A Primer on Understanding Pediatric Health Care Quality Measurement.

Advanced practice registered nurses implement evidence-based care guidelines and assess the quality of care delivered to pediatric and adolescent populations to ensure that the highest standards of care are provided to the patients and their families. Standardized health care quality measures allow for assessment of clinical competence, monitoring of equitable health care distribution, improvement of provider/institutional accountability, development of standards for accreditation and certification, informing of quality improvement efforts, and creation of criteria for provider incentive payments. The purpose of this article is to explain why health care quality measures are established, what agencies oversee the development of meaningful pediatric quality measures, and how these measures inform and improve the care provided by pediatric-focused advanced practice registered nurses.

Progressive Dosing of Observed Real-Life Clinical Exposure for Nurse Practitioner Training.

BACKGROUND: In most advanced practice programs, preceptors are relied on for providing student clinical experiences. Preceptor feedback often indicates that many students show competency deficits in well child care, case presentation, and clinical skills. METHOD: An innovative preclinical experience was developed using nonscripted pediatric patient and family volunteers from the local community. During the three 4-hour experiences, students obtained a health history, performed a full physical examination, and presented their findings using a standardized case presentation format. Student anxiety and levels of confidence were assessed before and after each experience. RESULTS: Student anxiety decreased, and self-confidence and clinical skill competencies improved. Students who participated in the experiences with faculty demonstrated improved entry-level competencies, compared with previous cohorts who had not received the intervention. CONCLUSION: Preclinical experiences using pediatric patients improved advanced practice nursing student confidence and competencies and reduced anxiety, improving overall entry-level clinical performance. [J Nurs Educ. 2017;56(9):552-555.].

Parental perception of child's body mass index and health within primary care.

BACKGROUND AND PURPOSE: Overweight and obesity are sensitive issues to address with pediatric patients during any visit. Patients and families may not recognize that their child is overweight or obese and may not be ready to make change. The goals for this study were to collect overall statistics on the clinic in regards to weight status of children presenting for well child visits and to capture parental perception of the child's weight status in relation to child's age. METHODS: A consecutive sample of parents and caregivers with a child aged 2-18 completed the survey and consented for the study on the day of the survey during a well child visit. CONCLUSIONS: Parents, regardless of culture and age tended to underestimate the weight of their child. These findings further support the literature in that the younger the child, the more likely it is that the parent underestimates their weight status. IMPLICATIONS FOR PRACTICE: Interventions should include early education with parents on what a healthy weight is and how it can predict future health. Addressing and recognizing early concerns and assessing parental perception can be important if educational messages are delivered throughout the span of the early years.

An Evaluation of the Identification and Management of Overweight and Obesity in a Pediatric Clinic.

With the rise in overweight and obesity in children, it is imperative for health care providers to routinely address appropriate body mass index for children during primary care visits. The purposes of this project were to determine if overweight and obese children are accurately being identified and to evaluate provider adherence to American Academy of Pediatrics guidelines for the management of obesity. A retrospective chart review was completed for all children ages 2, 6, and 10 years who presented for a well-child visit from January 1, 2011, through June 30, 2011. Based on a review of 255 charts, 21.6% of patients were overweight and 18.4% were obese according to standards of the Centers for Disease Control and Prevention. Of these children, 34% were properly documented as being either overweight or obese, and documentation was lacking for the remaining 66%. Of the children correctly identified as being overweight or obese, only 11% and 26%, respectively, were counseled on therapeutic lifestyle changes, including diet and exercise. This review provides evidence that providers have opportunities to intervene early with well-child examinations and that providers have great room for improvement on counseling overweight and obese children.

Análisis psicométrico del cuestionario de clima laboral de la Fuerza Aérea Colombiana / Psychometric Analysis of a Questionnaire on Work Environment in the Colombian Air Forces

El objetivo del presente estudio fue proponer un instrumento para medir el clima laboral en la Fuerza Aérea Colombiana. Para ello se diseñó el cuestionario de clima laboral, se evaluaron las características psicométricas y se estableció su utilidad como instrumento de medida. El estudio fue de tipo instrumental, con la participación de 3272 de sus funcionarios, diferenciados por grupos de rango, dependencia, jefatura y bases en el ámbito nacional. Se realizó el análisis de ítems para identificar la potencia discriminativa de cada uno de los ítems, para diferenciar entre quiénes tienen alta percepción de un buen clima laboral y los que no la tienen; la homogeneidad y la consistencia interna. Todas las escalas obtuvieron un alpha mayor a 0,72 y del análisis de cada ítem, se propone una escala de 58 elementos. Se concluye que el cuestionario de clima laboral tiene buena capacidad discriminativa y de homogeneidad.

The purpose of the study was to propose an instrument in order to measure the work environment in the Colombian Air Forces. In order to do this, a questionnaire of work environment was designed; then the psychometric characteristics were evaluated and the utility as an instrument of measurement was established. This study was instrumental and 3272 military servants took part in it and were classified according to their rank, branch where they work, if they were the chief of a division and location in the national territory. In order to identify the discriminative potential of each one of the items to differentiate among the military servants who have a high perception of a good work environment and those who do not have it, each item was analyzed. Homogeneity and inner consistency were also studied. All the scales got an alpha bigger than 0,72 and according to each item, a scale of 58 items is proposed. It was concluded that the questionnaire of work environment has a good homogeneity and discriminative capacity.

Renal replacement therapy among disadvantaged populations in Mexico: a report from the Jalisco Dialysis and Transplant Registry (REDTJAL).

BACKGROUND: End-stage renal disease represents a serious public health problem in Jalisco, Mexico. It is reported among the 10 leading causes of death, with an annual mortality rate of 12 deaths per 100,000 population. The state population is 6.3 million, and more than half do not have medical insurance. In this study, we report the population's access to renal replacement therapy (RRT). METHODS: Patients > or =15 years of age, who started RRT between January 1998 and December 2000 at social security or health secretariat medical facilities, were included. Nine facilities participated in the study. At the start of treatment, the patient's facility, age, gender, cause of renal failure, and initial treatment modality were registered. RESULTS: Within the study period, 2456 started RRT, 1767 (72%) at social security facilities and 687 (28%) at health secretariat facilities, for an annual incidence rate of 195 per million population (pmp). The main cause of renal failure was diabetes mellitus (51% of patients). There were significant differences between the 2 populations. Patients with social security were older (53.1 +/- 17 vs. 45.1 +/- 20 years, P= 0.001) and had more diabetes (54% vs. 42%, P= 0.001) than those without social security. They had higher acceptance (327 pmp vs. 99 pmp, P= 0.001) and prevalence rates (939 pmp vs. 166 pmp, P= 0.001) than patients without medical insurance. Dialysis use was similar in both populations. Eighty-five percent of patients were on continuous ambulatory peritoneal dialysis and 15% on hemodialysis. Kidney transplant rate was higher among insured patients (72 pmp vs. 7.5 pmp, P= 0.001). The number of dialysis programs and nephrologists that offered renal care also differed. There were 10 dialysis programs in social security and 3 in health secretariat facilities. Fourteen nephrologists looked after the insured population, whereas 5 cared for the uninsured (7.7 pmp vs. 2.1 pmp, P= 0.001). The latter had access to 8 hemodialysis stations compared with 34 for the insured population (3.4 pmp vs. 18.8 pmp, P= 0.001). CONCLUSIONS: Access to RRT is unequal in our state. Although it is universal for the insured population, it is severely restricted for the poor. Social and economical factors, as well as the limited number of understaffed, centralized dialysis facilities, could explain these differences.