The Role of the Nurse Practitioner in Congenital Heart Surgery

Pediatric nurse practitioners are often members of the interdisciplinary team caring for children with congenital heart disease. The collaborative practice model, in which a physician-led team of physicians, nurse practitioners, and other clinicians work together to provide comprehensive, quality patient care, has had positive benefits for patients and their families, physicians, and nurses. The acute care pediatric nurse practitioner combines advanced training in assessment, diagnosis, and management of common pediatric health problems with advanced nursing expertise in patient education, counseling, and health promotion to meet the specialized needs of children with complex acute and chronic illnesses. This article focuses on the development and current practice of pediatric nurse practitioners in acute care settings and concludes with a discussion of the role of nurse practitioners on the postoperative cardiac surgery service at Children's Hospital, Boston.     

The 18-month well-child visit in primary care: Clinical strategies for early intervention

Family physicians, paediatricians, nurse practitioners and all primary health care providers are well-positioned in the health care system to provide identification and intervention for developmental delay in early childhood. This can be accomplished through the promotion of healthy child development by supporting children and their parents, paying special attention to issues of attachment and parent-child interactions. Early recognition and intervention is critical for addressing all developmental, social and behavioural problems in young children. A familiarity with local community resources and services is crucial; it will assist primary health care providers in supporting families by providing extra assistance and assessment for families at risk. The present article reports on the evidence-based interventions at the 18-month visit including screening tools, resources and a case example. The importance of interdisciplinary coordination to provide a comprehensive approach to screening, assessment and intervention for developmental delays in infants and young children is highlighted.     

Common Conditions That Mimic Findings of Sexual Abuse

Sexual abuse is a problem of epidemic proportions in our society. Given the prevalence of sexual abuse, it is vital for medical providers, including pediatric nurse practitioners, to recognize sexual abuse in their patients and respond appropriately. Failing to recognize sexual abuse can leave children at risk for continued abuse and potentially lead to the sexual abuse of additional children. Serious ramifications also can arise when sexual abuse is diagnosed erroneously. Children can be removed from their homes and placed in foster care. An innocent person can be prosecuted. It is important for pediatric nurse practitioners to understand that the majority of children who are sexually abused will have a normal or nonspecific ano-genital examination. However, physical findings of sexual abuse are noted in approximately 4% of children who give a history of sexual abuse. Certain clinical findings can mimic sexual abuse. This article will discuss some of the more common findings mistaken for sexual abuse and assist the pediatric nurse practitioner in correctly recognizing these findings and responding appropriately.     

An integrated approach to the care of adult patients with prior atriopulmonary fontan surgery.

Because of improved survival among children born with heart disease, more adults than children are now living with congenital heart defects, providing a new challenge for ongoing evaluation and care. At Children's Memorial Hospital in Chicago, we have gained extensive expertise in the long-term outcome of patients with repaired single ventricle anatomy, particularly with regard to arrhythmias and impaired hemodynamics, and have developed an integrated approach to their care. This article will summarize (a) single ventricle physiology, (b) evolution of the Fontan operation and the long-term multi-system sequelae, (c) treatment options for patients with prior Fontan surgery, focusing on Fontan conversion with arrhythmia surgery, and (d) unique management of adult patients with prior Fontan surgery. For the foreseeable future, pediatric nurse practitioners will have an important role, including coordination of care and providing continuity in the care of adults with prior Fontan surgery.     

Discerning bright futures of electronic health records

The recent release of the Bright Futures Guidelines, third edition, brings new opportunity and new power to our work with children and their families. Pediatricians, with their colleague nurse practitioners and family physicians, now address "new morbidities" of behavioral and psychosocial problems, developmental disabilities, and environmental stressors, in addition to the traditional morbidities of infection or malnutrition. Properly designed EHRs can add efficiency to this important work. Schor has discussed the changing nature of the health supervision encounter. If these well child visits are to remain relevant and vibrant, if clinicians are to effectively address the physical, emotional, and social health needs of our children and adolescents, new models of data management are essential. This is the challenge in the development of electronic health records for the primary care of children and youth.     

The role of the nurse practitioner in an individualized education plan and coordination of care for the child with Asperger's syndrome.

The purpose of this article is to describe the role nurse practitioners can play in the diagnosis, early intervention, and coordination of care for children with Asperger's Syndrome and their families. The article outlines strategies for how nurse practitioners in both school and primary care settings can use the Individualized Educational Plan as a mechanism where they may join an interdisciplinary team of professionals and parents. Nurse practitioners can assist parents, children, and school personnel in planning, intervening, and coordinating services for these families and their children, who are at risk for academic failure and social isolation.     

