Associations between Child Opportunity Index and Pediatric Cardiac Surgical Outcomes.

OBJECTIVE: To assess the relationship between the Child Opportunity Index (COI), a comprehensive measurement of social determinants of health, and specific COI domains on patient-specific outcomes following congenital cardiac surgery in the metropolitan region of Atlanta, Georgia. STUDY DESIGN: In this retrospective chart review, we included patients who underwent an index operation for congenital heart disease between 2010 and 2020 in a single pediatric health care system. Patients' addresses were geocoded and mapped to census tracts. Descriptive statistics, univariable analysis, and multivariable regression models were employed to assess associations between variables and outcomes. RESULTS: Of the 7460 index surgeries, 3798 (51%) met eligibility criteria. Presence of an adverse outcome, defined as either mortality or 1 of several other major postoperative morbidities, was significantly associated with COI in the univariable model (P = .008), but not the multivariable regression model (P = .39). Postoperative hospital length of stay was significantly associated with COI (P < .001) in univariable and multivariable regression models. There was no significant association between COI and readmission within 30 days of hospital discharge in univariable (P < .094) and multivariable (P = .49) models. CONCLUSION: COI is associated with postoperative hospital length of stay but not all outcomes in patients after congenital heart surgery. By understanding the role of COI in outcomes related to cardiac surgery, targeted interventions can be developed to improve health equity.

A Survey of Community Providers on Feeding Problems in Autism Spectrum Disorder.

PURPOSE: Feeding problems, ranging from mild to severe, are common in children with autism spectrum disorder. We conducted a 15-item online survey of community providers to gather information on service demand and current treatment approaches for this clinical population. METHODS: Respondents, speech-language pathologists, occupational therapists, registered dietitians, and Board-Certified Behavior Analysts, were recruited via e-mail listservs, professional conferences, continuing education programs, social media and electronic newsletters. The survey included questions about professional discipline, years in practice, patient population served, feeding problem types, therapeutic approaches, and level of interest in parent-mediated interventions. RESULTS: A total of 541 community practitioners responded to the survey; 419 provided usable data. Across all providers, 97% (n = 406) reported seeing children with ASD and feeding problems. Of these, 90% (n = 367) offered treatment. Providers (n = 23) who did not treat feeding problems cited "insufficient training." Most common presenting problems included limited dietary variety, texture sensitivity, and disruptive mealtime behavior. Although treatment approaches varied across disciplines, 89.3% indicated openness to parent-mediated treatment. CONCLUSIONS: These results indicate a high demand for treatment of children with ASD and feeding problems across disciplines. Food selectivity was the most common problem. Treatment approaches varied across disciplines. Dissemination and implementation of evidence-based, parent-mediated intervention is warranted.

Examining adaptations necessary to support the implementation of a parent-mediated intervention for children with autism spectrum disorder and moderate feeding problems.

LAY ABSTRACT: Moderate feeding problems and disruptive mealtime behaviors are common in children with autism spectrum disorder. Although parent-mediated interventions are able to support feeding problems in autistic children, most research has occurred within specialty clinics when delivered by highly trained clinicians. Thus, the fit of these interventions within community settings is not clear. To address this limitation, this study explored adaptations to a parent-mediated intervention, Managing Eating Aversions and Limited Variety (i.e. MEAL Plan), to improve its fit and use within community settings. Participants were 14 multidisciplinary providers who attended one of the three intensive workgroups that included focus groups about the fit of MEAL Plan in their practice setting. Qualitative analysis was used to determine the main themes that came up within the focus groups. Specific themes included the appropriateness MEAL Plan for autistic and non-autistic children, how providers might adapt their delivery of MEAL Plan, billing and insurance considerations, administrator support for MEAL Plan, and the content and format of ongoing training and consultation. By proactively considering and responding to these factors, it may be possible to enhance MEAL Plan so that it is better able to be delivered and sustained within community practices that support autistic children.

Nurses' Perceptions of a Novel Rooming-in Program for Infants With Critical Congenital Heart Disease.

