuals globally and is one of the key public health issues in Canada impacting nearly one in four adults. Non-adherence to antihypertensive medications is a major contributor to uncontrolled hypertension and related complications. Objective: To examine the strategies that can be used by primary care providers to improve medication adherence in adult patients with hypertension. Methods: An integrative literature review approach (Toronto & Remington, 2020) was used along with the PRISMA guidelines (2021). A systematic search of CINAHL and Ovid MEDLINE was undertaken. A critical appraisal was conducted using two tools. Results: Six studies met the inclusion criteria. Study designs included randomized controlled trials, observational cohorts, and mixed-methods studies from developed countries. Three key strategies were identified to improve medication adherence in adults with hypertension within primary care settings: patient-centered interventions (e.g., education tools, reminders, self-monitoring); collaborative care strategies involving pharmacists and nurses; and fixed-dose combination therapies. Conclusion: Findings indicate that while several single strategies can support medication adherence in adults with hypertension, primary care providers should use a combination of strategies to achieve the most effective improvements in medication adherence and clinical outcomes.

The aim of this integrative review is to explore how mindfulness training affects postpartum anxiety (PPA) and/or postpartum depression (PPD). PPA and PPD can have negative effects on the postpartum (PP) person and child’s health, and which can result in intrauterine growth restrictions multigenerational repercussions or even perinatal suicide. Mindfulness is defined as the ability to maintain purposeful and intentional attention to the present moment. An emerging theme in the literature is the impact of mindfulness-based interventions on reducing anxiety and/or depression during PP. This integrative review included twelve studies examining the effects of mindfulness training on PPA and/or PPD. All studies reported that mindfulness training was associated with some reduction in PPA and/or PPD. However, findings were inconsistent as three out of the twelve studies found that anxiety and/or depression scores increased between six weeks to four months PP with mindfulness training. These findings highlight the need for further longitudinal, randomized control trials to explore the sustained effects of mindfulness training in this population.

Heart Failure (HF) is a life-limiting condition which causes symptoms beyond the physical manifestations of cardiac dysfunction. HF can significantly impact patients' quality of life (QOL), which is often not addressed in standard regimes of HF care. QOL encompasses the individual's physical, functional, psychological, and social aspects of life. The specialty of palliative care (PC) addresses all these aspects and can significantly improve a patient’s QOL. PC is underutilized for patients with HF due to the non-linear progression of the disease and the general uncertainty of the prognosis. The aim of this integrative review was to explore the impacts of early integration of outpatient PC on the QOL of patients with HF. Findings demonstrate that outpatient PC can positively impact the QOL of HF patients and can be introduced early in the disease process, even when patients are receiving life-prolonging treatment. PC can improve measures of overall QOL, palliative symptom burden, HF symptom burden, and depression in this populations. Primary care providers can implement the early introduction of PC for their HF patients to preserve their QOL despite their current prognosis.

Ovarian torsion is a rare gynecological emergency that occurs when the ovary spontaneously becomes twisted on itself. If not recognized and treated, it can result in tissue necrosis and loss of the ovary. Ovarian torsion most frequently affects women and people with ovaries in their childbearing years, and if oophorectomy is required from missed diagnosis, this can result in decreased fertility of the individual. Due to the broad differential diagnoses present with abdominal pain, ovarian torsion diagnosis is challenging for clinicians. An integrative review of available data was completed to determine factors that impact the diagnosis of ovarian torsion in adult non-pregnant women who present to the emergency department. A literature search was conducted using databases MEDLINE and CINAHL for articles in English and studies published from 2000-2025. A total of 12 papers were reviewed and data extraction completed to ascertain common factors impacting the diagnosis of ovarian torsion. Methods of diagnosis for ovarian torsion include patient history and clinical exam, bloodwork and urinalysis, and imaging via ultrasound and/or computed tomography. There has been improvement in ovarian salvage rate in the last 20 years, possibly due to increased preference for attempting ovarian salvage versus oophorectomy even if ovaries appear dusky on initial exam. No single physical exam or diagnostic can rule out torsion definitively, and care should not be delayed obtaining an ultrasound if high suspicion for ovarian torsion. The gold standard for diagnosis and treatment of ovarian torsion remains operative exploration, and clinicians should not hesitate to involve obstetrics and gynecology promptly when they suspect a patient has ovarian torsion.

