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Background Precision health considers individual lifestyle, genetics, behaviors, and environment context and facilitates interventions aimed at helping individuals achieve well-being and optimal health. Purpose To present the Nursing Science Precision Health (NSPH) Model and describe the integration of precision health concepts within the domains of symptom and self-management science as reflected in the National Institute of Nursing Research P30 Centers of Excellence and P20 Exploratory Centers. Methods Center members developed the NSPH Model and the manuscript based on presentations and discussions at the annual NINR Center Directors Meeting and in follow-up telephone meetings. Discussion The NSPH Model comprises four precision components (measurement; characterization of phenotype including lifestyle and environment; characterization of genotype and other biomarkers; and intervention target discovery, design, and delivery) that are underpinned by an information and data science infrastructure. Conclusion Nurse scientist leadership is necessary to realize the vision of precision health as reflected in the NSPH Model.

Precision health considers individual lifestyle, genetics, behaviors, and environment context and facilitates interventions aimed at helping individuals achieve well-being and optimal health. The purposes of this manuscript are to present the Nursing Science Precision Health (NSPH) Model and describe the integration of precision health concepts within the domains of symptom and self-management science as reflected in the National Institute of Nursing Research P30 Centers of Excellence and P20 Exploratory Centers. Center members developed the NSPH Model and the manuscript based on presentations and discussions at the annual NINR Center Directors Meeting and in follow-up telephone meetings. The NSPH Model comprises four precision components (measurement; characterization of phenotype including lifestyle and environment; characterization of genotype and other biomarkers; and intervention target discovery, design, and delivery) that are underpinned by an information and data science infrastructure. Nurse scientist leadership is necessary to realize the vision of precision health.

Although genetic knowledge related to sudden arrhythmia death syndromes (SADS) has enhanced risk prediction and treatment, it is challenging to assess genetic literacy of individual patients and families. To address this, participants attending the 2015 SADS conference were asked to complete a survey measuring general knowledge of genes and heredity. Correct responses averaged 85 ± 9% with correct responses of ≥ 80% for 17 of 21 questions. However, attitudes toward genetic testing varied markedly. These results suggest that understanding motivations or disincentives to pursue genetic testing is as important as enhancing genetic knowledge for providing effective treatments for SADS.

The Pediatric Anesthesia and Neuro-Development Assessment (PANDA) study team held its biennial symposium in April 2018 to discuss issues on anesthetic neurotoxicity in the developing brain. One of the sessions invited speakers with different areas of expertise to discuss “Outcomes Research in Vulnerable Pediatric Populations.” The vulnerable populations included neonates, children with congenital heart disease, children from low socioeconomic status, and children with incarcerated parents. Each speaker presented some of the ongoing research efforts in these groups as well as the challenges encountered in studying them.

A prison nursery is dedicated housing inside a criminal justice facility where incarcerated pregnant women continue to co-reside with and be the primary caregiver for their infants for a defined period of time following birth. Available globally, prison nurseries have been variously appraised as inadequate substitutes for social welfare in impoverished countries or as protections for child development and attachment where supportive resources are provided. Existence of nurseries in the USA has been relatively rare and erratic, with between one and thirteen state corrections departments supporting prison nurseries at any point in history. The exception is the New York State facility which is over a century old. Outcome studies for prison nurseries have primarily been descriptive based on observations, surveys, official records, and interviews. Evidence for reduction in criminal recidivism enhanced family support, and re-entry success remains contradictory or under-reported. The humanizing effects of infant presence on prisoners and staff and maternal grief and worry regarding children are consistent themes. Child development outcomes have been measured in the UK, Spain, and the USA, the latter with the most promising results associated with supportive programs. Community alternatives to maternal incarceration are receiving increasing attention to avoid separation of one or more children from parents.

Cardiovascular disease is the leading cause of mortality in the United States, accounting for one fourth of deaths. Higher rates of obesity put Hispanic and Black men at increased risk. The American Heart Association cites diet quality, physical activity, and body weight as alterations responsive to health promotion intervention. Prevention strategies need to begin in adolescence and the emerging adulthood years to impact cumulative risk factors. A scoping review identified search terms and this was followed by a systematic review of Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed databases for articles published in English from January 1, 2002, through May 11, 2017. This review explores community-based content, delivery, recruitment, or retention strategies used with young men of color aged 15 to 24 years. Of 17 articles describing 16 individual interventions and 1 describing multiple interventions (with samples ranging from 37 to 4,800), 13 reported significant results in one or more domains. No studies specifically targeted the needs of young men and only three had more than 50% male participants. There was a gap in studies that addressed young men in the ages of interest with most interventions reaching participants aged 11 to 19 years. Cultural tailoring was addressed through recruitment setting, interventionist characteristics, community involvement, and theoretical frameworks such as motivational interviewing that allow individual goal setting. Because young men seek access to preventive health services less than young women, it is suggested that interventions that are community based or use push technology (send information directly to the user) be increased.

Doctor of Nursing Practice (DNP) programs have focused on competencies needed to deliver comprehensive patient care across settings and time. Endorsed by professional nursing associations, these competencies are typically evaluated through detailed case narratives written by DNP candidates. Beyond competency metrics, the essence of comprehensive care for advanced nursing practice has not been carefully explicated. In this study, a phenomenological analysis is applied to a purposive sample of 12 DNP case narratives to identify the meaning of comprehensive care as transmitted in practice. Clinical assessment precision, diagnostic acumen, and advocacy emerge consistently but only the more audacious nurse practitioners directly challenge health system fragmentation.

