Child Trafficking: What School Nurses Need to Know.

Human trafficking is a severe form of child abuse and maltreatment. Cases are pervasive and no demographic, socioeconomic status, community, or school is immune. The most effective response to human trafficking in school settings requires increased awareness and establishing policies, protocols, and procedures that support collaborative response to suspected human trafficking. School nurses are well equipped to lead these efforts. While the National Association of School Nurses acknowledges the importance of the role of the school nurse in child trafficking response in their Human Trafficking Position Statement, resources to aid school nurses in coordinated recognition and response efforts remain limited. This article reviews clinical guidance on human trafficking through a school-based lens, highlights indicators that should alert school nurses to the risk of trafficking, outlines best practices for response to abuse and exploitation, and provides additional tools and resources available to aid school nurses in their approach to caring for children experiencing trafficking.

A case for the health welfare of Texans-A nurse practitioner state regulation policy analysis.

ABSTRACT: Restrictive nurse practitioner (NP) practice regulation at the state level continues to obstruct patient access to quality affordable care because primary care provider shortages heighten across the nation. Evidence-based research supports NPs as cost-effective providers without conceding quality of care. A patchwork of highly variable state policies subjectively determines the degree of collaborative oversight required for NPs to practice in each state. An objective review of policies influencing NP capacity to deliver care promotes evidence-informed policy adaptation. A policy analysis was completed using Bardach and Patashnik's framework to evaluate policy options for NP practice regulation in Texas. Full practice authority (FPA) policy effect was quantitively evaluated through difference-in-differences regression models using selected measures of all 50 states and the District of Columbia. Health welfare outcomes were calculated using emergency department utilization, average household health expenditures, poor physical health days, and NP-specific adverse action reports (AAR). Overall, FPA policy did not have a statistically significant effect on state-clustered emergency department utilization, average household health expenditures, or poor physical health days. Full practice authority was associated with decreased NP AAR. The analysis supports FPA as a viable policy option for states such as Texas and counters claims FPA policy adoption results in detrimental sequalae in the health of the population.

The Cost of Caring During COVID-19: A Clarion Call to Action to Support the Pediatric Advanced Practice Nursing Workforce.

INTRODUCTION: This study reexamined the holistic impacts of COVID-19 on the pediatric advanced practice registered nursing (APRN) workforce two years after the 2020 assessment. METHOD: This cross-sectional descriptive study used a convenience sample of pediatric APRNs affiliated with the National Association of Pediatric Nurse Practitioners (NAPNAP). A modified NAPNAP survey explored numerous impacts of COVID-19 on the pediatric APRN workforce. RESULTS: Study participants (n = 1,087) reported widespread pandemic impacts across personal and professional domains. Alarmingly, 87% reported professional burnout, and 80% expressed concern over their overall mental health. The impacts of the pandemic on child health are ominous, with 94% of participants reporting pediatric mental health concerns, a devastating increase from the previous study. DISCUSSION: The pediatric APRN workforce is in crisis amid a national pediatric mental health emergency. Multilevel interventions are critically emergent to sustain the APRN workforce and promote the health and well-being of children and families.

Holistic Hypertension Management.

Hypertension (HTN) is a major health care problem affecting nearly half of American's adult population. HTN is one of the costliest diagnoses among cardiovascular disease and leads to other major cardiovascular complications, which increase overall morbidity and mortality. Of those diagnosed with HTN in America, only one-fourth of patients are living with well-controlled HTN. This evidenced-based HTN management practice innovation was conducted to explore evidenced-based, holistic nursing practice of a low-sodium dietary approach to stop hypertension (DASH) diet, and exercise alongside antihypertensive medication management in decreasing systolic blood pressure (SBP) and diastolic blood pressure (DBP) in adult patients diagnosed with HTN. This community-based holistic care initiative supports data previously published, which suggests a low-sodium DASH diet, exercise, and antihypertensive medication management are effective in decreasing SBP and DBP. This project supported clinicians seeking to integrate a complementary holistic and traditional approach to HTN management in patients diagnosed with HTN.

