The Peds NP: Pearls of Pediatric Evidence-Based Practice: Recent Episodes
Becky Carson
Everyday application of clinical pearls in pediatrics using great (real!) stories, cases, and personal experiences with current evidence-based practice for students and healthcare providers focused on caring for children.
Disclaimers & Show Notes: https://docs.google.com/document/d/1xip4me4VwhzBuXx9QSj-CA4GsIxVJira_uat4ab__PY/edit?usp=sharing
In the last episode of our mini-series on Immunizations Updates, we are joined again by pediatric nurse practitioner, Dr. Maddie Manfredi, for a live role-play extended episode focused on motivational interviewing (MI) in the setting of vaccine hesitancy. During 5 cases built around common worries surrounding pediatric vaccines, Dr. Manfredi uses evidence-based approaches to explore hesitancy and reach a common goal– a child’s health and well-being.
The cases cover:
-
Immune system overload
-
Misinformation and distrust
-
The autism myth
-
Preference for a natural lifestyle
-
Low risk disease perception
This episode demonstrates what a therapeutic relationship looks like and how to navigate real-world conversations with caregivers across a spectrum of hesitancy. Through five case-based scenarios, listeners will hear MI techniques applied in real time and walk away with practical scripts and strategies to use in clinical encounters.
Website: www.thepedsnp.com
Contact: thepedsnp@gmail.com
Instagram: @thepedsnppodcast
AACN Essentials Mapping (Domain. sub-competency):
1.1f, 1.2g
2.2c, 2.2f, 2.3b, 2.4e
3.1a, 3.2b, 3.3d
4.1a, 4.1d, 4.2c
5.1b, 5.2a, 5.3c
6.2b, 6.3a
7.1c, 7.2d
8.2c, 8.3d
9.1a, 9.2f, 9.3c
10.2a, 10.2d, 10.3b
References:
Bernstein, T. A., Broome, M., Millman, J., Epstein, J., & Derouin, A. (2022). Promoting strategies to increase HPV vaccination in the pediatric primary care setting. Journal of Pediatric Health Care, 36(2), e36–e41. https://doi.org/10.1016/j.pedhc.2021.10.009
Bullen, M., Heriot, G.S., & Jamrozik, E. (2023). Herd immunity, vaccination and moral obligation. Journal of Medical Ethics, 49(9), 636–641. https://doi.org/10.1136/jme-2022-108485
Braun, C., & O'Leary, S. T. (2020). Recent advances in addressing vaccine hesitancy. Current Opinion in Pediatrics, 32(4), 601–609. https://doi.org/10.1097/MOP.0000000000000929
Brewer, N. T., Chapman, G. B., Rothman, A. J., Leask, J., & Kempe, A. (2017). Increasing vaccination: Putting psychological science into action. Psychological Science in the Public Interest: A Journal of the American Psychological Society, 18(3), 149–207. https://doi.org/10.1177/1529100618760521
Brewer, N. T. (2021). What works to increase vaccine uptake. Academic Pediatrics, 21(4S), S9-S16. https://doi.org/10.1016.j.acap.2021.01.017
Centers for Disease Control and Prevention. (2024a, August 9). Reasons to vaccinate. https://www.cdc.gov/vaccines-children/reasons/index.html
Centers for Disease Control and Prevention. (2024c). Talking with parents about vaccines. https://www.cdc.gov/vaccines-children/hcp/conversation-tips/index.html
Eagan, R.L., Larson, H.J., & de Figueiredo, A. (2023). Recent trends in vaccine coverage and confidence: A cause for concern. Human Vaccines & Immunotherapeutics, 19(2), 2237374. https://doi.org/10.1080/21645515.2023.2237374
Frew, P.M., & Lutz, C.S. (2017). Interventions to increase pediatric vaccine uptake: An overview of recent findings. Human Vaccines & Immunotherapeutics, 13(11), 2503-2511. https://doi.org/10.1080/21645515.2017.1367069
Gagneur, A., Gutnick, D., Berthiaume, P., Diana, A., Rollnick, S., & Saha, P. (2024). From vaccine hesitancy to vaccine motivation: A motivational interviewing based approach to vaccine counselling. Human Vaccines & Immunotherapeutics, 20(1), 2391625. https://doi.org/10.1080/21645515.2024.2391625
Jarrett, C., Wilson, R., O'Leary, M., Eckersberger, E., Larson, H. J., & SAGE Working Group on Vaccine Hesitancy. (2015). Strategies for addressing vaccine hesitancy - A systematic review. Vaccine, 33(34), 4180–4190. https://doi.org/10.1016/j.vaccine.2015.04.040
Kestenbaum, L. A., & Feemster, K. A. (2015). Identifying and addressing vaccine hesitancy. Pediatric Annals, 44(4), e71–e75. https://doi.org/10.3928/00904481-20150410-07
Lafnitzegger, A., & Gaviria-Agudelo, C. (2022). Vaccine hesitancy in pediatrics. Advances in pediatrics, 69(1), 163–176. https://doi.org/10.1016/j.yapd.2022.03.011
Limaye, R. J., Opel, D. J., Dempsey, A., Ellingson, M., Spina, C., Omer, S. B., Dudley, M. Z., Salmon, D. A., & Leary, S. O. (2021). Communicating with vaccine-hesitant parents: A narrative review. Academic pediatrics, 21(4S), S24–S29. https://doi.org/10.1016/j.acap.2021.01.018
McClure, C. C., Cataldi, J. R., & O'Leary, S. T. (2017). Vaccine hesitancy: Where we are and where we are going. Clinical Therapeutics, 39(8), 1550–1562. https://doi.org/10.1016/j.clinthera.2017.07.003
Mical, R., Martin-Velez, J., Blackstone, T., & Derouin, A. (2021). Vaccine hesitancy in rural pediatric primary care. Journal of Pediatric Health Care, 35(1), 16–22. https://doi.org/10.1016/j.pedhc.2020.07.003
Minta, A. A., Ferrari, M., Antoni, S., Lambert, B., Sayi, T. S., Hsu, C. H., Steulet, C., Gacic-Dobo, M., Rota, P. A., Mulders, M. N., Wimmer, A., Bose, A. S., O'Connor, P., & Crowcroft, N. S. (2024). Progress toward measles elimination - Worldwide, 2000-2023. MMWR. Morbidity and Mortality Weekly Report, 73(45), 1036–1042. https://doi.org/10.15585/mmwr.mm7345a4
Nandi, A., & Shet, A. (2020). Why vaccines matter: understanding the broader health, economic, and child development benefits of routine vaccination. Human Vaccines & Immunotherapeutics, 16(8), 1900-1904. https://doi.org/10.1080/21645515.2019.1708669
Nyhan, B., Reifler, J., Richey, S., & Freed, G. L. (2014). Effective messages in vaccine promotion: A randomized trial. Pediatrics, 133(4), e835–e842. https://doi.org/10.1542/peds.2013-2365
Obohwemu, K., Christie-de Jong, F., & Ling, J. (2022). Parental childhood vaccine hesitancy and predicting uptake of vaccinations: a systematic review. Primary Health Care Research & Development, 23, e68. https://doi.org/10.1017/S1463423622000512
Offit, P. A., & Moser, C. A. (2009). The problem with Dr Bob's alternative vaccine schedule. Pediatrics, 123(1), e164–e169. https://doi.org/10.1542/peds.2008-2189
O'Leary, S. T., Opel, D. J., Cataldi, J. R., Hackell, J. M.; Committee on Infection Diseases, Committee on Practice and Ambulatory Medicine, & Committee on Bioethics. (2024). Strategies for improving vaccine communication and uptake. Pediatrics, 153(3), e2023065483. https://doi.org/10.1542/peds.2023-065483
Opel, D. J., Heritage, J., Taylor, J. A., Mangione-Smith, R., Salas, H. S., DeVere, V., Zhou, C., & Robinson, J. D. (2013). The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics, 132(6), 1037–1046. https://doi.org/10.1542/peds.2013-2037
Opel, D. J., Mangione-Smith, R., Robinson, J.D., Heritage, J., DeVere, V., Salas, H.S., Zhou, C., & Taylor, J. A. (2015). The influence of provider communication behaviors on parental vaccine acceptance and visit experience. American Journal of Public Health, 105(10), 1998–2004. https://doi.org/10.2105/AJPH.2014.302425
Petca, A., Borislavschi, A., Zvanca, M. E., Petca, R. C., Sandru, F., & Dumitrascu, M. C. (2020). Non-sexual HPV transmission and role of vaccination for a better future (Review). Experimental and therapeutic medicine, 20(6), 186. https://doi.org/10.3892/etm.2020.9316
Shattock, A. J., Johnson, H. C., Sim, S. Y., Carter, A., Lambach, P., Hutubessy, R. C. W., Thompson, K. M., Badizadegan, K., Lambert, B., Ferrari, M. J., Jit, M., Fu, H., Silal, S. P., Hounsell, R. A., White, R. G., Mosser, J. F., Gaythorpe, K. A. M., Trotter, C. L., Lindstrand, A., O'Brien, K. L., Bar-Zeev, N. (2024). Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization. Lancet (London, England), 403(10441), 2307–2316. https://doi.org/10.1016/S0140-6736(24)00850-X
Smith M. J. (2015). Promoting vaccine confidence. Infectious Disease Clinics of North America, 29(4), 759–769. https://doi.org/10.1016/j.idc.2015.07.004
Songol, A., Amiri-Farahani, L., Haghani, S., Pezaro, S., & Omrani Saravi, S. (2023). Comparing the effect of parental education via both lecture and film upon vaccination uptake for children under one year of age: A cluster randomized clinical trial. Vaccine, 41(5), 1067-1073. https://doi.org/10.1016/j.vaccine.2022.12.012
