The pediatric nurse practitioner movement began in 1964 and is now 25 years old. Anniversaries are a good time for pausing to look backward and look forward. This brief history reports some early pediatric nurse practitioner adventures and a few of the beginning episodes of the National Association of Pediatric Nurse Associates and Practitioners. These special highlights make a remarkable statement about an elite cohort of nurses.
This article reviews the growth and changes that have occurred in home health care with emphasis on the most recent changes. The various types of home health organizations are defined along with the growth or decline in the types of agencies. The services provided by home health care providers along with client eligibility for home health care and the mechanisms for payment of service are discussed. The nurses' role in home health care at all levels of the organization is outlined. The roles reviewed include staff nurse, clinical specialist, practitioner, clinical supervisor, and manager. Finally, the future of home health care is briefly presented.
In 1988 the characteristics of the 2560 members of NAPNAP were determined by means of a mailed survey. Approximately 52% of the members returned usable questionnaires. Members were asked for information about their educational preparation, demographic characteristics, and professional employment status. Data about members' practice, how their practice has changed over time where possible, and implications for the future are reported.
In 1988, the 2560 members of NAPNAP were surveyed about their educational preparation, demographic characteristics, and professional employment status. Questions were included on members' opinions about issues that should be emphasized by NAPNAP in the future. Approximately 52% of the members returned usable questionnaires. In this second part of the survey results, we report the characteristics of members, how these characteristics have changed over time, and what the members believe NAPNAP's future priorities should be.
The relatively high infant mortality rate in the United States has remained stable during the last few years largely as a result of the steady rate of infants born with low birth weight. Further reductions in the infant mortality rate depend on the prevention of low birth weight births and improved quality of health in the first year of life. Groups such as the National Commission to Prevent Infant Mortality, the Institute of Medicine, and the American Nurses' Association have outlined steps for professionals and for the public and private sectors. PNPs are vital to this effort through clinical practice, program development, advocacy, and research.
The 1992 membership survey, authorized by the Executive Board of NAPNAP as part of an ongoing plan to survey members every 4 years, had three foci: (a) demographic characteristics of NAPNAP members, (b) practice characteristics of NAPNAP members, and (c) opinions of NAPNAP members related to health care issues. Information gathered from this membership survey will be used to assist in planning NAPNAP programs and direction, to advocate for pediatric nurse practitioners and for NAPNAP, and to inform health professionals, policy makers, and the general public about characteristics of a pediatric nurse practitioner and the work pediatric nurse practitioners do. NAPNAP members received the survey during the summer 1992, and 65% of the random sample of 800 were returned, a clear indication of strong interest on the part of NAPNAP members to be heard. This article, the second of two describing survey results, presents data describing characteristics of members' practice and the clients they serve.
Significant changes have occurred in the 4 years since the last NAPNAP membership survey was conducted. Membership in NAPNAP has shown strong, sustained growth; the role of nurses in advanced practice has expanded greatly, and an increasing possibility exists for national health care reform. In response to these changes and as a part of its long-range strategic planning, the NAPNAP Executive Board, in 1991, authorized an ongoing plan to conduct a membership survey every 4 years. The 1992 membership survey was mailed to a random sample of 800 NAPNAP members. Sixty-five percent were returned. The survey collected information on (a) demographic characteristics of NAPNAP members, (b) practice characteristics of NAPNAP members, and (c) opinions of NAPNAP members related to health care issues. This article presents summary data on demographic characteristics, issues, and opinions of NAPNAP members.
The 1997 NAPNAP membership survey examined demographic and practice characteristics of NAPNAP members. Surveys were mailed to a random sample of 800 NAPNAP members in spring 1997. Five hundred seventy-three surveys (70%) were returned. Two hundred eighty-eight respondents (50.8%) stated that they worked full time as a nurse practitioner (NP); 158 (27.9%) worked part time as an NP; and 121 (21.3%) were not employed as an NP. Data relating to the nature and scope of pediatric nurse practitioner practice were compiled from the responses of those who worked either full time or part time. Characteristics of pediatric nurse practitioners, their practice, and the clients they serve are described. Comparisons are made with data from previous NAPNAP membership surveys.
Although it is unlikely that the legislative endeavors of 1996 and 1997 relating to the health care industry will be matched in 1998, implementing regulations of the Balanced Budget Act and the Health Insurance Portability and Accountability Act will predicate the successes or shortcomings of these new laws in 1998. It is important that NPs stay in close contact with their state legislators and Medicaid officers responsible for implementing the SCHIP. NPs should also closely track efforts at the Federal level to ensure inclusion of non-physician providers in legislation that is important to NPs, such as bans on "gag" clauses--a protection that should include all health care providers.
Recently, public and professional emphasis has been placed on addressing the increasing prevalence of childhood overweight.
This survey study was conducted with two cohorts of pediatric nurse practitioners (N = 413) to explore differences in self-reported practice skills over time.