Pediatric Nurse Practitioner Knowledge of and Attitudes Toward Human Trafficking: A Psychometric Evaluation.

INTRODUCTION: Human trafficking is an urgent health threat. This study sought to psychometrically validate the novel Pediatric Nurse Practitioner Knowledge and Attitudes Toward Human Trafficking scale. METHOD: Using data from a 2018 study of pediatric-focused advanced practice registered nurses (n = 777), this secondary analysis examined dimensionality and reliability of the survey. RESULTS: The Cronbach α for scale constructs was < 0.7 for knowledge and 0.78 for attitudes. Exploratory and confirmatory analyses identified a bifactor model for knowledge with relative fit indexes within standard cutoffs, root mean square error of approximation = 0.03, comparative fit index = 0.95, Tucker-Lewis index = 0.94, and standardized root mean square residual = 0.06. The attitudes construct indicated a 2-factor model with root mean square error of approximation = 0.04, comparative fit index = 0.99, Tucker-Lewis index = 0.98, and standardized root mean square residual = 0.06, within standard cutoffs. DISCUSSION: The scale is a promising tool in advancing nursing response to trafficking but needs further refinement to increase utility and uptake.

Human trafficking policies of professional nursing organizations: Opportunity for innovative and influential policy voice.

Human trafficking is a grievous human rights violation and rapidly emerging public health threat to which most nurses are ill-equipped to effectively respond. Curricula development within academic institutions and standard setting of organizational, education, accreditation, or licensing entities are a slow-moving and complicated process ill-equipped to adequately inform nursing practice in a timely way. Professional nursing organizations are ideally situated with knowledge, skills, and attributes to effectively contribute in a timely manner to policy creation and implementation directed toward emerging health threats. This analysis identifies only nine of 104 national nursing organizations that deliver vision, skills, position statements, practice guidelines, or other tools for members seeking evidence-based, credible, professional resources to initiate health policies and clinical protocols for human trafficking. Opportunity exists for nursing organizations to leverage the collective professional skill sets of their members to efficiently galvanize the nursing profession to effectively respond to persons encountered in clinical settings who are abused and exploited through trafficking.

Increasing HPV Vaccination Rates Using Text Reminders: An Integrative Review of the Literature.

INTRODUCTION: Human papillomavirus (HPV) is the most common sexually transmitted infection among youth in the United States. Although HPV vaccinations are readily available, HPV immunizations remain lower than target rates. The purpose of this review is to consider text message reminder system efficacy to improve HPV vaccination rates in eligible children. METHOD: A literature review was conducted using Cumulative Index to Nursing and Allied Health Literature and PubMed databases to search articles illustrating the effect of text message reminder systems. RESULTS: Research is primarily conclusive of improved HPV vaccination rates through text message reminder systems, indicating the need for practice guidelines directed at text message delivery and text message content. DISCUSSION: This integrative review synthesizes and highlights available literature on implementing text message reminder systems to improve HPV vaccination rates. Once the text message reminder system is in place, automatic arrangement of preventive care service is hassle-free for practices.

Partners for Vulnerable Youth and the Alliance for Children in Trafficking: Using the Policy Circle Model as a Framework for Change.

The National Association of Pediatric Nurse Practitioners (NAPNAP) was the first-ever professional organization for nurse practitioners (NPs) and remains dedicated to advancing the NP role to improve child health. In 2016, NAPNAP Partners for Vulnerable Youth (NPVY) was established as a 501(c)(3) to take a leadership role in advocacy and education efforts for at-risk pediatric populations. NPVY launched the Alliance for Children in Trafficking (ACT), with far-reaching implications for nursing leadership to leverage expertise from collective organizational membership to improve health. This paper will demonstrate use of the Policy Circle model as a framework for planned policy change.

The Role of Nursing in the School Setting to Lead Efforts to Impact Child Trafficking: An Integrative Review.

