Analysis of education and previous nursing experience of certified PNPs in the United States.

BACKGROUND: Educational programs to prepare nurse practitioners (NPs) were historically built upon foundational nursing experience. Originally prepared as certificate programs in 1965, the educational requirements for nurse practitioners (NPs) rapidly shifted from certificate programs to the Master's degree (DellaBella, 2015; Fairman, 2008). As Doctor of Nursing Practice (DNP) degree programs increase in number, it is unknown whether this foundational nursing experience has changed, or if it differs by certification type for pediatric nurse practitioners (PNPs). This study aimed to evaluate the educational preparation and prior nursing experience of primary care and acute care certified PNPs. METHODS: A national survey of members of the Pediatric Nurse Practitioner Certification Board (N = 17,530) was completed (Mudd et al., 2022). A sub-analysis of this data was conducted (n = 1974). RESULTS: There was no statistical evidence among either primary or acute care PNPs of an association between previous nursing experience and type of degree preparation (Master's or DNP). There was only a weak association between educational preparation and experience among acute care nurse practitioners. Most respondents were prepared at the Master's level, and 85% of all respondents had >1 year of nursing experience prior to returning for additional PNP education. DISCUSSION: This study adds to the literature as it describes the educational preparation and foundational nursing experience of primary and acute care PNPs. It can serve as a benchmark as the move to the DNP continues for Advanced Practice Registered Nurse preparation.

Sucesso da punção intravenosa periférica após capacitação dos profissionais de enfermagem para o uso da transiluminação / Puncture Success after training nurses in the use of transillumination / Éxito de la punción venosa periférica después de la formación de profesionales de enfermería en el uso de la transiluminación

Objetivo: avaliar o índice de sucesso na primeira tentativa de cateterização intravenosa periférica em crianças após capacitação de profissionais de enfermagem para o uso de transiluminação. Método: estudo observacional, prospectivo, comparativo do tipo antes e depois, realizado com enfermeiros e técnicos de enfermagem que foram capacitados para a cateterização guiada pela transiluminação e observados executando 35 procedimentos antes e 35 após a capacitação, no período de novembro de 2018 a maio de 2019, após aprovação do mérito ético do protocolo de pesquisa. Os dados foram analisados de forma descritiva e analítica. Resultados: o índice de sucesso na primeira tentativa foi de 62,9% antes e 65,7% depois (p=0,803). Os técnicos de enfermagem executaram mais a punção antes da capacitação e os enfermeiros depois (p<0,01). Conclusão: a capacitação de profissionais para realizar a punção guiada pela transiluminação aumentou o índice de sucesso na primeira tentativa de punção intravenosa periférica, sem diferença estastiticamente significativa(AU)

Objective: to evaluate the puncture success in the first attempt in children after training nursing professionals in the use of transillumination. Method: observational, prospective, comparative before-and-after study, carried out with nurses and nursing technicians were trained for transillumination-guided catheterization and observed performing 35 procedures before and 35 after training, from November 2018 to May 2019, after approval of the ethical merit of the research. Data were analyzed descriptively and analytically. Results: success in the first attempt was 62.9% before and 65.7% after (p=0.803). Nursing technicians performed more punctures before training and nurses after (p<0.01). Conclusion: the training professionals to perform transillumination-guided puncture increased success in the first attempt at peripheral intravenous puncture, without significant statistical difference(AU)

Objetivo: evaluar la tasa de éxito en el primer intento de cateterización venosa periférica en niños después de capacitar a los profesionales de enfermería en el uso de la transiluminación. Método: estudio observacional, prospectivo, comparativo de antes y después, realizado junto a enfermeros y técnicos de enfermería capacitados para cateterización guiada por transiluminación y observados realizando 35 procedimientos antes y 35 después del entrenamiento, de noviembre de 2018 a mayo de 2019, previa aprobación del mérito ético del protocolo de la investigación. Los datos se analizaron de forma descriptiva y analítica. Resultados: la tasa de éxito en el primer intento fue del 62,9% antes y del 65,7% después (p=0,803). Los técnicos de enfermería realizaron más punciones antes del entrenamiento y los enfermeros después (p<0,01). Conclusión: la formación de profesionales para realizar la punción guiada por transiluminación aumentó la tasa de éxito en el primer intento de punción venosa periférica, sin diferencia estadística significativa(AU)

Pediatric Critical Care Simulation Curriculum: Training Nurse Practitioners to Lead in the Management of Critically Ill Children.

