• No results found

A PROGRAM TO INCREASE HEALTH CARE FOR CHILDREN: THE PEDIATRIC NURSE PRACTITIONER PROGRAM

N/A
N/A
Protected

Academic year: 2020

Share "A PROGRAM TO INCREASE HEALTH CARE FOR CHILDREN: THE PEDIATRIC NURSE PRACTITIONER PROGRAM"

Copied!
7
0
0

Loading.... (view fulltext now)

Full text

(1)

A

PROGRAM

TO

INCREASE

HEALTH

CARE

FOR

CHILDREN:

THE

PEDIATRIC

NURSE

PRACTITIONER

PROGRAM

Henry K. Silver, M.D., Loretta C. Ford, Ed.D., and Susan G. Steady, M.S.

From the Department of Pediatrics of the School of Medicine and the School of Nurs-ing, University of Colorado Medical Center, Denver

(Received October 18, accepted for publication December 21, 1966.)

Supported by a grant from the Commonwealth Fund, New York, with additional assistance from the

Research Committee of the University of Colorado Medical Center, the Denver Health Department

and the Huerfano-Las Animas Health Department.

Presented at the Thirty-fifth Annual \Ieeting of the American Academy of Pediatrics at Chicago, Illinois, October 24, 1966.

L.C.F. is Professor of Nursing, and S.G.S. is Clinical Assistant in Pediatrics, University of Colorado

School of Nursing.

ADDRESS: (H.K.S.) University of Colorado Medical Center 4200 East Ninth Avenue, Denver, Colorado 80220.

PEDIATHICS, Vol. 39, No. 5. MLIV 1967 756

T

HE INCREASE in population of the

United States is occurring at a much

more rapid rate than the increase in

medi-cal and nursing personnel available to

maintain health services at an optimum

level. Unless the pattern of furnishing

health care, particularly to lower

socioeco-nomic groups in both urban and rural area,

is drastically improved, these groups will

suffer from increasingly inadequate health

supervision. This paper describes an educa-tional and training program in pediatrics for professional nurses (the “pediatric nurse

practitioner” program) which prepares

them to assume an expanded role in

pro-viding increased health care for children in areas where there are limited facilities for

such care.

METHODS

The pediatric nurse practitioner program

was developed under the combined

aus-pices of the Department of Pediatrics of the

School of Medicine and the School of

Nurs-ing of the University of Colorado. The

proj-ect is conducted in two phases. The first is

carried out at the University of Colorado

Medical Center in Denver where each

nurse receives approximately 4 months of

intensive theory and practice in pediatrics

under the direction of senior faculty

mem-bers of the schools of medicine and nursing.

The second phase of the nurses’ educational

program involves the application of the

nurses’ newly acquired knowledge and

skills in field offices in areas with many

resi-dents of low socioeconomic status who have

an obvious need for improved and

aug-mented health care.

During the initial phase at the \Iedical

Center, the program for pediatric nurse

practitioner trainees includes a variety of

educational experiences:

They are assigned to the regular

well-child clinic, the special clinic for low birth weight infants, and the newborn nurseries where they see patients in conjunction with

one of the project directors (H.K.S.) and

other members of the pediatric staff. Here, and in other clinics and teaching seminars, the project nurses focus on increasing their

knowledge and skills and learn improved

interviewing techniques appropriate for

their expanded roles and responsibilities, methods for obtaining significant

informa-tion necessary for optimum counseling of

parents in child-rearing practices, the

es-sentials of a complete basic physical

exam-ination, and techniques of assessing and

managing many minor problems of the

healthy child. In other seminars conducted

by the medical and nursing project

direc-tors and others, various aspects of

parent-child relationships, variations of growth

patterns, physical and psychosocial

(2)

(including breast feeding, the prescription

and modification of formulas, introduction

of solid foods, vitamin and other nutritional

requirements, etc.), and immunization

pro-cedures and schedules (including

modifica-tion of schedules in individualized

circum-stances) are reviewed.

The nurse practitioner trainees partici-pate actively in clinics and the emergency

room in the workup of both well and ill

children with a variety of acute and

chron-ic problems. They interview families,

per-form appropriate examinations, and

partici-pate in discussions regarding patient care.