Registered professional and advanced practice nurses in the school setting, as a specialized practice entity, are leaders in implementation of evidence-based practice, skilled coordinators of care, advocates for students, and experts in designing systems assisting individuals and communities to reach full potential. Child trafficking (CT) is an emerging public health threat impacting safety and well-being of students present in the school setting. This literature review identified four themes in five studies: (1) training impacts nurses' knowledge, awareness, and attitudes; (2) school nursing is underrepresented in training, education, prevention, response, and research; (3) lack of collaboration exists between school staff and school nurses; and (4) formal education and length of experience impact levels of interventions school nurses are able to provide. School nurses are opportunely situated to intervene as advocates for vulnerable children to develop a coordinated, effective response to CT risk factors, mitigating risk and fostering resiliency with systems-based change.

Ethical implications of next-generation sequencing and the future of newborn screening.

ABSTRACT: Over the last 50 years, routine newborn blood screening for congenital disorders has been hailed as a miracle of modern science, saving countless lives by providing a means to detect and treat life-threatening disorders before symptoms present. Despite progress made with more than 5,000 babies effectively identified with rare conditions each year, congenital anomalies collectively remain at the top of the list as the cause of death for babies under 1 year of age, accounting for more than 20% of all infant mortalities. Rapid technological advances have seen the original singular newborn screen for phenylketonuria expand to a core set of 34 conditions and an additional 26 secondary conditions on the Recommended Uniform Screening Panel, with wide state-to-state variation for implementation. As genomic analysis evolves to enable next-generation sequencing, debates continue over the ethical, legal, and social implications of identifying conditions for which there is no effective treatment. Nurse practitioners should be engaged and informed in providing evidence-based support to families engaging in ethical complex decision making surrounding newborn screening while effectively balancing risk-benefit analysis with individual beliefs and values.

Addressing the Clinical Impact of COVID-19 on Pediatric Mental Health.

The COVID-19 pandemic impacts daily lives of families globally. Sequelae are not limited to physical consequences of medical complications but extend into social, emotional, spiritual, and psychological health. Interventions including mask-wearing and physical distancing are intended to prevent viral spread, but have unintended negative effects on mental health and child development. Although it is too early to know the full impact, practicing pediatric clinicians are well-positioned to help young people recover and thrive despite challenges presented. This article will review the impact of COVID-19 on child mental health and give practical interventions to foster resilience in youth and their families.

Exhausted and Burned Out: COVID-19 Emerging Impacts Threaten the Health of the Pediatric Advanced Practice Registered Nursing Workforce.

INTRODUCTION: The purpose of this study was to describe the holistic impacts of COVID-19 on pediatric advanced practice registered nurses (APRNs). METHOD: AA convenience sample of APRNs affiliated with the National Association of Pediatric Nurse Practitioners participated in this cross-sectional descriptive study. An investigator-developed survey explored multifocal, holistic impacts of COVID-19. RESULTS: A total of 886 participants were provided the survey, with 796 (90%) completing the entire survey. Respondents indicated adverse impacts across personal, clinical, educational, and research foci. Among the most alarming findings, 34% indicated moderate or extreme concern for feeling professionally burned out, 25% feeling nervous or anxious, and 15% feeling depressed or hopeless. DISCUSSION: The pediatricAPRN workforce pipeline is at significant risk for provider burnout and compromised mental health. Acknowledgment of pandemic-related trauma on families, children and APRNs is essential. Sustained intentional efforts to cultivate holistic wellness are critically emergent.

Direct to consumer genetic and genomic testing with associated implications for advanced nursing practice.

ABSTRACT: Direct-to-consumer genetic and genomic testing (DTCGT) has paved the way for consumers to gain information about their genetic makeup. Consumers may seek DTCGT to estimate ethnic background, identify genetic relations, or obtain raw DNA information that can be used for other purposes, such as testing for paternity and identifying genetically linked illnesses. Despite robust progress in genetic and genomic testing, most people have a low exposure threshold to DTCGT. Patient consumers may unnecessarily experience anxiety if they do not have a health care provider (HCP) to consult and review their results. Presently, there is a knowledge gap in how accurately HCPs can interpret and communicate genetic test results to patients compared with genetic specialists who may be inaccessible to underserved populations. Genetic and genomic information is rapidly progressing in health care and can identify patients at increased risk for certain diseases and improve patient care and outcomes. Appropriate use of genetic and genomic testing and knowing the limitations and difficulties of current testing available are integral to the success of HCPs in using these results in health promotion and improving quality of life. Health care providers should be aware of DTCGT recommendations and implications for patients, be prepared to counsel patients who present with testing results in hand, seeking advisement, and be competent in determining the need for further diagnostic testing or referral to a specialist genetic counselor.

