Journal of Pediatric Health Care - Articles in Press

Cytogenetic Evaluation: A Primer for Pediatric Nurse Practitioners - Corrected Proof

Ann-Leslie Zaslav, Marie Ann Marino, Corrine Y. Jurgens, Theresa Mercado — 2012-05-17

Abstract: Patients with genetic disorders require specific types of cytogenetic testing for accurate diagnosis and prognosis followed by prompt treatment. This primer will serve as a guide for pediatric nurse practitioners on the use of various cytogenetic testing for the diagnosis of genetic disorders. Knowledge of the latest cytogenetic technologies will facilitate diagnosis and counseling related to genetic abnormalities such as inherited disorders, mental retardation, developmental delay, and autism. This reference will enable pediatric nurse practitioners to help identify patients with various inherited genetic disorders and provide subsequent monitoring and treatment.

Development of a Hospital-Based Care Coordination Program for Children With Special Health Care Needs - Corrected Proof

Janine M. Petitgout, Daniel E. Pelzer, Stacy A. McConkey, Kirsten Hanrahan — 2012-05-11

Abstract: A hospital-based Continuity of Care program for children with special health care needs is described. A family-centered team approach provides care coordination and a medical home. The program has grown during the past 10 years to include inpatients and outpatients from multiple services and outreach clinics. Improved outcomes, including decreased length of stay, decreased cost, and high family satisfaction, are demonstrated by participants in the program. Pediatric nurse practitioners play an important role in the medical home, collaborating with primary care providers, hospital-based specialists, community services, and social workers to provide services to children with special health care needs.

Acute Care Pediatric Nurse Practitioner: A Practice Analysis Study - Corrected Proof

Karin Reuter-Rice — 2012-05-11

Abstract: Introduction: It is the responsibility of certification organizations to provide psychometrically sound and legally defensible examinations. Practice research serves as the certification framework for validating advanced practice roles and updating national qualifying examinations. This national study describes the practice of the acute care pediatric nurse practitioner (ACPNP) since the inception of the certified pediatric nurse practitioner-acute care (CPNP-AC) examination in 2005.Method: A descriptive analysis of the 2009 practice survey of U.S. ACPNPs (291 respondents) was performed.Results: Most ACPNP respondents were White women; the mean age was 40 years, and 47.9% had been formally educated as ACPNPs. More than 40% practiced in the Midwestern United States. Most respondents (86.2%) practiced in urban areas. Respondents reported spending 71% of practice time in inpatient settings. The most frequently cited areas of practice were critical care (27.5%), followed by emergency department (10.7%) and specialty practices.Discussion: In light of recent advanced practice regulatory role distinctions, this re-examination of the ACPNP practice 5 years after initiation of the CPNP-AC certification examination demonstrates changes in clinical practice and educational preparation requirements.

Care Coordination for Children With Complex Special Health Care Needs: The Value of the Advanced Practice Nurse's Enhanced Scope of Knowledge and Practice - Corrected Proof

2012-05-07

Abstract: Efficiency and effectiveness of care coordination depends on a match between the needs of the population and the skills, scope of practice, and intensity of services provided by the care coordinator. Existing literature that addresses the relevance of the advanced practice nurse (APN) role as a fit for coordination of care for children with special health care needs (SHCN) is limited. The objective of this article is to describe the value of the APN's enhanced scope of knowledge and practice for relationship-based care coordination in health care homes that serve children with complex SHCN. The TeleFamilies project is provided as an example of the integration of an APN care coordinator in a health care home for children with SHCN.

Parental Experiences Transitioning Their Adolescent With Epilepsy and Cognitive Impairments to Adult Health Care - Corrected Proof

Rebecca J. Schultz — 2012-05-07

Abstract: Introduction: The objective of this study was to explicate processes that parents of adolescents with epilepsy and cognitive impairments undergo as they help their adolescents transition to adult health care.Method: A qualitative grounded theory methodology was used in this study. Theoretical sampling techniques were used to recruit seven ethnically diverse parents of adolescents 18 years or older with epilepsy and cognitive impairments from the community in a large metropolitan area in the southern United States. Data collection and analysis occurred simultaneously using coding and constant comparison analysis.Results: The substantive theory Journey of Advocacy was developed from interviewing the participants. The theory has five categories: crisis sparks transition, parents in turmoil, parents as advocates, web of information, and captive waiting. Parents emerged as strong advocates in the transition process.Discussion: Transitioning this group of adolescents to adult health care was an unplanned, complex, multisystem process. This study affirms the need to develop a transition program that acknowledges the unique challenges of transitioning adolescents with cognitive impairments and the interrelationship between these parents and other systems.

How Much Milk Is Too Much? A Case Study of an Obese Toddler - Corrected Proof

Barbara Gray, Maria C. Reyes, Lori L. Conners — 2012-05-04

Jo Ann Serota, DNP, RN, CPNP

Acute and Non-Acute Lower Extremity Pain in the Pediatric Population: Part III - Corrected Proof

Allison D. Duey-Holtz, Sara L. Collins, Leah B. Hunt, Polly F. Cromwell — 2012-04-26

Robert J. Yetman, MD

Evaluation of Methods to Relieve Parental Perceptions of Vaccine-Associated Pain and Anxiety in Children: A Pilot Study - Corrected Proof

Karlen E. Luthy, Renea L. Beckstrand, Amy Pulsipher — 2012-04-26

Abstract: Introduction: The pain and anxiety associated with vaccination is a significant reason why parents are reluctant to have their children vaccinated. Distraction methods and vapocoolant sprays may be use to modify the parent's perceptions of their child's pain and anxiety, thus encouraging parents to return for the child's next vaccination.Methods: A convenience sample of 68 parents with children ranging in age from 2 to 12 years was selected. The parents and the child were randomly assigned to three groups: a control group, a DVD distraction group, or a vapocoolant spray group. After the child was vaccinated, parents evaluated the child's pain and anxiety.Results: No significant difference in the parents' perception of their child's pain or anxiety was found between the two treatment groups compared with the control group. Some parents expressed the desire to be able to choose the type of distraction method their child received rather than having them randomly assigned to a group.Discussion: Although quantitative results were not statistically significant in this pilot study, parents commented that the DVD distraction method seemed helpful before and/or after vaccination, but not during vaccination, and parents appreciated the distraction. Parents, however, would prefer to choose the intervention rather than being randomly assigned to a group. The effectiveness of interventions with regard to parental perceptions of pain or anxiety warrants further study.