Szilagyi, P. G., Albertin, C. S., Gurfinkel, D., Saville, A. W., Vangala, S., Rice, J. D., Helmkamp, L., Zimet, G. D., Valderrama, R., Breck, A., Rand, C. M., Humiston, S. G., & Kempe, A. (2020). Prevalence and characteristics of HPV vaccine hesitancy among parents of adolescents across the US. Vaccine, 38(38), 6027–6037. https://doi.org/10.1016/j.vaccine.2020.06.074
World Health Organization. (n.d.). A brief history of vaccines. https://www.who.int/news-room/spotlight/history-of-vaccination/a-brief-history-of-vaccination
World Health Organization. (2015, August 18). Vaccine hesitancy: A growing challenge for immunization programmes. https://www.who.int/news/item/18-08-2015-vaccine-hesitancy-a-growing-challenge-for-immunization-programmes
World Health Organization. (2019). Ten threats to global health in 2019. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019
Zhou, F., Jatlaoui, T. C., Leidner, A. J., Carter, R. J., Dong, X., Santoli, J. M., Stokley, S., Daskalakis, D. C., & Peacock, G. (2024). Health and economic benefits of routine childhood immunizations in the era of the vaccines for children program - United States, 1994-2023. MMWR. Morbidity and Mortality Weekly Report, 73(31), 682–685. https://doi.org/10.15585/mmwr.mm7331a2
As we continue on in our mini series on Immunizations Updates, we are joined by pediatric nurse practitioner Dr. Maddie Manfredi to explore the growing challenge of vaccine hesitancy. Together we will review the profound public health impact of immunizations, define vaccine hesitancy as a spectrum of decision-making rather than simple refusal, and discuss its implications for herd immunity and pediatric outcomes. Dr. Manfredi shares findings from her DNP project, including the use of a novel Caregiver Vaccine Readiness Survey to proactively identify concerns and guide more tailored, patient-centered conversations using motivational interviewing. We’ll highlight the critical role of provider communication in building trust, addressing caregiver concerns, and improving vaccine acceptance, with promising results shared from a DNP project on MMR vaccine acceptance. The episode underscores that how we communicate matters just as much as what we say and invites listeners to rethink traditional approaches in today’s complex sociopolitical landscape. Stay tuned for the next episode, where Dr. Carson and Dr. Manfredi model motivational interviewing strategies through case-based role play.
Website: www.thepedsnp.com
Contact: thepedsnp@gmail.com
Instagram: @thepedsnppodcast
AACN Essentials Mapping (Domain. sub-competency):
1.1f, 1.2g
2.2c, 2.2f, 2.3b, 2.4e
3.1a, 3.2b, 3.3d
4.1a, 4.1d, 4.2c
5.1b, 5.2a, 5.3c
6.2b, 6.3a
7.1c, 7.2d
8.2c, 8.3d
9.1a, 9.2f, 9.3c
10.2a, 10.2d, 10.3b
References:
Bernstein, T. A., Broome, M., Millman, J., Epstein, J., & Derouin, A. (2022). Promoting strategies to increase HPV vaccination in the pediatric primary care setting. Journal of Pediatric Health Care, 36(2), e36–e41. https://doi.org/10.1016/j.pedhc.2021.10.009
Bullen, M., Heriot, G.S., & Jamrozik, E. (2023). Herd immunity, vaccination and moral obligation. Journal of Medical Ethics, 49(9), 636–641. https://doi.org/10.1136/jme-2022-108485
Braun, C., & O'Leary, S. T. (2020). Recent advances in addressing vaccine hesitancy. Current Opinion in Pediatrics, 32(4), 601–609. https://doi.org/10.1097/MOP.0000000000000929
Brewer, N. T., Chapman, G. B., Rothman, A. J., Leask, J., & Kempe, A. (2017). Increasing vaccination: Putting psychological science into action. Psychological Science in the Public Interest: A Journal of the American Psychological Society, 18(3), 149–207. https://doi.org/10.1177/1529100618760521
Brewer, N. T. (2021). What works to increase vaccine uptake. Academic Pediatrics, 21(4S), S9-S16. https://doi.org/10.1016.j.acap.2021.01.017
Centers for Disease Control and Prevention. (2024a, August 9). Reasons to vaccinate. https://www.cdc.gov/vaccines-children/reasons/index.html
Centers for Disease Control and Prevention. (2024c). Talking with parents about vaccines. https://www.cdc.gov/vaccines-children/hcp/conversation-tips/index.html
Eagan, R.L., Larson, H.J., & de Figueiredo, A. (2023). Recent trends in vaccine coverage and confidence: A cause for concern. Human Vaccines & Immunotherapeutics, 19(2), 2237374. https://doi.org/10.1080/21645515.2023.2237374
Frew, P.M., & Lutz, C.S. (2017). Interventions to increase pediatric vaccine uptake: An overview of recent findings. Human Vaccines & Immunotherapeutics, 13(11), 2503-2511. https://doi.org/10.1080/21645515.2017.1367069
Gagneur, A., Gutnick, D., Berthiaume, P., Diana, A., Rollnick, S., & Saha, P. (2024). From vaccine hesitancy to vaccine motivation: A motivational interviewing based approach to vaccine counselling. Human Vaccines & Immunotherapeutics, 20(1), 2391625. https://doi.org/10.1080/21645515.2024.2391625
Jarrett, C., Wilson, R., O'Leary, M., Eckersberger, E., Larson, H. J., & SAGE Working Group on Vaccine Hesitancy. (2015). Strategies for addressing vaccine hesitancy - A systematic review. Vaccine, 33(34), 4180–4190. https://doi.org/10.1016/j.vaccine.2015.04.040
Kestenbaum, L. A., & Feemster, K. A. (2015). Identifying and addressing vaccine hesitancy. Pediatric Annals, 44(4), e71–e75. https://doi.org/10.3928/00904481-20150410-07
Lafnitzegger, A., & Gaviria-Agudelo, C. (2022). Vaccine hesitancy in pediatrics. Advances in pediatrics, 69(1), 163–176. https://doi.org/10.1016/j.yapd.2022.03.011
Limaye, R. J., Opel, D. J., Dempsey, A., Ellingson, M., Spina, C., Omer, S. B., Dudley, M. Z., Salmon, D. A., & Leary, S. O. (2021). Communicating with vaccine-hesitant parents: A narrative review. Academic pediatrics, 21(4S), S24–S29. https://doi.org/10.1016/j.acap.2021.01.018
McClure, C. C., Cataldi, J. R., & O'Leary, S. T. (2017). Vaccine hesitancy: Where we are and where we are going. Clinical Therapeutics, 39(8), 1550–1562. https://doi.org/10.1016/j.clinthera.2017.07.003
Mical, R., Martin-Velez, J., Blackstone, T., & Derouin, A. (2021). Vaccine hesitancy in rural pediatric primary care. Journal of Pediatric Health Care, 35(1), 16–22. https://doi.org/10.1016/j.pedhc.2020.07.003
Minta, A. A., Ferrari, M., Antoni, S., Lambert, B., Sayi, T. S., Hsu, C. H., Steulet, C., Gacic-Dobo, M., Rota, P. A., Mulders, M. N., Wimmer, A., Bose, A. S., O'Connor, P., & Crowcroft, N. S. (2024). Progress toward measles elimination - Worldwide, 2000-2023. MMWR. Morbidity and Mortality Weekly Report, 73(45), 1036–1042. https://doi.org/10.15585/mmwr.mm7345a4
Nandi, A., & Shet, A. (2020). Why vaccines matter: understanding the broader health, economic, and child development benefits of routine vaccination. Human Vaccines & Immunotherapeutics, 16(8), 1900-1904. https://doi.org/10.1080/21645515.2019.1708669
Nyhan, B., Reifler, J., Richey, S., & Freed, G. L. (2014). Effective messages in vaccine promotion: A randomized trial. Pediatrics, 133(4), e835–e842. https://doi.org/10.1542/peds.2013-2365
Obohwemu, K., Christie-de Jong, F., & Ling, J. (2022). Parental childhood vaccine hesitancy and predicting uptake of vaccinations: a systematic review. Primary Health Care Research & Development, 23, e68. https://doi.org/10.1017/S1463423622000512
O'Leary, S. T., Opel, D. J., Cataldi, J. R., Hackell, J. M.; Committee on Infection Diseases, Committee on Practice and Ambulatory Medicine, & Committee on Bioethics. (2024). Strategies for improving vaccine communication and uptake. Pediatrics, 153(3), e2023065483. https://doi.org/10.1542/peds.2023-065483
Opel, D. J., Heritage, J., Taylor, J. A., Mangione-Smith, R., Salas, H. S., DeVere, V., Zhou, C., & Robinson, J. D. (2013). The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics, 132(6), 1037–1046. https://doi.org/10.1542/peds.2013-2037
Opel, D. J., Mangione-Smith, R., Robinson, J.D., Heritage, J., DeVere, V., Salas, H.S., Zhou, C., & Taylor, J. A. (2015). The influence of provider communication behaviors on parental vaccine acceptance and visit experience. American Journal of Public Health, 105(10), 1998–2004. https://doi.org/10.2105/AJPH.2014.302425
Shattock, A. J., Johnson, H. C., Sim, S. Y., Carter, A., Lambach, P., Hutubessy, R. C. W., Thompson, K. M., Badizadegan, K., Lambert, B., Ferrari, M. J., Jit, M., Fu, H., Silal, S. P., Hounsell, R. A., White, R. G., Mosser, J. F., Gaythorpe, K. A. M., Trotter, C. L., Lindstrand, A., O'Brien, K. L., Bar-Zeev, N. (2024). Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization. Lancet (London, England), 403(10441), 2307–2316. https://doi.org/10.1016/S0140-6736(24)00850-X