They work with members of the pediatric

faculty and house staff in the evaluation

and management of children with a variety

of disorders including upper respiratory

in-fections, otitis media, croup, various skin eruptions, diarrhea, constipation, allergic

disorders, and the common contagious

dis-eases. The trainees learn how to obtain

var-ious specimens including diagnostic

cul-tures and to perform hemoglobin

deter-minations, white blood counts, and

urinal-yses. They also assist in the management

of a number of emergency situations,

in-eluding poisonings, accidents, hemorrhage,

apnea, etc. Competence is developed in

as-sessing the overall status of an ill child in

order to determine the acuteness and

sever-ity of disease so that a decision can be

made regarding the illnesses which can be

managed by the nurse and those which will

need immediate referral to a medical

facili-ty. Specific guidelines have been

estab-lished to assist them in judging when refer-ral to a physician is indicated.

The nurse trainees are assigned to the

Developmental Clinic where they are

trained to perform and evaluate a

develop-mental screening test for children and to

gain competence in assessing a child’s

at-tainments.

They participate in seminars and other

teaching exercises in the Adolescent Clinic

and in Child Psychiatry where various

as-pects of emotional and personality

develop-ment and their deviations from normal are

reviewed. Particular emphasis is placed on

understanding the effect of various social,

economic, and ethnic factors as they apply

to the families with whom they will be

working.

In the Mental Retardation Clinic and the

Pediatric Neurology Clinic they develop

skills in understanding and evaluating

var-ious types of mental retardation and

con-vulsive disorders and in counseling parents

of children with various neurologic and

emotional problems.

During their assignments at the Medical Center, the nurse trainees are taught to use

the otoscope and the stethoscope so that

definite decisions based on objective data

can be made. They evaluate hearing

de-fects, speech difficulties, visual impair-ments, and various congenital and acquired

orthopedic deformities. They also learn the

essentials of good dental care and methods

of evaluating dental problems. From a

nu-tritionist they receive additional

informa-tion regarding dietary needs, food

substitu-tions, and low-cost balanced diets.

The 4-month training period at the

Medi-cal Center is followed by a 20-month

pen-od of continued training in a community

setting where a large number of children

from low-income families reside. Here, the

pediatric nurse practitioners establish field

stations (called “Child Health Stations” or

“Pediatric Nursing Stations”). At the health stations the nurses have office hours daily,

make home visits, and participate in the

follow-up care of those of their patients

who had been referred to other health facil-ities. Well child conferences and immuniza-tion clinics are held at specified periods

when patients are seen by appointment.

Sick children are seen at any time that the

health stations are open.

The project nurses offer their services to selected families with well and ill children

who are referred by physicians, by the

ex-isting public personnel, by other agencies,

and by self-referral. Although the nurses’ major efforts are in the area of child care, total family-centered services are also

pro-vided in selected cases. Communication

(3)

758

so as to afford the patients optimum service

without overlapping or duplication. The

nurse practitioners function within the

scope of the Professional Nurse Practice

Act of the State of Colorado. Their roles are

sharply defined, and a careful review of

their activities by members of the State

Board of Nursing Examiners, various

medi-cal societies, as well as by the insurance carrier who underwrites their malpractice

insurance, has demonstrated that their

functions are entirely ethical and legal and

in the highest tradition of the nursing

profession. The nurses coordinate their

ser-vices with existing community resources,

including physicians who visit the health

stations, the local health department,

spe-cial programs of the state health

depart-ment, the school health program, Project

Head Start centers, and the after-care

pro-grams of various referral centers. The

pm-cipal focus of the pediatric nurse practition-ems is on direct patient care; they function

within established guidelines agreed upon

with local and state health department

staffs.

Sick children who have minor illnesses

(mild upper respiratory infections, mild

gastrointestinal disturbances, minor skin

eruptions, etc.) are cared for by the nurses

using a previously established plan of

man-agement. More severely ill patients are

me-ferred to a physician for immediate medical

care. Children with chronic illnesses or

those needing special diagnostic and

thera-peutic studies are referred to an

appmopmi-ate medical facility to be seen at a later

time. Nurses may refer patients to

coop-erating local physicians, to the regional

health officers or health department clinics,

to established special clinics (e.g., orthope-die, epilepsy, hearing, tuberculosis, etc.), to

specialists in various fields who visit the

health stations or health department clinics

as consultants to the project, and to various

consultation clinics of the Medical Center.

Some of the latter meet periodically near

the health stations themselves.

Throughout the entire program particular

emphasis has been placed on defining the

dimensions and limitations of the expanded role that the pediatric nurse practitioners

fill and in evaluating the feasibility and

practicality of the program of training and

its effectiveness in affecting the quality of

health came in the community. Frequent

communication is maintained with the

Medical Center which continues to provide

supervision, consultation, and support of

the activities of the nurses, as well as

con-tinuing the evaluation of the skills they have acquired.