The Effect of the Internet on Teen and Young Adult Tobacco Use: A Literature Review - Corrected Proof

Susan R. Forsyth, Christine Kennedy, Ruth E. Malone — 2012-04-23

Abstract: Research has shown that a positive association exists between exposure to smoking imagery, such as that found in movies and print advertising, and the subsequent uptake of cigarette smoking. Children appear to be especially vulnerable to advertising messaging and other positive portrayals of smoking, given that most adult smokers develop the habit before age 18 years. Although many traditional types of media have been studied, the current generation of youth is growing up as digital natives, with young people increasingly using the Internet for entertainment and to obtain information. Currently the Internet is an essentially unregulated marketplace of ideas and images. However, the effect of the Internet on teen smoking initiation has received little attention in studies. In this literature review, we summarize and critique the existing work, identify current knowledge gaps, and offer suggestions to health care providers about how to address this issue.

Understanding Motivations for Abstinence Among Adolescent Young Women: Insights Into Effective Sexual Risk Reduction Strategies - Corrected Proof

2012-04-23

Abstract: Introduction: Pregnancy and sexually transmitted infections pose a significant threat to the health and well-being of adolescent women. Abstinence, when practiced, provides the most effective means of preventing these problems, yet the perspective of abstinent young women is not well understood. The purpose of this investigation was to characterize female adolescents' motivations for abstinence.Method: As part of a larger, cross-sectional quantitative study investigating predictors of HIV risk reduction behaviors, qualitative responses from study participants who never had intercourse were analyzed in a consensus-based process using content analysis and frequency counts. An urban primary care site in a tertiary care center served as the setting, with adolescent young women ages 15-19 years included in the sample.Results: Five broad topic categories emerged from the data that characterized motivations for abstinence in this sample: personal readiness, fear, beliefs and values, partner worthiness, and lack of opportunity.Discussion: A better understanding of the motivations for abstinence may serve to guide the development of interventions to delay intercourse.

Facilitating Pediatric Patient-Provider Communications Using Wireless Technology in Children and Adolescents With Sickle Cell Disease - Corrected Proof

2012-03-26

Abstract: Introduction: Use of wireless devices has the potential to transform delivery of primary care services for persons with sickle cell disease (SCD). The study examined text message communications between patients and an advanced practice registered nurse (APRN) and the different primary care activities that emerged with use of wireless technology.Methods: Patients (N = 37; mean age 13.9 ± 1.8 years; 45.9% male and 54.1% female) engaged in intermittent text conversations with the APRN as part of the Wireless Pain Intervention Program. Content analyses were used to analyze the content of text message exchanges between patients and the APRN.Results: The primary care needs that emerged were related to pain and symptom management and sickle cell crisis prevention. Two primary care categories (collaborating and coaching), four primary care subcategories (screening, referring, informing, and supporting), and 16 primary care activities were evident in text conversations.Discussion: The use of wireless technology may facilitate screening, prompt management of pain and symptoms, prevention or reduction of SCD-related complications, more efficient referral for treatments, timely patient education, and psychosocial support in children and adolescents with SCD.

Cyanotic Episodes in an Infant With Known Situs Inversus: Indications for an Apparent Life-Threatening Event Evaluation - Corrected Proof

Macallagh J. McEvoy — 2012-03-12

Karin Reuter-Rice, PhD, CPNP-AC, FCCM

Family Communication Patterns and Teen Drivers’ Attitudes Toward Driving Safety - Corrected Proof

2012-02-24

Abstract: Introduction: Family communication patterns (FCPs) play an important role in reducing the risk-taking behaviors of teens, such as substance use and safer sex. However, little is known about the relationship between family communication and teen driving safety.Method: We analyzed the baseline data from a randomized trial that included 163 parent-teen dyads, with teens who would be receiving their intermediate driver’s license within 3 months. FCPs were divided into four types—pluralistic, protective, consensual, and laissez-faire—and were correlated with the frequency of parent-teen discussions and teens’ driving safety attitudes.Results: The ratings on four types of FCPs were distributed quite evenly among teens and parents. Parents and teens agreed on their FCP ratings (p = .64). In families with communication patterns that were laissez-faire, protective, and pluralistic, parents talked to their teens less about safe driving than did parents in families with a consensual communication pattern (p < .01). Moreover, the frequency of parent-teen communication about safe driving was positively associated with teen attitudes toward safe driving (adjusted β = 0.35, p = .03).Discussion: Health care providers need to encourage parents, particularly those with non-consensual FCPs, to increase frequency of parent-teen interactions.

Using Reminder/Recall Systems to Improve Influenza Immunization Rates in Children With Asthma - Corrected Proof

Sorelle N. Jones Cooper, Benita Walton-Moss — 2012-02-10

Abstract: Introduction: Asthma is a major public health concern in the U.S. pediatric population. Children with asthma tend to fare worse when they acquire respiratory illnesses such as influenza, requiring more episodic office visits and hospitalizations than do healthy children with the same illnesses. Despite the American Academy of Pediatrics recommendation that children with chronic diseases be immunized for seasonal influenza annually, influenza immunization rates in this population peaks at < 30%. The purpose of this literature review was to examine the effectiveness of reminder/recall systems in improving influenza immunization rates among children with asthma.Method: This literature review was conducted using PubMed, CINAHL, EMBASE, and Cochrane. Of the 178 articles found, 12 met criteria for inclusion. Articles were included if they addressed influenza vaccination in asthmatic children and “high-risk” children and considered asthmatics in the definition of “high risk.” Additionally, inclusion criteria required discussion of at least one mode of reminder method or recall method that was used to influence the rate of influenza vaccination in children with asthma. For the purposes of this review, “reminders” is defined as any action performed by health provider or representative of the health provider that was aimed at informing and/or reiterating to patients the importance of influenza vaccination for asthmatic children and/or the potential for increased morbidity with acquisition of the flu and/or availability of the vaccine. “Recall” methods included all efforts made by the health provider or his/her representative to encourage patients to return to clinics for vaccination during the influenza season. Articles were excluded if they focused on improving influenza vaccination rates in healthy children and if they used reminder/recall systems to influence vaccination against diseases other than influenza. No systematic review was found on this particular topic.Results: Providers have used reminder and recall systems that alert patients of the need for vaccination and encourage compliance with this recommendation. Implemented techniques included verbal and mailed reminders, electronically generated alerts, and year-round scheduling of flu vaccination appointments.Discussion: Improvements have been seen in influenza immunization rates with the implementation of reminder/recall systems; however, most have been modest. Enhancements in patient education and access to vaccination are other areas of needed improvement.

