Kristy K. Martyn

Retrospective data collection using event history calendars.

BACKGROUND Event history calendars are used to collect retrospective data about events and life transitions over short and long periods of time. Event history calendars are highly structured, but flexible, approaches to interviewing respondents about past events that use their own past experiences as cues to remembering. Event history calendars incorporate autobiographical memory retrieval mechanisms to assist respondents in reconstructing past events and experiences accurately and completely. APPROACH A sample event history calendar and experiences from an ongoing study of adolescent risk behavior are described to illustrate event history calendar methodology application in nursing research. Event history calendar design, recording, interviewing, and interviewer training descriptions are included. DISCUSSION Event history calendars have been used extensively for retrospective data collection of occurrence, timing, and sequencing of a variety of life events in population studies, psychology, and sociology research, but not in nursing research. Because event history calendars improve recollection of complex sequences of personal events, they would be ideal for retrospective data collection in quantitative and qualitative nursing studies. Nursing expertise in history-taking make this a natural method of choice for retrospective data collection and as a means of stimulating communication during interviewing.

Low-Income African American Adolescents who Avoid Pregnancy: Tough Girls who Rewrite Negative Scripts

The purpose of this research was to generate a grounded theory that explains the social-psychological processes of low-income African American adolescents who avoided pregnancy. Data collection included focus groups and in-depth interviews with 17 women aged 19 to 26. Data analysis using the grounded theory method revealed that these girls were the recipients of negative social-psychological scripts, putting them at risk for poverty and early childbearing. The “tough girls” struggled to rewrite these scripts by recognizing their negativity, being disenchanted with the scripts, determining to be different, and creating better lives. These aware, introspective young women believed in self-responsibility, self-protection, education, and financial independence. Practice implications and considerations for programmatic interventions can be based on this analysis.

Pediatric nurse practitioners in the United States: current distribution and recent trends in training.

OBJECTIVE To assess the current distribution and training patterns of pediatric nurse practitioners (PNPs). STUDY DESIGN Secondary data analysis from the National Association of Pediatric Nurse Practitioners and the 2008 US Census Bureau were used to estimate the distribution of PNPs per 100,000 children. Data on nurse practitioner (NP) graduation and specialty education programs were obtained from the American Association of Colleges of Nursing. RESULTS PNPs have the greatest concentration in the New England and mid-Atlantic regions and a narrow band of Midwestern states. States that allow PNPs to practice or prescribe independently do not consistently have a higher density of PNPs per child population. There has been a slight decrease in the proportion of programs that offer PNP training. In the last decade, the proportion of NP graduates pursuing family nurse practitioner education has increased, and the proportion pursuing PNP education has decreased. CONCLUSION Workforce planning for the health care of children will require improved methods of assessment of the role of PNPs and the volume of care they provide. Increased use of PNPs in pediatrics will likely require greater effort at recruitment of NPs into the PNP specialty.

Provider Characteristics Desired by African American Women in Prenatal Care

Purpose: The purpose of this study was to describe provider characteristics African American pregnant women identified as important when interacting with their prenatal care providers in an outpatient office setting. Study Design and Method: A descriptive qualitative design was used to explore provider characteristics desired by African American women receiving prenatal care at two inner-city hospital—based obstetric clinics. A total of 22 African American women between the ages of 19 and 28 years participated in the study. Findings: Four major provider characteristic themes emerged from the data: (a) demonstrating quality patient—provider communication, (b) providing continuity of care, (c) treating the women with respect, and (d) delivering compassionate care. Discussion and Conclusion: An overarching theme revealed by the data analysis was the desire by African American women in this study to have their prenatal providers know and remember them. They wanted their providers to understand the context of their lives from their prenatal interactions. Incorporating findings from this study to improve patient—provider interactions during prenatal care could provide an increased understanding of the many complex variables affecting African American women’s lives. Implications for Practice and Research: Prenatal care provides an opportunity for African American women to develop a trusting relationship with a provider. Developing models of prenatal care congruent with the realities of African American women’s lives has the potential to improve patient— provider interactions and potentially affect birth outcomes.

Pediatric Nurse Practitioners: Roles and Scope of Practice

BACKGROUND: There are ∼13 000 pediatric nurse practitioners (PNPs) in the United States. PNPs have been suggested as professionals who could provide care to the growing cadre of children with chronic illnesses and expand the pool of subspecialty care providers. Little is known about current roles of PNPs in primary or subspecialty care. OBJECTIVE: To gain a better understanding of the roles, focus of practice, professional setting, and professional responsibilities of PNPs. METHODS: We conducted a mail survey of a random national sample of 1200 PNPs stratified according to states that license NPs to practice independently. χ2 statistics were used to assess responses from PNPs in states that allow independent practice versus those that do not and on PNPs in primary versus specialty care. RESULTS: The overall response rate was 82.4%. Ninety-six percent (n = 636) of the PNPs were female. More than half of all the respondents (59% [n = 391]) worked in primary care, and almost two-thirds (64% [n = 394]) did not provide care in inpatient settings. Only 11% of the PNPs in states that allow independent practice, practiced independently. CONCLUSIONS: The majority of PNPs currently work in primary care, and most do not have any inpatient roles. It does not seem that independent PNP practices are responsible for a significant portion of pediatric visits. For those who posit that PNPs will help alleviate the currently perceived shortage of pediatric subspecialists, our findings indicate that it likely will not occur without a significant change in the PNP workforce distribution.