This study examined long-term outcomes of children who spent their first 1 to 18 months in a U.S. prison nursery. Behavioral development in 47 preschool children who lived in a prison nursery was compared with 64 children from a large national dataset who were separated from their mothers because of incarceration. Separation was associated with significantly worse anxious/depressed scores, even after controlling for risks in the caregiving environment. Findings suggest that prison nursery co-residence with developmental support confers some resilience in children who experience early maternal incarceration. Co-residence programs should be promoted as a best practice for incarcerated childbearing women.

Objective:The objective of this conceptual paper was to present important constructs in attachment theory as they apply to parent and caregiver behavior in pediatric palliative care. Clarification of these constructs is provided with specific reference to their clinical application as well as their reflection in current empirical literature. Social attachment theory is proposed as a developmentally contextual model for the study of parenting in pediatric palliative and end-of-life care.Method:A comprehensive search was conducted of pertinent literatures. These included classic as well as recent theory and research in attachment theory in addition to the empirical literatures on parent and family experience in pediatric palliative care, serious illness, and beyond to parental bereavement. Other relevant literature was examined with respect to the phenomena of concern.Results:The empirical literature in pediatric palliative care supports the use of central concepts in attachment theory as foundational for further inquiry. This is evidenced in the emphasis on the importance of parental protection of the child, as well as executive activities such as decision making and other prominent parental operations, parental psychological resolution of the child's diagnosis and illness as well as coping and meaning making, and the core significance of parental relationships with providers who provide secure-base and safe-haven functions.Significance of Results:The promise for developing integrated, conceptually based interventions from construction through implementation is of urgent importance to children and families receiving pediatric palliative care services. Focusing on key parental behaviors and processes within the context of a well-studied and contextually appropriate model will inform this task efficiently. The attachment paradigm meets these criteria and has promise in allowing us to move forward in developing well-defined, inclusive, and conceptually grounded protocols for child and family psychosocial research, practice, and education in this specialty

The authors propose an interim parallel strategy for the thoughtful inclusion of trained traditional birth attendants (TTBAs) in the maternal and child health (MCH) human resources of low-resource nations to improve safe childbirth. This is in contrast with international policy recommendations that traditional birth attendants (TBAs) be eliminated and replaced by skilled birth attendants (SBAs). Dimensions for critical awareness that should inform global MCH enterprises are identified and elaborated in support of this proposal: omnipresent women’s status, international nursing and midwifery standards, ethnographic values and strategies, local government roles, culturally specific birthing expectations, and the realities of current MCH human resources infrastructures.

The interactions between public health and criminal justice (CJ) involvement are receiving increased attention. Although incarceration rates in the United States appear to be stabilizing after decades of rapid increase, they remain the highest in the world (Tsai & Scommegna, 2012). An estimated one in every 107 adults was incarcerated in 2011 (Glaze & Park, 2012). Estimates increase to one in 31 with the addition of persons under community supervision (Pew Center On The States, 2009). Public policy decisions and uneven law enforcement have led to endemic levels of CJ involvement in many low-income African American communities (Clear, 2007). The incarcerated population shows disparities in chronic medical conditions (Binswanger, Krueger, & Steiner, 2009), infectious diseases (Harzke et al., 2010), substance dependence and mental health disorders (James & Glaze, 2005). Incarcerated women, when compared to incarcerated men and community-residing women, have a significantly higher prevalence of medical, mental health, and substance dependence disorders (Binswanger et al., 2010). On the last day of 2010, approximately 113, 000 women resided in state and federal prisons, a 646% increase from 1980 (Guerino, Harrison, & Sabol, 2011). The rise in incarceration rates over the past three decades has created a multigenerational public health problem. Approximately 60% of incarcerated women report having an average of 2 children (Glaze & Maruschak, 2008). An estimated 6–10% of women are pregnant upon incarceration (Clarke, Phipps, Tong, Rose, & Gold, 2010). While women represent a smaller proportion of the incarcerated population than men, women are more likely to have been their child’s primary caregiver before their last arrest (Glaze & Maruschak, 2008). Incarcerated mothers also overwhelmingly report that they intend to care for their children after release (Stringer & Barnes, 2012). Children of incarcerated women are at higher risk of behavioral health problems than their peers (Lee, Fang, & Luo, 2013). This population is also more likely to have later personal CJ contact (Huebner & Gustafson, 2007). Affected children also experience parental separation, and often parental illicit substance use, mental illness, and domestic violence, all of which are adverse childhood experiences associated with morbidity and premature mortality (Brown et al., 2009). Prison Nurseries A variety of parenting programs within prisons attempt to address these multigenerational effects. Parenting classes of varying designs are now offered in prison settings (Hoffmann, Byrd, & Kightlinger, 2010). For incarcerated women with infants, eight U.S. states currently have a prison nursery, a special unit on which eligible incarcerated women with infants live together (Goshin & Byrne, 2009). This is in contrast to the more prevalent policy of removing infants from the mothers within 48 hours of birth. General eligibility criteria are that a woman be pregnant on incarceration and have no history of crimes against children (Women’s Prison Association, 2009). Women convicted of violent offenses are automatically excluded in most states. Lengths of stay range from 1– 36 months, with most programs allowing 12–18 months. Current U.S. programs are described as enriched, developmentally appropriate environments staffed by corrections officers and civilian professionals, including nurses (Fearn & Parker, 2004). Group prenatal and parenting courses are required in most facilities (Goshin & Byrne, 2009). These may be delivered by fellow incarcerated mothers (peer facilitators), professional staff, or through collaborations with community-based organizations. Other resources include: lactation support; civilian experts in child development; a day care center allowing mothers to attend counseling, drug treatment, educational and vocational programs; and advocates who facilitate contact with family members who do not reside in the nursery. Longitudinal research in the oldest U.S. prison nursery showed positive child outcomes during the nursery and after release. Development during infancy and toddlerhood was within normal limits across domains (Byrne, 2010). Attachment was more likely to be secure than what would be expected by the high proportion of insecurity and unresolved trauma in the mothers’ backgrounds (Byrne, Goshin, & Joestl, 2010). During the preschool period, children who had lived with their mothers in the prison nursery had lower anxious-depressed behavior problem scores than a comparison group of children who were separated from their mothers in infancy or toddlerhood because of incarceration (Author, in Press). Criminal recidivism, or the return to a correctional institution after release, threatens these positive outcomes. Recidivism and drug relapse were the most common causes of separation in dyads released from this prison nursery (Byrne, Goshin, & Blanchard-Lewis, 2012). Criminal Recidivism as a Public Health Nursing Outcome Given the connection between health and CJ contact, recidivism is an important public health outcome. An estimated 95% of all prisoners are released (Hughes & Wilson, 2003). Institutional factors within correctional settings create increased risk for injury, infectious disease, and other health threats, potentially leaving people sicker upon exit than entry (Ludwig, Cohen, Parsons, & Venters, 2012). Health conditions untreated during incarceration further complicate the reentry period. After release, those experiencing health problems may continue to cycle in and out of correctional institutions at great cost to their own wellbeing, and the wellness of their families and communities (Baillargeon, Binswanger, Penn, Williams, & Murray, 2009). Most women released from the general prison population will have subsequent CJ contact. Almost 60% will be rearrested, 38% will be reconvicted, and 30–45% will return to prison within three years (Cloyes, Wong, Latimer, & Abarca, 2010b; Deschenes, Owen, & Crow, 2006). More extensive history of prior arrests, incarceration for property or drug crimes, African American race, younger age, substance dependence, and mental illness are associated with recidivism (Cloyes, Wong, Latimer, & Abarca, 2010a; Deschenes, et al., 2006). Reporting dependent children has not been associated with decreased recidivism in women released from the general prison population (Huebner et al., 2010). In incarcerated mothers with a history of substance dependence, self reported expectation to live with children after release has also not been found to significantly affect recidivism after controlling for important confounders (Robbins, Martin, & Surratt, 2009). Recidivism rates appear lower for women released from prison nurseries (Carlson, 2009; Rowland & Watts, 2007). Research on recidivism in this population has thus far been limited by small sample sizes, short follow-up time frames, and unsystematic data sources, or a lack of specification for all three. Recidivism has also been analyzed dichotomously without regard to timing. Prevention and delay of recidivism are both important goals. Predictors of time to recidivism in this population have also not been explored. Finally, the effect on recidivism of prison nursery specific policy issues, such as length of stay and whether a woman’s child is released before her, has received no attention. Research Questions and Hypotheses The aim of this exploratory study was to analyze three-year recidivism in women who co-resided with their infants in X prison nursery. We hypothesized that time to recidivism would be directly associated with younger age at release, history of substance dependence, clinically significant depressive symptomatology during the nursery stay, release of the child without his or her mother, and being in the prison nursery for violation of parole conditions after a previous prison release.