Medical Home and Pediatric Primary Care Utilization Among Children With Special Health Care Needs - Corrected Proof

2012-01-16

Abstract: Introduction: The medical home model seeks to improve health care delivery by enhancing primary care. This study examined the relationship between the presence of a medical home and pediatric primary care office visits by children with special health care needs (CSHCN) using the data from 2005-2006 National Survey of Children with Special Healthcare Needs.Method: Survey logistic regression was used to analyze the relationship.Results: When CSHCN age, gender, ethnicity/race, functional status, insurance status, household education, residence, and income were included in the model, CSHCN with a medical home were 1.6 times more likely to have six or more annual pediatric primary care office visits than were children without a medical home [odds ratio = 1.60, 95% confidence interval = (1.47, 1.75)]. Female CSHCN, younger CSHCN, children with public health insurance, children with severe functional limitations, and CSHCN living in rural areas also were more likely to have a larger number of visits.Discussion: By controlling for child sociodemographic characteristics, this study provides empirical evidence about how medical home availability affects primary care utilization by CSHCN.

Childhood Obesity and Dental Caries in Homeless Children - Corrected Proof

Sheau-Huey Chiu, Marguerite A. DiMarco, Jessica L. Prokop — 2012-01-13

Abstract: Introduction: Childhood obesity and dental caries are increasing epidemics, especially among children who are living below the poverty level. This study was conducted to determine the relationship between body mass index (BMI) and caries in homeless children.Methods: A secondary data analysis with a correlational design was used. A convenience sample of 157 children was recruited from a homeless shelter.Results: Pearson’s and partial correlations were used to explore the relationships among age, BMI, and caries. Most of the children were girls and were African American. Slightly more than half of the children were overweight (19.7%) or obese (30.6%) and had caries (50.3%). Significant positive correlations between age and BMI (p = .03) as well as between age and caries (p = .003) were found. As BMI increased, so did caries (p = .08).Discussion: Consistent with reports from the Centers for Disease Control and Prevention, homeless children had higher BMI and caries rates than the national averages. Although a definitive conclusion between obesity and dental caries cannot be drawn, these two health issues are important areas for all pediatric health care providers to address at every visit.

Maternal Health Needs and Interest in Screening for Depression and Health Behaviors During Pediatric Visits - Corrected Proof

Lorraine O. Walker, Eun-Ok Im, Diane O. Tyler — 2012-01-13

Abstract: Introduction: Our aims were to assess postpartum health care barriers; health status (including depression and health behaviors); missed opportunities to discuss maternal health at health visits; acceptability of maternal screening in pediatric settings; and association of these variables with income level and race/ethnicity.Method: A mail survey was used with names randomly drawn from birth files and balanced for race/ethnicity and income level.Results: The adjusted response rate was 27.6%, with 41% reporting one or more health care barrier(s), 22% screening positive for depression, and 30% screening positive for alcohol abuse. Women of lower income were eight times more likely than those of higher income to have health care barriers (adjusted odds ratio = 8.15; 95% confidence interval: 3.60, 18.44). Missed discussions of postpartum depression or behavioral health during pediatric or other health care visits ranged from 26% to 79%. Acceptability of discussing topics, including depression, smoking, and alcohol use at pediatric care visits generally exceeded 85%.Discussion: Postpartum women experienced income-associated barriers to health care and generally had favorable views about maternal screening in pediatric settings.

Modifiable Family Factors Among Treatment-seeking Families of Children With High Body Mass Index: Report of a Pilot Study - Corrected Proof

2012-01-09

Abstract: Purpose: The purpose of this pilot study was to explore parenting style and other potential family and social indicators of an obesogenic or weight-promoting family environment. Modifiable factors were sought on which to base a nursing behavioral intervention that could be combined with diet and exercise to reduce youth weight.Methods: Twenty-eight parents and their 9- to 18-year-old children who were seeking care for overweight responded to in-home surveys to characterize parenting style (warmth/responsiveness and control). We also examined the extent to which parent modeling of health behavior, child feeding practices, parent knowledge of nutrition, and family social characteristics differed by the control aspect of parenting style.Results: Nearly all youth and parents reported substantial parental love (responsiveness), suggesting little variability in the warmth aspect of parenting style. In contrast, considerable variability was found in the control (moderate versus high) aspect of parenting style. Large effect sizes indicated that mothers with moderate control perceived their lifetime weight to be higher, had more concern about their youth’s weight (p = .03), had better knowledge of nutrition, and had a lower body mass index (p = .02) than did mothers with high (firm or restrictive) control. Moderate effect sizes indicated that mothers with moderate control demonstrated better modeling behavior, higher perception of youth weight, practiced less pressure to eat, and had youth with lower body mass index and percent body fat than did mothers with high (firm or restrictive) control. Families who volunteered for the study kept their data gathering appointments, but we recommend a recruitment period of more than 4 months and the inclusion of several referral sites.Discussion: Further study of how parent control is related to youth overweight and how appropriate control can be achieved among families with teens who are overweight is recommended.

Novice to Expert: The Evolution of an Advanced Practice Evaluation Tool - Corrected Proof

2012-01-09

Abstract: Professional performance evaluation provides an opportunity to measure the practice of health providers within healthcare settings. Standardized evaluation can be challenging as a result of diverse practice arenas, multiple evaluators and standards of care. Using Benner’s novice to expert model, a Performance Excellence and Accountability tool (PEAC Tool©) has been designed to measure advanced practice providers performance based upon facets of professional practice. This article discusses development, practical implementation and evaluation of a PEAC Tool©.