Smith M. J. (2015). Promoting vaccine confidence. Infectious Disease Clinics of North America, 29(4), 759–769. https://doi.org/10.1016/j.idc.2015.07.004
Songol, A., Amiri-Farahani, L., Haghani, S., Pezaro, S., & Omrani Saravi, S. (2023). Comparing the effect of parental education via both lecture and film upon vaccination uptake for children under one year of age: A cluster randomized clinical trial. Vaccine, 41(5), 1067-1073. https://doi.org/10.1016/j.vaccine.2022.12.012
Szilagyi, P. G., Albertin, C. S., Gurfinkel, D., Saville, A. W., Vangala, S., Rice, J. D., Helmkamp, L., Zimet, G. D., Valderrama, R., Breck, A., Rand, C. M., Humiston, S. G., & Kempe, A. (2020). Prevalence and characteristics of HPV vaccine hesitancy among parents of adolescents across the US. Vaccine, 38(38), 6027–6037. https://doi.org/10.1016/j.vaccine.2020.06.074
World Health Organization. (n.d.). A brief history of vaccines. https://www.who.int/news-room/spotlight/history-of-vaccination/a-brief-history-of-vaccination
World Health Organization. (2015, August 18). Vaccine hesitancy: A growing challenge for immunization programmes. https://www.who.int/news/item/18-08-2015-vaccine-hesitancy-a-growing-challenge-for-immunization-programmes
World Health Organization. (2019). Ten threats to global health in 2019. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019
Zhou, F., Jatlaoui, T. C., Leidner, A. J., Carter, R. J., Dong, X., Santoli, J. M., Stokley, S., Daskalakis, D. C., & Peacock, G. (2024). Health and economic benefits of routine childhood immunizations in the era of the vaccines for children program - United States, 1994-2023. MMWR. Morbidity and Mortality Weekly Report, 73(31), 682–685. https://doi.org/10.15585/mmwr.mm7331a2
In the second episode of our Immunization Updates mini-series, we’ll break down the evolving—and increasingly confusing—2026 pediatric immunization landscape, helping clinicians make sense of diverging CDC and AAP vaccine schedules.
Following major federal changes to the ACIP process and subsequent shifts in CDC recommendations, several vaccines were reclassified from universal use to “high-risk” or “shared decision-making,” creating uncertainty for providers and families alike. We’ll walk through what changed, why it matters, and how these updates compare to the AAP’s continued endorsement of universal protection against 18 diseases.
Using real-world examples like HPV and RSV prevention, this episode unpacks how wording, categorization, and policy decisions impact clinical care, patient understanding, and public confidence. We end with practical strategies for navigating vaccine conversations, maintaining an AAP-aligned workflow, addressing insurance and liability concerns, and documenting when families choose alternate approaches. This episode is a must-listen for pediatric providers who want to stay grounded in evidence, communicate clearly with families, and confidently advocate for childhood immunizations in a shifting policy environment.
Website: www.thepedsnp.come
Contact: thepedsnp@gmail.com
Instagram: @thepedsnppodcast
AACN Essentials Mapping (Domain. sub-competency):
1.1, 1.3
2.5
3.3, 3.5
4.2
6.1
9.1
References:
Abers, M. S., Ulrich, A. K., & Walensky, R. P. (2026). Universal Hepatitis B Vaccination at Birth-Risks of Revising the Recommendation. JAMA, 335(7), 569–570. https://doi.org/10.1001/jama.2025.24996
American Academy of Pediatrics. (2026, January 26). AAP’s 2026 immunization schedule keeps routine recommendations intact after overhaul of federal schedule. AAP News. https://publications.aap.org/aapnews/news/34141/
American Academy of Pediatrics. (2026). What is the difference between the AAP immunization recommendations and other vaccine schedules? HealthyChildren.org. https://www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/what-is-the-difference-between-the-AAP-recommended-immunization-schedule-and-other-vaccine-schedules.aspx
American Public Health Association. (2026, March 16). Federal Judge Blocks Immunization Schedule Changes, Stays ACIP Member Appointments. APHA News Releases. https://www.apha.org/news-and-media/news-releases/apha-news-releases/federal-judge-blocks-immunization-schedule-changes#:~:text=A%20coalition%20of%20leading%20medical,the%20December%202025%20ACIP%20meeting.
Arthur, E. (2025). AAP has been leading voice on childhood vaccine recommendations since 1930s. AAP News. Retrieved from https://publications.aap.org/aapnews/news/32762/AAP-has-been-leading-voice-on-childhood-vaccine?searchresult=1
Association of Immunization Managers. (2026, February 13). What to know about one-dose HPV vaccination. Childhood Immunization. https://www.immunizationmanagers.org/what-to-know-about-one-dose-hpv-vaccination/
Cacho, F., Gebretsadik, T., Anderson, L. J., Chappell, J. D., Rosas-Salazar, C., Ortiz, J. R....Hartert, T. (2024). Respiratory Syncytial Virus Prevalence and Risk Factors among Healthy Term Infants, United States. Emerging Infectious Diseases, 30(10), 2199-2202. https://doi.org/10.3201/eid3010.240609.
Centers for Disease Control and Prevention. (2025). Healthcare Professionals: Immunization Schedules. Vaccines and Immunizations. https://www.cdc.gov/vaccines/hcp/imz-schedules/index.html
Department of Health and Human Services. (2026). Fact Sheet: CDC Childhood Immunization Recommendations. Press Room. https://www.hhs.gov/press-room/fact-sheet-cdc-childhood-immunization-recommendations.html
Kates J, Bell C, Michaud J, Williams E, Tolbert J. Tracking state actions on vaccine policy and access. KFF. September 24, 2025. Accessed December 28, 2025. https://www.kff.org/covid-19/tracking-state-actions-on-vaccine-policy-and-access/#:~:text=Thirteen%20states%20have%20moved%20to,recommendations%20apply%20to%20all%20vaccines
Mello, M. M., Walensky, R. P., Osterholm, M. T., & Brennan, T. A. (2026, January 13). Navigating conflicting vaccination recommendations: Guidance for clinicians. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2844090
Montori, V. M., Ruissen, M. M., Hargraves, I. G., Brito, J. P., & Kunneman, M. (2023). Shared decision-making as a method of care. BMJ evidence-based medicine, 28(4), 213–217. https://doi.org/10.1136/bmjebm-2022-112068
O'Leary, S. T., Opel, D. J., Cataldi, J. R., Hackell, J. M., COMMITTEE ON INFECTIOUS DISEASES , COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE , & COMMITTEE ON BIOETHICS (2024). Strategies for Improving Vaccine Communication and Uptake. Pediatrics, 153(3), e2023065483. https://doi.org/10.1542/peds.2023-065483
Payne AB, Battan-Wraith S, Rowley EAK, et al. Effectiveness of nirsevimab among infants in their first RSV season in the United States, October 2023-March 2024: a test-negative design analysis. Lancet Reg Health Am. 2025;49:101196. Published 2025 Aug 6. doi:10.1016/j.lana.2025.101196
Radcliffe, C. R., Akkawi, G., & Carson, R. A. (2025). Practical Application of Nirsevimab Recommendations for Infants and Toddlers. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners, 39(4), 638–645. https://doi.org/10.1016/j.pedhc.2024.11.005
Schering, S. (2026). 12 medical groups representing 1 million health care professionals endorse AAP immunization schedule. AAP News. https://publications.aap.org/aapnews/news/34259/12-medical-groups-representing-1-million-health
U.S. Department of Health and Human Services. (2026). Fact Sheet: CDC Childhood Immunization Recommendations. Press Room. https://www.hhs.gov/press-room/fact-sheet-cdc-childhood-immunization-recommendations.html
Welcome to our vaccine-focused mini-series, "Immunizations Updates"! Today we will use data from the United States' measles resurgence following the 2025 outbreak to explore what every pediatric provider needs to know as cases continue to climb. We walk through how measles slipped toward losing its elimination status, how today’s clinicians can rapidly rebuild their diagnostic instincts, and what early symptoms are most likely to be missed. We also break down high‑risk groups, key clinical clues, key references, practice tips, and highlights from Lyles & Carson’s recent 2026 reference for prevention and post-exposure prophylaxis for children with inflammatory bowel disease. Along the way, we’ll discuss practical strategies for vaccine advocacy, documentation, differential diagnosis, and post‑exposure management, giving you the tools to protect vulnerable kids and strengthen vaccine confidence in their communities.