The Pediatric Anesthesia NeuroDevelopment Assessment research group at Columbia University Medical Center Department of Anesthesiology has conducted biannual national Symposia since 2008 to evaluate study data and invigorate continued thinking about unresolved issues of pediatric anesthesia neurotoxicities. The third Symposium extended the dialogue between pediatric anesthesiologists and surgeons in panel presentations and discussions by four surgical specialists. This paper reports the prevailing opinions expressed by a pediatric general surgeon, urologist, plastic surgeon and ophthalmologist and explores factors related to delayed operative intervention, need for multiple procedures, and parental concerns.

Prison nurseries prevent maternal separations related to incarceration for the small subset of children whose pregnant mothers are incarcerated in states with such programs. For a cohort of 100 children accepted by corrections into one prison nursery, subsequent separation patterns are analyzed. The largest numbers are caused by corrections' removal of infants from the nursery and infants reaching a one-year age limit. Criminal recidivism and substance abuse relapse threaten continued mothering during reentry. Focused and coordinated services are needed during prison stay and reentry years to sustain mothering for women and children accepted into prison nursery programs.

Correctional facilities are prime targets for nursing interventions to decrease health disparities, but challenges to post-release follow-up limit use of the longitudinal research designs needed to fully examine intervention effects. Using an adapted version of the Behavioral Model for Vulnerable Populations, we determined predictors of 1-year post-release study retention and subsequent reenrollment an average of 3 years later in 88 mother and child dyads recruited from a state prison nursery. Predisposing characteristics and enabling factors emerged as strong predictors of loss to follow-up. Female research participants can be successfully retained years after release from a correctional facility. Understanding the barriers and facilitators to post-release follow-up supports the creation of theoretically informed strategies to retain formerly incarcerated populations.

Objective:Using data from a multi-site study of parent–child symptom reporting concordance, this secondary analysis explored the role of parent self-efficacy related to pain management for seriously ill school-age children and adolescents.Method:In the initial study, 50 children and adolescents who were expected to survive 3 years or less were recruited along with their parent/primary caregiver. Parent self-report data were used in this secondary analysis to describe parent self-efficacy for managing their child's pain, caregiver strain, mood states, and perception of the child's pain; to explore relationships among these variables; and to determine predictors of greater self-efficacy.Results:Parents expressed a wide range of self-efficacy levels (Chronic Pain Self-Efficacy Scale; possible range 10–100, mean 76.2, SD 14.7) and higher levels on average than reported previously by family caregivers of adult patients. Caregiver Strain Index scores were markedly high (possible range 0–13, mean 8.1, SD 3.8) and inversely correlated with self-efficacy (r = −0.44, p = 0.001). On the Profile of Mood States parents reported more negative moods (t = 4.0, p t = −5.0, p R2 = 0.51).Significance of results:Findings advance knowledge of parent self-efficacy in managing the pain of a child with life-threatening illness. Results can be used to design supportive interventions enhancing parents’ caregiving roles during their child's last stages of life.