Initially, nurses selected for the project

were required to have a master’s degree in

public health nursing, but, subsequently,

nurses have been accepted with only a

bac-calaureate degree. Previous experience in

public health nursing has been found to be of particular value.

Presently, trainees are being prepared to

enter pediatrician’s offices where they will

act as nurse practitioners and associates of

the physician.

COMMENT

The pediatric nurse practitioner program

herein described prepares the nurse to

fur-nish comprehensive well child care to chil-dren of all ages, to identify and appraise

acute and chronic conditions and refer

them to other facilities as indicated, and to

evaluate and temporarily manage

emergen-cy situations until medical assistance is

available. Project nurses increase their

knowledge and skills in assessing the

physi-cal and psychosocial development of well

children; study variations of growth

pat-tems; learn to perform developmental tests

and evaluative procedures, such as history

taking, basic physical examinations and a

limited number of laboratory procedures; cou.nsel parents in child-rearing practices;

and carry out immunizations.

The program encourages earlier

iden-tification of children with physical or

emo-tional problems so that the children can be

referred for appropriate treatment. The

nurses serve in medically-deprived

commu-nities where they are in a position to

(4)

su-ARTICLES 759

pervision of the health care available to

children from low income families. As a

result of their training and their proximity

to their patients, the nurse practitioners can

initiate and carry out augmented

preven-live health services, improve the rate of

im-munization, and increase child health

su-pervision.

Throughout the United States the need

for increased health care for children is

great. It has been pointed out that there

a!-ready exists a shortage of scientific

man-power including physicians,1 nurses,2 social

workers, and nutritionists,3 and it has been predicted that there will be an even greater

shortage in the future.’ In order to

maintain the 1960 ratio of physicians

to population in 1970, it would be

neces-sary to have a net growth of more than

50,000 doctors, about 20% of the 1960

sup-ply of 257,000. Since such an increase is

not likely to occur, every effort needs to be

made for the best possible use of those men

and women akeady trained and qualified in

scientific careers.#{176}

The demand for medical and nursing

su-pervision and care is so great that doctors

and nurses need to determine what their

functions and roles should be so as to

intro-duce effective programs to meet these

needs.’’ It is becoming increasingly clear that competent professional nurses working

cooperatively with physicians can make

greater contributions to overall patient

care. Nurses are already performing many

duties which not long ago were considered

strictly the responsibility of doctors, and

there is reason to believe that professional

nurses could and should make still more

de-cisions regarding health care as the rapidly

increasing complexity of patient care

evolves and ways are sought to improve the

utilization of the skills of all available

health personnel.8 Increasingly, nurses are

expected to perform specialized tasks and

use independent judgment in meeting their

responsibilities.9 In order to do this, nurses must receive adequate training to perform the duties required by their broadened role.

Lesser1#{176}has emphasized that the gaps in

child health supervision in the pre-school

years, the inadequacies in the quality and

quantity of medical care received by

chil-dren in many low income families, the need

for more effective methods of case finding,

and the special problems of the

handi-capped child all point to the need for new

approaches in providing adequate health

care. Assistance to medically-deprived

chil-dren must take on a more extensive and

imaginative approach than society general-ly has offered. This will require

experimen-tation in the most effective use of

physi-cians, public health nurses, and others;

pro-grams need to be developed and supported

to test the effectiveness of different meth-ods of identifying children with significant

health problems. Some efforts have been

made in this direction, but more research is

indicated. It is recognized that the pediatric

nurse practitioner program herein

de-scnibed tends to aggravate an already

cx-isting nursing shortage, but it is expected that further realignment of the functions and role relationships of other groups in the

health professions will permit a more

effec-tive utilization of personnel at all levels.

It is necessary for medical and nursing leadership to come together to integrate

their work in order to solve the problems of

current and future needs for adequate

health services and to elucidate the new

roles they each have to fill. Physicians and

nurses can and should work together to

de-termine which of them can best assume

me-sponsibility for a particular aspect of a

pa-tient’s therapeutic regime at any point in

time. There is nothing in the code of ethics

of either the medical or nursing profession

which would preclude realignment of

func-tions carried out by physicians and nurses.11

Ways must be found to deliver improved

health services to children and their fami-lies. Special education of the physician and nurse is the powerful force upon which mcli-ance must be placed,12 and the

responsibil-ity for education lies within the province of

medical and nursing schools, which should

collaborate in developing programs of

(5)

as-760

pects of these programs will, of necessity,

be experimental and novel, but the need is

so great that traditional, hierarchical

orga-nizational structures need to be set aside so as to provide personnel capable of

achiev-ing the highest quality of health care.

