Carole Kenner

National Coalition for Health Professional Education in Genetics

With the explosion of genetic information, there has been a recognized need for more genetic knowledge among health care professionals. The National Coalition for Health Professional Education in Genetics (NCHPEG) was established in 1996 to address this need. This article briefly outlines the mission of this Coalition and gives an overview of its relationship to acute and critical care nurses.

National survey of genetics content in basic nursing preparatory programs in the United States.

The purpose of the study described in this article was to reassess the type and amount of genetics content in basic nursing preparatory programs in the United States. Recommendations are made for increasing genetics content in baccalaureate nursing programs. These recommendations are a result of the synthesis of the current survey data with previous data and recommendations.

Transition from hospital to home for parents of preterm infants.

Research on the phenomenon of transition spans several decades. This article discusses the transition from hospital to home and the challenges parents of preterm infants experience during a neonatal intensive care unit stay and after discharge. The article explores the link between parental problems and rehospitalizations and the need for accurate measures of transitional concerns. An example of a theoretical model and instrument is described.

Impact of a Parent-Based Interdisciplinary Intervention for Mothers on Adjustment in Children Newly Diagnosed With Cancer

OBJECTIVE To determine if maternal distress predicts child adjustment outcomes or if child adjustment outcomes predict maternal distress among children newly diagnosed with cancer, and if a parent-focused intervention has downstream effects on child adjustment. METHODS Mothers (n = 52) were randomly assigned to a clinic-based, interdisciplinary intervention for parents of children newly diagnosed with cancer. Measures of maternal distress and child adjustment were collected at baseline, posttreatment, and follow-up. RESULTS A lagged relationship was identified between maternal distress and child internalizing symptoms, but not externalizing symptoms. The parent intervention reduced child internalizing and externalizing symptoms at follow-up. Only the child internalizing symptoms effect was mediated by reduced maternal distress. The child externalizing symptoms effect was mediated by unobserved parent factors. CONCLUSIONS This study provides support for illness adjustment and coping models that emphasize the role of parent factors in driving child adjustment outcomes and is encouraging for future parent-focused intervention research.

Family-centered developmental care practices and research: what will the next century bring?

Family-centered developmental care is an essential element of neonatal intensive care. It is of particular importance when the infant is vulnerable and at greater risk for poor outcomes complicated by a family unit that is easily challenged by the unique needs of the infant. Yet, all infants and their families deserve this philosophy of caregiving. Family-centered developmental care must continue to be tested through research to determine which interventions work, what does not work, and which interventions need further refinement. This article provides a brief history of where we have been in neonatal caregiving, provides definitions for family-centered developmental caregiving and offers some “predictions” about where these practices need to be in the next century. Research questions and strategies are also addressed. As we continue to forge ahead integrating this philosophy into the caregiving arena, it is important to remember that there are many unanswered questions.

Outcomes for Children Exposed to Drugs In Utero

Substance abuse among pregnant women remains a national health issue. The incidence of infants born addicted to licit and illicit substances is increasing. The long-term outcomes have not been consistently documented. These appear to include mild to severe developmental and cognitive problems, depending upon the substance used. Central nervous system problems, behavioral dysfunction, and safety issues are major parental concerns for these children as they grow. Interventions must be aimed at thorough assessments, including an accurate maternal history, use of supports for positive neurodevelopment, parent education about infant/child cues, and encouragement of educational environments that are highly structured and safe. Consistent, long-term follow-up is essential to optimize long-term outcomes.

The NNP/DNP shortage: transforming neonatal nurse practitioners into DNPs.

Neonatal nurse practitioners (NNPs) represent a high-demand specialty practice that is especially targeted for US secondary and tertiary care neonatal intensive care units (NICUs). NNPs make primary decisions about the caregiving of high-risk newborns at the time of admission, throughout hospitalization, at transfer, and at discharge that require an advanced knowledge base in neonatology as well as NICU clinical experience. NNPs prepared at the masters level are currently in very short supply, with some estimates suggesting that for each NNP who graduates, there are 80 positions open across the country. Even with the present shortage, due to the high cost of NNP education, NNP programs are diminishing and those that are remaining are not graduating a sufficient number of new NNPs each year to keep up with the demand. To add to the basic shortage problem, in 2004 the American Association of Colleges of Nursing decided that by 2015, the terminal degree for all nurse practitioners should move from the masters degree to the doctor of nursing practice (DNP) degree. That decision added a minimum of 12 months of full-time education to the advanced education requirements for nurse practitioners. What impact will the decision to require a DNP degree have on NNP specialty practice? Will even more NNP programs close because of faculty shortages of NNPs prepared at the DNP level? If a worse shortage occurs in the number of NNPs prepared to practice in NICUs, will physician assistants or other nonphysician clinicians who meet the need for advanced neonatal care providers replace NNPs? What steps, if any, can nursing take to ensure that NNP specialty practice is still needed and survives after supplementing the DNP requirement to NNP education?

Fetal Alcohol Syndrome From Infancy Through Childhood: A Review of the Literature

Because fetal alcohol syndrome (FAS), or fetal alcohol effects (FAE), is being diagnosed in growing numbers of children, there is more interest in their common characteristics and how they change throughout childhood. Few longitudinal studies that describe the common childhood course of FAS address appropriate interventions. Some literature exists that describes follow-up and support services needed by these children and their families. This article examines the common childhood course of FAS/FAE and the interventions and services needed to promote positive child and family health.

Global Infant Mortality/Morbidity: a Clinical Issue, a Global Organizational Approach

This article posits that the burden and legacy of high neonatal morbidity and mortality rates are social and economic stresses at the local, national, regional, and international levels. Furthermore, if neonatal morbidity and mortality rates are not reduced through appropriate clinical and educational means, a significant local and global consequence will be the destabilization of workforces and economies in many parts of the world. Because coordinated clinical and education efforts are required if neonatal health outcomes are to improve, and it is essential that these endeavors be led by nurses, the labor sector most likely to provide the needed care and outreach to mothers and children, a globally respected specialty nursing organization must be at the center of developing and implementing the necessary clinical and educational interventions.

Neonatal thermoregulation: bed surface transfers.

Purpose: To describe temperature changes that occur in preterm infants following bed surface transfers. Design: The design was descriptive. Sample: The convenience sample was comprised of 20 preterm infants (<1,500 gm birth weight). Main outcome variable: Temperature stability after a bed transfer (i.e., radiant warmer to incubator) was the main outcome variable. Results: There were no significant differences in temperatures after bed surface transfer. However, the temperatures one hour after bed surface transfer were lower than baseline temperature before bed surface transfer.