Journal of Pediatric Health Care最新文献

Introduction: Routine adolescent vaccination rates fluctuate widely and at times fall below public health goals. This study aimed to assess parent perceptions and behaviors around vaccines and to explore potential effects of the pandemic on these parental vaccination decisions.

Method: Between February and March 2022, 64 caregivers of adolescents participated in six text-based online focus groups in which their knowledge and perception regarding routine vaccines were explored.

Results: Participants were predominantly female (84%), White (72%), and college-educated (77%). Their adolescents receiving all recommended vaccines was very important (61%) or important (34%). While caregivers appeared generally supportive of vaccines, knowledge and perception regarding these vaccines varied widely. Postpandemic, health care provider recommendations and vaccine requirements appeared to be a continued driver for obtaining vaccines.

Discussion: Health care providers should continue to apply evidence-based strategies to promote vaccine uptake while addressing misinformation and disinformation.

Osteosarcoma is the most common malignant bone tumor in pediatric and adolescent patients. Typical symptoms include nonspecific localized bone pain often occurring during the adolescent growth spurt. The timing and presentation of symptoms frequently lead primary care providers to associate them with benign conditions such as growing pains or sports-related injuries. As a result, diagnosis is frequently delayed. This case study examines a 14-year-old female whose persistent leg pain was initially misdiagnosed in a primary care setting, resulting in a delayed diagnosis of osteosarcoma. Despite normal initial imaging and examination, the patient later presented with worsening symptoms and neurological deficits, prompting advanced imaging and biopsy that confirmed malignancy. This case highlights the diagnostic challenges in primary care and the need for increased clinical awareness, standardized guidelines, and structured follow-up in pediatric patients presenting with unexplained, unilateral bone pain.

Advanced Practice Registered Nurses (APRNs) must understand billing and coding to accurately document their work and maximize their value. There is an ongoing need for education in billing and coding, as new knowledge emerges each year. Audits and investigations for billing breaches can lead to fraud charges and penalties due to a lack of knowledge. This article will review the background of medical billing, discuss primary care Current Procedural Terminology codes and evaluation/management codes, and cover recent updates in the primary care setting. It will then review acute care billing, including the pediatric intensive care unit, inpatient setting, and emergency room. As employers increasingly evaluate APRNs' productivity and revenue, proper coding, billing, and revenue generation are crucial for demonstrating APRNs value in both outpatient and inpatient settings.

Pediatric Nurse Practitioner Programs at Risk: A Critical Crossroads Pediatric nurse practitioners (PNPs) are advanced practice nurses who diagnose, treat, and manage the health needs of infants, children, adolescents, and young adults from birth through transition to adult care. PNP education programs focus exclusively on pediatric-specific curricula and clinical training around these health needs. PNP programs today are closing or experiencing enrollment declines at a time when pediatric healthcare demands are expanding. Now more than ever, we must ensure that children and their families retain access to accessible, high-quality specialized pediatric healthcare. This call to action provides specific, actionable takeaways for PNPs and others to preserve and invest in the PNP workforce.

Introduction: Premature infants are a vulnerable population with an increased risk for health problems and developmental delays. Breast milk has been positively linked to improved development and is widely recommended as the exclusive infant nutrition source for the first 6 months of life. The purpose of this quality improvement project was to decrease breastfeeding attrition rates through both provider and caregiver education.

Method: The project took place at an outpatient developmental practice following infants recently discharged from the NICU. Breast milk attrition by 4 months postconception age (PCA) was 45%. A provider education session was conducted, a reliable breast milk data collection method was workshopped, and a caregiver education packet was developed and distributed to caregivers at their intake visit to reach the project goal of 35% attrition.

Results: Breast milk attrition decreased from 45% to 35% throughout the project's duration. Healthcare staff reported 100% satisfaction with provided education, higher than the project goal of 80%. Quantitative and qualitative parental feedback strongly supported the project's interventions.

Discussion: A focused conversation about breast milk and its benefits with the child's caregiver and a child's developmental provider, combined with ongoing support, demonstrated an increase in the length of time for which the child received breast milk.

There is a need for more pediatric nurse practitioners, and most programs are facing significant difficulties sourcing willing preceptors. Among the issues surrounding clinical placement, programs have variable processes for affiliation agreements, locating preceptors, and policies surrounding paying stipends. This practice issue calls for immediate evaluation of the preceptor shortage and creative strategic planning to mitigate ongoing placement concerns. A lack of resolution will lead to additional shortages of prepared clinicians and perpetuate the cycle of difficulty obtaining mandatory clinical practice hours.

Advanced practice nurses (APNs) have gained increasing responsibilities over the last 50 years. Depending on when and where the APN was trained and the types of continuing education they have attended, they may not be fully aware of issues related to professional liability insurance (PLI), licensure, and tort law as they relate to malpractice, medical malpractice, and medical malpractice stress syndrome (MMSS). The purpose of this article is to provide a brief overview of these topics and highlight key points through a case study approach.

Introduction: Many children in state custody require concurrent hospitalization each year, but little is known about best practices in caring for them. This study explored healthcare providers' experiences working with and perceptions of the needs of hospitalized children in state custody.

Methods: Twenty-five healthcare providers from an urban children's hospital completed semi-structured interviews that were audio-recorded, transcribed, and analyzed using an inductive, thematic coding approach.

Results: Two sets of five themes emerged. First: (1) stressors associated with the Department of Children's Services, (2) emotional distress for providers, (3) limited support resources, (4) multidisciplinary care and coordination, and (5) patient-centered care. Second: (1) building relationships and forming attachments, (2) medical and developmental complexity, (3) isolation, (4) extended (sometimes medically unnecessary) hospitalization, and (5) lack of control.

Conclusions: Participants identified the many challenges associated with hospitalization for this population. By prioritizing collaborative care coordination and trauma-informed practices, teams can enhance outcomes for these children.