We report attachment classifications in a sample of pregnant women incarcerated in a state prison with a nursery program. Analyses were based on 69 women serving sentences for felony crimes who were followed from the birth of their child to completion of the prison nursery co-residence. They completed the Adult Attachment Interview shortly after entering the program and scales measuring depression, perceived parenting competency, and social support at study entry (Time 1) and program completion (Time 2). Incarcerated mothers had higher rates of insecure attachment than previous low-risk community samples. Compared with dismissing and secure mothers, preoccupied mothers reported higher levels of depressive symptoms, lower parenting competency, and lower satisfaction with social support at the conclusion of the nursery program. Higher scores on unresolved loss and derogation were associated with a history of substance abuse; higher scores on unresolved trauma were associated with depressive symptoms at program completion.

Within a larger intervention study, attachment was assessed with the Strange Situation Procedure for 30 infants who co-resided with their mothers in a prison nursery. Sixty percent of infants were classified secure, 75% who co-resided a year or more and 43% who co-resided less than a year, all within the range of normative community samples. The year-long co-residing group had significantly more secure and fewer disorganized infants than predicted by their mothers’ attachment status, measured by the Adult Attachment Interview, and a significantly greater proportion of secure infants than meta-analyzed community samples of mothers with low income, depression, or drug/alcohol abuse. Using intergenerational data collected with rigorous methods, this study provides the first evidence that mothers in a prison nursery setting can raise infants who are securely attached to them at rates comparable to healthy community children, even when the mother’s own internal attachment representation has been categorized as insecure.

The purpose of this study was to examine the prevalence and characteristics of children experiencing a continuum of inadequate sleep and its associations with child, family, and environmental variables.A secondary analysis of weighted responses of 68,418 parents or caregivers of children aged 6 to 17 years participating in the 2003 National Survey of Children's Health was conducted. Inadequate sleep was categorized as mild, moderate, or severe.Approximately one third of parents reported their child's sleep inadequacy as mild (18.6%), moderate (6.8%), or severe (5.8%). Age (P.001), fair/poor health status (P.001), frequent depressive symptoms (P.001), and high parental stress (P.001) demonstrated a progressive relationship from adequate to severe inadequate sleep. Controlling for child, family, and environment variables, parents of children with inadequate sleep were more likely to report frequent child depressive symptoms, high parental stress, and violent family conflict style.Sleep inadequacy affects 15 million American children, 6 million at a moderate or severe level. Identification of inadequate sleep should prompt further assessment of its associated factors-depressive symptoms, parental stress, and family conflict-for targeted clinical intervention.

Recent animal studies have shown that commonly used anesthetic agents may have serious neurotoxic effects on the developing brain. The purpose of this study was to assess the association between surgery for hernia repair and the risk of behavioral and developmental disorders in young children. We performed a retrospective cohort analysis of children who were enrollees of the New York State Medicaid program. Our analysis involved following a birth cohort of 383 children who underwent inguinal hernia repair during the first 3 years of life, and a sample of 5050 children frequency-matched on age with no history of hernia-repair before age 3. After controlling for age, sex, and complicating birth-related conditions such as low birth weight, children who underwent hernia repair under 3 years of age were more than twice as likely as children in the comparison group to be subsequently diagnosed with a developmental or behavioral disorder (adjusted hazard ratio 2.3, 95% confidence interval 1.3, 4.1). Our findings add to recent evidence of the potential association of surgery and its concurrent exposure to anesthetic agents with neurotoxicity and underscore the need for more rigorous clinical research on the long-term effects of surgery and anesthesia in children.

TOPIC: Self-injurious behaviors (SIBs) are a common coping mechanism in the adolescent population. A marked increase in SIB has been seen in recent years, yet effective treatment remains elusive. PURPOSE: This study aims to review current theoretical perspectives and treatment options that reflect a biopsychosocial framework. SOURCES: Selected multidisciplinary literature related to SIB. CONCLUSIONS: A 6-month multidisciplinary approach targeting the unique physical, emotional, and social needs of a 14-year-old girl in residential treatment led to the complete cessation of SIB.

Objective. The aim of this study was to describe and analyze the correlations between mentoring functions and political skill development among nurses who have earned or are candidates for a Ph.D. or doctorate of nursing practice (DNP) degree. Background. The healthcare system is in flux; future generations of Ph.D. and DNP nurse leaders will be required to demonstrate political acumen. Political skill to navigate organizational politics has had limited research within nursing. Methods. A cross-sectional research design using a web-based survey of 222 nurses who have earned or are candidates for a Ph.D. or DNP. This study utilized two validated tools to measure mentoring functions and political skill. Results. The response rate was 52% (n=115) of which 86 were Ph.D. and 29 were DNPs. An informal mentoring relationship was described by 62% of the respondents and formal mentoring by 35% of the protégés; only 25% (n=74) established a mentoring contract. Mentoring score showed significance for total political skill and moderate effect on the networking ability. The mentoring functions of advocacy, career development facilitation, learning facilitation, and friendship were found to correlate significantly with total political skill scores. Conclusions. This study established a benefit for nurses who have earned or are candidates for a Ph.D. or DNP from mentoring to support political skill development.

