Let's Not Reinvent the Wheel: Using Communities of Learning and Practice to Address SDOH and Advance Health Equity.

BACKGROUND: Despite advances in knowledge and science, evidence indicates that health care disparities and inequities continue to exist across diverse populations. Educating and training the next generation of health professionals to focus on addressing social determinants of health (SDOH) and advancing health equity is a key priority. This aim requires educational institutions, communities, and educators to strive for change in health professions education, to attain the goal of creating transformative educational systems that better meet the public health needs of the 21st Century. PURPOSE AND OUTCOMES: Communities of practice (CoPs) are groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly. The National Collaborative for Education to Address Social Determinants of Health (NCEAS) CoP is focused on integrating SDOH into the formal education of health professionals. The NCEAS CoP is one model to replicate how health professions educators can work together for transformative health workforce education and development. The NCEAS CoP will continue to advance health equity by sharing evidence-based models of education and practice that address SDOH and help build and sustain a culture of health and well-being through sharing models for transformative health professions education. CONCLUSIONS: Our work is an example that shows we can build partnerships across communities and professions, thereby freely sharing ideas and curricular innovations that address the systemic inequities that continue to fuel persistent health disparities and inequities, and contribute to moral distress and burnout of our health professionals.

A Preliminary Study of Executive Functioning in Preterm-Born Children: A Bilingual Advantage.

BACKGROUND: Preterm-born children are at increased risk for deficits in executive function (EF). EF is a set of cognitive processes including inhibition, attention, memory, and decision-making, among others. Bilingualism, operationalized as productive capacity in 2 languages (ie, English and Spanish), may enhance EF in children born preterm and in term-born children. PURPOSE: The purpose of this study was to examine the impact of bilingualism on executive functioning in bilingual and monolingual preterm and term-born children using a robust measure of bilingualism. METHODS: This study examined the impact of bilingualism on EF in 17 monolingual or bilingual preterm-born children, aged 6 to 7. The preterm-born sample was also compared with a normed, term-born sample of 38 monolingual, typically developing 6- to 7-year-olds. RESULTS: On the Creature Counting task of EF, bilingual preterm-born children performed with more accuracy and total switches than monolingual preterm-born children. There was no difference in accuracy between the term-born and entire preterm-born samples. The bilingual, preterm-born children performed more accurately than the term-born sample. IMPLICATIONS FOR PRACTICE AND RESEARCH: This preliminarily suggests bilingualism confers an advantage to preterm-born children's EF. Further research is needed on bilingual advantage of preterm-born children.

Leveraging the resources of foundations to advance health equity.

BACKGROUND: Foundations that support health and health care related issues are bell weathers for our nation's most pressing challenges in this area. The new National Academy of Medicine report, The Future of Nursing 2020 to 2030: Charting a Path to Achieve Health Equity has been perfectly timed to provide foundations with the additional research and evidence they need to support health equity efforts through the utilization of the nursing workforce. Many foundations are thinking beyond traditional grant-making to align more of their assets with mission in creative ways. CONCLUSION: Funders are investing in strategies along a downstream-upstream continuum to promote health equity. This paper is aimed to encourage nurses to approach philanthropy as important partners in their efforts to advance health equity.

Longitudinal Survey of COVID-19 Burden and Related Policies in U.S. Neonatal Intensive Care Units.

OBJECTIVE: This study aimed to determine the prevalence of confirmed novel coronavirus disease 2019 (COVID-19) disease or infants under investigation among a cohort of U.S. neonatal intensive care units (NICUs). Secondarily, to evaluate hospital policies regarding maternal COVID-19 screening and related to those infants born to mothers under investigation or confirmed to have COVID-19. STUDY DESIGN: Serial cross-sectional surveys of MEDNAX-affiliated NICUs from March 26 to April 3, April 8 to April 19, May 4 to May 22, and July 13 to August 2, 2020. The surveys included questions regarding COVID-19 patient burden and policies regarding infant separation, feeding practices, and universal maternal screening. RESULTS: Among 386 MEDNAX-affiliated NICUs, responses were received from 153 (42%), 160 (44%), 165 (45%), 148 (38%) across four rounds representing an active patient census of 3,465, 3,486, 3,452, and 3,442 NICU admitted patients on the day of survey completion. Confirmed COVID-19 disease in NICU admitted infants was rare, with the prevalence rising from 0.03 (1 patient) to 0.44% (15 patients) across the four survey rounds, while the prevalence of patients under investigation increased from 0.8 to 2.6%. Hospitals isolating infants from COVID-19-positive mothers fell from 46 to 20% between the second and fourth surveys, while centers permitting direct maternal breastfeeding increased 17 to 47% over the same period. Centers reporting universal severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) screening for all expectant mothers increased from 52 to 69%. CONCLUSION: Among a large cohort of NICU infants, the prevalence of infants under investigation or with confirmed neonatal COVID-19 disease was low. Policies regarding universal maternal screening for SARS-CoV-2, infant isolation from positive mothers, and direct maternal breastfeeding for infants born to positive mothers are rapidly evolving. As universal maternal screening for SARS-CoV-2 becomes more common, the impact of these policies requires further investigation. KEY POINTS: · In this cohort, neonatal COVID-19 is rare.. · Policies regarding isolation and breastfeeding for infants are rapidly evolving.. · Most hospitals are now providing universal screening for expectant mothers for SARS-CoV-2..