The Canadian healthcare system is experiencing significant strain due to a growing and increasingly complex patient population, coupled with provider shortages. Consequently, patients are increasingly seeking emergency room care to address their healthcare needs, further exacerbating the burden on already overwhelmed emergency services. In response, communities in Ontario and Alberta have begun integrating nurse practitioners (NPs) into their emergency settings. This review aims to explore the patient experience of adults receiving NP-led care within the emergency department. Peer-reviewed literature from 2000 to the present were explored using Academic Search Complete, Web of Science, Google Scholar, and Medline OVID. Findings highlighted that NPs enhance the patient experience by fostering patient empowerment and promoting open communication, leading to increased patient satisfaction. Furthermore, NPs improve access to care by reducing wait times, decreasing length of stay, and minimizing instances of patients leaving without treatment. The established public trust in nurses extends to NPs, exhibiting positive patient perceptions of NPs. Despite increasing NP integration, confusion regarding the NP role continues to exist within both patient and healthcare communities, indicating a need for future research to address this ambiguity.

Background Primary care providers face challenges when caring for palliative care patients and their informal caregivers. Many primary care providers have limited understanding and comfort in providing palliative care. The situation is even more complex in rural areas, where access to resources is often challenging. A primary care providers lack of experience can result in inconsistent and inefficient approaches to care. Method This integrative review examines research from CINAHL on palliative care as it affects informal caregivers and their experiences. It focuses on the actions of Primary Care Providers (PCPs) and how their interventions impact informal caregivers. CASP checklists and thematic analysis were used to critically analyze and organize the results. Results The reviewed studies revealed four themes: support, communication and coordination, post-discharge transition, and holistic, person-centred care. The findings suggested that palliative care does not always need to be interventional but can serve as essential supportive care. Conclusion The findings of this review highlight the need for a collaborative team approach in palliative care, which goes beyond the provider-patient dyad. Integrating this approach into palliative care plans can improve care for individuals during palliative care.

Modifiable risk factors for cardiovascular health are often associated with healthy diet, physical activity, and smoking cessation. Rarely is psychological stress mentioned or attributed to cardiovascular disease (CVD). However, the literature is beginning to recognize psychological stress as contributing to an increased risk of CVD (Aggarwal et al., 2021; Rippe, 2018; Walton et al., 2002). Acute stress may impact the autonomic nervous system, increasing heart rate and blood pressure, while chronic stress is associated with inflammation and the development of atherosclerosis (Aggarwal et al., 2021; Ware, 2008). Healthcare guidelines remark on the need to address modifiable risk factors in preventing and treating CVD (British Columbia [BC] Guidelines, 2023; Jain et al., 2022; Pearson et al., 2021). However, the guidelines provide poor directives regarding what intervention a practitioner should use, and how they should use it, to reduce or manage patient stress. Furthermore, implementation of lifestyle interventions can be challenging, and practitioners often face several barriers. Therefore, an integrative literature review was conducted to identify stress-reducing interventions that primary care nurse practitioners (NP) can implement when treating CVD. Nine articles were reviewed utilizing Cooper’s (1982) systematic approach for integrative literature reviews, a method first published in 1982 and frequently cited and used throughout the literature. Randomized controlled trials, cohort studies, and qualitative research were included in this analysis. Unfortunately, this review did not yield conclusive evidence that psychosocial interventions can achieve statistically significant results in the treatment of CVD compared to standard CVD treatment. Nevertheless, the practice recommendations are that psychosocial stress should be assessed and monitored for those with CVD, and that lifestyle interventions should continue to be promoted as adjuncts to traditional treatment regimes.