Background: In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs). Methods: This study was guided by the basic strategic human resources management (SHRM) component model. A convergent mixed-method design was utilized to assess qualitative and quantitative data from the Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers project. Survey data was obtained from 837 mid-level providers, 83 of whom participated in a critical incident interview whose aim was to elicit negative events in the practice environment that induced intention to leave their job. HRH management practices were assessed quantitatively in 48 districts with 37 members of CHMTs participating in semi-structured interviews. Results: The eight human resources management practices enumerated in the basic SHRM component model were implemented unevenly. On the one hand, members of CHMTs and mid-level providers agreed that there were severe shortages of health workers, deficient salaries, and an overwhelming workload. On the other hand, members of CHMTs and mid-level providers differed in their perspectives on rewards and allocation of opportunities for in-service training. Although written standards of performance and supervision requirements were available in most districts, they did not reflect actual duties. Members of CHMTs reported high levels of autonomy in key HRH management practices, but mid-level providers disputed the degree to which the real situation on the ground was factored into job-related decision-making by CHMTs. Conclusions: The incongruence in perspectives offered by members of CHMTs and mid-level providers points to deficient HRH management practices, which contribute to poor practice environments in acute obstetric settings in Tanzania. Our findings indicate that members of CHMTs require additional support to adequately fulfill their HRH management role. Further research conducted in low-income countries is necessary to determine the appropriate package of interventions required to strengthen the capacity of members of CHMTs.

OBJECTIVE. Our goal was to identify characteristics associated with inadequate sleep for a national random sample of elementary school–aged children (6–11 years) and adolescents (12–17 years). METHODS. Data from 68418 participants in the 2003 National Survey of Children's Health were analyzed by using weighted bivariate and multivariate regression models. The dependent variable was report of not getting enough sleep for a child of his or her age ≥1 night of the past week. Independent variables included demographic characteristics, child health, school and other activities, and family life. RESULTS. Parents of elementary school–aged children with inadequate sleep were more likely to report that their child was having problems at school or had a father with fair or poor health. Parents of adolescents with inadequate sleep were more likely to report that their child had an atopic condition, frequent or severe headaches, a parent with less-than-excellent emotional health, or experienced frequent parental anger. Inadequate sleep in both age groups was associated with parental report that their child usually or always displayed depressive symptomatology, family disagreements involved heated arguing, or parental concern that the child was not always safe at home, at school, or in their neighborhood. CONCLUSIONS. Approximately 15 million American children are affected by inadequate sleep. Primary care providers should routinely identify and address inadequate sleep and its associated health, school, and family factors.

Background Attention is turning to nurses, who form the greatest proportion of health personnel worldwide, to play a greater role in delivering health services amidst a severe human resources for health crisis and overwhelming disease burden in low-income countries. Nurse leaders in low-income countries must consider essential context for nurses to fulfill their professional obligation to deliver safe and reliable health services. Professional practice models (PPMs) have been proposed as a framework for strategically positioning nurses to impact health outcomes. PPMs comprise 5 elements: professional values, patient care delivery systems, professional relationships, management approach and remuneration. In this paper, we synthesize the existing literature on PPMs for nurses in low-income countries. Methods An integrative review of CINAHL-EBSCO, PubMed and Scopus databases for English language journal articles published after 1990. Search terms included nurses, professionalism, professional practice models, low-income countries, developing countries and relevant Medical Subject Heading Terms (MeSH). Results Sixty nine articles published between 1993 and 2014 were included in the review. Twenty seven articles examined patient care delivery models, 17 professional relationships, 12 professional values, 11 remuneration and 1 management approach. One article looked at comprehensive PPMs. Conclusions Adopting comprehensive PPMs or their components can be a strategy to exploit the capacity of nurses and provide a framework for determining the full expression of the nursing role.

Objective: To identify characteristics associated with delayed/forgone care for children with special health care needs (CSHCN) in New York State (NYS) as reported by their parents. Methods: Data come from NYS participants in the 2000–2002 National Survey of Children with Special Health Care Needs. Data were analyzed using weighted bivariate and multivariate regression models. The dependent variable was report of delayed/forgone routine health care. Independent variables included illness characteristics, potential and actual access to care, and provider care characteristics. Results: In NYS, 8.4% reported delayed/forgone health care for their child. Parents of children with delayed/forgone care were more likely to report that their child was uninsured (adjusted odds ratio [aOR] 3.8, 95% confidence interval [CI] 1.3–11.8), had experienced interrupted health insurance (aOR 3.9, 95% CI 1.5–9.7), or their child’s insurance was not adequate for CSHCN (aOR 3.6, 95% CI 1.4–9.1). Further, these parents were more likely to report that providers never spend adequate time (aOR 6.3, 95% CI 1.2–34.4), provide sufficient information (aOR 8.0, 95% CI 2.5–25.0), act as partners in care (aOR 6.7, 95% CI 2.3–19.7), or display cultural sensitivity (aOR 5.4, 95% CI 1.2–24.3). Conclusions: An estimated 40,771 NYS CSHCN experience delayed/forgone routine health care. Their families report two noteworthy barriers: inadequate or discontinuous insurance coverage and poor communication with health-care providers. Access to care for CSHCN can be improved by increasing consistent comprehensive insurance coverage and increasing sensitivity in relationships between health care providers and families of CSHCN.

Funding mechanisms that require a mentor provide a unique opportunity to implement the research mentoring that is recognized as increasingly important in nursing. Little has been written about how to create and sustain the roles of mentor and principal investigator within a funded arrangement. This article analyzes one research mentoring relationship focused on maternal-infant interaction research and implemented through the Federal KO1 (Mentored Research Scientist Development Award) grant mechanism. Methods used are personal reflections on the 4-year mentorship experience and literature review using the National Library of Medicine database from 1990 to 2001. The mentoring relationship within the National Institutes of Health KO1 award is characterized by the personal commitment, common interests, and long-term professional development that are essential qualities of traditional mentoring but differs in that it is structured by the aims, activities, and length of each award. Effective participation requires organization, focus, and self-direction on the part of the mentored principal investigator and expertise, altruism, and generativity on the part of the mentor. A grant-based mentoring relationship can provide mutual benefits to the researcher and mentor but both must attend to sustaining and enriching the relationship.