Newborn With an Absent Red Reflex - Corrected Proof

2011-12-26

Jo Ann Serota, MSN, RN, CPNP

The Routine Use of Chest Radiographs After Chest Tube Removal in Children Who Have Had Cardiac Surgery - Corrected Proof

Cathy S. Woodward, Donna Dowling, Richard P. Taylor, Carol Savin — 2011-12-19

Abstract: Background: It is routine to obtain a chest radiograph (CXR) after removal of a chest tube (CT) to assess for pneumothorax. Retrospective studies have shown that clinical signs were present in most children with pneumothorax and were an indication for a CXR.Objective: Our objective was to determine if clinical indicators of pneumothorax are sufficient predictors of the need for CT reinsertion in children who have had a CT removed after cardiac surgery.Methods: The prospective study included a physical assessment before CT removal, using a two-person technique, which was repeated 2 hours after CT removal. Based on assessment findings, a decision was made regarding whether a CXR was indicated. The routine CXR was then obtained and read by a pediatric intensivist who was blinded to the decision of the investigator.Results: Sixty CTs were removed in 53 children. No false-positive predictions were made, because none of the children was predicted to have a pneumothorax requiring chest tube reinsertion, and none developed a significant pneumothorax (95% confidence interval: 0, 5%).Conclusions: The low rate of pneumothoraces in this study may be been related to how the CT was placed in surgery, the type of CT used, or the method of removal. In this study the risk of developing a pneumothorax requiring CT reinsertion after CT removal was at most 5% and therefore low enough to consider obtaining a CXR for symptomatic children only.

The Asian American Family and Mental Health: Implications for Child Health Professionals - Corrected Proof

Jeena Jacob, Barbara Gray, Ann Johnson — 2011-11-18

Abstract: The Asian American community has grown significantly in the United States during recent decades. The culture of their countries of origin as well as the society in which they currently live plays a pivotal role in their reaction to mental health and illness. Mental health issues are increasingly evident in Asian American communities. The need for the delivery of culturally competent health care and mental health services is paramount. A culturally competent framework that includes the use of a cultural competence model for practice can guide the health care provider in the recognition of problems, particularly in the children of Asian American families.

Pain and Decreased Vision in a Teenager - Corrected Proof

2011-11-17

A 14-year-old girl presents with pain and decreased vision in the right eye of 1 day’s duration. She is now unable to open the eye because of extreme pain and photosensitivity. The affected eye is tearing profusely and is producing mucoid discharge. The patient removed her contact lenses and put contact lens wetting solution in the eye, but the symptoms persisted. She put her contact lenses back in, which made the eye feel slightly better. However, by evening, her eyesight was very blurred and the eye was light sensitive, and she again removed her contact lenses. Upon waking this morning, she was unable to open the right eye because of extreme pain and light sensitivity and had very poor vision.

Stress and Quality of Life in Caregivers of Inner-city Minority Children With Poorly Controlled Asthma - Corrected Proof

2011-11-17

Abstract: Introduction: Caregiver quality of life (QOL) is known to influence asthma management behaviors. Risk factors for low caregiver QOL in families of inner-city children with asthma remain unclear. This study evaluated the interrelationships of asthma control, stress, and caregiver QOL.Method: Data were analyzed from a home-based behavioral intervention for children with persistent asthma after treatment for asthma in the emergency department. Caregivers reported on baseline demographics, asthma control, asthma management stress, life stress, and QOL. Hierarchical regression analysis examined the contributions of sociodemographic factors, asthma control, asthma management stress, and life stress in explaining caregiver QOL.Results: Children (N = 300) were primarily African American (96%) and young (mean age, 5.5 years). Caregivers were predominantly the biological mother (92%), single (70%), and unemployed (54%). Poor QOL was associated with higher caregiver education and number of children in the home, low asthma control, and increased asthma management stress and life stress. The model accounted for 28% of variance in caregiver QOL.Discussion: Findings underscore the need for multifaceted interventions to provide tools to caregivers of children with asthma to help them cope with asthma management demands and contemporary life stressors.

Provider Use of Corrected Age During Health Supervision Visits for Premature Infants - Corrected Proof

2011-10-28

Abstract: Introduction: Correcting age for prematurity is recommended by the American Academy of Pediatrics and the Centers for Disease Control and Prevention. The use of chronological age instead of corrected age for infants born prematurely may result in incorrect interpretations regarding the adequacy of a child’s growth or developmental progress and has the potential to negatively affect care. This study examined the frequency and impact of the use of corrected age by primary care providers.Method: A retrospective cross-sectional electronic health record review was performed for all infants < 32 weeks’ gestation who were seen for a health supervision visit in a 31-site pediatric network during a 1-year period. Primary care providers used an electronic health record that defaulted to chronological age information.Results: Primary care providers used corrected age for developmental surveillance for 24% of visits, they used chronological age for 71% of visits, and the age used was unclear in 5% of visits. The lower a child’s gestational age and the more that chronological age was used, the more concerns were identified by primary care providers. Dietary changes that included the introduction of solid foods, the start of fluoride, and the introduction of milk typically were recommended on the basis of chronological age.Discussion: Primary care providers used chronological age more than corrected age, which influenced assessment and recommendations for care. This study illustrates the impact of not using corrected age, the importance of ensuring that care aligns with guidelines, and the possible influence of the design of the electronic health record on patient care. Because families of premature infants rely on primary care providers to accurately identify sequelae associated with prematurity, and to provide reassurance when it is warranted, these findings have implications for all health care providers who treat premature infants.

Guideline-based Educational Intervention to Decrease the Risk for Readmission of Newborns With Severe Hyperbilirubinemia - Corrected Proof

Julee B. Waldrop, Christina K. Anderson, Debra H. Brandon — 2011-10-24

Abstract: Introduction: The purpose of this study was to determine if educational intervention with medical providers in combination with a management tool to facilitate clinical guideline usage would (a) increase quality of care, (b) increase compliance with published guidelines, and (c) decrease hospital readmissions as a result of hyperbilirubinemia in the first week of life.Method: A quality improvement initiative was undertaken with a preintervention/postintervention design.Intervention: An educational intervention was offered to persons who provide medical care to newborns. The charts of newborns were reviewed before and after the intervention in three samples: a care quality sample (N = 244), a compliance sample (N = 240), and a readmission sample.Results: In the quality care sample, documentation of three quality care indicators improved significantly and one worsened significantly. In the compliance sample, the percentage of infants who were given appropriate follow-up appointments in primary care based on their hyperbilirubinemia risk at discharge improved (p = .03), and the readmission rate of newborns within the first week of life as a result of hyperbilirubinemia decreased by 50%.Discussion: An educational intervention with a clinical tool may help change provider practice. Longer follow-up is needed to determine if the impact is sustainable.

