Mary C. O'Laughlen

Improving Asthma Care for African American Children by Increasing National Asthma Guideline Adherence

INTRODUCTION Children, particularly African American children, bear a disproportionate burden of asthma and are at highest risk for associated morbidity and mortality. The under-utilization of the National Asthma Education and Prevention Program (NAEPP) guidelines across all demographics and the under use of inhaled corticosteroids (ICS) as controller therapy in these children are well-documented. The primary aim of this study was to increase health care provider (HCP) adherence to the NAEPP guidelines by means of a guideline reminder tool, the Multi-colored Simplified Asthma Guideline Reminder, consequently increasing the prescription of ICS in this population. METHOD This study had a pre-experimental design with descriptive analysis. RESULTS The Multi-colored Simplified Asthma Guideline Reminder was effective in increasing HCP adherence to the NAEPP guidelines as evidenced by increased use of ICS as controller therapy. DISCUSSION Despite the increasing prevalence and burden of asthma in African American children, the associated prescriptive use of ICS has not increased substantially in the past decade. The greatest obstacle in the scope of improving asthma outcomes is the underuse of ICS by HCPs.

A Substance Use Decision Aid for Medically at-Risk Adolescents Results of a Randomized Controlled Trial for Cancer-Surviving Adolescents

Background: Adolescent survivors of childhood cancer engage in risky behaviors. Objective: This study tested a decision aid for cancer-surviving adolescents aimed at difficult decisions related to engaging in substance use behaviors. Methods: This randomized controlled trial recruited 243 teen survivors at 3 cancer centers. The cognitive-behavioral skills program focused on decision making and substance use within the context of past treatment. Effects at 6 and 12 months were examined for decision making, risk motivation, and substance use behaviors using linear regression models. Results: The majority of the teen cancer survivors (90%) rated the program as positive. There was an intermediate effect at 6 months for change in risk motivation for low riskers, but this effect was not sustained at 12 months. For quality decision making, there was no significant effect between treatment groups for either time point. Conclusions: The overall program effects were modest. Once teen survivors are in the program and learn what quality decision making is, their written reports indicated adjustment in their perception of their decision-making ability; thus, a more diagnostic baseline decision-making measure and a more intensive intervention are needed in the last 6 months. With 2 of 3 teen participants dealing with cognitive difficulties, the data suggest that this type of intervention will continue to be challenging, especially when 90% of their household members and 56% of their close friends model substance use. Implications for Practice: This effectiveness trial using late-effects clinics provides recommendations for further program development for medically at-risk adolescents, particularly ones with cognitive difficulties.

Managing asthma during pregnancy.

Purpose Pregnant women with asthma have many concerns about their respiratory health, as well as the health of their baby. A womans respiratory system experiences many physiological changes during pregnancy and when a diagnosis of asthma is present, the clinical effect of pregnancy on asthma is variable. Regardless of disease years, when asthma patients become pregnant, both patients and healthcare providers want to know how pregnancy affects asthma and how asthma may affect pregnancy outcomes. This article will review how to optimally manage asthma during pregnancy using an evidence-based approach that recognizes the patients changing needs. Data sources Literature collected from sources identified through searches of PubMed and CINAHL covering the periods from 1996 to 2012. Conclusion With the implementation of evidence-based management and treatment, pregnant patients who have asthma can be positioned to better control their symptoms and avoid unwanted complications that may affect the health of their baby. Implications for practice Pregnant patients with asthma may be cared for in a variety of healthcare settings ranging from primary care to specialty care to the emergency department. Consequently, it is imperative that healthcare providers across the array of clinical venues be proficient on how to optimize the asthma outcomes of their pregnant patients.Purpose: Pregnant women with asthma have many concerns about their respiratory health, as well as the health of their baby. A womans respiratory system experiences many physiological changes during pregnancy and when a diagnosis of asthma is present, the clinical effect of pregnancy on asthma is variable. Regardless of disease years, when asthma patients become pregnant, both patients and healthcare providers want to know how pregnancy affects asthma and how asthma may affect pregnancy outcomes. This article will review how to optimally manage asthma during pregnancy using an evidence‐based approach that recognizes the patients changing needs. Data sources: Literature collected from sources identified through searches of PubMed and CINAHL covering the periods from 1996 to 2012. Conclusion: With the implementation of evidence‐based management and treatment, pregnant patients who have asthma can be positioned to better control their symptoms and avoid unwanted complications that may affect the health of their baby. Implications for practice: Pregnant patients with asthma may be cared for in a variety of healthcare settings ranging from primary care to specialty care to the emergency department. Consequently, it is imperative that healthcare providers across the array of clinical venues be proficient on how to optimize the asthma outcomes of their pregnant patients.