Improving Diabetes Education in Mexican American Older Adults.

Lack of culturally sensitive, age-specific diabetes education in Mexican American older aged people may contribute to deficits in diabetes knowledge, self-management, and glycemic control. This quality improvement initiative applied evidence-based, culturally competent, age-specific education to improve health outcomes. A one-group, pretest/posttest design guided this project in a primary care community clinic. Mexican American adults >60 years, with type 2 diabetes mellitus (T2DM; N = 12) received 3 months of biweekly innovative classes including: healthy Mexican foods; family involvement; Spanish interpreter using simultaneous earphone technology; and interactive, bilingual, large-print materials. Paired sample t tests compared diabetes knowledge, self-management, and A1C levels. There was a significant improvement in preeducation and posteducation outcomes: knowledge, t(11) = -7.969, p = .000; d = 2.32, self-management, t(11) = -7.930, p = .000; d = 2.43, and A1C levels, t(11) = 6.434, p = .000; d = 0.78. Culturally competent, language-friendly innovation, age-specific T2DM education can positively impact knowledge, self-management behaviors, and glycemic values in older aged Mexican American people.

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.

COVID-19: Impacts and Implications for Pediatric Practice.

Since the rapid emergence of the novel coronavirus in December of 2019 and subsequent development of a global pandemic, clinicians around the world have struggled to understand and respond effectively in health care systems already strained before this latest viral outbreak. Leaders are making policy decisions while balancing the slow and precise nature of science with the rapid need for life-saving information.Pediatric nurse practitioners are ideally situated as a trusted source of health information for children. This continuing education article summarizes the latest evidence on the rapidly developing coronavirus pandemic.

Nurse Practitioner-Led Telehealth to Improve Outpatient Pediatric Tracheostomy Management in South Texas.

INTRODUCTION: Pediatric tracheostomy patients are a medically complex population with increased incidence of emergency room use, hospital readmission, tracheostomy-associated complications, and caregiver anxiety, especially within 30 days after discharge. METHOD: The specific aims of this quality improvement initiative include using a nurse-led, interprofessional care team to improve access to care with creation and implementation of a hospital-based discharge protocol and adoption of telehealth follow-up care for newly placed tracheostomy tubes. RESULTS: Telehealth was accessible for patients living more than 150 miles from the primary clinical site. Caregiver knowledge, satisfaction, self-efficacy, and competence in tracheostomy skills increased after protocol implementation. Outcomes included no tracheostomy-associated complications, emergency room visits, or unnecessary hospitalizations. DISCUSSION: Evaluation of this initiative showed promise telehealth was effective in supporting caregivers and refining proficiency caring for tracheostomy-dependent children. This facility's experience with nurse-led telehealth found it to be an accessible, affordable, and valuable health-care service .

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

INTRODUCTION: Part 1 of this series addressed low levels of awareness about child trafficking among pediatric health care providers, supporting the need for clinical practice guidelines to aid evidence-based response to potential victims in the clinical setting. The purpose of this article was to explore evidence related to effective clinical response when encountering at-risk children or those who have experienced trafficking and make recommendations for a practice guideline. METHOD: An integrated review of the literature included electronic data search of PubMed, Ovid, and CINAHL and application of the social ecological model for thematic analysis. RESULTS: Research is primarily inconclusive on the effective clinical response for victims and potential victims of child trafficking, indicating the need for practice guidelines directed at both prevention and intervention. DISCUSSION: This review supports pediatric clinicians as ideally equipped and situated to intervene in a myriad of care settings on behalf of children with health disparities who are vulnerable to trafficking, advocating for prevention, and optimization of 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.