Microcephaly, Lymphedema, Chorioretinal Dysplasia (MLCRD) Syndrome - Corrected Proof

Maria N. Kelly, Nausheen Khuddus, Silus Motamarry, Sanjeev Tuli — 2011-10-10

Jo Ann Serota, MSN, RN, CPNP

Accountable Care Organizations: Advocating for Children and PNPs Within New Models of Care - Corrected Proof

Mary L. Chesney, Linda L. Lindeke — 2011-10-10

Karen G. Duderstadt, PhD, RN, CPNP

Health-related Quality of Life, Depression, and Metabolic Parameters in Overweight Insulin-resistant Adolescents - Corrected Proof

2011-10-04

Abstract: Introduction: The purpose of this study was to examine the incidence and severity of depression and health-related quality of life (HRQoL) in youth with insulin resistance (IR) who are overweight/obese and to examine the impact on making lifestyle changes.Method: New patients presenting for treatment in an IR clinic were screened for depression and HRQoL and reassessed twice during a 1-year treatment period. Metabolic and growth parameters were obtained for each participant.Results: Elevated symptoms of depression were reported in 51% of the sample, and these symptoms were stable over time. Approximately 10% of these youth reported moderate or severe symptoms of depression. HRQoL scores indicated a good quality of life overall with slight improvement in some areas over time. Depression scores were not associated with demographic variables or metabolic parameters.Discussion: More than 50% of adolescents with IR and obesity reported elevated symptoms of depression. These results provide sufficient evidence for the need to conduct routine screening of depression for all youth with IR so that appropriate mental health referrals can be made.

Maladaptive Eating Patterns in Children - Corrected Proof

Sarah A. Wildermuth, Glenn R. Mesman, Wendy L. Ward — 2011-09-29

Abstract: Given the increasing frequency of obesity and related maladaptive eating patterns in pediatric populations, health care professionals in a variety of settings must find ways to treat persons who are obese and have maladaptive eating patterns. The authors summarized literature related to binge eating disorder, boredom eating, emotional eating, and night eating syndrome and developed educational handouts designed for children/adolescents and their families who present with these eating problems. These educational handouts may be used by primary care physicians, psychologists, psychiatrists, nurses, and other specialists in medical settings. They are free for use in educational purposes, with permission from the authors, but are not intended to replace appropriate health care and follow-up.

Anticipatory Guidance Preferences of Latina Migrant Farmworker Mothers - Corrected Proof

Jill F. Kilanowski — 2011-09-29

Abstract: Introduction: The purpose of the study was to learn preferences of Latina migrant farmworker mothers regarding the presentation of health education materials by discussing the strengths and weaknesses of numerous mixed-media samples.Method: This community-based participatory study was qualitative and descriptive in design. Focus groups were conducted in Spanish in four Midwest migrant camps with a convenience sample of mothers (N = 31). Adult learning and cultural care theories guided the study. Various modes of educational materials on various topics were presented.Results: Mothers preferred comic book-style handouts, games, food replicas, text in English/Spanish, and digital video discs or digital versatile discs, but almost none of them had media-playing equipment. They did not like black-and-white photos or cartoon-like illustrations. Identified themes of importance were colored illustrations, sizes mothers could easily carry in purses, and limited verbiage on a page.Discussion: The knowledge gained in this study will be used to customize health promotion interventions that are sensitive to migrant farmworker-preferred learning styles. The findings from this study can inform other interventions with Latino populations and serve as a prototype for other populations of immigrant non–English-speaking mothers.

Use of Prevention and Prevention Plus Weight Management Guidelines for Youth With Developmental Disabilities Living in Group Homes - Corrected Proof

Elizabeth F. Gephart, Deborah G. Loman — 2011-09-12

Abstract: Introduction: Prevention and Prevention Plus strategies for weight management were implemented for youth with developmental disabilities living in community group homes at a Midwestern educational/residential center.Methods: Caregiver staff were provided with weight management education, a communication tool for youth weight indices, weight and physical activity goals, dietary orders, and monthly follow-up communication. This 4-month study examined changes in weight indices, nutrition, physical activity, and staff perceptions of youth status using t tests, χ2 tests, and Wilcoxon signed-rank tests.Results: A significant decrease in mean body mass index percentile was found (t(39) = 2.93, p < .01, 95% confidence interval 1.29 to 7.04) that was primarily from change in the healthy weight category. More than 80% of the 40 youth achieved their weight goal. A significant improvement in daily fruit consumption ( p = .001) and vegetable consumption ( p < .001) was reported.Discussion: These prevention strategies are useful to promote staff understanding of dietary goals for weight management in youth with developmental disabilities living in group homes and should be incorporated into practice by health care providers. Additional efforts are needed to increase physical activity during the winter months.

National Asthma Education Prevention Program: Survey of Nurse Practitioners’ Knowledge, Attitudes, and Behaviors - Corrected Proof

2011-09-12

Abstract: Introduction: Much has been written regarding poor physician adherence to the National Asthma Education, Prevention Program (NAEPP) guidelines, but no data are available regarding nurse practitioners (NP) adherence. This descriptive study compared NP adherence to figures reported for medical doctors (MDs) in the 2001 and 2007 analyses by Cabana and colleagues.Method: A national, cross-sectional survey approach was used to assess NP knowledge, attitudes, and behaviors regarding the NAEPP guidelines. The survey was adapted from Cabana’s 48-item questionnaire.Results: NPs provided more prescriptions of inhaled corticosteroids (ICSs) to patients with daily symptoms than did physicians (NPs, 79%; MDs, 54%). Overall, compared with MDs, NPs reported higher adherence on three of the four NAEPP guideline components surveyed, two of which were statistically significant.Discussion: This survey suggests that NPs have greater adherence to prescribing ICSs than do MDs. However, improved adherence still needs to be a goal for all providers because prescription of ICSs is the cornerstone of management of persistent asthma.