INTRODUCTION: Acute care pediatric nurse practitioners have become frontline providers in the critical care environment and are expected to provide leadership in acutely critical situations. We describe a 2-day, high-fidelity, simulation-based curriculum focused on training the pediatric nurse practitioners for leadership in critical care scenarios. METHOD: This prospective pre-post interventional study used simulation-based pedagogy. Knowledge tests, time-to-task, and a follow-up survey were used to determine the effectiveness of the training. RESULTS: Participants (n = 23) improved their knowledge scores by 27% (pretest: 35.2% [standard deviation = 12.1%]; posttest: 62.2% [standard deviation = 13.8%], p < .001). In addition, time-to-task for resuscitation variables improved significantly. At 3 months, 100% of the participants who responded either agreed (15.4%) or strongly agreed (84.6%) that the boot camp prepared them to lead in a critical emergency. DISCUSSION: Simulation-based training is an effective strategy for educating critical care pediatric nurse practitioners and improves their ability to manage pediatric emergencies rapidly, which can be lifesaving.

Neonatal Nurse Practitioner Use of Ultrasonography to Verify Umbilical Venous Catheter Placement in the Neonatal Intensive Care Unit.

BACKGROUND: Literature dating back to 1982 supports the use of ultrasound to confirm UVC position as a more reliable method compared to x-ray. The use of ultrasound to confirm UVC position remains infrequent in the NICU. PURPOSE: To determine the feasibility of training an NNP in the acquisition and interpretation of a parasternal short-axis (PSAX) image of the heart to confirm UVC position. METHODS: A retrospective review of 48 charts evaluated descriptive data using standard technique of an x-ray to confirm UVC placement. An NNP was trained to acquire and interpret a parasternal short-axis (PSAX) cardiac view by a pediatric cardiologist. The NNP independently and prospectively evaluated 21 neonates and determined whether the UVC was in satisfactory or unsatisfactory position. The same image was blindly over-read by the pediatric cardiologist. Agreement between the NNP and pediatric cardiologist interpretations as well as the pediatric cardiologist and radiologist interpretations was evaluated using the κ-test. RESULTS: Initial pediatric cardiology interpretation of UVC position showed the UVC to be malpositioned in 66% of neonates (n = 14). NNP and pediatric cardiology interpretations in UVC position had 86% agreement (κ-0.667). Pediatric cardiology (ultrasound) and radiology interpretations (x-ray) in UVC position had 86% agreement (κ-0.69). IMPLICATIONS FOR PRACTICE: It is feasible to train NNPs to perform and accurately interpret a single PSAX ultrasound image to determine satisfactory UVC position. IMPLICATIONS FOR RESEARCH: Increasing the use of ultrasound to determine satisfactory position of UVCs in the NICU can reduce unnecessary exposure to ionizing radiation in neonates.

A Statewide Tiered System for Screening and Diagnosis of Autism Spectrum Disorder.