Building a Safe and Healthy America: Eliminating Corporal Punishment via Positive Parenting

Abstract corporal punishment (CP) is associated with negative short-term and long-term children outcomes. However, many caregivers continue to administer spankings and other forms of CP. Pediatric nurse practitioners are in a unique position to affect change in parental behavior related to CP use and other parenting practices. This article will summarize the research on the dangers of CP and the corresponding benefits of positive parenting. It defines positive parenting and offers resources pediatric health care providers, including pediatric nurse practitioners, can use to educate both themselves and caregivers about specific discipline techniques appropriate to each developmental stage. Finally, it suggests practice strategies pediatric nurse practitioners can use to help caregivers replace CP and other harsh parenting practices with positive parenting to build a safe and healthy America.     

Child Maltreatment: Screening and Anticipatory Guidance

Child maltreatment is a problem of epidemic proportions in the United States. Given the numbers of children affected by child maltreatment and the dire consequences that can develop, prompt identification of child maltreatment is crucial. Despite support of the implementation and development of protocols for child maltreatment screening by professional organizations such as the National Association of Pediatric Nurse Practitioners and American Academy of Pediatrics, little is available in the literature regarding the screening practices of pediatric nurse practitioners and other pediatric health care providers. This Continuing Education article will help pediatric nurse practitioners incorporate this vital screening intervention into their practice. Practical examples of when and how to incorporate screening questions and anticipatory guidance for discipline practices, crying, intimate partner violence (domestic violence), physical abuse, and sexual abuse will be discussed.     

Keeping children with congenital heart disease healthy

Keeping children with congenital heart disease healthy is vital to their long-term survival and quality of life. Nurse practitioners are in an excellent position to keep these sometimes fragile children healthy before, between, and after their cardiac surgeries. Primary care visits should address developmental morbidity. Referral for in-depth evaluations and intervention should be initiated for children with hemodynamically significant heart disease. Infants may also experience poor feeding. Nutritional guidance may include fortifying formulas or enteral tube feedings. Attention to immunization status and prevention of winter illnesses and endocarditis may reduce complications in this high-risk group of children.     

Physical abuse: Recognition and reporting.

This article provides primary care providers, including pediatric nurse practitioners, with a framework for understanding the dynamics of child abuse, recognizing physical abuse injuries, and reporting concerns of suspected physical abuse to child protective services. Three children die in America every day as a result of child abuse or neglect. Many children who have severe injuries at the time that physical abuse is diagnosed have previously presented with less severe injuries, and physical abuse was overlooked. Physical assessment for children presenting with bruises, bite marks, burns, skeletal injuries, abdominal trauma, and head injuries will be discussed. Prompt recognition and reporting of physical abuse injuries by primary care providers is imperative for the protection of children.     

Congenital syphilis: A guide to diagnosis and management

Although congenital syphilis is a rare disease in Canada, infected infants may experience severe sequelae, including cerebral palsy, hydrocephalus, sensorineural hearing loss and musculoskeletal deformity. Timely treatment of congenital syphilis during pregnancy may prevent all of the above sequelae. However, the diagnosis of suspected cases and management of congenital syphilis may be confusing, and the potential for severe disability is high when cases are missed. The present review provides assistance to practitioners in the diagnosis of suspected cases and management of children with presumed or confirmed infection.     

Management of children with swallowing disorders.

Early diagnosis and treatment of feeding and swallowing problems may improve a child's health status and quality of life and reduce health care costs. Pediatric nurse practitioners have a salient role in the early diagnosis of children at risk for feeding and swallowing problems. Increased knowledge about the normal swallowing process, children at risk for feeding and swallowing disorders, and associated symptoms enhances early diagnosis and treatment. The child's general health history and physical evaluation, along with additional diagnostic tests, provide the basis for the formulation of an individualized feeding program by an interdisciplinary team. Pediatric nurse practitioners, through their knowledge about dysphagia and participation on a interdisciplinary team, can provide support for family members and assist them in adapting to and caring for a child with a swallowing impairment.     

A Job Task Analysis of the Expanding Role of the Pediatric Mental Health Specialist and the Nurse Practitioner in Pediatric Mental Health

Lack of access to support, services, and providers for children and adolescents with mental health conditions is a serious problem in the United States. Fewer than half of the children who need services obtain them. To meet this demand, the Pediatric Nursing Certification Board launched a new specialty certification in 2011 for advanced practice registered nurses called the pediatric primary care mental health specialist (PMHS). In 2016, a job task analysis of the role of the PMHS and nurse practitioners practicing in pediatric mental health and developmental/behavioral pediatrics was conducted. Surveys were completed by 293 respondents. Demographic characteristics, tasks performed in practice, diagnoses made, assessment and screening tools used, and types of pharmacologic and nonpharmacologic interventions were obtained and are reported. The roles of the PMHS and nurse practitioner in pediatric mental health are well established and key to expanding services and access to children and their families.     