Background: The numerous parent-child interaction measures available include few that are appropriate to brief clinical encounters or to research settings where time, cost, space, and subject burden are critical factors. Objectives: This study compares the newer Mother-Infant Communication Screening (MICS) with the established Nursing Child Assessment Satellite Training (NCAST) Teaching Scale (NCAT). Methods: Theoretical foundations, development, administration, support, and published psychometrics for the two scales are contrasted. Videotapes of 171 caregiver-child interactions in an urban, Hispanic, high-risk sample (children aged 5 months to 36 months) were scored by two trained coders who had established inter-rater reliabilities of .90 (NCAT) and .85 (MICS). Results: Validity correlation coefficients were r = .504, p < .001 for total scores and r =.492, p

Purpose: To explore how mentoring can be used to build research competence in nursing in various professional and geographic settings. Organizing construct: The traditional concept of mentoring in interdisciplinary health professions and its application to nursing research. Methods: Literature review of MEDLINE and CINAHL databases 1990–2001 and personal reflections on mentoring and mentored experiences. Findings: Mentoring relationship models identified include: traditional mentor and protege, team, peer, inclusive, and mentoring forward. E-mentoring strategies facilitate interactions for long-distance relationships. Discrete projects, multiple mentor sources, and mutually beneficial peer relationships can enable mentoring across one's career. Psychosocial dimensions of mentoring support creative work. When scholarly productivity with funded research is the desired outcome, intense involvement of a protege with an expert researcher is essential. Conclusion: Choices among mentoring models can be made in accordance with resources, priorities, and objectives congruent with a given nursing setting and time, but optimum scholarly productivity requires experts and sustained support.

Transportable instruments for use in home and field settings have been used for decades on the basis of assumed reliability. This article describes a study that compares two portable devices for measuring length, the tape measure and the Measure Mat, against a clinical standard stadiometer with two convenience samples of Hispanic and African-American infants in an urban general pediatrics practice setting. Mean net difference between the stadiometer and the tape measure was 1.68 inches in the first sample and 0.92 inches in the second; the difference between the stadiometer and the Measure Mat was 0.92 inches. The least variability and random error (SD = 0.57 inch) was shown in the paired measurements using the stadiometer and the Measure Mat. Bland-Altman plots showed positive bias for both portable devices across the range of measurements.

The Pediatric Anesthesia NeuroDevelopment Assessment team at Columbia University Medical Center Department of Anesthesiology convened its fourth biennial Symposium to address unresolved issues concerning potential neurotoxic effects of anesthetic agents and sedatives on young children and to assess study findings to date. Dialogue initiated at the third Symposium was continued between anesthesiologists, researchers, and a panel of expert pediatric surgeons representing general surgery and dermatology, orthopedic, and urology specialties. The panel explored the need to balance benefits of early surgery using improved technologies against potential anesthetic risks, practice changes while awaiting definitive answers, and importance of continued interprofessional dialogue.

Background Nurses in Vietnam, as is typical of many low-income countries, are hampered from impacting health outcomes by low occupational status, overcrowded hospitals and few career development opportunities. In order to understand the current practice environment encountered by nurses in Vietnam in the most realistic way, we listened to the voices of nurses currently performing nursing roles in Vietnam. Purpose The purpose of this study was to explore the emic (insider) perspectives on cultural meaning applied by nurses at a northern Vietnamese women�s hospital to influence professional practice and interpret experience. Design A micro-ethnography approach was used. Methods Seven nurses and one vice-Dean of a school of nursing were interviewed. Data collection consisted of open-ended interviews, participant observation and journal recordings. Spradley�s (1979, 1980) Development Research Sequence was used to guide data collection and analysis. Results/Findings Five themes emerged. These were the big number of patients is a burden for nurses; nurses do not, cannot make their own decisions (but they can and do); my feeling depends on doctor's feeling; nurses learn more from doctor; and just a few nurses can attend the [Vietnamese Nurses Association] meeting. Conclusion The experiences described by the nurses and the vice-Dean of a nursing school reflect the challenges of practicing nursing in one Vietnamese hospital and the resourcefulness of nurses in overcoming those challenges. Recurrent themes highlight the need to better position nurses in Vietnam to advance towards full expression of the professional nursing role.

The New Parent Warmline of the Parent Education Program at Saint Vincents Hospital and Medical Center in New York City evaluated 5 years of service. Retrospective analysis of logs sampled from 3 time periods confirmed that the Warmline is reaching its heterogeneous target population and making initial contact within the newborn's first weeks of life. The average call lasts 7.9 min, answers 3.4 questions, and delivers 1.6 services, including education, counseling, advocacy, and referral. Through referral, the Warmline is an early gateway to other services needed by those new parents who have additional stressors.

