An overview and policy implications of national nurse identifier systems: A call for unity and integration.

There is a clear and growing need to be able record and track the contributions of individual registered nurses (RNs) to patient care and patient care outcomes in the US and also understand the state of the nursing workforce. The National Academies of Sciences, Engineering, and Medicine report, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (2021), identified the need to track nurses' collective and individual contributions to patient care outcomes. This capability depends upon the adoption of a unique nurse identifier and its implementation within electronic health records. Additionally, there is a need to understand the nature and characteristics of the overall nursing workforce including supply and demand, turnover, attrition, credentialing, and geographic areas of practice. This need for data to support workforce studies and planning is dependent upon comprehensive databases describing the nursing workforce, with unique nurse identification to support linkage across data sources. There are two existing national nurse identifiers- the National Provider Identifier and the National Council of State Boards of Nursing Identifier. This article provides an overview of these two national nurse identifiers; reviews three databases that are not nurse specific to understand lessons learned in the development of those databases; and discusses the ethical, legal, social, diversity, equity, and inclusion implications of a unique nurse identifier.

Value-Based Payment: What Does It Mean for Nurses?

Among the many lessons that have been reinforced by the SARS-COVID-19 pandemic is the failure of our current fee-for-service health care system to either adequately respond to patient needs or offer financial sustainability. This has enhanced bipartisan interest in moving forward with value-based payment reforms. Nurses have a rich history of innovative care models that speak to their potential centrality in delivery system reforms. However, deficits in terms of educational preparation, and in some cases resistance, to considering cost alongside quality, has hindered the profession's contribution to the conversation about value-based payments and their implications for system change. Addressing this deficit will allow nurses to more fully engage in redesigning health care to better serve the physical, emotional, and economic well-being of this nation. It also has the potential to unleash nurses from the tethers of a fee-for-service system where they have been relegated to a labor cost and firmly locate nurses in a value-generating role. Nurse administrators and educators bear the responsibility for preparing nurses for this next chapter of nursing.

White Paper: Recognizing Child Trafficking as a Critical Emerging Health Threat.

Human trafficking is a pandemic human rights violation with an emerging paradigm shift that reframes an issue traditionally seen through a criminal justice lens to that of a public health crisis, particularly for children. Children and adolescents who are trafficked or are at risk for trafficking should receive evidence-based, trauma-informed, and culturally responsive care from trained health care providers (HCPs). The purpose of this article was to engage and equip pediatric HCPs to respond effectively to human trafficking in the clinical setting, improving health outcomes for affected and at-risk children. Pediatric HCPs are ideally positioned to intervene and advocate for children with health disparities and vulnerability to trafficking in a broad spectrum of care settings and to optimize equitable health outcomes.

Human Trafficking of Children: Nurse Practitioner Knowledge, Beliefs, and Experience Supporting the Development of a Practice Guideline: Part One.

INTRODUCTION: Up to 87% of trafficking victims encounter a health care provider while being trafficked but are not recognized as victims. Most health care providers receive little or no training, and awareness remains low. To describe the knowledge, beliefs, and attitudes of pediatric advanced practice registered nurses about human trafficking. METHOD: A survey of the National Association of Pediatric Nurse Practitioners membership (n = 8,647) before the intervention measured knowledge, beliefs, and experience regarding child trafficking. An awareness campaign was implemented with continuing education, national media presence, Train the Trainer programs, and creation of a nonprofit organization to direct strategic initiatives. RESULTS: Overall, 799 (9%) NAPNAP members completed the survey. Although 87% believed it possible that they might encounter a victim of trafficking in their practice, 35% were unsure if they had provided care for a victim. Only 24% reported confidence in their ability to identify a child at risk for trafficking. DISCUSSION: These survey findings indicate the need for clinical practice guidelines to identify potential and actual victims of human trafficking. Pediatric advanced practice registered nurses are ideally equipped and situated to intervene on behalf of vulnerable children with health disparities in a myriad of care settings, advocating for prevention and optimization of equitable health outcomes.

"Having a Baby Changes Everything" Reflective Functioning in Pregnant Adolescents.

UNLABELLED: Reflective functioning (RF), the capacity to envision thoughts, feelings, needs and intentions within the self and others, is thought to be central to sensitive parenting, yet this capacity has been unexamined among pregnant adolescents. We explored how RF was related to the emotional experience of adolescent pregnancy. DESIGN AND METHODS: This qualitative study was guided by interpretive description. Participants were 30 Latina and African-American adolescents (mean age 17.7+1.5years) residing in a low-income urban community. All adolescents were interviewed with the Pregnancy Interview (a 22 question semi-structured interview) in their third trimester of pregnancy. Interview transcripts had been previously coded for levels of RF (1-9 with higher levels denoting higher reflectiveness), and this secondary analysis focused on the teens' experience of pregnancy and their emerging reflective capacities. We used a priori and inductive coding with all interviews and developed patterns and themes. RESULTS: These interviews provided an in-depth understanding of the complex adolescent emotional experiences of pregnancy. We identified five themes that create a picture of how the participants reflected upon their pregnancies, unborn babies, emerging parental roles, and complicated relationships with family and partners. CONCLUSIONS AND PRACTICE IMPLICATIONS: Adolescent developmental issues and harsh family and neighborhood environments permeated the teens' experience of pregnancy and limited capacity for RF. Understanding distinctive features of RF in pregnant adolescents may contribute to developing conceptual models and tailored clinical approaches for enhancing parental reflectiveness and sensitivity in these vulnerable young women as they enter into the transition to parenthood.

Adolescent mothers' experiences of caring for their children while homeless.

