Developing a Transition Care Coordination Program for Youth With Spina Bifida.

INTRODUCTION: This quality improvement pilot study focused on developing and facilitating readiness for transition in youth with spina bifida. The results contribute to a broader institution-wide initiative at a subspecialty pediatric organization. METHODS: The clinical roles of six nurse care coordinators were restructured to add responsibility for transition care coordination. Together, parents, youth, and nurse transition care coordinators created and implemented individualized family-centered care plans focused on improving self-management and readiness for transition to adulthood. The Transition Readiness Assessment Questionnaire was administered before and after intervention initiation. RESULTS: Fourteen youth-parent pairs participated in this study. Postintervention Transition Readiness Assessment Questionnaire results indicated that both parents and youth perceived improvement in transition readiness. Youth perceived more improvement than did parents. DISCUSSION: This pilot study showed that budget-neutral processes can be systematically implemented to facilitate transition preparation from pediatric to adult health care services for youth with spina bifida and their families.

Increasing Epilepsy Awareness in Schools: A Seizure Smart Schools Project.

A high prevalence of epilepsy diagnoses and seizure events among students was identified at a large Midwestern school district. In partnership with the Epilepsy Foundation of Minnesota (EFMN), a quality improvement project was conducted to provide education and resources to staff caring for school children with seizures. School nurses (N = 26) were trained as seizure management educators and instructed staff in 21 schools on seizure awareness and response. School nurses utilized new seizure management resources, a procedural guideline, and care plan updates. The majority of school nurses rated the resources and training interventions as "very helpful." School nurse confidence in managing students with seizures increased, seizure action plan use increased, and 88% of children's records with new seizure diagnoses had completed documentation. School nurses played vital roles in increasing seizure awareness as educators and care managers. EFMN is using this project as an exemplar for expanding its Seizure Smart Schools program.

Pediatric Care Coordination: Lessons Learned and Future Priorities.

A fundamental component of the medical home model is care coordination. In Minnesota, this model informed design and implementation of the state's health care home (HCH) model, a key element of statewide healthcare reform legislation. Children with medical complexity (CMC) often require care from multiple specialists and community resources. Coordinating this multi-faceted care within the HCH is challenging. This article describes the need for specialized models of care coordination for CMC. Two models of care coordination for CMC were developed to address this challenge. The TeleFamilies Model of Pediatric Care Coordination uses an advanced practice registered nurse care (APRN) coordinator embedded within an established HCH. The PRoSPer Model of Pediatric Care Coordination uses a registered nurse/social worker care coordinator team embedded within a specialty care system. We describe key findings from implementation of these models, and conclude with lessons learned. Replication of the models is encouraged to increase the evidence base for care coordination for the growing population of children with medical complexities.

A national survey of the primary and acute care pediatric nurse practitioner educational preparation.

INTRODUCTION: The past decade has been marked by a gradual expansion of the traditional primary care role of the pediatric nurse practitioner (PNP) into practice arenas that call for more acute and critical care of children. The purpose of the study was to explore the educational programming needs of dual (combined) track PNP programs that prepare graduates to provide care to children and adolescents across the continuum of health and illness. METHOD: A two-phase, exploratory, mixed method design was utilized. An electronic survey was completed by 65% of PNP program directors in the country. Semi-structured telephone interviews were conducted with hospital-based PNPs who were practicing in roles that met a range of health care needs across the primary and acute care continuum. RESULTS: Primary care and acute care programs have more common than unique elements, and the vast majority of clinical competencies are common to both types of program. Only three competencies appear to be unique to acute care programs. DISCUSSION: The Association of Faculties of Pediatric Nurse Practitioner Programs should utilize existing evidence and develop guidelines for dual PNP programs that focus on the provision of care to children across a wide continuum of health and illness.

Using gaming simulation to evaluate bioterrorism and emergency readiness education.

OBJECTIVE: We performed an outcome evaluation of the impact of public health preparedness training as a group comparison posttest design to determine the differences in the way individuals who had participated in training performed in a simulated emergency. METHODS: The Experimental Group 1 included students who had graduated from or were currently enrolled in the bioterrorism and emergency readiness (BT/ER) curriculum at the University of Minnesota School of Public Health. The comparison groups included individuals who had access to the Internet and were aware of the 2006 online simulation Disaster in Franklin County: A Public Health Simulation. The evaluation process employed surveys and the gaming simulation as sources for primary data. RESULTS: Participants in the BT/ER curriculum (p=0.0001) and other participants completing at least 45 hours of training in the past year (p=0.0001) demonstrated higher effectiveness scores (accuracy of chosen responses within the simulation) than participants who did not report significant amounts of training. CONCLUSIONS: This evaluation research demonstrated that training is significantly associated with better performance in a simulated emergency using gaming technology.

Children's Perceptions of Healthcare Survey.

