Donna Hallas

Role of pediatric nurse practitioners in oral health care.

Dental caries remain the most prevalent unmet health need in US children. Access to care is particularly problematic for poor children and is compounded by the shortage of dentists to meet the needs of this patient population. Expanding the roles of pediatricians, family physicians, and pediatric nurse practitioners (PNPs) who provide primary care services to children may be a strategy to address in this issue. Enhancements in current PNP education and certification processes are needed to support the expansion of oral health-related clinical responsibilities. Although oral health is included in the published curriculum for PNPs and certification exams require specific oral health knowledge, gaps in postgraduate training persist and few data document the extent to which current oral health-related educational goals are being achieved. We recommend enhancements in oral health education and research to evaluate curriculum innovations, the development of partnerships between stakeholder groups to leverage existing resources, and ongoing surveillance of oral health-related practice patterns among PNPs. Leadership at the national level is needed to develop policies that support curriculum changes and the implementation of oral health practice guidelines for PNPs that will improve access and reduce health disparities.

Putting the Mouth Back in the Head: HEENT to HEENOT

Improving oral health is a leading population health goal; however, curricula preparing health professionals have a dearth of oral health content and clinical experiences. We detail an educational and clinical innovation transitioning the traditional head, ears, eyes, nose, and throat (HEENT) examination to the addition of the teeth, gums, mucosa, tongue, and palate examination (HEENOT) for assessment, diagnosis, and treatment of oral-systemic health. Many New York University nursing, dental, and medical faculty and students have been exposed to interprofessional oral health HEENOT classroom, simulation, and clinical experiences. This was associated with increased dental-primary care referrals. This innovation has potential to build interprofessional oral health workforce capacity that addresses a significant public health issue, increases oral health care access, and improves oral-systemic health across the lifespan.

Nursing Strategies to Reduce the Incidence of Early Childhood Caries in Culturally Diverse Populations

In the United States, early childhood caries (ECC) is a major unmet health care need adversely affecting the overall health of young children from diverse ethnic populations. Nurses who work in the newborn nursery, pediatrics, public, and community health centers have a unique opportunity to positively influence a change in this epidemic of ECC. Guided by Leiningers theory of cultural care, these authors describe ways to implement a comprehensive culturally sensitive oral health education program for parents of newborns and infants. Interventions based on the best available evidence for oral health education, a culturally sensitive caries risk assessment, recommendations for fluoride varnish treatments, and ways for parents to establish a dental home for the infant by 12 months old are presented.

Evaluation of the clinical hour requirement and attainment of core clinical competencies by nurse practitioner students

Purpose: The purpose of this study was to analyze the national practice of fulfilling 500 clinical hours as a requirement for graduation from nurse practitioner (NP) programs at the masters level and to compare this standard to a comprehensive approach of evaluating attainment of clinical competencies. Data sources: The National Organization of NP Faculties (NONPF) and specialty accreditation bodies publications were used for references to clinical hour and core competency requirements for graduation from NP programs. Data from one university from student documentation on a commercial electronic tracking system were also analyzed. Conclusions: Data analysis revealed that the 500 clinical hours correlated to populations, skills performed, required levels of decision making, and expected diagnoses. However, assurance that these clinical hour requirements translated to exposure to all core competencies for entry into practice could not be established. Implications for practice: A more comprehensive approach to the evaluation of student core competencies by implementing one or more performance‐based assessments, such as case‐based evaluations, simulations, or objective structured clinical examinations (OSCEs), as a strategic part of NP evaluation prior to graduation is proposed. This change is viewed as critical to the continued success of NP programs as masters level education transitions to direct BS to DNP educational preparation for advanced nursing practice.

The Sensitivity Training Clown Workshop: Enhancing Therapeutic Communication Skills in Nursing Students

Aim. The aim of this study was to examine the long‐term effectiveness of the Sensitivity Training Clown Workshop (STCW) provided to 131 baccalaureate nursing students. Background. The STCW was designed and implemented through a collaboration between the artistic director of the Big Apple Circus and nurse faculty to help students understand emotions, learn peripheral awareness skills, and become engaged with patients. Method. Forty participants responded to an 18‐month follow‐up evaluation survey. Results. The majority of participants reported applying lessons learned in the workshop in their current practice, regardless of their area of nursing employment. Conclusion. The STCW is an effective method of educating nursing students for pediatric practice. The techniques used in the workshop are applicable to other practice settings.

