Professional practice of pediatric nurse practitioners: implications for education and training of PNPs.

INTRODUCTION: The purpose of this study was to describe the characteristics of employment, the characteristics of children served, and the role functions of recent graduates of pediatric nurse practitioner (PNP) programs and to compare these characteristics across programs. METHOD: A 60-item multiple-choice survey tool was sent to graduates from 1996-1998 of 6 universities across the United States. RESULTS: A total of 137 surveys were received for a return rate of 52%. Less than half of the respondents (44%) indicated that they were employed in a primary care practice. Seventy percent indicated they "often" or "sometimes" provided care to children with acute/critical conditions, and 77% reported caring for children with chronic conditions. Role functions of case management, staff development, consultation, administration, and implementation of research were performed "often" or "sometimes" by more than 50% of respondents. Findings were fairly consistent in 5 out of 6 programs surveyed. DISCUSSION: Graduates of PNP programs are increasingly called on to provide care to children with complex health care needs in non-primary care settings. Role functions beyond the traditional areas required for pediatric primary care are now common practice. Educational programs should address these dynamic changes by assessing the adequacy of their curricula and clinical residencies in preparing graduates.

Impact of Genetic potential and prematurity on growth outcomes.

PURPOSE: To explore the relationship between genetic potential and catch-up growth in school-age children who were born prematurely. STUDY DESIGN AND METHOD: This descriptive correlational study compared three groups of children who were born prematurely, sorted by birthweight groups into low, very low, and extremely low birthweight on measures of catch-up growth and body composition at school age (n = 45). Height and weight were compared to established norms for children of normal birthweight. Growth at school age and parental heights were also correlated. RESULTS: Children in all birthweight groups achieved growth within normal ranges (two standard deviations from the mean) by school age. The growth of the extremely low birthweight group was in the lower range of normal. Maternal height was the best predictor of children's heights at 8 to 10 years of age. CLINICAL IMPLICATIONS: Parents and providers can be reassured that many children overcome the adverse effects of prematurity on childhood growth. Throughout childhood, growth should be closely monitored using appropriate grids, and correcting for prematurity.

Perceived barriers to rural nurse practitioner practice.

Studies of barriers to nurse practitioner (NP) practice show similar results for more than 20 years. Comparisons of barriers to rural NP practice have not been performed. Descriptive data about perceived barriers to practice were collected from 292 NPs in one midwestern state (urban, 229; rural, 63; response rate, 60%). A primary barrier was a lack of understanding by the general public about the NP role, which respondents found was detrimental to practice success. Physicians also lacked knowledge about the NP role. Rural practice barriers also included lack of peer support, suggesting that isolation from other NPs detracted from practice success. Educating the public and health professionals about NP education, scope of practice, and roles continues to be necessary. Media campaigns can increase understanding of NP practice. Rural NPs can use electronic means to communicate with each other to decrease practice isolation. Removing barriers to practice remains an ongoing task to enhance rural nursing practice.

PNP roles and interventions with children with special needs and their families.

Pediatric nurse practitioners (PNPs) can create excellent professional roles caring for children with special health care needs (CSHCN) and their families. Children with chronic conditions represent an estimated 31% of the US population younger than 18 years (approximately 20 million children in 1988). Five percent of all children who have multiple special needs account for approximately 40% of all pediatric health care expenditures. Skill building is needed for PNPs who have traditionally focused on wellness and common acute illnesses in primary care settings. Role theory and research can guide PNPs in creating roles and interventions to improve the health, safety, and developmental outcomes for CSHCN and their families. Two roles are described, with examples of specific nursing interventions. Assisting child care centers to serve children and families with special needs is an ideal role for PNPs who have knowledge of health and regulatory issues. Another important PNP role is working with adolescents with special health care needs as they transition from pediatric to adult care. Many resources (such as those from the Maternal and Child Health Bureau) are available to assist PNPs to create new roles and interventions for CSHCN and their families.

Practical issues in obtaining child assent for research.

This article describes ways to engage children in clinical research through a carefully planned assent process. When assent is handled well, children may gain a sense of control over their choice to participate in research, which may in turn enhance their cooperation in the process. Ways to engage children in the assent process, the historical development of consent and assent, and discussion of the issues surrounding parental consent and child assent are presented. Practical suggestions are provided to make research participation a positive and appealing process for children.

Creating spaces that enhance nurse practitioner practice.

STUDY QUESTION: What barriers related to limitations of space or facilities do nurse practitioners (NPs) describe in association with their current practice? METHOD: This was a descriptive quantitative/qualitative study of 81 NPs in one Midwestern state with a survey instrument previously developed under the auspices of the Division of Nursing and the American Association of Colleges of Nursing regarding advanced practice nursing. RESULTS: Of 641 questionnaires mailed to the total number of prescribing NPs in the state, 372 (58%) were returned. Of that number, 81 (22%) indicated that space limitations were a barrier to practice. Seven themes emerged in qualitative analysis of their narrative descriptions of this barrier. DISCUSSION: Results of this study can assist NPs to articulate their space requirements and enhance existing spaces to better meet patient and NP needs.

Health, growth, and use of community services in NICU graduates at early school age.

PURPOSE: To examine outcomes related to health, growth, and use of community health and education services in children ages 6 to 8 years who received newborn intensive care because of prematurity or perinatal complications. METHOD: Parents of 81 children who had received neonatal intensive care at a Midwest US tertiary care center completed a mailed questionnaire. Three birth weight groups (very low birth weight [VLBW] < 1500 g, n = 35; low birth weight [LBW] 1501-2500 g, n = 24, and normal birth weight [NBW] > 2500 g, n = 22) were compared regarding growth, health, and use of community-based services using descriptive statistics and one-way analysis of variance. FINDINGS: VLBW and NBW groups had more ongoing health concerns. Growth patterns were similar in all groups. VLBW and NBW groups demonstrated greater use of community-based services, and service use increased at school age. CONCLUSIONS: Comprehensive systems are needed for follow-up of high-risk infants to detect and refer problems early. Neonatal histories must be tracked throughout childhood. Seriously ill term NBW infants are at risk for later morbidity and require follow-up similar to that provided for VLBW children.

A comparison of practice domains of clinical nurse specialists and nurse practitioners.

This qualitative study was carried out to add empirical data to the discussion of the essentials of advanced practice graduate nursing education. Study participants were 15 nurse practitioners (NPs) whose original preparation was as clinical nurse specialists (CNSs). These nurses subsequently completed post-master's preparation as NPs at a midwest US school of nursing. The nurses were interviewed regarding similarities and differences between the NP and CNS roles based on their own experiences. They stated that their 1-year post-master's NP educational program broadened their knowledge base and increased their skills of direct data collection in history taking and physical examination. They described increased NP role autonomy and clinical decision making. Comparison of study results with the six practice domains of the National Association of Nurse Practitioner Faculties (NONPF) Curriculum Guidelines appeared to verify the NONPF domains as being operant in advanced nursing practice. Each role had distinct expression of the NONPF practice domains, particularly in two areas: management of client health-illness states and the professional role. Results suggest that advanced practice graduate nursing curricular content needs to be explicit regarding CNS and NP role domains to retain the respective strengths of each. A "hybrid" CNS/NP curriculum faces the danger of lacking both the depth and specificity of knowledge that has resulted in the roles' past successes.