Prenatal Parent Education for First-Time Expectant Parents: “Making It Through Labor Is Just the Beginning…” - Corrected Proof

Christine A. Ateah — 2011-08-19

Abstract: Introduction: The purpose of this pilot project was to determine first-time expectant parents’ perceptions of a parent education intervention, their education needs, and preferred sources and modes of such education.Method: The intervention was carried out during the last class of a public health prenatal education series. A total of 31 first-time expectant parents participated and included both women (N = 16) and men (N = 15) (mean, 29 years). The intervention was an in-person session on the topics of a safe sleeping environment, shaken baby syndrome, physical punishment risks and positive parenting, and expected development and safety. Participants completed the Infant Safety Education Project Questionnaire after the intervention.Results: Overall, most participants in this study found the content useful, planned to use it in caring for their infant, and indicated that this information should be shared with all expectant parents.Discussion: Findings support a larger scale study to determine parent education needs of expectant parents and the development, implementation, and evaluation of programming. Pediatric nurse practitioners and other primary care practitioners should be aware of the education needs of expectant parents and be prepared to provide anticipatory guidance and resources as appropriate.

Breastfeeding and Human Lactation: Education and Curricular Issues for Pediatric Nurse Practitioners - Corrected Proof

Allison E. Boyd, Diane L. Spatz — 2011-08-16

Abstract: Introduction: This study explores the breastfeeding and human lactation education offered in pediatric nurse practitioner (PNP) masters-level nursing programs.Methods: An online survey about breastfeeding and human lactation education offered in the PNP curriculum was sent to all PNP programs in the United States with viable contact information (N = 84). The response rate was 42.9%.Results: All of the respondents indicated that their PNP program curriculum includes the promotion of breastfeeding. However, 5.9% of programs do not offer any courses that incorporate these topics, and 73.5% teach this content in only one to two courses. More than three quarters of programs (81.8%) offer opportunities to counsel expectant mothers on infant feeding choices, promote breastfeeding in the clinical setting, and teach breastfeeding techniques. However, 18.2% of programs do not offer any of these opportunities.Discussion: The breastfeeding and lactation education offered in PNP programs is inconsistent. Formal incorporation of research-based lactation education into PNP curricula will help to standardize knowledge and aid in the PNP clinical role.

Use of the Extended Parallel Processing Model to Evaluate Culturally Relevant Kernicterus Messages - Corrected Proof

2011-08-16

Abstract: Introduction: Kernicterus is a serious but easily preventable disease in newborns that is not well-known even by some health care professionals. This study evaluated a parent guide and poster on kernicterus awareness and prevention generated by the Centers for Disease Control and Prevention. The Extended Parallel Processing Model was used as a framework for creating the interview protocol and analyzing the results.Method: In-depth interviews were conducted with four parents and six health care personnel of different ethnicities to evaluate the materials. Content for the parent guide and poster was held constant, but photos were varied according to the ethnicity of the baby (white, African American, or Hispanic) and the language in which the interviews were conducted (English and Spanish).Results: The parent guide was evaluated positively, but reactions to the poster were varied. The consensus was that the poster drew more attention than the pocket guide but lacked sufficient information about what jaundice is or how to treat it, while the pocket guide provided information, especially with regard to efficacy. The Extended Parallel Processing Model claims that when efficacy is equal to or higher than perceived threat, respondents should engage in recommended responses, which was the general finding from these interviews.Discussion: Recommendations for improvements of the materials are presented. The focus on different ethnicities in the materials was perceived as unnecessary and potentially counter-productive. Both parents and health care professionals mentioned the lack of information regarding treatment. Providing information on the length and effectiveness of treatment for jaundice and kernicterus might increase efficacy in averting the threat in both conditions.

Exploring the Day-to-Day Life of Mothers Dealing With Preschool Children Who Have Behavioral Disorders - Corrected Proof

Sallie Coke, Regena Spratling, Ptlene Minick — 2011-08-16

Abstract: Introduction: The purpose of this study was to explore the day-to-day life of mothers dealing with preschool children who have behavioral disorders and to explore the mothers’ experiences with their children’s health care.Method: A qualitative design was used to explore mothers’ experiences in their day-to-day lives. A purposive sample of eight mothers was interviewed in their homes. A recorded face-to-face format was used that included open-ended, semi-structured questions.Results: Two major themes emerged from the day-to-day experiences of these mothers: “abandoning my other child” and “parenting in unsupportive environments.”Discussion: The theme of “parenting in unsupportive environments” reflects the frustrations the mothers felt in their day-to-day lives while trying to find help for their children. The theme of “abandoning my other child” refers to the siblings of the children with behavioral disorders being overlooked by the mothers because so much of the mothers’ attention and time was given to the child with the behavioral disorder.

Women’s Understanding of Different Dosing Instructions for a Liquid Pediatric Medication - Corrected Proof

2011-08-08

Abstract: Introduction: Dosing errors by caregivers are common and often are directly attributed to poorly designed instructions. The purpose of this study was to assess whether instruction wording—that is, implicit versus explicit dosage intervals—was associated with participants’ ability to describe and correctly measure a dose of a commonly prescribed liquid pediatric prescription medication.Methods: English-speaking women (n = 193) of child-bearing age were recruited to participate in this study from an outpatient residency clinic in the southeastern United States. Based on a priori randomization, each participant was presented with one of two medication bottles that were identical except for the instructions: (1) “SHAKE LIQUID WELL AND GIVE (CHILD’S NAME) 6 ML BY MOUTH EVERY 12 HOURS” (“implicit” dosage interval),” or (2) “SHAKE LIQUID WELL AND GIVE (CHILD’S NAME) 6 ML BY MOUTH AT 7 AM AND 7 PM” (“explicit” dosage interval). Participants completed a structured interview to assess sociodemographic characteristics, health literacy skills, ability to describe and demonstrate the dosage of the liquid medication, and preferences for label format.Results: Seventy-two participants (37.3%) were able to correctly describe how they would give the medicine to a child during a 24-hour period, while 145 women (75.1%) were able to correctly demonstrate how they would give one dose of the medication. Approximately one third of participants (32.1%) were able to correctly describe and measure a dose of the medication. Slightly more than half of participants (n = 103, 53.4%) indicated that they would prefer instructions with “explicit” dosage intervals.Discussion: This study suggests that few people can accurately describe how liquid medications are to be administered, while more people can demonstrate the correct dose to be administered.