Cervical cancer incidence continues to rise across Canada. Unlike some other cancers, cervical cancer is largely preventable through a combination of vaccination and routine screening. Cervical cancer screening was introduced in British Columbia in 1955 using the Papanicoulau smear which requires a cervical specimen be obtained during a pelvic exam. However, the pelvic exam has been identified by patients as a barrier to participation in cervical cancer screening. Today, vaginal human papillomavirus testing provides a safe, validated alternative to the Papanicoulau smear. Importantly, the human papillomavirus specimen can be collected by patients themselves using a vaginal swab, thereby removing pelvic exam-related barriers to cervical cancer screening. Specimen self-collection tends to be preferred by patients, however primary care providers' perspectives on its use are not known. Primary care providers, including nurse practitioners, have the potential to impact their patients' health behaviours, and as such, understanding providers' perspectives on the use of self-collection is an important consideration in order to reduce the burden of cervical cancer.

This integrative review examines the growing prevalence of depression, a leading cause of primary care visits in Canada, and the need for accessible treatment options such as telemedicine. Despite substantial evidence supporting the widespread adoption of telemedicine in primary care, including for treating depression, research on patient experiences with telemedicine for depression remains limited. This integrative review aims to explore patients' experiences of using telemedicine for the treatment of depression in primary care to identify areas for enhancing the quality of care. The key findings reveal several themes influencing patient experience: the therapeutic relationship, the environment of care delivery, individualization of treatment approaches, accessibility of telemedicine, and the level of knowledge patients possess regarding telemental health. The findings have implications for primary care providers, including nurse practitioners (NPs), in optimizing the delivery of telemedicine for depression. Limitations of this review include a restricted number of studies that specifically focused on depression. Further investigation is needed to gain a deeper understanding of patient experiences with telemedicine for depression treatment.

Synthesizing the findings from diverse methodologies, this integrative review aimed to guide nurse practitioners (NPs) in supporting the mental health and wellbeing of Syrian adults with refugee experiences in Canada (Syrian Adults). A comprehensive search strategy was conducted in three databases (APA PsycInfo, MEDLINE with Full Text (EBSCO) and Web of Science), Google Scholar and Google Search Engine to identify relevant literature. Twelve publications met the inclusion criteria and were critically appraised. The analysis of these publications led to the identification of four key themes: (1) Correlates and Social Determinants of Mental Health, (2) Cultural and Linguistic Considerations (including the subthemes of Stigma and Perceptions of Mental Distress; and Screening and Self-Report Tools), (3) Non-Clinical Facilitators of Mental Wellbeing, and (4) Trauma and Provision of Trauma-Informed Care. The findings of this integrative review highlight the importance for NPs to build their foundational knowledge to provide comprehensive, culturally appropriate, and trauma-informed care. Key strategies include the use of validated mental health screening tools tailored for Arabic-speaking and/or refugee populations, fostering trust and safety through an awareness of the role of stigma and trauma in mental health care, utilizing interpreters and cultural brokers where appropriate, and assessing social determinants of health during routine assessments. This review also emphasizes the importance of interagency collaboration and ongoing professional development in cross-cultural mental health to support access to care and mental wellbeing for Syrian Adults.