Website: www.thepedsnp.come
Contact: thepedsnp@gmail.com
Instagram: @thepedsnppodcast
AACN Essentials Mapping (Domain. sub-competency):
1.1f, 1.2g, 1.2h, 1.2i, 1.3d,
2.1d, 2.2j, 2.4g
3.1m, 3.2e, 3.3c, 3.3e, 3.3f, 3.5f, 3.5g, 3.6g
4.1i, 4.2f, 4.2k, 4.3e
9.1i, 9.2i, 9.3i
10.1c, 10.2g, 102i, 10.3l, 10.3o
References:
American Academy of Pediatrics [AAP]. (2026). Measles Infection Prevention and Control Frequently Asked Questions. Patient Care. https://www.aap.org/en/patient-care/measles/measles-frequently-asked-questions/#:~:text=Because%20measles%20in%20HCP%20has,of%20serologic%20immunity%20is%20demonstrated.
Centers for Disease Control and Prevention [CDC]. (2026, February 20). Measles cases and outbreaks. Retrieved from https://www.cdc.gov/measles/data-research/index.html
Do, L. A. H., & Mulholland, K. (2025). Measles 2025. The New England Journal of Medicine, 392(25), 1–12. https://doi.org/10.1056/NEJMra2504516
Kiang, M. V., Bubar, K. M., Maldonado, Y., Hotez, P. J., & Lo, N. C. (2025). Modeling reemergence of vaccine-eliminated infectious diseases under declining vaccination in the US. JAMA. https://doi.org/10.1001/jama.2025.70336
Imdad, A., Mayo-Wilson, E., Haykal, M. R., Regan, A., Sidhu, J., Smith, A., & Bhutta, Z. A. (2022). Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. The Cochrane database of systematic reviews, 3(3), CD008524. https://doi.org/10.1002/14651858.CD008524.pub4
Lyles, J. L., & Carson, R. A. (2026). Prevention and post-exposure prophylaxis for measles in children with inflammatory bowel disease. Journal of pediatric gastroenterology and nutrition, 10.1002/jpn3.70336. Advance online publication. https://doi.org/10.1002/jpn3.70336
National Institutes of Health. (2025). Vitamin A and carotenoids. Health Information. https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/
Rhodesia, R.E. (2025). Public health wake-up call: Will the US lose measles elimination status? News. Contagion Live. https://www.contagionlive.com/view/public-health-wake-up-call-will-the-us-lose-measles-elimination-status-
Sheikh, I.N., Kamdar, K.Y., & Ardura, M.I. (2023). Ensure proper immunization for patients who received chemotherapy or transplantation. AAP News. https://publications.aap.org/aapnews/news/23569/Ensure-proper-immunization-for-patients-who?autologincheck=redirected
World Health Organization [WHO]. (2024). Provisional measles and rubella data. Retrieved from https://immunizationdata.who.int/global?topic=Provisional-measles-and-rubella-data
WHO. (2025). Measles. https://www.who.int/news-room/fact-sheets/detail/measles
Welcome to the Choosing Wisely Campaign series! This is the fifth and final episode of our 5-part series exploring the ABIM Foundation’s Choosing Wisely Lists. This campaign aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures.
Our last case-based episode focuses on a school-aged male presenting with new-onset enuresis. After a discussion of the differential diagnosis and evidence-based evaluation strategies, we apply recommendations from multiple AAP Choosing Wisely lists to create a care plan that is safe, resource-conscious, and child-centered.
Throughout this episode, we’ll highlight how ethical care principles—beneficence, nonmaleficence, autonomy, and justice—guide high-value decision-making and help us avoid unnecessary imaging, laboratory studies, and interventions that add cost without improving outcomes. This familiar case in pediatrics is worthy of a rewind to relisten to a throwback episode that will reinforce your skills and emphasize the clinical diagnosis and management without added diagnostics, referrals, or medications.
This case closes out our series on Choosing Wisely in Pediatrics, but the principles we’ve explored should continue to inform your practice every day. If you missed earlier episodes, rewind to learn more about the campaign’s background and listen to cases on fever and cough, gastroenterology presentations, and more.
Series Learning Objectives:
- Introduction to the Choosing Wisely Campaign: Understand the origins, historical precedent, and primary goals of the campaign.
- Case-Based Applications: Explore five common presentations in primary and acute care pediatrics, applying concepts from various Choosing Wisely lists to guide management and resource stewardship.
- Effective Communication: Learn strategies for engaging in tough conversations with parents and colleagues to create allies and ensure evidence-based practices are followed.
Modified rMETRIQ Score: 15/15 What does this mean?
Competencies:
AACN Essentials:
- 1: 1.1 g; 1.2 f; 1.3 d, e
- 2: 2.1 d, e; 2.2 g; 2.4 f, g; 2.5 h, i, j, k
- 7: 7.2 g, h, k
- 9: 9.1i, j; 9.2 i, j; 9.3 i, k
NONPF NP Core Competencies:
- 1: NP 1.1h; NP 1.2 k, m; NP 1.3 f, j, h
- 2: NP 2.1 j, g; NP 2.2 k, n; NP 2.4 h, i; NP 2.5 k, l, m, n, o
- 7: NP 7.2 m
- 9: NP 9.1 m, n; NP 9.2 n; NP 9.3 p
References:
AAP Section on Emergency Medicine & Canadian Association of Emergency Physicians. (2022). Five things physicians and patients should question. Retrieved from https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWEmergencyMedicine.pdf
AAP Section on Gastroenterology, Hepatology, and Nutrition. (2023). Five things physicians and patients should question. https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWGastroenterology.pdf
AAP Section on Urology. (2022). Five things physicians and patients should question. Retrieved from https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWUrology.pdf
Daniel, M., Szymanik-Grzelak, H., Sierdziński, J., Podsiadły, E., Kowalewska-Młot, M., & Pańczyk-Tomaszewska, M. (2023). Epidemiology and Risk Factors of UTIs in Children-A Single-Center Observation. Journal of personalized medicine, 13(1), 138. https://doi.org/10.3390/jpm13010138
McMullen, P.C., Zangaro, G., Selzer, C., Williams, H. (2026). Nurse Practitioner Claims and the National Practitioner Data Bank: Trends, Analysis, and Implications for Nurse Practitioner Education and Practice. Journal for Nurse Practitioners, 22(1), p. 105569, https://doi-org.proxy.lib.duke.edu/10.1016/j.nurpra.2025.105569
Tabbers, M. M., DiLorenzo, C., Berger, M. Y., Faure, C., Langendam, M. W., Nurko, S., Staiano, A., Vandenplas, Y., Benninga, M. A., European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, & North American Society for Pediatric Gastroenterology (2014). Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of pediatric gastroenterology and nutrition, 58(2), 258–274. https://doi.org/10.1097/MPG.0000000000000266
UCSF Benioff Children's Hospitals. (n.d.). Constipation & urologic problems. https://www.ucsfbenioffchildrens.org/conditions/constipation-and-urologic-problems
Vaughan, D. (2015). The Challenger Launch Decision: Risky Technology, Deviance, and Culture at NASA. University of Chicago Press. DOI: 10.7208/chicago/9780226346960.001.0001
Wilbanks, Bryan A. PhD, DNP, CRNA. Evaluation of Methods to Measure Production Pressure: A Literature Review. Journal of Nursing Care Quality 35(2):p E14-E19, April/June 2020. | DOI: 10.1097/NCQ.0000000000000411
Welcome to the Choosing Wisely Campaign series! This is the fourth episode of a 5-part series exploring the ABIM Foundation’s Choosing Wisely Lists. This campaign aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures.