Emotional Maltreatment - Corrected Proof

Gail Hornor — 2011-07-11

Abstract: Child abuse is a problem that affects the lives of many American children. The public is often bombarded with information regarding horrific cases of physical and sexual abuse. Emotional maltreatment, however, has been slow to achieve recognition as a serious social problem for a variety of reasons. Compared with physical or sexual abuse, emotional maltreatment is more difficult to identify and define, and good epidemiological data are not available. An erroneous perception also exists that the sequelae of emotional maltreatment are less severe than that of physical and/or sexual abuse. Prompt identification of emotional maltreatment, appropriate intervention and referral, and reporting of concerns to child protective services are essential to the health and well-being of the child. This article will define emotional maltreatment, discuss consequences of emotional maltreatment, and provide implications for pediatric nurse practitioner practice.

Use of Paid Child Care Health Care Consultants in Early Care and Education Settings: Results of a National Study Comparing Provision of Health Screening Services Among Head Start and Non-Head Start Centers - Corrected Proof

2011-07-11

Abstract: Introduction: Child care health consultants (CCHCs) are health professionals who provide consultation and referral services to child care programs. The use of CCHCs has been recommended as an important component of high-quality child care. The purpose of this study was to examine the potential association between the use of paid CCHCs and child care center director reports of (a) center maintenance of health records and emergency procedures and (b) center facilitation of health screenings and assessments.Method: A national, randomized telephone survey of directors of 1822 licensed child care center directors was conducted.Results: With a response rate of 93%, most directors (72.7%) reported that they did not employ a CCHC. However, directors employing CCHCs were more likely to report provision of health-promoting screenings and assessments for children in their center. This pattern held true for both Head Start and non-Head Start centers.Discussion: This study suggests that CCHCs can serve as health promotion advocates in early care and education settings, helping centers establish appropriate policies and arranging for health assessments and screenings for children.

Manufactured Environmental Toxicants and Children’s Health: An Evidence-Based Review and Anticipatory Guidance - Corrected Proof

Jennifer Bevacqua — 2011-05-18

Abstract: Manufactured environmental toxicants (METs) are a global problem, causing or contributing to health maladies across socioeconomic classes. This article is intended to educate pediatric nurse practitioners (PNPs) about select METs and their effects on the health of children. Infants and children are especially vulnerable to the effects of METs because of their physiological and developmental characteristics. Moreover, PNPs are obligated to be informed about METs and share their knowledge with families via anticipatory guidance so that caregivers can make informed decisions. PNPs should advocate for proper regulation of METs and prevention of their harmful effects.

Introduction of Active Video Gaming Into the Middle School Curriculum as a School-based Childhood Obesity Intervention - Corrected Proof

Margaret Quinn — 2011-05-16

Abstract: School-based physical education (PE) interventions are encouraged as a recommendation to support an increase in moderate to vigorous physical therapy by modifying curricula to allow for more active time in PE class. Based on these recommendations, the goal of this project was to incorporate a video gaming system as a fitness activity into a traditional PE class to enhance the curriculum and increase student participation and active time. The sample consisted of 86 sixth-grade students at a pilot middle school. A paired samples t test was conducted to evaluate whether students (n = 82) increased their participation in PE class after the intervention. The results indicated that the postintervention students (M = 4.37, SD = .80) were significantly more active in PE class than before the intervention (M = 4.16, SD = .88, t(81) = −2.27, P = .026). Significant findings included an increase in the percentage of students using the software options of Just Dance and Dance Dance Revolution before and after the intervention. Prior to implementation, the use of Just Dance was reported at 11.6%; the percentage more than doubled to 25.6% after the intervention. Similar findings were noted for Dance Dance Revolution, as pre-implementation use was reported to be 10.5% and postintervention usage was reported to be 19.8%. This project has proved to be an effective intervention to meet state and national PE standards while increasing adolescent activity as a measure to decrease the childhood obesity epidemic. The intervention also suggests that positive modeling behaviors proposed in school can encourage positive behaviors at home. Long-term efficacy and continued usage within this school and expansion to other schools and to alternate age groups warrants further investigation.

Poquito a Poquito: How Latino Families With Children Who Have Asthma Make Changes in Their Home - Corrected Proof

Angela Kueny, Jill Berg, Yasmin Chowdhury, Nancy Anderson — 2011-05-13

Abstract: Introduction: The purpose of this study was to assess the cultural and environmental barriers to making asthma-focused changes in the homes of Latino families with children who have asthma.Methods: A descriptive qualitative design guided data collection and analysis in this study. Participating families described their experiences in caring for their children with asthma and the barriers they encountered when trying to modify their home environments and manage their children’s asthma symptoms.Results: Families discussed a spectrum of methods to manage their children’s asthma symptoms, including barriers they experienced and successful changes they made in their homes. “Little by little” parents made minor adjustments, as they were able, to alleviate their children’s asthma symptoms.Discussion: Nurses working with Latino families who experience similar barriers can use these findings to guide inquiries about families’ successful changes in their home environment and use them as a starting place to work collaboratively with families to reduce their children’s asthma exacerbations. This process will allow nurses to use culturally and family tailored interventions to fit their needs and goals.

Adolescent Asthma Education Programs for Teens: Review and Summary - Corrected Proof

Brenda Srof, Peggy Taboas, Barbara Velsor-Friedrich — 2011-05-13

Abstract: The purpose of this review is to describe and evaluate education programs for teens with asthma. Although asthma educational programs for children are plentiful, this is not the case for adolescents. The developmental tasks of adolescence require asthma education programs that are uniquely tailored to this age group. Although several well-designed studies appear in the literature, further research is needed to evaluate the efficacy of asthma education programs among teens. Although the quality of research varies, demonstrated program benefits include improved asthma self-management, self-efficacy, family support mechanisms, and quality of life. Practice implications point to the need for education programs in schools and camp settings that are consistent with national asthma guidelines.