BACKGROUND: The transition to home for infants who require complex care can be overwhelming for caregivers. Infants with critical congenital heart disease (CCHD) require advanced care management, so their caregivers must acquire extensive training before the infants are discharged home. Rooming-in programs have improved patient outcomes in other settings, such as the postpartum period. However, little research has examined a rooming-in program in a pediatric cardiac acute care setting. OBJECTIVE: To describe nurses' perceptions of a novel rooming-in program implemented in a pediatric cardiac acute care unit. METHODS: A qualitative descriptive research design was used to describe nurses' perceptions of the rooming-in program for infants with CCHD. Three focus groups were conducted with a convenience sample of 13 registered nurses who cared for infants with CCHD during the rooming-in program. Four trained independent coders performed qualitative thematic analysis. RESULTS: Nurses provided critical insight into the rooming-in program. Three themes were identified: improved nursing and family outcomes, leading the way through collaboration, and room for improvement. CONCLUSIONS: Infants with CCHD have complex needs, and caregivers must acquire advanced skills to adequately care for these infants. This study is the first to explore nurses' perceptions of a rooming-in program for infants with CCHD. The findings could improve rooming-in programs in the pediatric acute care setting, which can translate to better patient outcomes.

Addressing immunizations in nursing education: Immunization resources for undergraduate nursing.

Nursing faculty are challenged to integrate immunization content in prelicensure nursing curricula. Historically, most immunization content has been delivered in pediatrics courses, with less emphasis on other populations across the lifespan. Skills related to vaccine administration may be prioritized over the most current immunization science, such as pathophysiology, immunology, and epidemiology. As the most trusted profession rated by the public (Saad, 2020), nurses are ideally suited to address vaccine hesitancy and promote vaccination in the communities they serve. Nurses apply active listening, problem solving, and communication skills with patients and their families, contributing to a person's confidence in their decision to be vaccinated. The Centers for Disease Control and Prevention and the Association for Prevention Teaching and Research collaborated to develop a framework for immunization content and teaching resources, Immunization Resources for Undergraduate Nursing (IRUN), for faculty to use in designing the nursing curricula. Content includes a curriculum framework, curriculum mapping tool, multiple teaching resources, and a dedicated website (IRUNursing.org). The framework provides guidance for faculty on integrating immunization content into a curriculum. Teaching resources include case studies, simulation scenarios, and PowerPoint slide decks. Although primarily focused on prelicensure nursing education, resources are also relevant to advanced professional nursing education.

Racial and Ethnic Disparities in Autism Spectrum Disorder: Implications for Care.

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by difficulties with social interaction and communication and the presence of restrictive and repetitive behavior. Individuals with ASD, particularly those from diverse racial and ethnic backgrounds, are at higher risk of certain health conditions and mortality over the lifespan. Disparities in timing of diagnosis, access to services, and quality of care have a significant impact on the trajectory of individuals on the autism spectrum. Health care providers and law enforcement officers often interact with individuals with ASD and need adequate preparation to provide person-centered care to this vulnerable population.

A framework for evaluating SDOH curriculum integration.

Social determinants of health (SDOH) directly contribute to health inequities among populations and communities. These structural and social forces impact health and health outcomes. Nurses play a vital role in addressing the SDOH and closing gaps relative to disparate outcomes. Integration of SDOH in nursing curriculums has become highly prioritized in nursing education as marginalized communities continue to experience inequities in health, which have been highlighted during the COVID pandemic. Many schools of nursing have embedded SDOH in course content throughout curricula but lack a structured approach to appraise the effectiveness of incorporating these concepts. This paper describes a framework used to evaluate SDOH integration in pre-and post-licensure curriculum.

Integrating Early Brain Science and Skills Into Prelicensure Nursing Curriculum to Promote Parent-Child Interaction.

BACKGROUND: Research shows that the number of loving words children hear in their first 3 years of life has a tremendous impact on their health, developmental, and literacy outcomes. Early language transactions should be rich in engagement, quantity, quality, and context-a term called language nutrition. PROBLEM: The curriculum in most nursing programs does not emphasize the importance of early language exposure and ways to empower families to talk with their babies. APPROACH: The Talk With Me Baby Curriculum for Nurses, which includes techniques to empower families to better engage conversationally with their babies, was integrated into the prelicensure nursing curriculum. OUTCOMES: More than 1,300 nursing students have received knowledge and skills on early language exposure and ways nurses can promote parent-child interactions. CONCLUSION: Nurses have the opportunity to empower families to engage with their babies socially, emotionally, and linguistically as a means of promoting healthy brain development.