Although autism spectrum disorder (ASD) can be reliably detected in the second year of life, the average age of diagnosis is 4 to 5 years. Limitations in access to timely ASD diagnostic evaluations delay enrollment in interventions known to improve developmental outcomes. As such, developing and testing streamlined methods for ASD diagnosis is a public health and research priority. In this report, we describe the Early Autism Evaluation (EAE) Hub system, a statewide initiative for ASD screening and diagnosis in the primary care setting. Development of the EAE Hub system involved geographically targeted provision of developmental screening technical assistance to primary care, community outreach, and training primary care clinicians in ASD evaluation. At the EAE Hubs, a standard clinical pathway was implemented for evaluation of children, ages 18 to 48 months, at risk for ASD. From 2012 to 2018, 2076 children were evaluated (mean age: 30 months; median evaluation wait time: 62 days), and 33% of children received a diagnosis of ASD. Our findings suggest that developing a tiered system of developmental screening and early ASD evaluation is feasible in a geographic region facing health care access problems. Through targeted delivery of education, outreach, and intensive practice-based training, large numbers of young children at risk for ASD can be identified, referred, and evaluated in the local primary care setting. The EAE Hub model has potential for dissemination to other states facing similar neurodevelopmental health care system burdens. Implementation lessons learned and key system successes, challenges, and future directions are reviewed.

Pediatric Nurse Practitioners' Knowledge and Attitudes Regarding Pain Management Study in Central China.

BACKGROUND: Nurses' level of knowledge about pain management directly determines the steps of implementation of clinical pain policies. METHOD: This study surveyed 2,882 pediatric nurse practitioners from six children's hospitals using demographics and pain management questionnaires, as well as the Chinese version questionnaire of the Pediatric Nurse Practitioners' Knowledge and Attitudes Survey Regarding Pain (PNKAS) via the WeChat application. RESULTS: The total score on the PNKAS was 14.88 ± 3.58 for the pediatric nurse practitioners. Multiple regression results showed the main factors influencing the PNKAS score related to position, the frequency of receiving training pain-related knowledge, and working department, which could account for 35.1% of the total variance. CONCLUSION: Pediatric nurse practitioners from pediatric hospitals were not found to have sufficient knowledge or an appropriate attitude regarding pain management. A new standardized training project of pain management that is closely related to clinical practice for children should be conducted in the future. [J Contin Educ Nurs. 2019;50(6):275-281.].

Advancing the practice of nursing through specialty fellowship development for pediatric nurse practitioners.

Fellowship training for physicians has historically been a training model for physicians to specialize their practice and develop research skills following medical school and residency. Advanced practice registered nurses, specifically nurse practitioners (NPs) practice in primary care, acute care, and specialty settings across the lifespan. Fellowship programs have emerged as a way for NPs to specialize their practice and meet the needs of an expanding health care system. This article describes the design, implementation, and outcomes of two similar yet distinct specialty NP fellowship programs: one in Developmental-Behavioral Pediatrics and one in Pediatric Physical Medicine and Rehabilitation.

Improving Neurodevelopmental Outcomes in NICU Patients.

BACKGROUND: Premature infants experience stressors such as external stimulation with sounds, light, touch, and open positioning in NICU that negatively affect outcomes. PURPOSE: The purpose of this study was to measure the effectiveness of a developmental positioning intervention on length of stay, weight gain, and tone/flexion compared with neonates without structured positioning. METHODS: Study design was quasi-experimental with nonequivalent groups. A retrospective chart review of 50 neonates with the inclusion criteria of 34 weeks of gestation or less and no anomalies provided a preintervention sample. After the education in-service on positioning, a convenience sample of 27 infants was enrolled. Infant Position Assessment Tool was used as a visual guide for positioning and scoring by the researcher for intervention fidelity. Hammersmith scoring was completed by the occupational therapist prior to discharge. FINDINGS: The postintervention group was younger and sicker than the control group (P < .05). The postintervention sample (M = 7.05 where 7 = 29 to <30 weeks of gestation) was younger than the preintervention sample (M = 7.22). The postintervention sample was smaller (M = 1302.15 g) than the preintervention sample (M = 1385.94 g). Results showed that the postintervention group had clinically significant weight gain and mean Hammersmith score (3.28) was higher showing positioning positively affected tone and flexion scores. IMPLICATIONS FOR PRACTICE: With greater structure and consistent attention to developmental positioning, outcomes are positively affected. IMPLICATIONS FOR FUTURE RESEARCH: Further research with larger sample sizes will identify stronger associations and relationships between positioning and outcome measures.

Bullying: What the PNP Needs to Know.