Robotic Uses in Pediatric Care: A Comprehensive Review.

PROBLEM: Advances in technology have made robotics acceptable in healthcare and medical environments. The aim of this literature review was to examine how the pediatric population can benefit from robotic therapy and assistance that are currently available or being developed in diverse settings. ELIGIBILITY CRITERIA: English language full-text publications focusing on pediatric robotic therapy studies for infants and children under the age of 17 indexed in PubMed and CINAHL and published from 2008 to 2018. SAMPLE: A total of 272 articles were identified, 69 full-text articles were retrieved and assessed for eligibility, and 21 studies were finally used in the literature review. RESULTS: From 21 studies, all studies reviewed showed that children benefited from robotic therapies were 1) responsive to the therapies and 2) favored robot's presence since the robotic systems increased their attention and ability to participate in tasks. Due to small sample size, results were statistically inconclusive. CONCLUSIONS: We identified positive findings, where utilizing pediatric robots played vital roles in assisting and enhancing current pediatric and NICU treatments. Overall, our findings suggested that more clinical trials would be essential, but the uses of robots may contribute to the future advancement in pediatric and neonatal healthcare. IMPLICATIONS: These review and analysis can be used to inform healthcare environments where there is a room for applying robotic assistance, although most studies required further testing with larger sample size to validate their results. This suggests the need for further research for robotics in pediatric and neonatal healthcare.

Leveraging the Skills of Nurses and the Power of Language Nutrition to Ensure a Better Future for Children.

BACKGROUND: Early language exposure is critical for language acquisition and significantly influences a child's literacy skills. However, preterm infants may experience language deprivation in the neonatal intensive care unit. Nurses are vital to helping parents understand their critical role in early language development. PURPOSE: To discuss the impact of language-rich interactions and interventions that promote early language exposure, or Language Nutrition, by parents and caregivers on the long-term developmental, language, and educational outcomes of high-risk infants. METHODS/SEARCH STRATEGY: A literature search was conducted using PubMed and Web of Science to identify articles that examined the influence of language interactions with high-risk infants on developmental outcomes. Recent campaigns touting the importance of early language exposure were identified through the Bridging the Word Gap Research Network. FINDINGS/RESULTS: Increasing preterm infants' exposure to Language Nutrition improves their language development, promotes parent-infant attachment, and decreases parent stress. In addition, it may result in greater neuroplasticity and volume of the auditory cortex. Several campaigns have been developed to increase children's access to Language Nutrition and can be implemented into everyday pediatric and neonatal care. IMPLICATIONS FOR PRACTICE: Pediatric, neonatal nurses and advanced practice nurses are uniquely positioned to play a transformational role in high-risk infants' developmental trajectory by educating parents about the importance of Language Nutrition and supporting parents as they engage with their infant. IMPLICATIONS FOR RESEARCH: Studies investigating the population-level impact of interventions aimed at increasing infants' access to Language Nutrition as well as studies identifying effective ways to communicate messages about Language Nutrition are warranted.

Predictors of Co-occurring Neurodevelopmental Disabilities in Children With Autism Spectrum Disorders.