Importance Exposure of young animals to commonly used anesthetics causes neurotoxicity including impaired neurocognitive function and abnormal behavior. The potential neurocognitive and behavioral effects of anesthesia exposure in young children are thus important to understand. Objective To examine if a single anesthesia exposure in otherwise healthy young children was associated with impaired neurocognitive development and abnormal behavior in later childhood. Design, Setting, and Participants Sibling-matched cohort study conducted between May 2009 and April 2015 at 4 university-based US pediatric tertiary care hospitals. The study cohort included sibling pairs within 36 months in age and currently 8 to 15 years old. The exposed siblings were healthy at surgery/anesthesia. Neurocognitive and behavior outcomes were prospectively assessed with retrospectively documented anesthesia exposure data. Exposures A single exposure to general anesthesia during inguinal hernia surgery in the exposed sibling and no anesthesia exposure in the unexposed sibling, before age 36 months. Main Outcomes and Measures The primary outcome was global cognitive function (IQ). Secondary outcomes included domain-specific neurocognitive functions and behavior. A detailed neuropsychological battery assessed IQ and domain-specific neurocognitive functions. Parents completed validated, standardized reports of behavior. Results Among the 105 sibling pairs, the exposed siblings (mean age, 17.3 months at surgery/anesthesia; 9.5% female) and the unexposed siblings (44% female) had IQ testing at mean ages of 10.6 and 10.9 years, respectively. All exposed children received inhaled anesthetic agents, and anesthesia duration ranged from 20 to 240 minutes, with a median duration of 80 minutes. Mean IQ scores between exposed siblings (scores: full scale = 111; performance = 108; verbal = 111) and unexposed siblings (scores: full scale = 111; performance = 107; verbal = 111) were not statistically significantly different. Differences in mean IQ scores between sibling pairs were: full scale = −0.2 (95% CI, −2.6 to 2.9); performance = 0.5 (95% CI, −2.7 to 3.7); and verbal = −0.5 (95% CI, −3.2 to 2.2). No statistically significant differences in mean scores were found between sibling pairs in memory/learning, motor/processing speed, visuospatial function, attention, executive function, language, or behavior. Conclusions and Relevance Among healthy children with a single anesthesia exposure before age 36 months, compared with healthy siblings with no anesthesia exposure, there were no statistically significant differences in IQ scores in later childhood. Further study of repeated exposure, prolonged exposure, and vulnerable subgroups is needed.

Animal studies have documented that exposure of the developing brain to commonly used anesthetic agents induces neurotoxicity and late abnormal neurobehavioral functions as adults. Results from clinical studies have all been analyzed using existing data sets, and these studies produced inconsistent results. To provide more definitive evidence to address the clinical relevance of anesthetic neurotoxicity in children, an interdisciplinary team of investigators designed and developed the Pediatric Anesthesia NeuroDevelopment Assessment (PANDA) project. We present pilot study results in 28 sibling pairs recruited and tested at the Columbia University Medical Center (CUMC) and Children's Hospital of Boston (CHB) for the PANDA project.The PANDA project uses an ambidirectional cohort design. We performed prospective neuropsychological assessment in 28 exposed-unexposed sibling pairs from 6 to 11 years of age. The exposed siblings were ASA 1 or 2 and had received a single episode of anesthesia for inguinal hernia repair before the age of 36 months and the unexposed siblings had no anesthesia before the age of 36 months. All the sibling pairs were English speaking and were 36 weeks of gestational age or older. Each sibling pair underwent a direct testing using the Wechsler Abbreviated Scale of Intelligence (WASI) and the NEuroPSYchological Assessment, second edition (NEPSY II), and the parents completed questionnaires related to behavior using CBCL and Conners rating. Data are presented as means±SD. We conducted descriptive analyses of the demographic data. We compared both the exposed and the unexposed sibling groups on WASI and NEPSY II, and total and T scores from CBCL and Conners rating were analyzed as continuous data using the paired t test between the two groups. A P0.05 was considered significant.After the Institutional Review Board approval for the study at both CUMC and CHB, the full PANDA study protocol was implemented to perform a pilot feasibility study. Our success rate was 96.7% in obtaining detailed medical and anesthesia records in our historical cohort. The scores for verbal IQ (exposed=106.1±16.3, unexposed=109.2±17.9), performance IQ (exposed=109.1±16.0, unexposed=113.9±15.9), and full IQ (exposed=108.2±14.0, unexposed=112.8±16.8) were comparable between the siblings. There were no differences between the two groups in T scores for any of the NEPSY II subdomains, CBCL, or Conners rating. An abstraction protocol with web-based electronic data capture forms also was developed in conjunction with the International Center for Health Outcomes and Innovation Research (InCHOIR).The pilot study provided useful information for feasibility to recruit the sample size and to obtain relevant clinical data. For the final study protocol, both the neuropsychological battery and the age range for testing were revised. Our results confirmed the feasibility of our study approach and yielded pilot data from neuropsychological testing.

Prison nurseries prevent maternal separations related to incarceration for the small subset of children whose pregnant mothers are incarcerated in states with such programs. For a cohort of 100 children accepted by corrections into one prison nursery, subsequent separation patterns are analyzed. The largest numbers are caused by corrections’ removal of infants from the nursery and infants reaching a one-year age limit. Criminal recidivism and substance abuse relapse threaten continued mothering during reentry. Focused and coordinated services are needed during prison stay and reentry years to sustain mothering for women and children accepted into prison nursery programs.

Objective:The objective of this study was to develop a clinically relevant tool to assess parental engagement in decision making and planning for seriously ill children during palliative care consultations. Although little is known about the structure and process of planning meetings between parents and providers, less is known about the nature of parental engagement as it relates to decision making ability in pediatric end-of-life care. Using attachment and caregiving as a framework, this study clarified important dimensions of parental engagement.Method:Using a multi-phase, template-matching technique, both literature and pediatric palliative care consultation data were analyzed, iteratively reviewed, matched, and categorized to create a measure of parental engagement. The attachment paradigm serves as the theoretical framework for the study, which focuses on parental engagement in decision making as a caregiving system function. Attachment and related literatures as well as coping and pediatric palliative care literatures were used in the initial conceptual sampling phase.Results:The study yielded two groups of findings. The first set of findings centered on the findings of the literature and consultation template-matching phases of the work. These two phases yielded a conceptual model of parental engagement as a psychobehavioral complex consisting of three dimensions: information-centered dialogue, insightful participation, and achievement of a collaboratively agreed-upon plan. The final phases consisted of creation of a 9 point Parental Engagement Scale, scoring of the consultations, and establishment of initial inter- rater reliability at .80. Psychometric testing continues.Significance of results:Parental engagement in decision making is a critical area for study and intervention. If we can support parents in their caregiving executive functions while understanding the psychological and emotional underpinnings of the caregiving system and parental engagement itself, we can move inquiry forward in understanding parental needs for intervention during this most profoundly challenging time.

