PNP Corner

Pediatric educational and policy conferences are always special, providing opportunities to update knowledge and practice skills; introduce new practice guidelines with rationales for evidence-based changes; present the most recent research findings that have the potential to improve practice and healthcare outcomes; and unequalled opportunities for networking.

The evidence is clear: Practitioners who fail to administer immunizations according to the Centers for Disease Control and Prevention and Advisory Committee on Immunization Practices schedules results in adverse outcomes for children and adolescents who are needlessly exposed to vaccine preventable diseases.

I totally agree with Dr. Schuman’s perspective in his article that “it is inappropriate and irresponsible for pediatricians [and I include, PNPs] to encourage the use of cannabidiol (CBD) until more studies are available” to assure the safety and efficacy of CBD are clearly established in rigorous randomized controlled clinical trials (RCTs).

'Building a medical home for children with autism' describes the importance of establishing a medical home in a pediatric office for children with a diagnosis of autistic spectrum disorder (ASD) and discusses five major management strategies for the successful management of children in the medical home.

To me, it seems that we are trapped traveling around the world within ‘non-connected circles’ that encompass viewpoints adversely affecting significant scientific immunization advances developed to improve the health and well-being of infants, children, adolescents, their families, and all individuals who interact with them.

Covering the father as both parent and influential partner in childrearing from preconception to entrance into young adulthood, this issue provides the foundation for thoughtful consideration of how we, as nurse practitioners, can address paternal parenting and apply the past 10 years of research results on fathers to better inform our practices.

Best practices for both hospital and ambulatory care centers include methods to encourage the continuous educational development of all members of nursing and interprofessional (IP) teams. One successful, but sometimes resisted strategy, is to engage all members of the team in planned monthly journal club luncheons in which the members review a recently published article that may impact practice management strategies.

The dilemmas and barriers that providers encounter daily in clinical practice in attempting to maintain confidentiality for their adolescent patient while simultaneously protecting the adolescent from potential harm are daunting for providers as there are no nationally recognized, evidence-based standards addressing adolescent confidentiality and privacy issues in the delivery of quality healthcare to adolescents.

I recommend not only reading "You've been served! What to do if you get sued for malpractice," but also consider current practice strategies and those that can be implemented with the goal of preventing malpractice claims.

Imagine the joy of experiencing a late fall, winter, and spring season of never having to press the e-prescribing submit button in the electronic health record for an antiviral medication to treat an infant, child, or adolescent who is very ill after contracting influenza.

CAR T-cell therapy offers pediatric patients hope, but also can bring numerous physical and emotional roller coaster experiences for the family.

A commitment all healthcare professionals must make to their individual professions, the interprofessional community and patients, and to themselves is to become life-long learners.

I recommend trying “Riddle me this! – as pediatric providers we tend to enjoy playing and many of us enjoy the challenges of active engagement in online learning that is also informative.

‘Quality diagnostic reasoning’ curbs medical diagnostic errors.

Mental health is a critical component of pediatric overall health. Early recognition of subtle signs and symptoms of mental health problems followed by immediate treatment is an equally critical element to ensure the establishment of normal mental health throughout development.

Drs. Bass and Valasek’s article in the August 2018 issue of Contemporary Pediatrics titled “Sports-related concussion: When it’s OK to return to play” provides a comprehensive review of sports-related concussions (SRC).

No one wants to make an error, let alone an error that is life threatening. How can individual or group providers create a culture of safety within their practices?

I recommend reviewing and strongly considering the implementation of the pilot project of Drs Dickson and Fontana including the six-step approach for oral health care in pediatric practices.

Jane Mendle, PhD’s research at Cornell University in Ithaca, New York, investigating the long-term psychological effects of early puberty has significant implications for our practices as pediatric nurse practitioners-and for all healthcare providers.

There are two articles in the March 2018 issue of Contemporary Pediatrics that merit your attention: Dr. Bass’ article on “Is it the flu?” and Ms. Zimlich’s article on “Major vaccines addressed in updated ACIP guidelines.”

Is the overwhelming problem of too many opioid and narcotic pain prescriptions related to the identification of ‘pain’ as the ‘fifth vital sign’?  Was the intention for the designation, the ‘fifth vital sign’, an expectation that individuals would be pain free during hospital stays, eg, after a surgical procedure, or after visiting ambulatory centers for an injury?

Pediatric providers need to help patients and their parents develop critical thinking about their personal healthcare and the long-term outcomes from their decisions.

Ms. Hester presents a heartwarming story describing the puppy brigade program’s design and its process for helping children to heal at Akron Children’s Hospital in Ohio while receiving both inpatient and outpatient care.

Dr. Bass’ recent article in Contemporary Pediatrics, “Personalized medicine, right drug, right patient, right time,” provides a miniature but profound view of what may be the future of pediatric healthcare: focusing on healthcare that is truly individualized through precision science in the areas of diagnosis and treatment, rather than generalized, population-based treatment guidelines.

I highly recommend reading his article, and then reflecting on your current office- and hospital-based practices surrounding prescribing medications for children to determine areas to apply these best practice initiatives in your personal work settings.

Opioids have impacted every population served by all healthcare providers in the United States and by now every nurse practitioner (NP) has been exposed to the opioid scourge. Perhaps it’s time to reassess the role for NPs in caring for their individual populations confronting an opioid crisis.

Every nurse practitioner should review the AAP guidelines and include an action plan in each of their practice settings. All providers should communicate information to all school, camp, and field nurses who are often the first to assess a child presenting with symptoms of anaphylaxis outside a medical facility.

Goals for NPs caring for children and adolescents with weight problems are early identification and referral to treatment in order to prevent the well-known adverse effects the diagnosis of eating disorders places on the child, adolescent, and family members-and, in time, the overall health of the adult population.

Traditionally, first positions for graduating registered nurses (RNs) are hospital based, where many have expertise and experience in emergency management. However, when RNs attend graduate school to become primary care nurse practitioners, planning for managing emergencies in an outpatient medical office may or may not have been a part of graduate education.