PURPOSE: Co-occurring neurodevelopmental disabilities (including cognitive and language delays and attention deficit hyperactivity disorder) affect over half of children with ASD and may affect later behavioral, language, and cognitive outcomes beyond the ASD diagnosis. However, no studies have examined predictors of co-occurring neurodevelopmental disabilities in children with ASD. This study investigated whether maternal sociodemographic, perinatal and neonatal factors are associated with co-occurring disabilities. DESIGN AND METHODS: This study involved a retrospective analysis of medical records for children diagnosed with ASD between 2009 and 2010 at an Autism Center in the southeast United States. Logistic regression was used to identify predictors of co-occurring neurodevelopmental disabilities. RESULTS: Of the 385 children in the sample, 61% had a co-occurring neurodevelopmental disability. Children whose mothers had less education (OR: 0.905), had never been married (OR: 1.803), or had bleeding during pregnancy (OR: 2.233) were more likely to have a co-occurring neurodevelopmental disability. Both preterm birth and African American race were associated with bleeding during pregnancy. CONCLUSIONS: Several maternal and perinatal risk factors for ASD were found to put children at risk for further diagnoses of co-occurring neurodevelopmental disabilities. While prematurity, a well-established risk factor for ASD, as well as maternal ethnicity was not found to increase the risk of a co-occurring disability, this study suggests that bleeding during pregnancy may moderate these relationships. PRACTICE IMPLICATIONS: Understanding maternal, perinatal, and neonatal risk factors may inform healthcare provider screening for ASD and co-occurring neurodevelopmental disabilities by helping providers recognize infants who present with multiple risk factors.

Probability of an Autism Diagnosis by Gestational Age.

Early preterm infants (EPT) (<33 6/7 weeks) are at increased risk for autism spectrum disorders (ASDs) but prevalence estimates vary widely across studies. Furthermore, there are very few studies addressing the association between late preterm (LPT) births (34-36 6/7 weeks) and ASDs. To address the question of whether LPT infants carry the same risk for ASDs as full-term infants, this study aimed to estimate the relative probability of an ASD diagnosis using Bayes rule. A retrospective cohort analysis of 406 children was undertaken to look at gestational age, ASDs, and birth history. The application of Bayes rule was used, given that there is not sufficient information about the joint probabilities related to prematurity and autism. Using the estimated gestational age proportions within ASD diagnosis, plus national estimates of ASDs, probabilities for ASDs within a given gestational age were calculated. Among these 406 children with ASDs, 6.7% were EPT and 10.6% were LPT. In comparison to full term, EPT children are at 1.9 multiplicative increase in risk (95% CI [1.3, 2.5]). While the probability of ASDs for LPT children was higher than that for term, the estimated relative risk of the LPT infants was not statistically significant (95% CI [0.9, 1.5]). EPT infants were significantly more likely to be diagnosed with ASDs compared to their term peers. While the relative probability of ASD diagnosis among children born LPT was not statistically significant in this limited sample, the results indicate a possible elevated risk. A larger cohort is needed to adequately estimate this risk.

Maternal and Neonatal Birth Factors Affecting the Age of ASD Diagnosis.

Early diagnosis of autism spectrum disorders (ASD) enables early intervention that improves long term functioning of children with ASD but is often delayed until age of school entry. Few studies have identified factors that affect timely diagnosis. This study addressed how maternal education, race, age, marital status as well as neonatal birth factors affect the age at which a child is diagnosed with ASD. This study involved a retrospective analysis of 664 records of children treated at one of the largest autism treatment centers in the United States from March 1, 2009 to December 30, 2010. Logistic regression and Cox proportional hazards regression were used to identify maternal and neonatal factors associated with age of diagnosis. Infant gender, maternal race, marital status, and maternal age were identified as significant factors for predicting the age of ASD diagnosis. In the Cox proportional hazards regression model, only maternal race and marital status were included. Median survival age till diagnosis of children born to married mothers was 53.4 months compared to 57.8 months and 63.7 months of children born to single and divorced or widowed mothers respectively. Median survival age till diagnosis for children of African American mothers was 53.8 months compared to 57.2 months for children of Caucasian mothers. No statistically significant difference of timing of ASD diagnosis was found for children of varying gestational age. Children born to older or married mothers and mothers of minority races were more likely to have an earlier ASD diagnosis. No statistically significant differences in timing of ASD diagnosis were found for children born at varying gestational ages. Identification of these factors has the potential to inform public health outreach aimed at promoting timely ASD diagnosis. This work could enhance clinical practice for timelier diagnoses of ASD by supporting parents and clinicians around the world in identifying risk factors beyond gender and SES and developing strategies to recognize earlier signs of ASD and contribute to improved development outcomes in children with ASD.

