Linda L. Lindeke

Neurobehavioral evidence for working-memory deficits in school-aged children with histories of prematurity.

Cognitive performance in 7‐ to 9‐year‐old preterm neonatal intensive‐care survivors was compared with that in age‐matched control children. Non‐verbal memory span, spatial working‐memory abilities, planning, set‐shifting, and recognition memory for both spatial and patterned stimuli were assessed using the Cambridge Neuropsychological Testing Automated Battery. Relative to children in the control group, neonatal intensive‐care unit (NICU) survivors demonstrated 25% more memory errors on the spatial working‐memory task. Their use of strategy on this task was similar to a control group of 5‐year‐olds. Planning times on‘Tower of London’problems were long relative to those of term controls. NICU survivors demonstrated poorer pattern recognition as well as a shorter spatial memory span. The groups did not differ in visual‐discrimination learning or in spatial‐recognition memory. No specific neonatal risk factor accounted for the observed differences, although scores on the Neurobiological Risk Score (NBRS), a composite measure of neonatal risk, did predict several aspects of later task performance. Whether these data reflect a developmental delay in brain maturation in NICU survivors or the presence of a permanent information‐processing deficit due to adverse neonatal events must be assessed through continued follow‐up.

Maintaining professional integrity in the midst of interdisciplinary collaboration.

Abstract Nurses are encountering many opportunities and incentives to engage in interdisciplinary initiatives. The aim of these initiatives, which are sponsored by private foundations, academic institutions, and managed care entities, is to increase the quality and efficiency of health care. Maintaining professional integrity in the midst of interdisciplinary collaboration is complex and warrants close examination. Contextual issues, which include differing values, professionalism, boundary questions, communication, and power, affect the success of interdisciplinary activities.

Capturing children's voices for quality improvement.

PurposeTo query children about the perceptions of their inpatient healthcare experiences in order to improve care to make it more developmentally appropriate and responsive to childrens needs and desires. Study Design and MethodsChildren (n = 120) were interviewed and their comments were recorded as they described the best and worst things about their hospitalization and made recommendations for change. They were approached at the time of discharge from a tertiary care unit. Content analysis was used to compare their responses within their developmental levels. Themes were developed, and data were co-coded for trustworthiness of findings. Quotes were extracted that illustrated the themes. ResultsChildren provided insightful and specific data regarding the perceptions of their hospital experiences. Pain and discomfort were cited most frequently as the worst aspects of hospitalization and the areas most needing improvement. Play activities were valued by children of all ages. Their positive relationships with hospital staff were described frequently. The developmental stage of children determined the specificity and diversity of their comments. Clinical ImplicationsChildrens unique perspectives should be sought regularly and their data included in ongoing programs of quality assessment. When only parents are queried, important and insightful perspectives of children are missed that could improve care quality.

Music as a nursing intervention for preterm infants in the NICU.

Although there is general agreement that noise in the neonatal intensive care unit should be reduced, there is controversy about the use of music as a developmental care strategy with preterm infants. Much literature supports using music with preterm infants, indicating that it enhances physiologic and neurobehavioral functioning, but some experts worry that music is overstimulating. This article presents evidence supporting the use of music with preterm infants as well as criticism of same. Recommendations for music interventions with preterm infants are discussed, although further research is needed before specific guidelines can be established.

Reimbursement realities of advanced nursing practice

Abstract Rising costs of health care require advanced practice nurses to be cost-effective and knowledgeable regarding reimbursement of their services within rapidly expanding managed care organizations. However, the rapid pace of change in reimbursement legislation, policies, and procedures makes this a daunting task.

A national survey of the primary and acute care pediatric nurse practitioner educational preparation.

INTRODUCTION The past decade has been marked by a gradual expansion of the traditional primary care role of the pediatric nurse practitioner (PNP) into practice arenas that call for more acute and critical care of children. The purpose of the study was to explore the educational programming needs of dual (combined) track PNP programs that prepare graduates to provide care to children and adolescents across the continuum of health and illness. METHOD A two-phase, exploratory, mixed method design was utilized. An electronic survey was completed by 65% of PNP program directors in the country. Semi-structured telephone interviews were conducted with hospital-based PNPs who were practicing in roles that met a range of health care needs across the primary and acute care continuum. RESULTS Primary care and acute care programs have more common than unique elements, and the vast majority of clinical competencies are common to both types of program. Only three competencies appear to be unique to acute care programs. DISCUSSION The Association of Faculties of Pediatric Nurse Practitioner Programs should utilize existing evidence and develop guidelines for dual PNP programs that focus on the provision of care to children across a wide continuum of health and illness.

Neonatal predictors of school-based services used by NICU graduates at school age.