Our third case-based episode presents a child with fever and cough. After a clear discussion of the case and thoughtful consideration of the etiology and treatment strategies, we use the AAP’s Choosing Wisely Hospital Medicine and Infectious Diseases lists to create a resource-conscious care plan that is safe and patient-centered.
In the coming episodes, we’ll explore the pediatric lists and apply our knowledge to cases of common presentations seen in primary and acute care pediatrics.
Series Learning Objectives:
- Introduction to the Choosing Wisely Campaign: Understand the origins, historical precedent, and primary goals of the campaign.
- Case-Based Applications: Explore five common presentations in primary and acute care pediatrics, applying concepts from various Choosing Wisely lists to guide management and resource stewardship.
- Effective Communication: Learn strategies for engaging in tough conversations with parents and colleagues to create allies and ensure evidence-based practices are followed.
Modified rMETRIQ Score: 14/15
Competencies:
AACN Essentials:
- 1: 1.1 g; 1.2 f; 1.3 d, e
- 2: 2.1 d, e; 2.2 g; 2.4 f, g; 2.5 h, i, j, k
- 7: 7.2 g, h, k
- 9: 9.1i, j; 9.2 i, j; 9.3 i, k
NONPF NP Core Competencies:
- 1: NP 1.1h; NP 1.2 k, m; NP 1.3 f, j, h
- 2: NP 2.1 j, g; NP 2.2 k, n; NP 2.4 h, i; NP 2.5 k, l, m, n, o
- 7: NP 7.2 m
- 9: NP 9.1 m, n; NP 9.2 n; NP 9.3 p
References
ABIM Foundation. (2019). Communicating about overuse with vulnerable populations. Retrieved from https://www.choosingwisely.org/files/Communicating-About-Overuse-to-Vulnerable-Population_Final2.pdf
American Academy of Pediatrics [AAP] Committee on Infectious Diseases & Pediatric Infectious Diseases Society. (2018). Five things physicians and patients should question. Retrieved from https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWInfectiousDisease.pdf
de Benedictis, F. M., Kerem, E., Chang, A. B., Colin, A. A., Zar, H. J., & Bush, A. (2020). Complicated pneumonia in children. Lancet (London, England), 396(10253), 786–798. https://doi.org/10.1016/S0140-6736(20)31550-6
Kato, H. (2024) Antibiotic therapy for bacterial pneumonia. J Pharm Health Care Sci 10, 45. https://doi.org/10.1186/s40780-024-00367-5
Schlapbach, L. J., Watson, R. S., Sorce, L. R., Argent, A. C., Menon, K., Hall, M. W., Akech, S., Albers, D. J., Alpern, E. R., Balamuth, F., Bembea, M., Biban, P., Carrol, E. D., Chiotos, K., Chisti, M. J., DeWitt, P. E., Evans, I., Flauzino de Oliveira, C., Horvat, C. M., Inwald, D., … Society of Critical Care Medicine Pediatric Sepsis Definition Task Force (2024). International Consensus Criteria for Pediatric Sepsis and Septic Shock. JAMA, 331(8), 665–674. https://doi.org/10.1001/jama.2024.0179
Smith, D. K., Kuckel, D. P., & Recidoro, A. M. (2021). Community-Acquired Pneumonia in Children: Rapid Evidence Review. American family physician, 104(6), 618–625.
Society of Hospital Medicine, AAP, & Academic Pediatric Association. (2021). Five things physicians and patients should question. Retrieved from https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWHospitalmedicine.pdf
Yun K. W. (2024). Community-acquired pneumonia in children: updated perspectives on its etiology, diagnosis, and treatment. Clinical and experimental pediatrics, 67(2), 80–89. https://doi.org/10.3345/cep.2022.01452
Welcome to the Choosing Wisely Campaign series! This is the third episode of a 5-part series exploring the ABIM Foundation’s Choosing Wisely Lists. This campaign aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures.
Our second case-based episode presents an infant with diarrhea and diaper dermatitis. After a clear discussion of the case and thoughtful consideration of the etiology and treatment strategies, we use the AAP’s Choosing Wisely dermatology and gastroenterology, hepatology, and nutrition lists to create a resource-conscious care plan that is safe and patient-centered.
In the coming episodes, we’ll explore the pediatric lists and apply our knowledge to cases of common presentations seen in primary and acute care pediatrics.
Series Learning Objectives:
- Introduction to the Choosing Wisely Campaign: Understand the origins, historical precedent, and primary goals of the campaign.
- Case-Based Applications: Explore five common presentations in primary and acute care pediatrics, applying concepts from various Choosing Wisely lists to guide management and resource stewardship.
- Effective Communication: Learn strategies for engaging in tough conversations with parents and colleagues to create allies and ensure evidence-based practices are followed.
Modified rMETRIQ Score: 15/15
Competencies:
AACN Essentials:
- 1: 1.1 g, 1.2f, 1.3de
- 2: 2.1 de, 2.2g, 2.4fg, 2.5 hijk
- 7: 7.2 ghk
- 9: 9.1ij, 9.2ij, 9.3ik
NONPF NP Core Competencies:
- 1: NP1.1h, NP 1.2km, NP 1.3fjh
- 2: NP2.1jg, NP2.2kn, NP 2.4hi, NP2.5 klmno
- 7: NP7.2m
- 9: NP9.1mn, NP9.2n, NP9.3p
References
ABIM Foundation. (2019). Communicating about overuse with vulnerable populations. Retrieved from https://www.choosingwisely.org/files/Communicating-About-Overuse-to-Vulnerable-Population_Final2.pdf
AAP Section on Dermatology. (2021). Five things physicians and patients should question. https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWDermatology.pdf
AAP Section on Gastroenterology, Hepatology, and Nutrition. (2023). Five things physicians and patients should question. https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWGastroenterology.pdf
Harriet Lane Service (Johns Hopkins Hospital), Anderson, C. C., Kapoor, S., & Mark, T. E. (2024). The Harriet Lane handbook: a manual for pediatric house officers (23rd ed.). Elsevier.
Jauregui, J., Nelson, D., Choo, E., Stearns, B., Levine, A. C., Liebmann, O., & Shah, S. P. (2014). External validation and comparison of three pediatric clinical dehydration scales. PloS one, 9(5), e95739. https://doi.org/10.1371/journal.pone.0095739
Johnson, H., & Yu, J. (2022). Current and Emerging Therapies in Pediatric Atopic Dermatitis. Dermatology and therapy, 12(12), 2691–2703. https://doi.org/10.1007/s13555-022-00829-4
Semon, A. K., Keenan, O., & Zackular, J. P. (2021). Clostridioides difficile and the Microbiota Early in Life. Journal of the Pediatric Infectious Diseases Society, 10(Supplement_3), S3–S7. https://doi.org/10.1093/jpids/piab063
Welcome to the Choosing Wisely Campaign series! This is the second episode of a 6-part series exploring the ABIM Foundation’s Choosing Wisely Lists. This campaign aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures.
The first of our case-based episodes presents a school age child with syncope. After a clear discussion of the case and thoughtful consideration of an acute care differential, we use the AAP’s Choosing Wisely cardiac list to create a resource-conscious care plan that is safe and patient-centered.
In the coming episodes, we’ll explore the pediatric lists and apply our knowledge to cases of common presentations seen in primary and acute care pediatrics.
Series Learning Objectives:
- Introduction to the Choosing Wisely Campaign: Understand the origins, historical precedent, and primary goals of the campaign.
- Case-Based Applications: Explore five common presentations in primary and acute care pediatrics, applying concepts from various Choosing Wisely lists to guide management and resource stewardship.
- Effective Communication: Learn strategies for engaging in tough conversations with parents and colleagues to create allies and ensure evidence-based practices are followed.
Competencies:
AACN Essentials:
- 1: 1.1 g, 1.2f
- 2: 2.1 de, 2.2g, 2.5 ij
- 6: 6.1 i
- 7: 7.2 ghk
- 9: 9.1ij, 9.2ij, 9.3ik
NONPF NP Core Competencies:
- 1: NP1.1h, NP 1.2km
- 2: NP2.1jg, NP2.2kn, NP2.5 lo
- 6: NP6.1o
- 7: NP7.2m
- 9: NP9.1mn, NP9.2n, NP9.3p
References:
AAP Section on Cardiology and Cardiac Surgery. (2020). Five things physicians and patients should question. https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWCardio.pdf
Gilpin, K., & Goode, Z. (2024). Syncope. Pediatrics in review, 45(10), 606–608. https://doi.org/10.1542/pir.2023-006053
Welcome to the Choosing Wisely Campaign series! This 6-part series will explore the ABIM Foundation’s Choosing Wisely Campaign, its historical precedent, and its goals. We will discuss how this initiative aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures.