Background: The increasing complexity of trauma care and provider shortages have led to the expanded role of nurse practitioners (NPs). While NPs are integrated into various healthcare settings, their influence on length of stay (LOS) for adult trauma patients remains an area of interest, particularly from a qualitative perspective. Objective: This integrative review explores qualitative findings on how NPs can influence LOS in adult trauma patients, identifying potential contributions such as care coordination, efficiency, and provider workload. Methods: A systematic search of CINAHL, MEDLINE, and Google Scholar was conducted to identify qualitative studies that examined the impact of NPs on LOS in adult trauma care. Using an integrative review approach, data were analyzed to assess how NPs influence LOS. Key themes were synthesized, LOS outcomes were reported, and the generalizability and applicability of the integrative review findings were discussed. Results: Findings suggest NPs contribute to reduced LOS by improving care coordination, enhancing multidisciplinary communication, and facilitating discharge planning. However, the extent of their impact remains unclear due to limited evidence. Conclusion: While NPs are described as valuable members of trauma teams, their specific impact on LOS in adult trauma patients is not well established in the qualitative literature. Further research is needed to explore this relationship and determine whether NP-led interventions can effectively reduce LOS. Keywords: trauma service, trauma center, trauma centre, trauma unit, nurse practitioner, advance practice nurse, trauma nurse practitioner, length of stay, LOS, impact on length of stay, hospital length of stay.

Cervical cancer (CC) remains a major public health concern, disproportionately affecting low-income populations due to barriers in screening and follow-up care. Inadequate follow-up after a positive HPV self-sample result puts individuals at higher risk of disease progression, yet there is limited research on effective follow-up strategies for this group. This integrative review explores interventions aimed at improving adherence to follow-up care in low-income women. A systematic search identified eight studies examining follow-up interventions in lowincome populations. Follow-up rates varied widely (5.6%–92%), with higher adherence observed when multiple follow-up methods were used, such as phone calls, text messages, postal mail, and home visits. Patient education, patient navigation, and the provision of a second self-sampling kit also showed promise in increasing follow-up rates. However, inconsistencies in study methodologies and healthcare settings make direct comparisons challenging. These findings highlight the need for standardized, evidence-based follow-up strategies to address disparities in CC care. Future research should focus on scalable, cost-effective interventions, including mobile health (mHealth) approaches and patient navigation models. Policy efforts should prioritize integrating multi-modal follow-up strategies into national screening programs to improve outcomes for vulnerable populations.

Aim: To explore whether Nurse Practitioner-led outpatient interventions targeting heart failure patients can reduce hospital readmissions or emergency department visits, thereby improving healthcare efficiency and demands on hospitals. Background: Heart failure is a leading cause of hospital readmissions, contributing significantly to healthcare system strain. Despite advancements in HF care, readmission rates remain high, posing substantial clinical and financial burdens. Nurse Practitioners, with their expertise in chronic disease management and holistic care, are well-positioned to address these challenges through proactive, personalized post-discharge care. Method: An integrative review synthesizing most recent evidence on Nurse Practitioner-led outpatient care models for heart failure patients, focusing on their impact on readmissions and emergency department visits. Results: Evidence suggests that Nurse Practitioner-led interventions improve post-discharge continuity of care, reducing preventable readmissions and emergency department visits. These models effectively target key factors contributing to readmissions, including medication adherence, dietary management, patient education, and timely patient follow-ups. Although no ethical concerns were identified, additional rigorous research across diverse populations and settings is necessary to solidify the evidence base and guide widespread implementation. Conclusion: Nurse Practitioner-led care presents a viable and scalable strategy to improve outcomes in heart failure management and alleviate healthcare system pressures. Further research and policy support are crucial to expand and standardize these programs.

The opioid crisis remains a significant public health concern, with fentanyl contributing to 79% of accidental opioid-related deaths in Canada between January and June 2024, nearly a 40% increase since the national surveillance in 2016. Opioid agonist therapy (OAT), using medications such as methadone and buprenorphine, is an evidence-based treatment for opioid use disorder (OUD) that aims to reduce harm and mortality. While OAT is increasingly delivered in primary care to improve accessibility, patient retention in these programs remains a significant challenge. Retention is a commonly used outcome in OUD treatment studies; however, there is no universal definition. This integrative review explores the factors influencing OAT retention among individuals with opioid use disorder in primary care settings. A systematic search of peerreviewed literature published from 2016 to 2024 identified nine U.S.-based studies, including three qualitative and six cohort studies. Findings indicate that comorbid mental health and substance use disorders, along with limited access to psychosocial supports, negatively affect retention. Conversely, low-barrier, trauma-informed, and multidisciplinary care models are associated with improved outcomes. These findings highlight the need for OAT programs to adapt to the complex needs of patients with OUD by providing individualized, flexible, and accessible treatment options. Integrating mental health and addiction care within primary care settings may improve patient engagement and decrease opioid-related harm and mortality.