Mexican Adolescents' Alcohol Use, Family Intimacy, and Parent-Adolescent Communication

Despite widespread adolescent alcohol use, research on individual and contextual factors among Mexican adolescents is limited. This study describes the relationship between adolescent risk/protective factors, parent-adolescent communication, and their effects on alcohol use of 14- to 17-year-old adolescents living in Mexico (N = 829; 458 girls, 371 boys). In this study, adolescents reported that 55% ever used alcohol, 24% used alcohol in the past 30 days, and 10% reported binge drinking. Adolescents with high family intimacy were less likely to report ever using alcohol and binge drinking. Regression analysis revealed that parent-adolescent communication mediated the effect of family intimacy on overall and binge drinking. Alcohol use prevention with Mexican adolescents should focus on family intimacy and parent-adolescent communication.

Nurse Practitioners and Physician Assistants Employed by General and Subspecialty Pediatricians

OBJECTIVE: There is little nationally representative information describing the current manner in which nurse practitioners (NPs) and physician assistants (PAs) work in pediatric practices and their professional activities. To understand better the current NP and PA workforce in pediatric primary and subspecialty care, we conducted a national survey of pediatricians. METHODS: A survey study of a random national sample of 498 pediatric generalists and 1696 subspecialists in the United States was performed by using a structured questionnaire administered by mail. The survey focused on practice settings, employment, and scope of work of NPs and PAs. RESULTS: Response rates were 72% for generalists and 77% for subspecialists. More than one-half (55%) of generalists reported that they do not currently work with NPs or PAs, compared with only one-third of subspecialists who do not. Many generalists and subspecialists intend to increase the number of NPs and PAs in their practices in the next 5 years. More generalist and subspecialty practices work with NPs than with PAs. There was great variability between generalists and subspecialists and among different subspecialties in the proportions that worked with NPs and PAs. The scope of work of NPs and PAs also varied between generalists and subspecialists. CONCLUSIONS: Planned increases in the number of NPs hired and expansion of their scope of work might put subspecialists and general pediatricians in competition with regard to recruitment and hiring of a limited pool of new pediatric NPs. Similar issues might arise with PAs.

Modifiable influences on female HPV vaccine uptake at the clinic encounter level: A literature review

Purpose: A review of the literature to identify modifiable influences on female human papillomavirus (HPV) vaccine uptake relevant to clinical practice in order to support nurse practitioners (NPs) in the prevention of cervical cancer. Data sources: PubMed, CINAHL, reference lists of publications that surfaced in the electronic search. Conclusions: Six influences are modifiable and potentially amenable to being addressed at the clinic encounter level: (a) cost and insurance coverage, (b) provider recommendation, (c) vaccination opportunity, (d) HPV and HPV vaccine knowledge, (e) vaccine safety concerns, and (f) HPV risk. Implications for practice: NPs have an important role in improving HPV vaccine uptake and research suggests several areas they can address to increase vaccination during clinic visits.

Neonatal Nurse Practitioners: Distribution, Roles and Scope of Practice

OBJECTIVE: We sought to determine the distribution and scope of practice of the neonatal nurse practitioner (NNP) workforce across the United States. METHODS: To determine distribution, we used counts of certified NNPs from the National Certification Corp (Chicago, IL). We calculated state NNP/child population ratios as the number of NNPs divided by the state population 0 to 17 years of age. We calculated NNP/NICU bed ratios as the number of NNPs divided by the total number of NICU beds per state. To characterize roles and scope of practice, we conducted a mail survey of a random national sample of 300 NNPs in states that license nurse practitioners to practice independently and 350 NNPs in states that require physician involvement. RESULTS: The greatest concentrations of NNPs per capita were in the Midwest, South, and Mid-Atlantic region. Thirty-one states had <100 total NNPs. The survey response rate was 77.1%. More than one-half of NNP respondents (54% [n = 211]) reported that they spent the majority of their time in a community hospital, whereas more than one-third (37% [n = 144]) were in an academic health center. Only 2% (n = 7) reported that they engaged in independent practice. CONCLUSIONS: As with many health care professionals, the supply of NNPs may not be distributed according to need. With increasing concern regarding the availability of NNPs, comprehensive studies that examine the demand for NNPs and the roles of other clinicians in the NICU should provide a greater understanding of appropriate NICU workforce capacity and needs.

Private Practice Rates Among Pediatric Subspecialists

OBJECTIVE: Historically, most pediatric subspecialists have conducted their clinical work in academic health centers. However, increases in the absolute numbers of pediatric subspecialists in past decades, combined with greater concentrations of children in urban and suburban settings, might result in more opportunities for pediatric subspecialists to enter private practice. Our goal was to assess the proportions of subspecialists in private practice. METHODS: We surveyed a stratified, random, national sample of 1696 subspecialists from 5 subspecialties and assessed the ownership of their current clinical practice settings. RESULTS: The response rate was 77%. Two-thirds of respondents (65% [n = 705]) reported that they work in academic hospitals or outpatient clinics. Compared with other subspecialists, greater proportions of neonatologists (38% [n = 92]) and critical care physicians (19% [n = 44]) reported that they work in community hospitals. Larger proportions of cardiologists (27% [n = 58]) and gastroenterologists (24% [n = 47]) reported that they work in private outpatient practices. CONCLUSIONS: There were significant proportions of pediatric subspecialists in private practice in most of the 5 subspecialties studied. Ensuring childrens access to pediatric subspecialists likely will require a robust workforce in both academic and private clinical settings. Ongoing studies of the career trajectories of pediatric subspecialists with respect to their venues of practice will be essential for future workforce planning.