The introduction episode dives into the historic 2010 editorial in the New England Journal of Medicine that inspired over 80 professional societies to write their “Top 5 Lists” of tests and procedures that could be avoided in evidence-based care. To better understand the problem, we then pick apart the survey that provided insight into why we over order and the harm it causes to vulnerable populations.
In the coming episodes, we’ll explore the pediatric lists and apply our knowledge to cases of common presentations seen in primary and acute care pediatrics.
Author: Becky Carson, DNP, APRN, CPNP-PC/AC
www.thepedsnp.com
Instagram: @thepedsnppodcast
Series Learning Objectives:
- Introduction to the Choosing Wisely Campaign: Understand the origins, historical precedent, and primary goals of the campaign.
- Case-Based Applications: Explore five common presentations in primary and acute care pediatrics, applying concepts from various Choosing Wisely lists to guide management and resource stewardship.
- Effective Communication: Learn strategies for engaging in tough conversations with parents and colleagues to create allies and ensure evidence-based practices are followed.
Competencies:
AACN Essentials:
- 1: 1.1 g, 1.2f
- 2: 2.1 de, 2.2g, 2.5 ij
- 6: 6.1 i
- 7: 7.2 ghk
- 9: 9.1ij, 9.2ij, 9.3ik
NONPF NP Core Competencies:
- 1: NP1.1h, NP 1.2km
- 2: NP2.1jg, NP2.2kn, NP2.5 lo
- 6: NP6.1o
- 7: NP7.2m
- 9: NP9.1mn, NP9.2n, NP9.3p
Modified rMETRIQ Score: 15/15
Learn more about our peer review process at www.thepedsnp.com/peerreview
References:
ABIM Foundation. (2019). Communicating about overuse with vulnerable populations. Retrieved from https://www.choosingwisely.org/files/Communicating-About-Overuse-to-Vulnerable-Population_Final2.pdf
Brody, H. (2010). Medicine's ethical responsibility for health care reform--the Top Five list. The New England journal of medicine, 362(4), 283–285. https://doi.org/10.1056/NEJMp0911423
Lipitz-Snyderman, A., & Bach, P. B. (2013). Overuse of health care services: when less is more … more or less. JAMA internal medicine, 173(14), 1277–1278. https://doi.org/10.1001/jamainternmed.2013.6181
PerryUndem Research/Communication. (2014). Unnecessary tests and procedures in the health care system. Retrieved from https://www.choosingwisely.org/files/Final-Choosing-Wisely-Survey-Report.pdf
Smith-Bindman, R., Chu, P. W., Azman Firdaus, H., Stewart, C., Malekhedayat, M., Alber, S., Bolch, W. E., Mahendra, M., Berrington de González, A., & Miglioretti, D. L. (2025). Projected Lifetime Cancer Risks From Current Computed Tomography Imaging. JAMA internal medicine, e250505. Advance online publication. https://doi.org/10.1001/jamainternmed.2025.0505
Wyman, O. (2019). Right Place, Right Time: Health Information & Vulnerable Populations. https://www.oliverwyman.com/RightPlaceRightTime.html
This is the final episode of The Peds NP Acute Care PNP Faculty series. The series was created and peer-reviewed by national leaders in acute care PNP education in collaboration to meet the needs of our current and future colleagues. In the push for competency-based education where faculty verify the skills of what a student can do, rather than their knowledge, our series focuses on the application of didactic content with a practical approach so that you can learn nuances of clinical skills before you reach the bedside.
As I come to an end of my time as a faculty member at the Catholic University of America and our Acute Care PNP Faculty series, I remember my graduation from Johns Hopkins. These terminal moments are likened to a graduation, and serve as a wonderful time for reflection. The episode recollects the student speaker commencement address given at my graduation, filled with vehicular metaphors and acknowledgements of failure. A common theme of “Onward” is woven throughout to remind listeners that, at whatever graduation you find yourself celebrating right now, be hopeful and excited at the good that is left to do in the world.
The Peds NP will return in 2025 from Duke University…
Author: Becky Carson, DNP, APRN, CPNP-PC/AC
Peer Review:
This episode was peer reviewed using a modified revised METRIQ (rMETRIQ) Score. Learn more about The Peds NP's formal peer review process at www.thepedsnp.com/peerreview
rMETRIQ Score: 13/15
What does this score mean? This episode underwent a formal quality assurance and peer review process. It received a lower score because of the editorial nature of the content that could not achieve the highest score for question 4 criteria.
Financial disclosures/conflicts of interest: None
Connect with The Peds NP
email: thepedsnp@gmail.com
Instagram: @thepedsnppodcast
References:
Carson, R.A. (2024). Student speaker commencement address [Speech transcript]. Johns Hopkins School of Nursing Commencement. https://alumni.jhu.edu/commencement-2016(Original work published 2016).
Welcome to The Peds NP Acute Care Faculty series! This series was created and peer-reviewed by national leaders in acute care PNP education collaborating with one another to meet the needs of our current and future colleagues. In the push for competency-based education where faculty verify the skills of what a student can do, rather than their knowledge, our series focuses on the application of didactic content with a practical approach so that you can learn nuances of clinical skills before you reach the bedside.
This episode reviews the features of a patient presentation in the pediatric intensive care unit (PICU) and goes in depth on how learners can incorporate trends, new findings, and summaries into a succinct discussion in family-centered rounds. After an introduction with some general best practices, the guide begins with effective pre-rounding and progresses to the step-by-step components of a PICU patient presentation. The template describes each component’s contents in detail, followed immediately by an example to demonstrate the practical application of each concept… “It might sound something like this:”... This episode is a valuable tool for any pediatric provider seeking to increase their skills in succinct synthesis and patient presentations, regardless of clinical setting.
This episode was peer reviewed by The Peds NP faculty series peer review team. You can read about our novel and scholarly approach to peer review, review our faculty lineup, and learn more about the series, competency mapping, references, and show notes at www.thepedsnp.com. There was no financial support or conflicts of interest to report. Follow me on Instagram @thepedsnppodcast. Email me at thepedsnp@gmail.com. Remember that this isn’t just a podcast, you’re listening for the kids.
Authors (alphabetical): Jackie Calhoun, DNP, CRNP, CPNP-AC, CCRN, Becky Carson, DNP, APRN, CPNP-PC/AC, Lena Oliveros, MSN, CPNP-AC, Priscila Reid, DNP, APRN, FNP-C, CPNP-AC
Peer Review:
This episode was peer reviewed using a modified revised METRIQ (rMETRIQ) Score. Learn more about The Peds NP's formal peer review process at www.thepedsnp.com/peerreview
rMETRIQ Score: 15/15
What does this score mean? This episode underwent a quality assurance process using formal peer review and achieved the top scores based on established quality criteria for podcasts.
Financial disclosures/conflicts of interest: None
Connect with The Peds NP
email: thepedsnp@gmail.com
Instagram: @thepedsnppodcast
References:
Bolick, B.N., Reuter-Rice, K., Madden, M.A., Severin, P.N. (2020). Pediatric Acute Care: A guide for Interprofessional Practice (2nd ed.). Jones & Barlett Learning. Burlington, MA.
Oubre, R. (2024). Systems versus problem-based notes. Dr. Oubre’s Digest. https://droubredigest.beehiiv.com/p/systems-versus-problems-based-notes
Stanford Medicine. (nd). Coaching best practices– Presenting a patient. https://med.stanford.edu/content/dam/sm/peds/documents/Program%20Information/coaching/Coaching%20Feedback%20Summary_Presenting%20a%20Patient.pdf
UC San Diego School of Medicine. (2018). Overview and general information about oral presentation. Practical Guide to Clinical Medicine. https://meded.ucsd.edu/clinicalmed/oral.html
Welcome to The Peds NP Acute Care Faculty series! This series was created and peer-edited by national leaders in acute care PNP education collaborating with one another to meet the needs of our future colleagues. In the push for competency-based education where faculty verify the skills of what a student can do, rather than their knowledge, our series focuses on the application of didactic content with a practical approach so that you can learn nuances of clinical skills before you reach the bedside.
*This is the second episode in a 2 part series on enteral feeding. Listen to Episode 75: Malnutrition and Feeding Tube Selection first.
This episode walks through the decision-making for which enteral formula to select based on the patient's age, protein needs, and GI function. A list of commercially available examples is listed for each age group and protein type. Fluid and caloric goals are discussed to determine if concentrated formulas are appropriate. Lastly, the process of starting continuous feeds and advancing to bolus feeds while assessing for tolerance is reviewed. Build functional skills by following along with a case study that is continued from the prior episode. It's proof that there's more than just formula that goes into tube feedings.
