[Caring for patients with pediatric endocrinopathies and diabetes into adulthood: challenges of an often difficult transition].
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Abstract:
The success of therapies for a number of pediatric disorders has posed new challenges for the long-term follow-up of adolescents with chronic endocrinopathies. Unfortunately, too many patients are lost during the transfer from pediatric to adult clinics. The transition process should be well-organized and include the young person and family. Recognizing the special needs of these adolescents is an important step in developing patient-centered approaches to care that enable patients to develop autonomy and self care skills. Key elements in this process include structured policies and guidelines, communication and close collaboration between pediatric and adult clinics, and integrating nurse clinicians in the transition process to help close the gaps in care.Keywords:
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This article provides firsthand insight into advanced practice pediatric nursing in the home health care setting. In the past few years, the role of the advanced practice registered nurse in pediatric care has expanded to include such practice areas as school-based health clinics, child protective agencies, and home care. Nurse practitioners’ job descriptions often differ based on where they work, although hospitals and clinics tend to have fairly standard roles for the nurse practitioner. Advance practice roles within major metropolitan hospitals may differ from department to department and from clinic to clinic.
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The pediatric nurse-practitioner program prepares nurses to assume an expanded role in providing total health care to children in the offices of private pediatricians and in areas with inadequate health services. Nurses provide comprehensive well-child care to well children and identify, appraise, and temporarily manage certain acute and chronic conditions of the sick child. The program has resulted in a realignment of functions performed by physicians and nurses so that each of them can assume responsibility for those aspects of the patients' needs that they can perform most effectively. As associates of pediatricians in private practice, pediatric nurse practitioners function skillfully and competently in providing professional service which results in improved patient care and the more effcient and effective use of the skills and time of both the physician and the nurse.
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Results of an opinion survey of parents who take their children to a pediatrician who has a specially-trained pediatric nurse practitioner as an associate in his office revealed a high degree of satisfaction with the combined care provided jointly by these two health professionals. Parents (94%) expressed satisfaction with services they received and with their opportunity to maintain adequate communication with the physician, while 57% stated that joint care was better than care they had received from a physician alone. Parents were also highly satisfied with home visits by the pediatric nurse practitioner, by her visits to the hospital in the neonatal period, and with other aspects of care their children had received. Over 90% of parents considered the association of a pediatrician and a pediatric nurse practitioner to be a desirable and inevitable trend in the private practice of medicine.
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In Swiss primary care, general practitioner (GP) home visits have decreased due to impending GP shortages particularly in rural areas. Nurse practitioners (NP) are newly introduced in family practices and could potentially offer home visits to the increasing number of multimorbid elderly. We analysed consultation data from two pilot projects (Practice A and Practice B) with the goal to measure the frequency and patient characteristics of NP consultations both in the practice and on home visits, and to determine the NPs’ autonomy based on the required GP supervision. In Practice A, 17% of all NP consultations were home visits, in Practice B 51%. In both practices, the NPs saw older patients and reported higher autonomy on home visits compared to consultations in the practice. In Practice A, the NP encountered a higher share of multimorbid patients on home visits than in the practice, and the NP’s proportion of autonomously conducted consultations increased from 0% in the first month to 19% after 13 months of GP supervision. In Practice B, the NP was autonomous in about three-quarters of consultations after 2 years on the job. These first cases provide some evidence that NPs could reach a relatively high degree of autonomy and might pose a potential solution for the decreasing numbers of GP home visits to multimorbid elderly in Swiss primary care.
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The recent movement towards defining advanced nursing practice offers opportunities and challenges for pediatric nurse practitioners and educators. The definitions of nurse practitioner, clinical nurse specialist, and advanced practice nurse indicate similarities and distinct differences in role definitions and expectations. Nurse practitioner practice and education will need to change significantly for nurse practitioners to be considered advanced practice nurses and to retain their legacy as nursing leaders.
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In 1990 we celebrated the 25th anniversary of the nurse practitioner (NP) movement. We now have had considerable experience with the role, and it is appropriate to examine our contributions to the maturity of nursing as a profession. Nursing's future health care delivery role in an increasingly competitive health care arena may well depend on the autonomy, of the practice of professional nursing. This article focuses on NPs, their autonomy, and their contributions to the professionalization of nursing.
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Abstract To evaluate the telephone management of five common acute pediatric problems, a "programmed mother" made unidentified calls to five pediatric nurse practitioners, 28 pediatric house officers and 23 pediatricians in practice. Calls were tape recorded and scored for history taking, disposition and interviewing skill. Nurse practitioners averaged 79.6 per cent of the total possible theoretical score for history taking, house officers 69.1 per cent, and practicing pediatricians 52.6 per cent (P<0.001). For disposition, nurse practitioners averaged 71.1 per cent of the maximum score, in contrast to 60.1 per cent for house officers and 58.9 per cent for practicing pediatricians. Similarly, nurse practitioners had significantly higher (P<0.001) scores for interviewing skills. No significant differences were found among house officers in the first, second and third years in history taking, disposition or interviewing skills. We conclude that pediatric nurse practitioners manage common pediatric problems by telephone better than house officers or practicing pediatricians and that better training for this aspect of practice is needed. (N Engl J Med 298:130–135, 1978)
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