The purpose of this descriptive phenomenological study was to describe homeless adolescent mothers' experiences of caring for their children while living in a shelter. Eight homeless adolescent mothers participated in the study. Data were analyzed using Colaizzi [Colaizzi, P. (1978). Psychological research as the phenomenologist views it. In R. S. Valle & M. King (Eds.) Existential Foundations of Psychology (chapter 3). New York, NY: Oxford University Press]. Five themes were generated: (a) tough and troubling times, (b) acting out, (c) wishing it undone, (d) hostile encounters, and (e) steering clear. Nurses working with homeless families may help these young mothers cope with the demands of shelter living while keeping in mind that distinctive support needs may arise during different times of the homeless experience.

Establishing a school-based clinic in Managua, Nicaragua.

In May 2007, Yale University sent a team of nurse practitioner faculty and students to Managua, Nicaragua, as part of a five-year project to provide health care for children who attended a small school in a poor area of the city. Over the course of four days, 88 children were examined and treated. Although the Ministry of Health of Nicaragua theoretically provides health care for all, resources are often limited and difficult to access. By working with teachers and families, the team from Yale University is attempting to help the community establish a school-based clinic to meet the day-to-day needs of the children and establish health care contacts for more serious health care needs.

Nurses' response to pain communication from patients: a post-test experimental study.

BACKGROUND: Inadequate communication about pain can result in increased pain for patients. OBJECTIVES: The purpose of the current pilot study was to test how nurses respond when patients use their own words, a pain intensity scale, or both to communicate pain. DESIGN: A post-test only experimental design was used with three pain description conditions, personal and numeric; personal only; numeric only. SETTING: The setting included six hospitals and one school of nursing located in the northeastern United States. PARTICIPANTS: PARTICIPANTS included 122 registered medical surgical nurses. METHODS: Nurses were randomly assigned to condition, and read a vignette about a trauma patient with moderately severe pain. The vignettes were identical except for the patient's pain description and age. The nurses then wrote how they would respond to the patient's pain. Two blind raters content analyzed the responses, giving nurses one point for including each of six a priori criteria derived from the Acute Pain Management Panel [1992. Acute Pain Management: operative or medical procedures and trauma. Clinical practice guideline (AHCPR Publication No. 92-0032)., Rockville, MD, USA] and the American Pain Society [2003. Principles of analgesic use in the treatment of acute pain and cancer pain, Glenville, IL, USA]. RESULTS: Nurses planned similar numbers of pain management strategies across the three conditions, with a mean of 2.1 (SD=1.14) strategies out of the recommended six. CONCLUSIONS: Nurses did not respond with more pain management strategies when patients describe pain in their own words, or in their own words and a pain intensity scale. The relatively small number of pain management strategies planned by the nurses suggests that nurses use few strategies to respond to moderately severe pain problems.

Homeless adolescent mothers: a metasynthesis of their life experiences.

The purpose of this article was to synthesize the findings of six qualitative studies on homeless adolescent mothers. Metasynthesis was conducted using the meta-ethnographic approach of Noblit and Hare [Noblit, G., & Hare, R. (1988). Meta-ethnography: Synthesizing qualitative studies. Newbury Park, CA: Sage Publications]. Six reciprocal translations illuminating the experiences of homeless adolescent mothers emerged: being homeless, enduring abuse, lamenting lost years, searching for support, recreating self, and seeking a better life. The findings may be used by nurses working with this population as the basis for a framework of intervention strategies directed toward helping these mothers cope with their dual transitions into motherhood and adulthood while simultaneously being homeless.

Barriers to effective pediatric asthma care.

Although progress has been made in understanding the pathophysiology of asthma and identifying key features of quality asthma care, the prevalence of childhood asthma remains high. Barriers to effective asthma care that currently exist include the persistence of environmental risk factors, disparities in care that stem from poverty and cultural differences, and inconsistencies in the quality of asthma care provided by clinicians. Pediatric nurse practitioners at Yale New Haven Children's Hospital have actively implemented the recommended guidelines for asthma care and addressed causes for some of the disparities in asthma health care. Two major initiatives are described: the Asthma Care Coordination Project at Yale New Haven Hospital Pediatric Primary Care Center, and the establishment of an Asthma Outreach Program. Recommended resources and Web sites for the practitioner are also provided.

Inpatient asthma clinical pathways for the pediatric patient: an integrative review of the literature.

BACKGROUND: Asthma is one of the most prevalent childhood chronic illnesses in the United States leading to nearly 190,000 pediatric hospitalizations yearly. In response to the increasing number of children with asthma being hospitalized, some institutions have developed and implemented clinical pathways and are now reporting their findings in the literature. The purpose of this paper was to conduct an integrative literature review of studies using an inpatient clinical pathway for the management of pediatric asthma. METHOD: Five research-based articles evaluating clinical pathways for the management of inpatient pediatric asthma were included in this review. The integrative review was conducted using the guidelines set forth by Ganong (1987). RESULTS: The results revealed that clinical pathways appear to be effective in reducing length of stay and hospital costs associated with inpatient pediatric asthma. The pathways were not as effective in reducing readmission rates or affecting clinical outcomes for patients such as increasing asthma education, the use of controller medications, spacers, and peak flow meters. PRACTICE IMPLICATIONS: Although the pathways are effective in reducing hospitalization costs associated with asthma, there was little reported improvement in clinical outcomes. Nurses should ensure that each pediatric asthma hospitalization provides an opportunity to promote education about asthma. This approach may lead to decreased asthma admissions and increased self and family management of pediatric asthma. Future research should focus on the clinical outcomes of patients using the inpatient pathways and also on the development of pathways to be used in outpatient settings that manage pediatric asthma.