Background Ill or premature newborns are at increased risk for ongoing morbidity throughout childhood. Federal legislation now mandates that states provide early intervention, special education, and disability accommodations for children with special needs. Because all children born prematurely do not require all services, targeting services to the children with greatest risk is essential. This study examined whether neonatal characteristics could predict special school-based service use (speech, occupational, physical therapy, special education) in later childhood. Methods Subjects were 53 children, ages 7 to 11 years, graduates of one Midwest Level 3 neonatal intensive care unit (NICU). Neonatal data were used to calculate Neurobiologic Risk Scores (NBRS), a sum of illness factors related to brain damage. Birth weight, length of NICU stay, and NBRS were compared to the children’s school performance on standardized tools and to report cards. Results Most children studied were not receiving special school services. The NBRS and parent report of child competency were related (p = 0.01). Length of NICU stay correlated with teachers’ reports of children’s academic performance (p = 0.04), and to use of special school services use (p = 0.03). As the NBRS score increased, report card performance decreased. Conclusions Neonatal characteristics predicted school-age service use. This is important for nurses because predicting which children are most likely to need special services can aid in tracking children at high risk for prompt assessments and referrals. Parents, healthcare providers, educators, advocacy groups, and funding agencies need accurate outcome data to influence health, educational, and social policy decisions.

Rural hospital preparedness for neonatal resuscitation.

CONTEXT Neonatal resuscitation is a critical component of perinatal services in all settings. PURPOSE To systematically describe preparedness of rural hospitals for neonatal resuscitation, and to determine whether delivery volume and level of perinatal care were associated with overall preparedness or its indicators. METHODS We developed the 15-point Hospital Neonatal Resuscitation Survey to examine institutional preparedness for neonatal resuscitation in 4 areas: policy and procedure, resuscitation team membership, continuing education, and connections with a wider system of perinatal care. All 58 rural hospitals with perinatal services in 2 upper Midwestern states (North Dakota and Minnesota) were asked to provide information describing preparedness for neonatal resuscitation. Nursing administrators responded to the survey. FINDINGS A total of 26 hospitals took part. Annual delivery volume ranged from 4 to 958. Preparedness scores ranged from 4 to 12. Hospitals with more than 125 deliveries each year reported significantly higher levels of preparedness than lower volume hospitals (9.50 vs 5.83, P < .001). Overall preparedness was not associated with level of perinatal care. Most rural hospitals did not identify a formal collaborative relationship with a regional level III perinatal center. CONCLUSIONS Substantial variation in hospital preparedness for neonatal resuscitation was identified. Preparedness was associated with delivery volume. Lack of collaborative agreements between rural hospitals and level III perinatal centers was pervasive. Additional research into the measurement of hospital preparedness for neonatal resuscitation as a component of quality rural perinatal care is needed to optimize outcomes for rural-born neonates.

Emerging Issues Regarding Pediatric Nurse Practitioner Education in Acute and Primary Care

The climate of health care in the United States continues to be tumultuous, with widespread calls for change. Concerns about health care costs are matched by public demands for quality, safety, efficiency, and appropriate access for all (Institute Of Medicine [IOM], 2001; Sorian, 2006). Nurse practitioners (NPs) are increasingly recognized as providing a level of care comparable to physicians (Brooks, 2009), prompting the design of newmodels of care delivery that integrate NPs. This growing recognitionofeffectivenesshasgiven rise to a myriad of new NP positions in diverse settings ranging from community-based to high-acuity critical care. Nursing educators are challenged to effectively deliver NP educational programs to meet the demand for highly skilled advanced practice registered nurses (APRNs). Recent landmark collaboration between theNational Council of State Board of Nursing (NCSBN) and the APRN Joint Dialogue Group has resulted in the widely supported document, ‘‘Consensus Model for APRN Regulation: Legislation, Accreditation, Certification, and Education’’ (NCSBN, 2008). This publication establishes common language around titles, scopes of practice, and patient populations; it clarifies terminology, regulation, and roles of all types of APRNs, including primary care and acute care NPs. The consensus document lays the groundwork to create a consistent approach to APRN credentialing by logically linking the

Family-centered Health Care/Medical Home: APN Roles in Shaping New Care Models

www.jpedhc.org The Patient Protection and Affordable Care Act (PPACA) of 2010 is the legislation that created the foundation for reformof theU.S. health care system.The legislation established and funds diverse policies and projects to realign the financial incentives in the current health care insurance market. It encourages efficiency and quality and directs funds toward prevention and population health. Many regulations and rules from the legislation are currently being formulated to translate the law’s provisions into actual changes in health care practices and processes (Table 1). The law includes much for advanced practice nurses (APNs) to celebrate, such as funding for nursemanaged centers and increased nurse education loans and grants. Care innovations, a provision in the health care reform legislation, have significant potential for enhancing APN practice even though physician-exclusive language in the legislation resulted in nurse practitioners (NPs) not being fully included in key provisions of the care innovations reforms. This article focuses on one of the care innovations strongly supported in the PPACA, the health care/medical home. It provides background on the health care/medical home model, the importance of family-focused caremodels, and suggestions for possible partnership for APNs to forge with family advocacy groups to improve access and quality and to strengthen the position of NPs in the newmodels of health care delivery.