Mikki Meadows-Oliver

Abstract

Preceptors are essential in the clinical education of prelicensure registered nursing and advanced practice registered nursing students. However, there is a growing scarcity of preceptors available to provide clinical education. Additionally, preceptors have not uniformly received professional development in the practice of teaching that is essential in delivering high quality clinical education, and clinical education in nursing is an unfunded mandate. This article reviews the current state of preceptors, the importance and challenges of preceptors in clinical education, the lack of funding for clinical education by preceptors, and proposed solutions.

Abstract

School connectedness is the degree to which students experience acceptance, inclusion, and care by school personnel and peers. A sense of belonging incorporates an emotional connection to the community. School connectedness and belonging are protective factors that promote student engagement, accomplishment, and community performance. Despite the rise in students from immigrant families in the United States, belonging and connectedness for youth from diverse cultural and linguistic experiences are understudied. School-based nurses, our term, is inclusive of advanced practice pediatric, family, and psychiatric nurse practitioners, are well-positioned to support school connectedness for youth who may encounter hurdles to health care because of cultural and linguistic differences. We present practice suggestions for language, culture, and inclusion using three health conditions experienced by youth: anxiety, asthma, and obesity. School-based nurses and other school personnel who provide linguistic and culturally appropriate care can support students in feeling connected and included in their school communities.

Abstract

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.

Abstract

Discussion of culture is complex and, within a mental health context, may prove to be complicated and controversial. This chapter defines culture, acculturation, and marginalization, explores cultural factors that advanced practice registered nurses (APRNs) must understand. It addresses the complex needs of immigrant, refugee, displaced, and culturally vulnerable youth living in challenging in country environments or who are crossing numerous global geographic boundaries. Cultural factors have an impact on the mental/behavioral health of immigrant and refugee children and the children of immigrant parents. The chapter also includes practice, education, and research implications along with recommendations for APRNs working with immigrant, refugee, displaced, and culturally vulnerable populations, and concludes with a case exemplar to illustrate key considerations.

Abstract

Pediatric bipolar, now more commonly referred to as disruptive mood dysregulation disorder (DMDD), is estimated to impact between 0.8% and 4.3% of youth. This chapter describes the symptoms, etiology, and management of mood dysregulation in children and adolescents with a focus on depression, DMDD, persistent depressive disorder, and persistent mood disorder. Additionally, the NIMH researched severe mood dysregulation disorder descriptors are presented. Associated risk factors, screening and assessment tools for use in primary care, evidence-based management strategies, roles for the advanced practice registered nurse (APRN), consequences of untreated mood dysregulation disorders, and implications for conducting and using nursing research in practice with this population are also presented. The chapter differentiates between the roles and responsibilities of primary care practitioners and child and adolescent psychiatric-mental health APRNs in managing the range of mood dysregulation disorders in children and adolescents.

Abstract

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.

Abstract

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.

Abstract

Background: Worldwide, it is estimated that 235-334 million people have been diagnosed with asthma. In Nicaragua, the current asthma rate for children 13–14 years of age was 15.2%. Purpose: The purpose of this study was to determine the prevalence of asthma at this school-based health clinic in Managua, Nicaragua, associated symptoms or diseases, determine asthma classification, medications, and hospitalization rates. Methods: A retrospective chart review was performed on all pediatric patient's medical records seen in the clinic during a 5-day period (n = 105). Results: A total of 23 patients (21.9%) had asthma documented in the medical chart and were included in the analysis. Of the 23 patients, 3 (13%) patients were classified with intermittent asthma while the rest of the patients (87%) were not classified. Albuterol was prescribed for 19 (86%) of the patients with two patients who had both albuterol and QVAR® prescribed. Six (26%) patients had a family history of asthma. Discussion: This study demonstrated the prevalence of asthma in school-aged children in Nicaragua is significant and higher than previously reported. The lack of a classification of asthma prevents patients from potentially being treated appropriately.

Abstract

This clinical pilot research project evaluated clinical outcomes for asthmatic children enrolled in a home-based Asthma Outreach Program. Through a quasi-experimental single-group intervention design, a convenience sample of 37 children, ranging in age from 6 to 16 years, was used for this study. At 6 months after enrollment in the Asthma Outreach Program, patients reported significantly fewer nighttime symptoms and primary care provider visits compared with the 6 months preceding enrollment. Patients also reported significantly fewer hospital and intensive care unit admissions and courses of oral steroids. Adherence to therapy and asthma control was also significantly improved.

Abstract

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.