Authors: Becky Carson, DNP, APRN, CPNP-PC/AC, Jessica D. Murphy, DNP, CPNP-AC, CPHON, CNE, & Marian Malone, DNP, APRN, CPNP-AC/PC
References:
Bechtold, M. L., Brown, P. M., Escuro, A., Grenda, B., Johnston, T., Kozeniecki, M., Limketkai, B. N., Nelson, K. K., Powers, J., Ronan, A., Schober, N., Strang, B. J., Swartz, C., Turner, J., Tweel, L., Walker, R., Epp, L., & Malone, A. (2022). When is enteral nutrition indicated? Journal of Parenteral and Enteral Nutrition, 46(7), 1470–1496. https://doi.org/10.1002/jpen.2364
Becker, P., Carney, L. N., Corkins, M. R., Monczka, J., Smith, E., Smith, S. E., Spear, B. A., & White, J. V. (2014). Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition. Nutrition in Clinical Practice, 30(1), 147–161. https://doi.org/10.1177/0884533614557642
Green Corkins, K. (2015). Nutrition‐focused physical examination in pediatric patients. Nutrition in Clinical Practice, 30(2), 203–209. https://doi.org/10.1177/0884533615572654
Hess, L., & Crossen, J. (2008). Pediatric Nutrition Handbook (3rd ed.). Cincinnati Children’s.
Mehta, N. M., Skillman, H. E., Irving, S. Y., Coss-Bu, J. A., Vermilyea, S., Farrington, E. A., McKeever, L., Hall, A. M., Goday, P. S., & Braunschweig, C. (2017). Guidelines for the provision and assessment of Nutrition Support Therapy in the pediatric critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Pediatric Critical Care Medicine, 18(7), 675–715. https://doi.org/10.1097/pcc.0000000000001134
Panchal, A. K., Manzi, J., Connolly, S., Christensen, M., Wakeham, M., Goday, P. S., & Mikhailov, T. A. (2014). Safety of enteral feedings in critically ill children receiving vasoactive agents. Journal of Parenteral and Enteral Nutrition, 40(2), 236–241. https://doi.org/10.1177/0148607114546533
Yi, Dae Young. (2018). Enteral nutrition in pediatric patients. Pediatric Gastroenterology, Hepatology & Nutrition, 21(1), 12-19. http://doi.org/10.5223/pghn.2018.21.1.12
Welcome back to The Peds NP Acute Care Faculty series! This series was created and peer-reviewed by national leaders in acute care PNP education collaborating with one another to meet the needs of our current and future colleagues. In the push for competency-based education where faculty verify the skills of what a student can do, rather than their knowledge, our series focuses on the application of didactic content with a practical approach so that you can learn nuances of clinical skills before you reach the bedside.
This episode begins with a brief review of malnutrition and pediatric nutritional assessment in acute care settings. Next we begin a choose-your-own-nutrition adventure by asking a series of questions that aid in medical decision-making for which nutrition route is appropriate, and, if enteral feeding is best, then determines the type of tube indicated. A case-based discussion with examples helps you to apply the concepts to a complex scenario. Our next episode will focus on formula selection, the initiation of feeds, and assessment of tolerance.
Authors: Becky Carson, DNP, APRN, CPNP-PC/AC, Jessica D. Murphy, DNP, CPNP-AC, CPHON, CNE, & Marian Malone, DNP, APRN, CPNP-AC/PC
References:
Bechtold, M. L., Brown, P. M., Escuro, A., Grenda, B., Johnston, T., Kozeniecki, M., Limketkai, B. N., Nelson, K. K., Powers, J., Ronan, A., Schober, N., Strang, B. J., Swartz, C., Turner, J., Tweel, L., Walker, R., Epp, L., & Malone, A. (2022). When is enteral nutrition indicated? Journal of Parenteral and Enteral Nutrition, 46(7), 1470–1496. https://doi.org/10.1002/jpen.2364
Becker, P., Carney, L. N., Corkins, M. R., Monczka, J., Smith, E., Smith, S. E., Spear, B. A., & White, J. V. (2014). Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition. Nutrition in Clinical Practice, 30(1), 147–161. https://doi.org/10.1177/0884533614557642
Green Corkins, K. (2015). Nutrition‐focused physical examination in pediatric patients. Nutrition in Clinical Practice, 30(2), 203–209. https://doi.org/10.1177/0884533615572654
Hess, L., & Crossen, J. (2008). Pediatric Nutrition Handbook (3rd ed.). Cincinnati Children’s.
Mehta, N. M., Skillman, H. E., Irving, S. Y., Coss-Bu, J. A., Vermilyea, S., Farrington, E. A., McKeever, L., Hall, A. M., Goday, P. S., & Braunschweig, C. (2017). Guidelines for the provision and assessment of Nutrition Support Therapy in the pediatric critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Pediatric Critical Care Medicine, 18(7), 675–715. https://doi.org/10.1097/pcc.0000000000001134
Panchal, A. K., Manzi, J., Connolly, S., Christensen, M., Wakeham, M., Goday, P. S., & Mikhailov, T. A. (2014). Safety of enteral feedings in critically ill children receiving vasoactive agents. Journal of Parenteral and Enteral Nutrition, 40(2), 236–241. https://doi.org/10.1177/0148607114546533
Yi, Dae Young. (2018). Enteral nutrition in pediatric patients. Pediatric Gastroenterology, Hepatology & Nutrition, 21(1), 12-19. http://doi.org/10.5223/pghn.2018.21.1.12
Meditation begins at 2:00.
This 5-minute meditation for pediatric providers is designed to help you center your day before your work to boost your wellness, improve resilience, and connect better with yourself, your patients, and your colleagues.
First we’ll create a peaceful environment and establish the ground rules of meditation, then get your body into position. The guided meditation takes you through 5 minutes of breath to help you calm your mind and body while making room for empathy and patience. No judgment, but lots of kindness and compassion for your thoughts and feelings. The session ends by bringing body and mind back into your space and showing gratitude for the practice. Use this meditation every day before you go to work with infants, children, adolescents, and young adults to improve your wellness and their outcomes.
References:
The Meditation Initiative. (nd). 5 minute guided meditation script. https://meditationinitiative.org/5-minute-meditation-script
Mindful. (2024). How to start your day with meditation. https://www.mindful.org/how-to-start-your-day-with-meditation/
Welcome back to The Peds NP Acute Care Faculty series! This series was created and peer-reviewed by national leaders in acute care PNP education collaborating with one another to meet the needs of our current and future colleagues. In the push for competency-based education where faculty verify the skills of what a student can do, rather than their knowledge, our series focuses on the application of didactic content with a practical approach so that you can learn nuances of clinical skills before you reach the bedside.
This episode explores wellness for the pediatric nurse practitioner. We first discuss burnout in terms of its physical and mental impact on the provider as well as poorer patient outcomes and healthcare systems burdens. After we identify symptoms of burnout and compassion fatigue, we’ll discuss what wellness looks like in various systems at work from organizational culture of wellness to ease of daily work and finally personal resilience. We end with a discussion on self-compassion and introduce the evidence in support of meditation as a strategy to promote mind-body wellness. For some, this concept is new, so the technical aspects of meditation are unpacked to facilitate your own path to daily wellness. This episode pairs well with the 5-minute meditation for pediatric providers.
References:
Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: care, health, and cost. Health affairs (Project Hope), 27(3), 759–769. https://doi.org/10.1377/hlthaff.27.3.759
Chan, G. K., Kuriakose, C., Blacker, A., Harshman, J., Kim, S., Jordan, L., & Shanafelt, T. D. (2021). An organizational initiative to assess and improve well-being in advanced practice providers. Journal of Interprofessional Education & Practice, 25, 100469-. https://doi.org/10.1016/j.xjep.2021.100469
Green, A. A., & Kinchen, E. V. (2021). The Effects of Mindfulness Meditation on Stress and Burnout in Nurses. Journal of holistic nursing : official journal of the American Holistic Nurses' Association, 39(4), 356–368. https://doi.org/10.1177/08980101211015818
Kabat-Zinn, J. (2005). Wherever You Go There You are (10th ed.). Hyperion
Kriakous, S. A., Elliott, K. A., Lamers, C., & Owen, R. (2021). The Effectiveness of Mindfulness-Based Stress Reduction on the Psychological Functioning of Healthcare Professionals: a Systematic Review. Mindfulness, 12(1), 1–28. https://doi.org/10.1007/s12671-020-01500-9
Leiter, M. P., & Maslach, C. (2004). Areas of worklife: A structured approach to organizational predictors of job burnout. In P. L. Perrewé & D. C. Ganster (Eds.), Emotional and physiological processes and positive intervention strategies (pp. 91–134). Elsevier Science/JAI Press.
Lennon, Y. (2023). The quintuple aim: What it is and why does it matter? Chess Health Solutions. https://www.chesshealthsolutions.com/2023/08/01/the-quintuple-aim-what-is-it-and-why-does-it-matter/#:~:text=The%20Quintuple%20Aim%20is%20an,system%20to%20establish%20health%20equity.