Despite generations of doubt about the true impact of bullying, it is now clear that childhood bullying can have significant lifelong consequences for victims and bullies alike. Recent school shootings and suicides by students who have been victims of bullying have helped to solidify public awareness of the gravity of the problem of childhood bullying. Adults who were frequently bullied in childhood have an increased frequency of psychiatric disorders, including anxiety, depression, and suicidality, extending into middle age (Arseneault, 2017). In fact, frequent bullying in childhood may impact victims similar to experiencing multiple adverse childhood experiences (Takizawa, Maughan, & Arseneault, 2014). Bullying also has a detrimental effect on young perpetrators (Zuckerman, 2016). Bullying is clearly a pediatric health care problem. This continuing education article will explore bullying in terms of definitions, epidemiology, types, risk factors, resilience factors, consequences, and implications for practice.

Using Google to Survey PNPs About Agricultural Safety.

INTRODUCTION: Youth and children in agriculture are highly vulnerable to the health hazards associated with agricultural work and the rural environment. METHODS: The purpose of this study was to conduct a national needs assessment for developing a continuing education unit that increases the knowledge of pediatric nurse practitioners (PNPs) on safety in an agricultural environment using the Google family of products. This was a cross-sectional, one-group design descriptive-correlational study. RESULTS: Surveys were received from 315 participants. On Day 1, 57% of responses were received, and 91% were received within Week 1. DISCUSSION: The use of the free Google Forms and Google Sheets facilitated this researcher to obtain a sample size, saving research expense dollars, and entering data file into SPSS. In addition, a pattern of survey return rates was demonstrated. Second, clinical implications indicate that agricultural safety is missing from PNP curricula: PNPs are not knowledgeable about existing resources and would be interested in a continuing education unit.

An advanced nurse practitioner service for neonates, children and young people.

The NHS continues to face unprecedented demands and reform which necessitates a move away from traditional modes of delivery. Over the past ten years economic austerity, changes to legislation and professional career developments have led to healthcare service redesign and innovations in nursing roles, including the development of the advanced nurse practitioner (ANP) role. This article explores how one organisation created an ANP service for out-of-hours neonatal and paediatric care in a district general hospital setting. It was found that ANPs help to provide continuity of care, support learning, inspire continued professional development and lead on healthcare agendas. However, the ANP service faced factors not exclusive to local context including an ageing workforce, difficulties in recruiting and retaining suitably qualified staff and economic pressures. The future of the service depends on it overcoming these factors while demonstrating that the shift from traditional models of care can lead to a positive outcome.

Distance-Learning, ADHD Quality Improvement in Primary Care: A Cluster-Randomized Trial.

OBJECTIVE: To evaluate a distance-learning, quality improvement intervention to improve pediatric primary care provider use of attention-deficit/hyperactivity disorder (ADHD) rating scales. METHODS: Primary care practices were cluster randomized to a 3-part distance-learning, quality improvement intervention (web-based education, collaborative consultation with ADHD experts, and performance feedback reports/calls), qualifying for Maintenance of Certification (MOC) Part IV credit, or wait-list control. We compared changes relative to a baseline period in rating scale use by study arm using logistic regression clustered by practice (primary analysis) and examined effect modification by level of clinician participation. An electronic health record-linked system for gathering ADHD rating scales from parents and teachers was implemented before the intervention period at all sites. Rating scale use was ascertained by manual chart review. RESULTS: One hundred five clinicians at 19 sites participated. Differences between arms were not significant. From the baseline to intervention period and after implementation of the electronic system, clinicians in both study arms were significantly more likely to administer and receive parent and teacher rating scales. Among intervention clinicians, those who participated in at least 1 feedback call or qualified for MOC credit were more likely to give parents rating scales with differences of 14.2 (95% confidence interval [CI], 0.6-27.7) and 18.8 (95% CI, 1.9-35.7) percentage points, respectively. CONCLUSION: A 3-part clinician-focused distance-learning, quality improvement intervention did not improve rating scale use. Complementary strategies that support workflows and more fully engage clinicians may be needed to bolster care. Electronic systems that gather rating scales may help achieve this goal. Index terms: ADHD, primary care, quality improvement, clinical decision support.