SUMMARY

The pediatric nurse practitioner program

herein described is a new educational and

training program in pediatrics for

profes-sional nurses which has been developed to

provide increased health care for children

in both rural and urban areas. The program

prepares nurses to furnish comprehensive

well child care to well children, to identify

and appraise acute and chronic conditions,

and to evaluate and temporarily manage

emergency situations until medical

assis-tance is available.

The details of the educational and

train-ing program and its implications in

improv-ing the utilization of scientific manpower are described.

REFERENCES

1. Rockefeller Brothers Fund Prospect for

Amer-ica: The Rockefeller Panel Reports. New

York: Doubleday, 1961.

2. Annual Meeting of the American Public

Health Association, October 1964, New York, New York.

3. United States Labor Department: Manpower Report of the President and Report on Manpower Requirements, Resources,

Utili-zation and Training by Department of

La-bor transmitted by Congress, 1963

(Publi-cation #0-676922). Washington, D.C.:

U.S. Government Printing Office, 1963.

4. Physicians for a Growing America. Report of the Surgeon General’s Consultant Group on

Medical Education, U.S. Public Health Ser-vice Publication Number 709. Washington,

D.C. : U.S. Government Printing Office, 1959.

5. Toward Quality in Nursing. Report of the

Surgeon General’s Consultant Group on Nursing. U.S. Public Health Service Publi-cation Number 992. Washington, D.C.: U.S. Government Printing Office, 1964.

6. President of the United States: National Ac-tion to Combat Mental Retardation (state-ment by the President regarding the need). President’s Panel on Mental Retardation. Washington, D.C. : U.S. Government Print-ing Office, 1962.

7. Perspectives for Nursing, A Report Prepared by the Committee on Perspectives of the National League for Nursing. New York, New York, 1965.

8. Pratt, H. : The doctor’s view of the changing nurse-physician relationship. J. Med. Educ., 40:767, 1965.

9. Toward Quality in Nursing Needs and Goals. Report of the Surgeon General’s Consulta-tion Group on Nursing, U.S. Department of Health, Education and Welfare. Wash-ington, D.C. : U.S. Government Printing Office, 1963.

10. Health of Children of School Age, U.S.

De-partment of Health, Education and Welfare,

Children’s Bureau Publication Number 427. Washington, D.C. : U.S. Government Print-ing Office, 1964.

11. Pellegrino, E. D. : The ethical implications of

changing patterns of medical care. North

Carolina Med. J., 26:73, 1965.

12. Schlotfeldt, R. M. : The nurse’s view of the changing nurse-physician relationship. J.

(6)

1967;39;756

Pediatrics

Henry K. Silver, Loretta C. Ford and Susan G. Steady

PEDIATRIC NURSE PRACTITIONER PROGRAM

A PROGRAM TO INCREASE HEALTH CARE FOR CHILDREN: THE

Services

Updated Information &

http://pediatrics.aappublications.org/content/39/5/756

including high resolution figures, can be found at:

Permissions & Licensing

http://www.aappublications.org/site/misc/Permissions.xhtml

entirety can be found online at:

Information about reproducing this article in parts (figures, tables) or in its

Reprints

(7)

1967;39;756

Pediatrics

Henry K. Silver, Loretta C. Ford and Susan G. Steady

PEDIATRIC NURSE PRACTITIONER PROGRAM

A PROGRAM TO INCREASE HEALTH CARE FOR CHILDREN: THE

http://pediatrics.aappublications.org/content/39/5/756

the World Wide Web at:

The online version of this article, along with updated information and services, is located on

American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

References

Related documents

The Integrated Catchment Model INCA has been applied to the whole Thames System to assess a range of scenarios and mitigation measures (Crossman et al., 2013) and the likely

Table B.1.: The set of stimuli word pairs (translated into English) used in the perception experiment — 50 concepts from 10 concept classes and the corresponding (valid or

This result is partially a consequence of lower confidence when rating the friend and canonical individual as well as smaller mean absolute distances between those two individuals

©2015 DAVIS BROWN KOEHN SHORS & ROBERTS P.C. Exercising Statutory Right • Right to file workers’ compensation claim • Right to pursue

Top-Co’s inner string cementing float equipment allows large diameter casing strings to be cemented through the drill pipe or tubing by stabbing/latching and sealing into the

The changing environment for legal services and the risks and challenges this brings A framework for understanding the purpose and process of making strategy And