Metabolic syndrome consists of a combination of abdominal obesity, dyslipidemia, hypertension, and elevated glucose levels. Metabolic syndrome is prevalent in North America with upwards of 20% of adults meeting criteria for the condition. It is associated with increased risk of morbidity and mortality, particularly cardiovascular disease, stroke, and renal failure. Its prevalence and widespread consequences have major implications for overall burden of disease and cost on the health care system. First-line treatments for management of metabolic syndrome and its associated individual components require a multifaceted approach including nonpharmacological therapy. This integrative review seeks to answer the question: “What are effective non-pharmacological interventions nurse practitioners can implement for the management of metabolic syndrome in primary care settings for adult patients?” The Whittemore and Knafl (2005) method was followed to ensure a thorough process to which the findings and conclusion are described. There are few guidelines offering effective means of implementing non-pharmacological management of this disease. This review assesses the literature and identifies 13 articles which address effective non-pharmacological interventions in the management of MetS. These interventions were grouped into four categories including, dietary interventions, exercise interventions, psychological support, and a combined intervention approach. The lengths of intervention varied from 3 months to 5 years. Providers responsible for delivery of the interventions varied and were not limited to nurse practitioners. The outcomes of significance included improved anthropometric and serological measures, as well as improved participant motivation and behaviour change. For optimal outcomes of patients, the management of metabolic syndrome in a primary care setting requires a multifaceted and patient-centred approach.

Osteoarthritis (OA) is the primary form of arthritis that affects a large portion of the Canadian population. With expected increases in OA prevalence over time, the magnitude of outcomes related to inadequate pain control will place further burdens on society and healthcare resources. Pain Coping Skills Training (PCST) is an intervention protocol derived from cognitive behavioural therapy and has traditionally been delivered by clinical psychologists to manage chronic pain related to OA. However, few providers in the primary care setting are trained in PCST. The lack of trained primary care providers creates a barrier to patient access in the community setting, which should be addressed. An integrative literature review has been conducted to identify if primary care providers, who work in primary care settings, can deliver PCST interventions to decrease pain interference and improve quality of life outcomes in adult patients diagnosed with OA. The results are discussed within the context of Canada's primary care practice. Eleven articles were reviewed using Whittemore and Knafl’s approach to the integrative literature review. The results suggest that PCST interventions are both practical and possible among providers that do not possess a background in mental health specialization. Thus, primary care providers are encouraged to obtain educational competency to deliver this effective therapy to manage the adverse psychological effects on chronic pain related to OA. This way, providers can offer a biopsychosocial approach in managing OA while also playing an essential role in improving access to PCST interventions in the primary care setting. Recommendations for facilitating the uptake of PCST interventions are discussed, and specific strategies for its use in primary care are presented.

Chronic pain is a significant problem that negatively affects quality of life resulting in distress, disability, and inappropriate prescription of analgesics. Primary care providers need evidence for non-pharmaceutical tools, such as mindfulness-based intervention, to manage the complexities of chronic pain. The purpose of this integrative literature review is to investigate the impact mindfulness may have on the quality of life of subjects with chronic pain. A background of relevant information is presented regarding chronic pain, quality of life, and mindfulness. Thereafter, a comprehensive search revealed 14 studies in this integrative literature review. Key findings include that there is low to moderate quality evidence that mindfulness improves QOL, especially in the domains of mental well-being. Overall, mindfulness can be an effective tool for individuals that are currently on pharmacological monotherapy. The study concludes with recommendations for future research and practice.