'Our Care through Our Eyes'. Impact of a co-produced digital educational programme on nurses' knowledge, confidence and attitudes in providing care for children and young people who have self-harmed: a mixed-methods study in the UK.

OBJECTIVES: (1) To determine the impact of a digital educational intervention on the knowledge, attitudes, confidence and behavioural intention of registered children's nurses working with children and young people (CYP) admitted with self-harm.(2) To explore the perceived impact, suitability and usefulness of the intervention. INTERVENTION: A digital educational intervention that had been co-produced with CYP service users, registered children's nurses and academics. SETTING: A prospective, uncontrolled, intervention study with preintervention and postintervention measurement, conducted at a large acute NHS Trust in the UK. PARTICIPANTS: From a pool of 251 registered children's nurses and 98 participants were recruited to complete the intervention (response rate=39%). At follow-up, 52% of participants completed the postintervention questionnaire, with 65% (n=33) of those reporting to have completed the digital educational intervention. PRIMARY OUTCOME MEASURES: Attitude towards self-harm in CYP was measured using a 13-item questionnaire; knowledge of self-harm in CYP was measured through an adapted 12-item questionnaire; confidence in different areas of practice was measured through Likert Scale responses; self-efficacy for working with CYP who have self-harmed was measured through an adapted version of the Self-efficacy Towards Helping Scale; clinical behavioural intention was measured by the Continuing Professional Development Reaction Questionnaire. Semistructured interviews were undertaken with a purposive sample of participants. RESULTS: For those who completed the intervention (n=33), improvements were observed in knowledge (effect size, ES: 0.69), confidence, and in some domains relating to attitudes (effectiveness domain-ES: 0.49), and clinical behavioural intention (belief about consequences-ES:0.49; moral norm-ES: 0.43; beliefs about capability-ES: 0.42). Qualitative findings suggest participants experienced skill development, feelings of empowerment and reflection on own practice. CONCLUSIONS: The effect of the intervention is promising and demonstrates the potential it has in improving registered children's nurse's knowledge, confidence and attitudes. However, further testing is required to confirm this.

Pediatric Nurse Practitioners in the Emergency Department: Implications for Education and Research.

The use of pediatric nurse practitioners in emergency departments is common in the United States. Defining competencies that are specific to the wide span of urgent and emergent pediatric conditions, along with a recognized practice standard for education and specialty certification for pediatric nurse practitioners practicing in emergency care, is needed. Pediatric emergency departments require a team of providers with a skill set that aligns with each patient's needs. The use of qualified pediatric nurse practitioners on these teams, both primary care and acute care certified, to provide care to these children is expanding, with implications for education and research.

Resilience.

Every child is a unique individual. This individuality is evident in children exposed to psychosocial trauma or adverse childhood experiences. There exists wide variation in the way children respond to toxic stressors in their lives. Some children appear to be relatively unaffected, while others develop a variety of psychological, behavioral, and physical consequences. What is the explanation for this phenomenon? Resiliency has been suggested to explain this variation in pathology expressions in trauma-exposed children. It is vital for pediatric nurse practitioners to understand the concept of resilience. This continuing education offering will define concepts of resilience and stress, explore the neurobiology of resilience, and examine interventions that promote resilience in children.

Sexually Transmitted Infections and Children: What the PNP Should Know.

Sexual abuse is a problem of epidemic proportions in the United States. In their practice, pediatric nurse practitioners will likely encounter children who have experienced sexual abuse-both those who have and have not previously been identified as victims. Sexually transmitted infections (STIs) are rare in sexually abused children and adolescents. However, when present, they can be crucial to making the diagnosis of sexual abuse and protecting children. This continuing education article will assist the pediatric nurse practitioner in interpreting the relationship between STIs and sexual abuse, correctly testing for STIs, and treating STIs in children and adolescents.

Utilization of the Premature Birth Knowledge Scale to Assess Pediatric Provider Knowledge of Neurodevelopmental Outcomes.