Child Neglect: Assessment and Intervention

Neglect is often a neglected form of child maltreatment even though it is the most common and deadliest form of child maltreatment. Pediatric nurse practitioners (PNPs) will most likely encounter neglected children in their practice. It is crucial that PNPs recognize child neglect in a timely manner and intervene appropriately. This continuing education article will help PNPs understand and respond to child neglect. Neglect will be defined and risk factors will be discussed. Children who are neglected can experience serious and lifelong consequences. The medical assessment and plan of care for children with concerns of suspected neglect will be discussed.     

A model program: neonatal nurse practitioners providing community health care for high-risk infants

Perinatal drug exposure costs our communities millions of dollars each year in hospital fees and in services such as foster care, child protection, and drug treatment. Infants and their families in this group require substantial long-term health care and community resources. Neonatal health care providers should take an active role in developing and implementing home visitation programs to support early hospital discharge and continuity of care for these high-risk infants and their families. Neonatal nurse practitioners should prepare in the future to practice not only in secondary-- and tertiary--level neonatal centers, but also in follow-up clinics, long-term developmental centers, and the community This article describes a home intervention program delivered by neonatal nurse practitioners for high-risk infants and their mothers. The target population is infants exposed prenatally to drugs and/or alcohol.     

Preanesthesia Considerations for the Nurse Practitioner

With increases in pediatric ambulatory surgery, primary health care providers such as nurse practitioners are being called upon to provide input about patients preoperatively or prior to other procedures requiring anesthesia. Because the anesthesia team may not meet the patient and family until the day of surgery; a thorough evaluation done by the primary care provider can supply the anesthesia team with the information required for optimal care. Such information includes a detailed history, including the patient's birth history, medical diagnoses, medications, allergies, recent laboratory test values, and the results of a recent physical examination. The purpose of this article is to provide primary care nurse practitioners with guidelines and information to consider when seeing their patient for a preprocedural visit.     

PNP roles and interventions with children with special needs and their families.

Pediatric nurse practitioners (PNPs) can create excellent professional roles caring for children with special health care needs (CSHCN) and their families. Children with chronic conditions represent an estimated 31% of the US population younger than 18 years (approximately 20 million children in 1988). Five percent of all children who have multiple special needs account for approximately 40% of all pediatric health care expenditures. Skill building is needed for PNPs who have traditionally focused on wellness and common acute illnesses in primary care settings. Role theory and research can guide PNPs in creating roles and interventions to improve the health, safety, and developmental outcomes for CSHCN and their families. Two roles are described, with examples of specific nursing interventions. Assisting child care centers to serve children and families with special needs is an ideal role for PNPs who have knowledge of health and regulatory issues. Another important PNP role is working with adolescents with special health care needs as they transition from pediatric to adult care. Many resources (such as those from the Maternal and Child Health Bureau) are available to assist PNPs to create new roles and interventions for CSHCN and their families.     

A Normal Ano-genital Exam: Sexual Abuse or Not?

Sexual abuse is a problem of epidemic proportions in the United States. Pediatric nurse practitioners (PNPs) are at the forefront of providing care to children and families. The PNP is in a unique position to educate patients and families regarding sexual abuse and dispel common myths associated with sexual abuse. One such myth is that a normal ano-genital examination is synonymous with the absence of sexual abuse. This article will provide primary care providers, including PNPs, with a framework for understanding why a normal ano-genital examination does not negate the possibility of sexual abuse/assault. Normal ano-genital anatomy, changes that occur with puberty, and physical properties related to the genitalia and anus will be discussed. Photos will provide visualization of both normal variants of the pre-pubertal hymen and genitalia as well as changes that occur with puberty. Implications for practice for PNPs will be discussed.     

Repeated sexual abuse allegations: a problem for primary care providers.

Sexual abuse of children is a problem of epidemic proportions in the United States. Primary care providers, including pediatric nurse practitioners, are increasingly presented with the problem of alleged sexual abuse in their patients, and primary care providers typically find it difficult to perform medical evaluations of children for sexual abuse. Having a child present repeatedly with sexual abuse concerns that cannot be substantiated is a stressful and frustrating experience for primary care providers. A case study is presented that illustrates the complexity and difficulty of one such case. A review of the literature will discuss the impact of divorce and Munchausen syndrome by proxy on repeated allegations of sexual abuse. Implications for practice are discussed, and a plan that addresses repeated sexual allegations in primary care settings is outlined.