Atrial fibrillation (AF) and heart failure (HF) have a highly interconnected relationship with similar risk factors and shared pathophysiology. They often occur together and are associated with increased morbidity and mortality. Unfortunately, the presence of one condition has implications for the treatment of the other. Guidelines exist for each disease, however, do not provide clarity when treating the conditions together. Due to the complex nature of the combined diseases, management requires a systematic and collaborative approach in primary care settings. The integrative review seeks to explore the following question, “How can the nurse practitioner (NP) best manage HF patients with AF in outpatient settings to help reduce the burden on the healthcare system?” A comprehensive search of the literature was undertaken and 20 articles were selected based on the inclusion criteria. The review findings provide insight into the diverse treatment options available to persons living with concomitant AF and HF. From the literature, catheter ablation, an invasive and specialized procedure, emerged as a superior treatment strategy for patients with combined AF and HF, particularly when compared the pharmacotherapy of rate and/or rhythm control. The management of AF in the setting of HF requires a collaborative approach between primary care providers (PCP) as well as specialists that are able to help manage the population of interest, such as cardiologist and electrophysiologists. Recommendations for practice, education, research, and policy have been made to support the role of PCPs, including NPs, in the management of AF in the HF population.

Type 2 diabetes mellitus (T2DM) is an increasing concern in Canada, with low socioeconomic status being a major risk factor. This review explores strategies to improve food access that promote healthy food choices among people experiencing food insecurity and living with T2DM. Whittemore and Knalf’s (2015) integrative literature review methodology was used to extract and analyse the evidence. Four key strategies emerged: 1) promoting healthy food affordability through incentives and disincentives, 2) understanding effective and ineffective food interventions, 3) enhancing nutritional education in the standard of care, and 4) manifesting empowerment through self-efficacy and diabetes management. These strategies can be applied by nurse practitioners within primary care. Aligned with a population health approach, they can direct practice, education, and research through healthy public policy focused on reducing the incidence of T2DM, particularly in people experiencing food insecurity.

Due to the aging population worldwide, need to access primary health care (PHC) services is increasing. Older adults are at a heightened risk of developing chronic diseases, poor health outcomes, and increased emergency department visits. Living in rural communities also increases the risk of chronicity for older adults due to a lack of PHC resources. However, there is limited information available to provide insight into how healthcare providers can reduce barriers to access to PHC for older adults. As PHC providers, nurse practitioners are in a position to implement strategies to reduce barriers older adults in rural communities face with accessing PHC services. An integrative literature review was conducted to identify barriers nurse practitioners within rural communities can reduce to improve older adults’ access to PHC services. An analysis of the literature revealed the complexity of barriers that prevent older adults from accessing PHC services in rural communities. Environmental, systemic, and individual barriers were reviewed alongside programs and interventions relevant to reducing barriers in the findings. Findings from the literature review suggested strategies to reduce these barriers, which nurse practitioners can promote in the PHC setting. These strategies include virtual care, home visits, nurse practitioner-models of care, interdisciplinary teamwork, and role clarification. In addition to these strategies, implications for practice, limitations of the study and suggestions for future research are discussed.