INTRODUCTION: Prematurity affects a significant portion (10-12%) of children in the Unites States, with potential for physical, psychological, neurodevelopmental, and behavioral impairments continuing long past the neonatal period. The specific aim of this research was to evaluate pediatric primary and specialty care providers' knowledge and understanding of neurodevelopmental outcomes of children born prematurely. METHODS: Pediatric nurse practitioner (PNP) members of the National Association of Pediatric Nurse Practitioners participated in an online survey using the 33-item Premature Birth Knowledge Scale (PB-KS) to assess their knowledge of current neurodevelopmental outcomes of children born prematurely. RESULTS: Neither years of practice as a registered nurse nor as a PNP predicted performance on the PB-KS. The mean score on the PB-KS in the PNP sample was 17.8 (possible score = 0-33), with a mean accuracy of 53.9%. Higher scores on the PB-KS were correlated with higher perceived level of preparation to care for children born prematurely. DISCUSSION: To our knowledge, this is the first study to use the PB-KS with pediatric primary and specialty providers. PNPs are uniquely situated to educate and support families facing the long-term consequences of premature birth; to do so they must maintain accurate understanding of current outcomes.

Enhancing Pediatric Trainees' and Students' Knowledge in Providing Care to Transgender Youth.

PURPOSE: To enhance pediatric trainees' and students' knowledge of the psychosocial and medical issues facing transgender youth through a comprehensive curriculum. METHODS: During the 2015-2016 academic year, we administered a transgender youth curriculum to fourth-year medical students, pediatric interns, psychiatry interns, and nurse practitioner students on their 1-month adolescent and young adult medicine rotation. The curriculum included six interactive, online modules and an observational experience in a multidisciplinary pediatric gender clinic. The online modules had a primary care focus with topics of general transgender terminology, taking a gender history, taking a psychosocial history, performing a sensitive physical examination, and formulating an assessment, psychosocial plan, and medical plan. At the completion of the curriculum, learners completed an evaluation that assessed change in perceived awareness and knowledge of transgender-related issues and learner satisfaction with the curriculum. RESULTS: Twenty learners participated in the curriculum with 100% completing the curriculum evaluations, 100% reporting completing all six online modules, and 90% attending the gender clinic. Learners demonstrated a statistically significant improvement in all pre-post knowledge/awareness measures. On a Likert scale where 5 indicated very satisfied, learners' mean rating of the quality of the curriculum was 4.5 ± .7; quality of the modules was 4.4 ± .7; and satisfaction with the observational experience was 4.5 ± .8. CONCLUSIONS: A comprehensive curriculum comprised interactive online modules and an observational experience in a pediatric gender clinic was effective at improving pediatric learners' perceived knowledge of the medical and psychosocial issues facing transgender youth. Learners also highly valued the curriculum.

Provider Training to Screen and Initiate Evidence-Based Pediatric Obesity Treatment in Routine Practice Settings: A Randomized Pilot Trial.

INTRODUCTION: This randomized pilot trial evaluated two training modalities for first-line, evidence-based pediatric obesity services (screening and goal setting) among nursing students. METHOD: Participants (N = 63) were randomized to live interactive training or Web-facilitated self-study training. Pretraining, post-training, and 1-month follow-up assessments evaluated training feasibility, acceptability, and impact (knowledge and skill via simulation). Moderator (previous experience) and predictor (content engagement) analyses were conducted. RESULTS: Nearly all participants (98%) completed assessments. Both types of training were acceptable, with higher ratings for live training and participants with previous experience (ps < .05). Knowledge and skill improved from pretraining to post-training and follow-up in both conditions (ps < .001). Live training demonstrated greater content engagement (p < .01). CONCLUSIONS: The training package was feasible, acceptable, and efficacious among nursing students. Given that live training had higher acceptability and engagement and online training offers greater scalability, integrating interactive live training components within Web-based training may optimize outcomes, which may enhance practitioners' delivery of pediatric obesity services.