Survey to child/adolescent psychiatry and developmental/behavioral pediatric training directors to expand psychiatric‐mental health training to nurse practitioners

BACKGROUND There is an ongoing shortage of child mental health professionals. Nurse practitioners (NPs) who completed behavioral and mental health training have proven that they can diagnose and manage many pediatric problems. PURPOSE To ask the training directors of both child/adolescent psychiatry (CAP) and developmental/behavioral pediatric (DBP) programs about their receptivity and willingness to give additional training for NPs who provide care to children with behavioral and mental health issues and examine the main obstacles to the development of such programs. METHODS A survey was sent to 151 CAP and DBP training directors in the United States. RESULTS The return rate was 67% (N = 101). Only 12% expressed objection to the concept of additional NP training in CAP or DBP, but only 53% of training directors currently reported having sufficient faculty to do so. Some training directors reported already having advanced behavioral and mental health training programs for NPs (31%) and most (82%) would consider expanding, if funded. CONCLUSIONS There is support for advanced training for NPs, but funding is needed to make this a reality. IMPLICATIONS FOR PRACTICE Expansion of such programs might rapidly improve accessibility and reduce waiting time of mental health providers for children and adolescents.Background There is an ongoing shortage of child mental health professionals. Nurse practitioners (NPs) who completed behavioral and mental health training have proven that they can diagnose and manage many pediatric problems. Purpose To ask the training directors of both child/adolescent psychiatry (CAP) and developmental/behavioral pediatric (DBP) programs about their receptivity and willingness to give additional training for NPs who provide care to children with behavioral and mental health issues and examine the main obstacles to the development of such programs. Methods A survey was sent to 151 CAP and DBP training directors in the United States. Results The return rate was 67% (N = 101). Only 12% expressed objection to the concept of additional NP training in CAP or DBP, but only 53% of training directors currently reported having sufficient faculty to do so. Some training directors reported already having advanced behavioral and mental health training programs for NPs (31%) and most (82%) would consider expanding, if funded. Conclusions There is support for advanced training for NPs, but funding is needed to make this a reality. Implications for practice Expansion of such programs might rapidly improve accessibility and reduce waiting time of mental health providers for children and adolescents.

NAPNAP Research Agenda: 2014-2019

Regena Spratling, PhD, RN, CPNP, Rita H. Pickler, PhD, RN, PNP-BC, FAAN, Christina Calamaro, PhD, CRNP, Juanita Conkin Dale, PhD, RN, CPNP-PC, Sharron Docherty, PhD, RN, PNP-BC, FAAN, Catherine J. Goodhue, MN, CPNP, Jill Kilanowski, PhD, RN, APRN, CPNP, FAAN, Ann Marie McCarthy, PhD, RN, FAAN, Mary C. O’Laughlen, PhD, RN, FNP-BC, FAAAAI, Lois S. Sadler, PhD, RN, PNP-BC, FAAN, Leigh Small, PhD, RN, CPNP-PC, FNAP, FAANP, FAAN, Kathleen Speer, PhD, RN, PPCNP-BC, Tami Thomas, PhD, RN, CPNP, RNC, FAANP, Susan Van Cleve, DNP, RN, CPNP, PMHS, Jennifer D Auria, PhD, RN, CPNP, & Dolores C. Jones, EdD, RN, CPNP

Managing asthma during pregnancy: Managing asthma during pregnancy

Purpose Pregnant women with asthma have many concerns about their respiratory health, as well as the health of their baby. A womans respiratory system experiences many physiological changes during pregnancy and when a diagnosis of asthma is present, the clinical effect of pregnancy on asthma is variable. Regardless of disease years, when asthma patients become pregnant, both patients and healthcare providers want to know how pregnancy affects asthma and how asthma may affect pregnancy outcomes. This article will review how to optimally manage asthma during pregnancy using an evidence-based approach that recognizes the patients changing needs. Data sources Literature collected from sources identified through searches of PubMed and CINAHL covering the periods from 1996 to 2012. Conclusion With the implementation of evidence-based management and treatment, pregnant patients who have asthma can be positioned to better control their symptoms and avoid unwanted complications that may affect the health of their baby. Implications for practice Pregnant patients with asthma may be cared for in a variety of healthcare settings ranging from primary care to specialty care to the emergency department. Consequently, it is imperative that healthcare providers across the array of clinical venues be proficient on how to optimize the asthma outcomes of their pregnant patients.Purpose: Pregnant women with asthma have many concerns about their respiratory health, as well as the health of their baby. A womans respiratory system experiences many physiological changes during pregnancy and when a diagnosis of asthma is present, the clinical effect of pregnancy on asthma is variable. Regardless of disease years, when asthma patients become pregnant, both patients and healthcare providers want to know how pregnancy affects asthma and how asthma may affect pregnancy outcomes. This article will review how to optimally manage asthma during pregnancy using an evidence‐based approach that recognizes the patients changing needs. Data sources: Literature collected from sources identified through searches of PubMed and CINAHL covering the periods from 1996 to 2012. Conclusion: With the implementation of evidence‐based management and treatment, pregnant patients who have asthma can be positioned to better control their symptoms and avoid unwanted complications that may affect the health of their baby. Implications for practice: Pregnant patients with asthma may be cared for in a variety of healthcare settings ranging from primary care to specialty care to the emergency department. Consequently, it is imperative that healthcare providers across the array of clinical venues be proficient on how to optimize the asthma outcomes of their pregnant patients.