Heart failure is a chronic, progressive disease that remains on the rise partially due to improvements in preventing cardiac related mortality from other causes. Implanted cardioverter defibrillators are indicated for patients that are at high risk for sudden cardiac death from ventricular arrhythmias (primary prevention), or for those who have survived a cardiac death (secondary prevention). Guidelines suggest simple and easy to follow directions for providers to determine which patients would be eligible to be considered for a device. However, despite national guidelines, research supporting cost effectiveness, and a repeatedly demonstrated reduction in mortality with device therapy, referral and utilization of ICDs remain low, with most of the non-referral and underutilization rates identified within the primary care provider group. In addition, for those patients who do receive ICDs, advanced care planning with consideration of deactivation of the device at end-of-life is rarely completed, leaving many patients at risk of undignified and painful shocks delivered within the last hours to days of life. This integrative review seeks to explore: Primary care management of the heart failure patient requiring an implanted cardioverter defibrillator. A comprehensive search of the literature was undertaken and 15 articles were selected for inclusion This review establishes that ICDs are effective and relatively low-risk devices that have significant mortality benefits, and patients with HF should be screened routinely for eligibility for the device in order to help prevent SCD. Furthermore, patients who receive an ICD should complete an informed advance care directive which includes directions for management of the ICD at end-of-life. ICD management, while often deferred to specialists, requires a collaborative approach and consistent evaluation from the patient’s primary care provider, as it has the potential to influence all aspects of patient’s quality of life, as well as quality of end-of-life care. Recommendations for practice, education, further research, and policy have been made to support the role of primary care providers, such as Nurse Practitioners, in the management of HF patients requiring an ICD.

Anxiety is a mental health condition affecting adolescents with negative side effects and consequences. Primary care providers are faced with a growing number of visits related to adolescent mental health and must be comfortable in assessing and treating the negative symptoms associated with anxiety. With the potential for anxiety to begin in adolescence and worsen in adulthood, a thorough search of the literature was completed to determine ways to help adolescents manage negative symptoms associated with anxiety and improve their coping skills. Mindfulness has been gaining popularity within the mental health community and therefore was chosen as the area of focus to determine how the implementation of mindfulness-based interventions in primary care could alleviate negative symptoms associated with adolescent anxiety. Upon completing the literature review, eight studies were chosen that highlighted how various care providers effectively delivered mindfulness interventions for adolescents experiencing anxiety, primarily within school and outpatient mental health settings. These studies showed trends related to positive effects including improving adolescent anxiety and improvements in other areas of the adolescents’ lives. Additionally, it was found that it was important for primary care providers to reinforce the importance of using a supportive approach including parents or caretakers as this was shown as a protective factor. Although there were no specific studies introducing mindfulness within adolescent primary care, a list of recommendations was developed to provide evidence-based rationale towards integrating mindfulness-based interventions within primary care. By doing so, this provides a foundation for mindfulness-based interventions that primary care providers can utilize to support adolescents in managing their negative symptoms associated with anxiety.

Diabetes is a serious health concern that affects millions of people world-wide. The comorbidities and complications of diabetes are complex and require awareness within the healthcare system. Diabetic retinopathy affects a significant number of patients living with diabetes. Early detection through screening is recognized as the standard of care, in order to assess and monitor for diabetic retinopathy progression. Unfortunately, screening services are not always accessed, especially within the suggested time frames and frequencies. Currently there is limited data regarding the barriers that exist for individuals to access these crucial screening services. An integrative literature review approach was conducted to answer the research question: What strategies can nurse practitioners in the primary care setting use to promote screening for people living with diabetes to reduce their risk and progression to blindness from diabetic retinopathy? Four themes emerged from the findings which provided insight into determinants that affect diabetic retinopathy screening adherence: structural barriers to care, socioeconomic conditions, emotional barriers to accessing healthcare, and knowledge deficits. Discussion of three recommendations for primary care practice focus on: reassessing screening methods and intervals, activity sharing, and providing education. Implications for future research to enhance patient care are outlined.

Primary care providers (PCPs) suffer from high rates of burnout. Burnout is the result of chronic workplace stress. Burnout can significantly impact the PCP’s personal and professional life and can lead to devastating consequences. Literature often addresses organization level strategies to improve burnout rates but there is a dearth of literature focusing specifically on PCP-directed strategies to prevent burnout. Using Whittemore and Knafl’s (2005) method for integrative literature reviews, ten articles were reviewed. Results suggest that PCPs can reduce burnout by building a strong professional community. Additionally, the results suggest that burnout may be prevented by strengthening one’s personal resources via positive emotions. Recommendations for building a strong professional community and strengthening the PCP’s personal resources are discussed and specific strategies PCPs can implement are presented.