Perinatal, neonatal, and family social factors predicting poor school outcome of low-birth-weight survivors: an integrative review.

PURPOSE: To examine the relationship of perinatal factors, neonatal factors, and family characteristics with school outcomes of low-birth-weight (LBW) children. DESIGN AND METHODS: An integrative review of the literature was performed using electronic databases focusing on key words, including school outcome, school performance, educational outcome, academic outcome/academic achievement, and LBW. RESULTS: The in utero or neonatal risk factors for poor school outcome included in this review were perinatal brain injury, brain structural abnormality, motor deficits, and neonatal conditions. Social risk factors found to contribute to poorer school outcomes were family structure, family stability, parental education, poverty, male sex, nonwhite race, and acculturation level. CONCLUSIONS: Long-term school outcomes of LBW children are influenced by a number of factors related to the characteristics of both children and their families. These factors need to be considered when designing preventive interventions.

Driving toward a culture shift: Case studies of social mission in nursing education.

BACKGROUND: Nursing schools need to provide students with the appropriate tools to develop competencies and resources to actualize moral courage to advance health equity and center social mission. PURPOSE: The purpose of this study was to describe six nursing programs that exemplify a variety of ways that social mission goals are pursued in different contexts. METHOD: Using a case study approach, we selected nursing schools that excelled in at least one of the following social mission domains: education program, community engagement, governance, diversity & inclusion, institutional culture & climate and research. We conducted video interviews with the administration, faculty and students. FINDINGS: Main themes were: (1) central university/college commitment; (2) allocation of school resources; (3) faculty buy-in; (4) community partnerships; and, (5) an institutional culture of inclusion. DISCUSSION: While each school approaches social mission differently, there are commonalities across cases including a number of necessary factors for schools to advance their social mission goals.

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.

Examining the Utility of Perceptual Noise Categorization in Pediatric and Neonatal Hospital Units.

Medical and nursing staff working in hospitals often experience exposure to extreme sound environments, and there is growing evidence of the negative impacts. Previous research highlighted various complexities regarding noise sources in hospitals; however, identifications of intrinsic noise categories that can reveal the complex mixture of existing hospital noise is still limited. The objective of this work was to identify intrinsic categories of the noise sources based on staff perceived annoyance and explore clear associations of these categorized noise sources with psychological perceptions. The staff perceptual responses regarding hospital noise were assessed by conducting surveys at the three pediatric and neonatal care units in two hospitals. Using principle component analysis (PCA), the psychological annoyance responses of 94 participants were used to derive the inherent structural patterns of the existing noise sources. The derived PCA categorization was validated on mixed-model analysis of variances, and employed on regression models to explore potential associations between the categorized noise factors and the staff's psychological perceptions. The results highlighted three intrinsic noise categories and their negative impacts on staff's psychological perceptions including work/rest disturbance and noisiness. Taken as a whole, the findings better reveal problematic noise source categories and establish a framework for hospital noise control that is less source-specific and more broadly generalizable.

Looking backwards to move forward: Using a social mission lens in nursing education.

The ideals of health equity continue to be constrained by the conditions in which people live, learn and work. But to what extents are nursing schools strengthening the preparedness of nurses to extend their reach and help individuals and communities achieve their highest level of health? A culture of health and health equity is built on a framework of social mission. The authors believe that social mission is not new to the nursing profession. However, a clear understanding of the historical evolution of social mission as it relates to nursing education could provide a solid foundation for understanding the extent to which nursing curricula aligns with a commitment to advancing healthcare outcomes. This manuscript is a commentary that outlines the foundational understanding of the history of social mission in nursing education through the present time and amplifies that educators should consider how adopting a social mission lens could help schools more effectively align their curricula, policies and practices with health equity. Social mission refers to the school's commitment to advance health equity in everything it does from admissions and faculty hiring policies, to curriculum development, the extent of community based experiential learning, and, ultimately measured in their graduates' outcomes (Mullan, 2017). It is the authors' view that the rich history, the magnitude of the sector, and the current transformational conversations occurring in the nursing profession, all call for a deeper analysis and engagement of nursing leaders in this topic.

Impact of restrictions on parental presence in neonatal intensive care units related to coronavirus disease 2019.