BACKGROUND: Few validated pediatric tools exist to directly gather data about children's perceptions of their own healthcare; parent surveys are typically used as proxies. A psychometrically sound, child-focused survey captures children's unique perceptions for quality improvement. OBJECTIVES: This study developed and evaluated reliability of a survey, assessed score differences by children's age, and compared the responses of children and parents. METHOD: The Children's Perceptions of Healthcare Survey was developed for inpatient and outpatient quality improvement. Following expert review, the tool was administered to 237 parent-child dyads at the time of discharge from an inpatient pediatric unit (n = 121) and after outpatient clinic visits (n = 116). Responses were analyzed and compared. RESULTS: Internal consistency reliability for the tool was high (child/adolescents: alpha = .84; parents: alpha = .86), with no significant differences by child age or child gender. Parent and child scores were significantly correlated (r = 0.29, P < .001). About half of parents' scores were higher than their children's scores. DISCUSSION: This tool worked well to collect data from a wide age range of children across healthcare settings. Children's perceptions were unique; involving children in care assessment is worthwhile and captures insights missed when only parents are surveyed. The Children's Perceptions of Healthcare Survey is a valid, psychometrically sound tool to capture children's unique perspectives regarding their healthcare and may be useful for system quality improvement.

Preparing pediatric nurse leaders for practice.

The growing prevalence of chronic conditions in childhood underscores the urgent need to educate pediatric nurse leaders to address the complex issues these children and families face. This article describes a model of graduate education for preparing pediatric nurse leaders who are equipped to manage and advocate for these children and families. Fifty-one master's prepared graduates completed a Strategic Plan Needs Assessment Survey in 2007 and were asked to indicate specific clinical and leadership competencies that they perceived were essential for pediatric nurse leaders in their areas of practice. Results revealed the highest priority for continuing education and outreach regarding pediatric health to be clinical updates and management of children with special healthcare needs (CSHCN), followed by health promotion for CSHCN and care coordination/case management. The highest priority for continuing education and outreach regarding leadership in pediatrics was evidence-based practice, followed by team care/interdisciplinary practice. The challenge for current nurse leaders is to be cognizant of the urgent need to prepare and retain future pediatric nurse leaders who are experts in the care of CSHCN and their families.

Rural perceptions of continuing professional education.

BACKGROUND: This study describes rural health care professionals' perceptions about professional isolation and the availability, accessibility, and relevance of continuing education. METHODS: Registered nurses (n = 165) and physicians (n = 59) providing health care services in 26 rural hospitals in two Midwestern states participated in the study. RESULTS: Rural health care providers experience barriers to accessing relevant continuing education. Although physicians reported higher levels of professional isolation than their nurse counterparts, professional isolation was identified as a concern by both provider groups. CONCLUSIONS: To ensure an adequate supply of knowledgeable and skillful rural health care professionals, continuing education specific to the delivery of care in rural settings is necessary. Once developed, the continuing education must be delivered in a manner that is acceptable and accessible to isolated rural providers.

Rural hospital preparedness for neonatal resuscitation.

CONTEXT: Neonatal resuscitation is a critical component of perinatal services in all settings. PURPOSE: To systematically describe preparedness of rural hospitals for neonatal resuscitation, and to determine whether delivery volume and level of perinatal care were associated with overall preparedness or its indicators. METHODS: We developed the 15-point Hospital Neonatal Resuscitation Survey to examine institutional preparedness for neonatal resuscitation in 4 areas: policy and procedure, resuscitation team membership, continuing education, and connections with a wider system of perinatal care. All 58 rural hospitals with perinatal services in 2 upper Midwestern states (North Dakota and Minnesota) were asked to provide information describing preparedness for neonatal resuscitation. Nursing administrators responded to the survey. FINDINGS: A total of 26 hospitals took part. Annual delivery volume ranged from 4 to 958. Preparedness scores ranged from 4 to 12. Hospitals with more than 125 deliveries each year reported significantly higher levels of preparedness than lower volume hospitals (9.50 vs 5.83, P < .001). Overall preparedness was not associated with level of perinatal care. Most rural hospitals did not identify a formal collaborative relationship with a regional level III perinatal center. CONCLUSIONS: Substantial variation in hospital preparedness for neonatal resuscitation was identified. Preparedness was associated with delivery volume. Lack of collaborative agreements between rural hospitals and level III perinatal centers was pervasive. Additional research into the measurement of hospital preparedness for neonatal resuscitation as a component of quality rural perinatal care is needed to optimize outcomes for rural-born neonates.

Music as a nursing intervention for preterm infants in the NICU.

Although there is general agreement that noise in the neonatal intensive care unit should be reduced, there is controversy about the use of music as a developmental care strategy with prererm infants. Much literature supports using music with preterm infants, indicating that it enhances physiologic and neurobehavioral functioning, but some experts worry that music is overstimulating. This article presents evidence supporting the use of music with preterm infants as well as criticism of same. Recommendations for music interventions with preterm infants are discussed, although fUrther research is needed before specific guidelines can he established.