Perspectives of Nurse Practitioners on Health Care Needs Among Latino Children and Families in the Rural Southeastern United States: A Pilot Study - Corrected Proof

YeounSoo Kim-Godwin, Megan J. McMurry — 2011-05-09

Abstract: Introduction: The purpose of this study was to explore perspectives of nurse practitioners on health care needs among Latino children and families in the rural Southeastern United States.Method: This qualitative research used semi-structured interviews with seven nurse practitioners (NPs) practicing in the rural southeastern part of North Carolina. Flanagan’s critical incident technique was used to describe the experiences of NPs providing health care for Latino children and parents.Results: Data analysis indicates that the most commonly reported illnesses by Latino children are upper respiratory infections and asthma, followed by otitis media, obesity, anemia, pneumonia, leukemia, and tumors. Barriers to health care for children included language and cultural differences, lack of access to care (e.g., lack of insurance, cost, and transportation), and health illiteracy/low education level of parents. The findings also suggest that Latinos are preserving their traditional health practices when treating their children’s illnesses, such as through use of foods, hot/cold items, herbs, coin on “belly button,” traditional juices, healing bracelets, and evil eye.Discussion: The findings of the study imply the need to incorporate culturally sensitive care when providing care for Latino children and parents.

Early Onset Multiple Sclerosis: A Review for Nurse Practitioners - Corrected Proof

Deborah B. Spiro — 2011-04-20

Abstract: Research demonstrates that 3.5% to 5% of persons with multiple sclerosis (MS) present before the age of 18 years. MS can present in early childhood through adolescence and must be considered as a differential diagnosis in patients with motor impairment, sensory changes, and cognitive disability. The diagnosis of early-onset MS is based on findings from a complete history and physical examination along with brain and spine imaging. The purpose of this article is to review recent literature on early-onset MS and offer suggestions or clinical practice in the identification and management of patients with this debilitating disease.

Depression and Stigma in High-risk Youth Living With HIV: A Multi-site Study - Corrected Proof

2011-04-18

Abstract: Introduction: This study explored the relationship between depression, stigma, and risk behaviors in a multi-site study of high-risk youth living with HIV (YLH) in the United States.Methods: All youth met screening criteria for either problem level substance use, current sexual risk, and/or suboptimal HIV medication adherence. Problem level substance use behavior was assessed with the CRAFFT, a six-item adolescent screener. A single item was used to screen for current sexual risk and for an HIV medication adherence problem. Stigma and depression were measured via standard self-report measures.Results: Multiple regression analysis revealed that behavioral infection, older age, more problem behaviors, and greater stigma each contributed to the prediction of higher depression scores in YLH. Associations between depression, stigma, and problem behaviors are discussed. More than half of the youth in this study scored at or above the clinical cut-off for depression. Results highlight the need for depression-focused risk reduction interventions that address stigma in YLH.Discussion: Study outcomes suggest that interventions are needed to address stigma and depression, not only among youth living with HIV, but in the communities in which they live.

Efficacy of Risperidone in Managing Maladaptive Behaviors for Children With Autistic Spectrum Disorder: A Meta Analysis - Corrected Proof

Akanksha Sharma, Steven R. Shaw — 2011-03-18

Abstract: Introduction: Atypical antipsychotic agents are widely used psychopharmacological interventions for autism spectrum disorders (ASDs). Among the atypical antipsychotic agents, risperidone has demonstrated considerable benefits in reducing several behavioral symptoms associated with ASDs. This meta-analysis examined research regarding the effectiveness of risperidone use among children with ASD using articles published since the year 2000.Methods: The database for the analyses comprised 22 studies including 16 open-label and six placebo-controlled studies. Based on the quality, sample size, and study design of studies prior to 2000, the database was then restricted to articles published after the year 2000. Effect sizes were calculated for each reported measure within a study to calculate an average effect size per study.Results: The mean effect size for the database was 1.047 and the sample weighted mean effect size was 1.108, with a variance of 0.18.Conclusions: Outcome measures demonstrated mean improvement in problematic behaviors equaling one standard deviation, and thus current evidence supports the effectiveness of risperidone in managing behavioral problems and symptoms for children with ASD. Although Risperdal has several adverse effects, most are manageable or extremely rare. An exception is rapid weight gain, which is common and can create significant health problems. Overall, for most children with autism and irritable and aggressive behavior, risperidone is an effective psychopharmacological treatment.

Puerto Rican Families’ Experiences of Asthma and Use of the Emergency Department for Asthma Care - Corrected Proof

Jean Coffey, Michelle Cloutier, Mikki Meadows-Oliver, Carlos Terrazos — 2011-03-17

Abstract: Puerto Ricans have been found to have higher asthma prevalence rates than non-Hispanic whites, blacks, and all other Hispanic subgroups. They also have the highest rates of emergency department (ED) use for the management of their asthma. Using a hermeneutic phenomenological approach, the aim of this study was to describe the lived experience of Puerto Rican families caring for their child's asthma and using the ED for asthma care. Six themes were generated from in-depth interviews with 10 Puerto-Rican caregivers: (1) The Folklore of Asthma, (2) Culture and the Medicine Woman, (3) In Awe of Asthma, (4) Praying to God, (5) The Decision–Time to Go, and (6) The ED Environment. The findings emphasize the necessity of establishing and maintaining a therapeutic partnership between primary care providers and families of children with asthma. The results may be used as a foundation for understanding motivations for seeking asthma care in the ED.

Risk and Protective Factors Associated With Stress in Mothers Whose Children Are Enrolled in Early Intervention Services - Corrected Proof

Linda M. Caley — 2011-03-07

Abstract: Introduction: Although considerable research has addressed children with special health care needs enrolled in early intervention (EI) services, little is known about families’ needs. This study provides baseline data on factors informing health promotion and prevention interventions for mothers of children enrolled in EI services who are experiencing high levels of stress.Methods: A non-experimental descriptive-correlational study measured the following risk and protective factors in mothers of children enrolled in EI services: parent stress, severity of child’s behavior, stressful life events, family functioning, appraisal of the situation, resources, and social support.Results: More than one third of mothers had stress and family-functioning scores necessitating referral. Services for cognitive or social-emotional delays, unhealthy family functioning, and many co-existing stress events were significantly associated with increased stress. Mothers did not find caring for a child with a disability stressful and were satisfied with their social support. Higher incomes and levels of education were significantly associated with less stress; however, this sample was highly educated with middle-class incomes.Discussion: Many mothers with children enrolled in EI services could be helped by specific primary, secondary, and tertiary interventions by pediatric nurse practitioners and primary health care providers.