OBJECTIVES: To determine the relationship between the emergence of COVID-19 and neonatal intensive care unit (NICU) family presence as well as how NICU design affects these changes. STUDY DESIGN: A cross-sectional survey from April 21 to 30, 2020. We queried sites regarding NICU demographics, NICU restrictions on parental presence, and changes in ancillary staff availability. RESULTS: Globally, 277 facilities responded to the survey. NICU policies preserving 24/7 parental presence decreased (83-53%, p < 0.001) and of preserving full parental participation in rounds fell (71-32%, p < 0.001). Single-family room design NICUs best preserved 24/7 parental presence after the emergence of COVID-19 (single-family room 65%, hybrid-design 57%, open bay design 45%, p = 0.018). In all, 120 (43%) NICUs reported reductions in therapy services, lactation medicine, and/or social work support. CONCLUSIONS: Hospital restrictions have significantly limited parental presence for NICU admitted infants, although single-family room design may attenuate this effect.

Facilitating Early Breast Milk Expression in Mothers of Very Low Birth Weight Infants.

BACKGROUND: Although early initiation of human milk (HM) expression after birth is known to increase lactation success in mothers of very low birthweight (VLBW) infants, initiation is frequently delayed, potentially decreasing both short- and long-term HM production. Obstetrical (OB) nurses are typically the healthcare provider responsible for facilitating the initial HM expression session. As delays in initiation are common, it is likely that nurses experience obstacles to facilitation of an early initiation of HM expression. The purpose of this study was to determine barriers OB nurses perceive in facilitating early initiation of HM expression in mothers of VLBW infants. STUDY DESIGN AND METHODS: An online survey was administered to nurses from three tertiary care OB units in Florida to determine perceived barriers to early initiation of HM expression in mothers of VLBW infants. RESULTS: Eighty-three nurses completed the survey. The following barriers were identified: (1) lack of time and personnel to assist mothers with HM expression, (2) nurse's perception of the mother's acuity level, and (3) nurse's perception of maternal pain and stress. Discrepancies between nursing judgment, action, and knowledge of unit policies were evident. CLINICAL IMPLICATIONS: Obstetric nurses encounter barriers when facilitating early HM expression in mothers giving birth to VLBW infants. It is possible these barriers could be removed through improvements in education, use of innovative staffing strategies, and maintenance of evidence-based policies.

The Power of Language Nutrition for Children's Brain Development, Health, and Future Academic Achievement.

Language Nutrition, a term created to describe language exposure that is rich in quality and quantity and delivered in the context of social interactions, is crucial for a child's development and is strongly associated with his/her future literacy, academic achievement, and health. However, significant differences in children's early language environments contribute to disparities in their educational and health trajectories. Interventions, including book distribution programs, coaching parents to enrich their child's language environment, and public awareness campaigns, have all been shown to positively influence a child's access to language-rich interactions. Incorporating Language Nutrition coaching and literacy promotion into pediatrics is a promising platform for building the capacity of parents to provide language exposure to their children. By teaching parents both how and why to treat their child as a conversational partner and by modeling such interactions, pediatric health care providers can help parents set their children on a pathway toward literacy, educational success, and health.

Bilingualism as a potential strategy to improve executive function in preterm infants: a review.

Preterm birth is associated with long-term deficits in executive functioning and cognitive performance. Using the model of brain plasticity as a theoretical framework, it is possible that preterm infants' neurodevelopmental sequelae can be altered. Evidence suggests that bilingualism confers cognitive advantages on executive functioning, so it is possible that bilingualism may improve preterm infants' neurodevelopment. However, bilingualism has only been studied in term children. This review examined literature that compared the performance of preterm-born children to term children and bilingual children to monolingual children on executive function tasks. To address cognitive disparities in preterm-born children, studies investigating the effect of bilingualism on preterm infants' executive functioning is warranted.

Using high-fidelity simulation to bridge clinical and classroom learning in undergraduate pediatric nursing.

In Patricia Benner's book, Educating Nurses: A Call for Radical Transformation, she recommends essential changes in policy, curriculum, and in the way nursing programs approach student learning. This study explored how two of Benner's key recommendations, (1) integrating the theoretical component and the clinical component and (2) moving education from an emphasis on critical thinking to an emphasis on clinical reasoning, could be achieved by integrating the use of high-fidelity patient simulation in a pediatric curriculum. Qualitative and quantitative data were collected from the group of traditional and nontraditional baccalaureate students (n=131). The quantitative data revealed learning objectives were met over 80% of the time in simulation exercises and the qualitative themes revealed a positive experience with the simulation exercises with a large proportion of students offering the sentiments that these scenarios become requirement prior to the start of clinical rotations.