Identification of Pediatric Oral Health Core Competencies through Interprofessional Education and Practice

Over the past seven years, the Department of Pediatric Dentistry at New York University College of Dentistry (NYUCD) and the Advanced Practice: Pediatrics and the Pediatric Nurse Practitioner (PNP) program at New York University College of Nursing (NYUCN) have engaged in a program of formal educational activities with the specific goals of advancing interprofessional education, evidence-based practice, and interprofessional strategies to improve the oral-systemic health of infants and young children. Mentoring interprofessional students in all health care professions to collaboratively assess, analyze, and care-manage patients demands that faculty reflect on current practices and determine ways to enhance the curriculum to include evidence-based scholarly activities, opportunities for interprofessional education and practice, and interprofessional socialization. Through the processes of interprofessional education and practice, the pediatric nursing and dental faculty identified interprofessional performance and affective oral health core competencies for all dental and pediatric primary care providers. Students demonstrated achievement of interprofessional core competencies, after completing the interprofessional educational clinical practice activities at Head Start programs that included interprofessional evidence-based collaborative practice, case analyses, and presentations with scholarly discussions that explored ways to improve the oral health of diverse pediatric populations. The goal of improving the oral health of all children begins with interprofessional education that lays the foundations for interprofessional practice.

Evidence-based care management of the late preterm infant.

44 Volume 25 Number 1 to the pediatric office for the first primary care office visit after discharge from the hospital. The GA of 35 weeks was confirmed by the Dubowitz assessment performed 4 hours after birth. A review of the hospital discharge record revealed a positive maternal history for hepatitis B antigen (HBsAg+); non-reactive rapid plasma reagin; and an emergency Caesarean section after 6 hours of labor because of fetal heart rate decelerations. Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. The infant measurements at birth were as follows: weight, 1.814 kg (4 lb, 8 oz); length, 45.72 cm (18 in); and head circumference, 31 cm. After an initial assessment in the newborn nursery, the infant was transferred to the Neonatal Intensive Care Unit (NICU) for transient tachypnea. The mother began breastfeeding on the second postpartum day and continued breastfeeding every 3 hours during the infant’s hospital stay. The record also revealed that the infant’s bilirubin level was 14.8 mg/dL during the first week of life. The infant was discharged home at 4 days of age with instructions to continue breastfeeding every 3 hours, and a pediatric office appointment was scheduled.

Social-Emotional Development of Toddlers: Randomized Controlled Trial of an Office-Based Intervention

Purpose: During the toddler years, temper tantrums and impulsive behaviors are the norm. These behaviors can frustrate even the most experienced mothers. Design and Methods: A prospective, double blind, randomized controlled trial using pre‐test/post‐test experimental design was used to examine the effectiveness of an office‐based educational program to improve maternal confidence and the social‐emotional development of toddlers. The Toddler Care Questionnaire (TCQ) was administered to all mothers as a pre and post intervention test. The treatment intervention was a videotaped (DVD) parenting skills intervention on the social‐emotional development of toddlers and on maternal confidence in caring for toddlers. Results: Sixty mothers and 60 toddlers entered the study with 29 mothertoddler dyads randomized to the treatment group and 31 to the control group. Twenty‐six (26) mother‐toddler dyads in the treatment and 25 mother‐toddler dyads in the control group completed the study. Pairwise comparisons of adjusted means showed significant improvements for both toddler groups on the Brigance toddler screen, and no statistically significant difference in gains between the groups. The mixed model results for the TCQ showed an overall significant improvement from preto post‐test, and a non‐significant interaction between group and time indicting no significant difference in gains seen by treatment groups. Conclusions: Brief educational programs on DVDs are an efficient way to offer information to mothers while in the office waiting area. Practice Implications: Pediatric nurses who encounter mothers who struggle with caring for their toddlers may find brief‐office based interventions a valuable tool for educating parents.

Management of a Child With Nutritional Rickets, Multiple Cavities, Enamel Hypoplasia, and Reactive Attachment Disorder

www.jpedhc.org with tooth hypersensitivity, multiple restorations, including some failed restorations, and enamel hypoplasia. In addition, the child presented with these diagnoses: nutritional rickets; fetal alcohol syndrome (FAS); intellectual disability; and reactive attachment disorder (RAD). Based on the presenting oral andmedical health care needs, this child was managed collaboratively by