Nurses' Perceptions of Rooming-in for Caregivers of Infants with CCHD.

Congenital heart disease (CHD) is the most common congenital defect. Infants with critical congenital heart disease (CCHD) require complex medical care, and their caregivers need extensive training before being discharged home to safely care for their child. The rooming-in process provides caregivers with an opportunity to learn, practice, and manage the skills required for discharge to home during hospitalization. Although the literature reflects positive implications for the use of the rooming-in process in other populations (e.g., neonatal abstinence syndrome), literature about the rooming-in process in a pediatric cardiac care setting is limited. There remains a gap in the literature pertaining to the viewpoints of nurses, specifically as it relates to implementing a rooming-in process. Therefore, a qualitative study design was chosen to explore the nurses' perceptions of the rooming-in process using focus groups. The purpose of this study was to gain insight from nurses as to strategies to enhance the rooming-in process for caregivers of infants with CCHD. Additionally, we explored potential education and interventions to improve outcomes for infants with CCHD preparing to be discharged home.

Assimilation of Expert Clinician Into the Academy: A Competency-Based Faculty Development Plan.

BACKGROUND: As expert clinicians are recruited to academic positions in response to nursing faculty shortages, comprehensive plans are needed for transitioning and role development. PROBLEM: Schools of nursing often lack infrastructures to support and develop new faculty. APPROACH: Team members from an academic-clinical partnership with the Department of Veterans Affairs created a competency-based faculty development plan. OUTCOMES: A comprehensive self-directed faculty development plan was established that included a needs assessment, competency-based guide, and online modular resources. CONCLUSION: The faculty development plan provides a tailored approach to support the transition of clinicians to the academic role. This strategy is a potential solution to addressing the faculty shortage, retention, and role strain issues and builds capacity in schools of nursing. This innovative plan is a first step in establishing a mechanism to measure faculty competencies and professional growth.

Clinical impact of early diagnosis of autism on the prognosis and parent-child relationships.

Autism spectrum disorder (ASD) refers to a lifelong condition that usually appears in late infancy or early childhood, and is characterized by social and communication deficits that impede optimal functioning. Despite widespread research and greater public awareness, ASD has an unclear etiology and no known cure, making it difficult to acquire accurate and timely diagnoses. In addition, once an ASD diagnosis is made, parents find it challenging to navigate the healthcare system and determine which interventions are most effective and appropriate for their child. A growing body of evidence supports the value of early diagnosis and treatment with evidence-based interventions, which can significantly improve the quality of life of individuals with ASD as well as of their carers and families. Particularly noteworthy are early interventions that occur in natural surroundings and can be modified to address age-related goals throughout the lifespan. Therefore, the purpose of this review is to: 1) provide readers with a brief background related to ASD; 2) describe commonly used screening instruments and tools for early diagnosis; 3) describe early interventions that have empirical support; and 4) discuss how the parent-child and family relationships can be affected through this process. This information can provide professionals with information they can use to assist families who make critical and potentially life-changing decisions for children with ASD.

Identifying the Barriers to Early Diagnosis and Treatment in Underserved Individuals with Autism Spectrum Disorders (ASD) and Their Families: A Qualitative Study.

Clinical accounts indicate that disparities exist among families of children with Autism Spectrum Disorders (ASD), and that these disparities impede timely diagnosis and intervention. Furthermore, families living in rural areas are more likely to have reduced access to proper care and use alternative, unproven, and potentially harmful treatments. The purpose of this project was to begin addressing these needs by engaging providers and families of children with ASD living in rural and typically underserved areas. The investigators established a Community Advisory Board (CAB) of ASD professionals (e.g., community-based healthcare and service providers, director of a center for disabilities, psychologist, autism researcher, and special education professional). Next, they conducted four focus groups comprised of a total of 35 major stakeholders (e.g., individuals with ASD, parents of individuals with ASD, community-based healthcare and service providers, school teachers) to determine potential resources, barriers to early diagnosis/treatment, and alternative treatment use in children with ASD. Focus group sessions were audio-recorded, transcribed verbatim, and analyzed by three trained independent coders. Community participants identified several barriers to early diagnosis and intervention, as well as a variety of alternative treatments used in children with ASD. Thematic analysis of focus group transcripts showed several overarching themes regarding barriers to early diagnosis and treatment. Findings from this study have implications for practice and future research.