Phenomenologic analysis of initial consults provided during the first year of a new Pediatric Advanced Care Team (PACT) program provides essential understanding of the experience and inform program direction and future clinical research. Parents bring to the consult a desire to remain experts in their children’s lives yet experience vulnerability as they seek assistance in making critical decisions often under conditions of disquieting uncertainty. Dynamic communication efforts involving the referring providers, PACT team members, and family are a key influence in facilitating consults’ stated goals and in establishing the integrated palliative paradigm in a tertiary care environment. Validation was provided for a new research infrastructure that will function concurrently with the PACT clinical program in this rapidly evolving field.

Prison nursery programs allow departments of correction to positively intervene in the lives of both incarcerated mothers and their infant children. The number of prison nurseries in the United States has risen dramatically in the past decade, yet there remains a significant gap between predominant correctional policy in this area and what is known about parenting and infant development. Using Kingdon's streams metaphor, this article examines the recent convergence of problem, policy, and political events related to incarcerated women with infant children and argues that this has created a window of opportunity for development of prison nursery programs. Aday's policy analysis criteria are also used to analyze available evidence regarding the effectiveness, efficiency, and equity of prison nursery programs as policy alternatives for incarcerated women with infant children.

Purpose: Children who exhibit the confusing symptom patterns associated with sensory processing deficits are often seen first by primary care providers, including family and pediatric nurse practitioners (NPs). The purpose of this article is to alert NPs to the state of the science for these disorders and to the roles NPs could play in filling the knowledge gaps in assessment, treatment, education, and research. Data sources: Literature searches using PubMed and MedLine databases and clinical practice observations. Conclusions: Sensory integration disorders have only begun to be defined during the past 35 years. They are not currently included in the DSM IV standard terminology, and are not yet substantively incorporated into most health disciplines’ curricula or practice, including those of the NP. Implications for practice: NPs are in a unique position to test hypothesized terminology for Sensory Processing Disorder (SPD) by contributing precise clinical descriptions of children who match as well as deviate from the criteria for three proposed diagnostic groups: Sensory Modulation Disorder (SMD), Sensory Discrimination Disorder (SDD), and Sensory-Based Motor Disorder (SBMD). Beyond the SPD diagnostic debate, for children with sensory deficit patterns the NP role can incorporate participating in interdisciplinary treatment plans, refining differential diagnoses, providing frontline referral and support for affected children and their families, and making both secondary prevention and critical causal research possible through validation of consistently accepted diagnostic criteria.

The purpose of this study was to describe pediatric nurses' projected responses to children's pain as described in vignettes of hospitalized children and to explore nurse characteristics that might influence those responses. A survey was mailed to a national random sample of 700 RNs, and 334 nurses responded. The survey included case reports of three hospitalized school-aged children experiencing pain. Nurses were asked to rate their perceptions of the children's pain levels and to indicate how much analgesia they would recommend. Contrary to earlier studies, in response to the scenarios, nurses in this sample perceived high levels of pain, said they would administer doses of analgesia close to the maximum prescribed by physicians, and recommended an array of non-pharmacologic methods to treat pain. Variation in pain perceptions and decisions was not related to key personal and professional characteristics of the nurses, including their education level, race/ethnicity, age, years of clinical experience, and receipt of continuing education about pain. Findings from this large national study suggest that most nurses would make appropriate decisions relating to the treatment of children's pain, perhaps reflecting changes in the emphasis on pain management.

The purpose of this study was to examine whether nurses' recommendations for managing children's pain were influenced by stereotypes based on children's personal attributes. Three vignettes, in which hospitalized children's sex, race, and attractiveness were experimentally manipulated, were mailed to a national random sample of 700 pediatric nurses; 334 nurses responded. Responses to vignette questions indicated little evidence of stereotyping. Nurses perceived similar levels of pain and recommended similar pain treatments, regardless of sex, race, and attractiveness. Nurses, on average, perceived children's pain at levels consistent with the children's self-reports and recommended assertive analgesic and non-pharmacologic pain management strategies. The results appear consistent with prevailing views on providing adequate pain treatment for children.

The study describes quality of life as perceived by parents and measured by the Child Health Questionnaire (CHQ-28) for a convenience sample of 33 HIV-infected children age 5 to 18 years cared for at home on complex antiretroviral drug regimens. When compared with normative data on healthy U.S. children, parent reports for the HIV-infected children did not differ significantly on the following CHQ concepts: role/social related to emotional, behavioral or physical problems; bodily pain; behavior; mental health; self-esteem; impact on parental time; family activities; and family cohesion. Parents perceived their children to be functioning at a level significantly lower than the norm in general health (t −6.47, p = .000), physical functioning (t −2.37, p = .024), and physical summary (t −3.80, p = .001). Parental impact-emotional was impressively higher than the norm (t −3.74, p = .001). Differences were independent of gender, primary language, ethnicity, and Centers for Disease Control and Prevention clinical classifications for pediatric HIV disease.