Advanced practice in pediatric nursing: blending roles.

In the past, pediatric advanced practice nurse's roles were the Clinical Nurse Specialist (CNS) in the inpatient setting and the Nurse Practitioner (NP) in the outpatient setting. With health care system changes, such as the shifting and blurring boundaries between inpatient and outpatient care, changes were required in the graduate curricula to blend the CNS and NP roles into an advanced practice nurse (APN) role. This article describes the model at Rush University, the advantages of the CNS/NP blended role, the revised APN curriculum, and examples of blended-role APNs in action. The curriculum change to blend the CNS/NP roles addresses the need for the blended APN role in changing health care systems.

Coping with transition: neonatal nurse practitioner education for the 21st century.

As neonatal intensive care nurses face downsizing and/or cross-training, new opportunities are emerging for advanced practice nurses in follow-up care of neonatal intensive care unit graduates, case management, quality improvement, and community hospital care. This article identifies current issues in neonatal nurse practitioner (NNP) education as the model has shifted from hospital-based, certificate programs to graduate degree programs offered by colleges/universities of nursing. Opportunities for increasing NNP role flexibility and recommendations for bridging the transition to a 21st century education model for neonatal advanced practice nurses are also discussed. Despite the turmoil of change and uncertainty, the future for neonatal advanced practice nurses is positive. Successful nurses will master the skills of adaptability, flexibility, self-directed learning, leadership, and the provision of relationship centered care. Neonatal nursing educators must constantly monitor clinical practice and re-evaluate the curriculum to ensure the necessary knowledge and skills for successful practice can be achieved from the educational program. It is critical that faculty are cognizant of emerging trends and changing roles in the practice area. Additional learning opportunities may be required for graduates to successfully move into the next century.

Viral infections of the newborn.

Viral infections of the newborn result in significant morbidity and mortality each year. The fetus and newborn are particularly vulnerable to viral infection. The range of expression may vary from no clinical disease to devastating illness and infection occurring before, during, or after birth. Nursing management is determined by the specific viral infection, the severity of the illness, and the unique conditions of the newborn and his/her family. Promising new therapies are on the horizon that may lessen the severity of viral disease. Until such time, the major thrusts of management of neonatal viral disease are prevention of infection and supportive care for the acutely ill newborn.

Bacterial growth in human milk during continuous feeding.

The present study was undertaken to determine both the time at which exponential growth of bacteria ensued in human milk during a continuous feeding and whether the fat content of the milk changed during a continuous feeding. Breast milk samples were obtained from 19 healthy lactating women between the 7th and 28th postpartum day. Nine samples were refrigerated and utilized in a simulated continuous feeding within 24 hours of collection. The remaining 10 samples were frozen for four to six weeks until use in the simulated feeding study. Bacterial colony counts and fat content (by creamatocrit) were then measured at the beginning of the simulated feeding and at hourly intervals from five to eight hours after the initiation of the study. Results indicated that logarithmic growth of the contaminating bacteria was not observed during the study time. No significant increase in total colony count was observed over the course of study in the frozen milk samples, whereas a significantly increased colony count was apparent by six hours for the fresh milk samples. Fat content of the milk decreased significantly within six hours for the frozen samples and within eight hours for the fresh milk. These data would suggest that when continuous drip feeding methods are employed for providing human milk to newborn infants, it may be desirable to change the entire feeding apparatus (syringe, tubing, and milk) at four hour intervals in order to optimize caloric intake and minimize the risk of bacterial overgrowth.

Type A behavior pattern and hypertension among inner-city black women.

Inner-city Black women were administered Rosenman and Friedman's A-B interview and invited to discuss stress experiences and traditional coronary heart disease risk factors while their blood pressure was monitored at two-minute intervals. Results revealed the essential reliability of the A-B classification for the sample and demonstrated a general congruence with type A behaviors reported in previous (mostly white male) samples. While type A Black women were not significantly more likely to be hypertensive than type B women, analyses of the intrasubject blood pressure variability revealed an interaction between A-B and hypertensive-normotensive status. Consistent with earlier findings, hypertensives were more variable than normotensives, but this was true only for type Bs; type As were intermediate and not differentiated in their variability. This finding calls attention to the possible adaptive function of type A behavior among stress inner-city Black females and raises the question of whether Rosenman and Friedman's personality theory might be objectionably simplistic.