Significant improvements in assessment, screening, and laboratory evaluations were reported, although reduced adherence to recommended psychosocial assessments was noted.
This study outlines self-reported barriers to effective childhood weight management. One support that participants requested was evidence-based guidelines. Motivational interviewing may be an additional strategy to enhance provider skills to assess and manage challenging patient behavior change (e.g., dietary and activity changes).
The potential effects of the report reach far into the health care community. This report could mark the beginning of an era of increased preventive health care. How the report is followed-up, however, is the key to the Year 2000 equation. Countless hours of study and countless dollars have, in the past, produced valuable reports similar to the Year 2000 report. Yet, the results of these other reports, because of lack of follow-up, are less than impressive. If the contributions of more than 7000 individuals are to translate to better health for the nation in the year 2000, follow-up measures must be enacted. This is an opportunity for action on the part of NAPNAP and all pediatric nurse practitioners.
In this study we examined the impact of the Expert Committee Recommendations (ECRs) on childhood obesity preventive care during well-child visits in the United States.
Data from the 2006-2009 National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey-outpatient department were used to examine frequencies of diet/nutrition and exercise counseling during well-child visits by children aged 2 to 18 years. Differences in rates of the counseling before and after the ECRs were made were compared.
Only 37% and 22% of all patients in 2006-2007 and 33% and 18% of all patients in 2008-2009 were provided with diet/nutrition and exercise counseling, respectively. The frequencies of counseling for patients with a diagnosis of obesity showed no change. Socioeconomically disadvantaged children received counseling less frequently after the ECRs were made.
Overall, rates of obesity preventive care were low in all years, with no evidence of improvement after the ECRs were made. Systematic approaches are needed to improve delivery of obesity preventive care irrespective of the socioeconomic backgrounds of children.
The 2009 H1N1 influenza pandemic took health care workers worldwide by surprise. Early in the course of the pandemic it was determined that children and pregnant women were at high risk of increased morbidity and mortality from the novel influenza virus. The Centers for Disease Control and Prevention and state and local public health officials quickly rallied to develop treatment guidelines for the new strain of influenza A, including emergency approvals for off-label use of some antiviral drugs. Prevention of the spread of influenza via vaccination and environmental controls is critical to the health of children. The 2009 H1N1 influenza virus emerged too late to be included in the 2009/2010 seasonal influenza vaccine, so production of a monovalent vaccine was set in motion. Five months from when the first cases of novel H1N1 appeared in Mexico and the United States, a vaccine was being distributed to high-risk patients. Looking ahead to the 2010/2011 influenza season, it is difficult to predict 2009 H1N1 activity. The 2010/2011 seasonal influenza vaccine will include the 2009 H1N1 strain, so it is critical to get all children vaccinated early in the flu season.
Adolescents with DS have many medical conditions that put them at risk for health impairment and disability, and therefore they require frequent monitoring and screening throughout adolescence. Transition from adolescence to adulthood requires much planning and reflection so that the individual with DS can achieve his or her potential and live life to the fullest. Adolescents with DS and their families should be supported and guided by NPs and other health care professionals during this challenging and often difficult time.U.S. Department of Education, 2004.
Abdominal migraine affects 1% to 4% of children and is a variant of migraine headaches. Onset is seen most often between the ages of 7 to 12 years, with girls affected more often than boys. Presenting symptoms include acute incapacitating non-colicky periumbilical abdominal pain that lasts for 1 or more hours. Pallor, anorexia, nausea, vomiting, photophobia, or headache may be associated with the episodes, and a family history of migraine headaches often is noted. The diagnostic process begins with a thorough history and physical examination and often follows a series of exclusions or elimination of other organic causes. Limited research exists regarding treatment options, but they may include pharmacologic intervention and prevention based on lifestyle modifications.
The sexual abuse of children in the United States is a problem of epidemic proportions. Sexual abuse is defined as any activity with a child that is conducted for the sexual gratification of the perpetrator. Common examples of sexual abuse include vaginal intercourse; oral-genital contact; anal-genital contact; fondling; finger manipulation; and stimulation of the offender. Sexual abuse may also occur in less typical patterns in which children are subjected to aberrant genital care practices, typically by their parents. Three case studies illustrate examples of aberrant genital practices. This type of abuse can be identified in primary care settings by asking specific questions of parents and children. Examples of such questions are provided.
While most adolescents will require only outpatient management and reassurance as their cycles become ovulatory over time, health care providers must evaluate each teen closely so that significant pathology can be quickly identified and treated appropriately. Abnormal vaginal bleeding in adolescents is a common occurrence, and the primary care provider should be comfortable with its evaluation and management. While most adolescents will require only outpatient management and reassurance as their cycles become ovulatory over time, health care providers must evaluate each teen closely so that significant pathology can be quickly identified and treated appropriately.