Makary, M. A., & Daniel, M. (2016). Medical error-the third leading cause of death in the US. BMJ (Clinical research ed.), 353, i2139. https://doi.org/10.1136/bmj.i2139
Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual review of psychology, 52, 397–422. https://doi.org/10.1146/annurev.psych.52.1.397
National Wellness Institute. (2024). NWI’s six dimensions of wellness. https://nationalwellness.org/resources/six-dimensions-of-wellness/#:~:text=Wellness%20is%20a%20conscious%2C%20self,a%20long%20and%20healthy%20life.
Neff, K. D. (2023). Self-Compassion: Theory, Method, Research, and Intervention. Annual Review of Psychology, 74(1), 193–218. https://doi.org/10.1146/annurev-psych-032420-031047
Panagioti, M., Khan, K., Keers, R. N., Abuzour, A., Phipps, D., Kontopantelis, E., Bower, P., Campbell, S., Haneef, R., Avery, A. J., & Ashcroft, D. M. (2019). Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. BMJ (Clinical research ed.), 366, l4185. https://doi.org/10.1136/bmj.l4185
Peters E. (2018). Compassion fatigue in nursing: A concept analysis. Nursing forum, 53(4), 466–480. https://doi.org/10.1111/nuf.12274
Shanafelt, T. D., & Noseworthy, J. H. (2017). Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clinic Proceedings, 92(1), 129–146. https://doi.org/10.1016/j.mayocp.2016.10.004
Shanafelt, T. D., Larson, D., Bohman, B., Roberts, R., Trockel, M., Weinlander, E., Springer, J., Wang, H., Stolz, S., & Murphy, D. (2023). Organization-Wide Approaches to Foster Effective Unit-Level Efforts to Improve Clinician Well-Being. Mayo Clinic Proceedings, 98(1), 163–180. https://doi.org/10.1016/j.mayocp.2022.10.031
Welcome to The Peds NP Acute Care Faculty series! This collaborative series was created and peer-reviewed by national experts and leaders in acute care PNP education to meet the needs of our current and future colleagues. In the push for competency-based education where faculty verify the skills of what a student can do, rather than their knowledge, our series focuses on the application of didactic content with a practical approach so that you can learn nuances of clinical skills before you reach the bedside.
This episode applies the concepts from the prior episode on “Delivering Bad News” (S11 Ep. 71) to a few examples where HIV status was disclosed to a pediatric patient. After reflection and discussion of a few ethical principles important to consent/assent, it’s time to practice delivering bad news in a case study. An unfolding case poses questions to get you thinking about what you might say. Make it interactive by pausing your podcast and answer the question yourself. The case walks you step-by-step through the process of delivering bad news to a child and their family using the SPIKES protocol. There's no perfect answer, but this example helps to prepare you for competency-based learning, so that you’re ready to deliver bad news in practice.
Authors (alphabetical): Becky Carson, DNP, APRN, CPNP-PC/AC, Ann Felauer, DNP, APRN, CPNP-PC/AC, Belinda Large, DNP, APRN, CPNP-PC/AC, and Robynn Stamm, DNP, APRN, CPNP-PC/AC
References
Brouwer, M. A., Maeckelberghe, E. L. M., van der Heide, A., Hein, I. M., & Verhagen, E. A. A. E. (2021). Breaking bad news: what parents would like you to know. Archives of disease in childhood, 106(3), 276–281. https://doi.org/10.1136/archdischild-2019-318398
Cassim, S., Kidd, J., Keenan, R., Middleton, K., Rolleston, A., Hokowhitu, B., Firth, M., Aitken, D., Wong, J., & Lawrenson, R. (2021). Indigenous perspectives on breaking bad news: ethical considerations for healthcare providers. Journal of medical ethics, medethics-2020-106916. Advance online publication. https://doi.org/10.1136/medethics-2020-106916
Field, M.J. & Behrman, R.E. (2003). When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. Chapter 4 communication, goal setting, and care planning. Committee on Palliative and End-of-Life Care for Children and Their Families. Institute of Medicine (US)
Holmes, S. N., & Illing, J. (2021). Breaking bad news: tackling cultural dilemmas. BMJ supportive & palliative care, 11(2), 128–132. https://doi.org/10.1136/bmjspcare-2020-002700
Kaplan, M. (2010). SPIKES: A framework for breaking bad news to patients with cancer. Clinical Journal of Oncology Nursing, 14(4), 514-516. https://cjon.ons.org/cjon/14/4/spikes-framework-breaking-bad-news-patients-cancer
Kumar, V., & Sarkhel, S. (2023). Clinical Practice Guidelines on Breaking Bad News. Indian journal of psychiatry, 65(2), 238–244. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_498_22
Labaf, A., Jahanshir, A., Baradaran, H., & Shahvaraninasab, A. (2015). Is it appropriate to use Western guidelines for breaking bad news in non-Western emergency departments? A patients’ perspective. Clinical Ethics, 10(1–2), 13–21. https://doi.org/10.1177/1477750915581797
Monden, K. R., Gentry, L., & Cox, T. R. (2016). Delivering bad news to patients. Proceedings (Baylor University. Medical Center), 29(1), 101–102. https://doi.org/10.1080/08998280.2016.11929380
Mostafavian, Z., Shaye, Z. A., & Farajpour, A. (2018). Mothers' preferences toward breaking bad news about their children cancer. Journal of family medicine and primary care, 7(3), 596–600. https://doi.org/10.4103/jfmpc.jfmpc_342_17
Welcome back to The Peds NP Acute Care Faculty series! This collaborative series was created and peer-reviewed by national experts and leaders in acute care PNP education. In the push for competency-based education where faculty verify the skills of what a learner can do, rather than their knowledge, our series focuses on the application of didactic content with a practical approach in a conversational way so that you can learn the nuances of clinical skills before you reach the bedside.
This episode discusses a standardized approach to delivering bad news, founded in the literature. The SPIKES protocol is the most well recognized approach to create an environment, assess patient and family knowledge and preferences, deliver the news compassionately, and empathize prior to a summary. With examples of phrasing you can offer at each step, you’ll gain the skills necessary to deliver bad news.
Authors (alphabetical): Becky Carson, DNP, APRN, CPNP-PC/AC, Ann Felauer, DNP, APRN, CPNP-PC/AC, Belinda Large, DNP, APRN, CPNP-PC/AC, and Robynn Stamm, DNP, APRN, CPNP-PC/AC
References:
Brouwer, M. A., Maeckelberghe, E. L. M., van der Heide, A., Hein, I. M., & Verhagen, E. A. A. E. (2021). Breaking bad news: what parents would like you to know. Archives of disease in childhood, 106(3), 276–281. https://doi.org/10.1136/archdischild-2019-318398
Buckman R. (1984). Breaking bad news: why is it still so difficult?. British medical journal (Clinical research ed.), 288(6430), 1597–1599. https://doi.org/10.1136/bmj.288.6430.1597
Buckman R. (2001). Communication skills in palliative care: a practical guide. Neurologic clinics, 19(4), 989–1004. https://doi.org/10.1016/s0733-8619(05)70057-8
Institute of Medicine (US) Committee on Palliative and End-of-Life Care for Children and Their Families, Field, M. J., & Behrman, R. E. (Eds.). (2003). When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. Chapter 4 communication, goal setting, and care planning. National Academies Press (US).
Kaplan M. (2010). SPIKES: a framework for breaking bad news to patients with cancer. Clinical journal of oncology nursing, 14(4), 514–516. https://doi.org/10.1188/10.CJON.514-516
Ptacek, J. T., & Eberhardt, T. L. (1996). Breaking bad news. A review of the literature. JAMA, 276(6), 496–502.
Sisk, B., Frankel, R., Kodish, E., & Harry Isaacson, J. (2016). The Truth about Truth-Telling in American Medicine: A Brief History. The Permanente journal, 20(3), 15–219. https://doi.org/10.7812/TPP/15-219
Varkey B. (2021). Principles of Clinical Ethics and Their Application to Practice. Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 30(1), 17–28. https://doi.org/10.1159/000509119
Welcome back to The Peds NP Acute Care Faculty series! This series was created and peer-reviewed by national leaders in acute care PNP education collaborating with one another to meet the needs of our current and future colleagues. In the push for competency-based education where faculty verify the skills of what a student can do, rather than their knowledge, our series focuses on the application of didactic content with a practical approach so that you can learn nuances of clinical skills before you reach the bedside.
For many scholars, the poster and its prerequisite abstract are the first product of dissemination of their work. This episode guides the new scholar through the entire process– from selecting a conference destination, writing the abstract in a concise manner, creation of the poster, and the poster session at the conference. Key pearls and pitfalls of abstract submission, the use of artificial intelligence, and your final poster presentation complete the beginner’s guide to dissemination.
This episode was peer reviewed by The Peds NP faculty series peer review team. You can read about our novel and scholarly approach to peer review, review our faculty lineup, and learn more about the series, competency mapping, references, and show notes at www.thepedsnp.com. There was no financial support or conflicts of interest to report. Follow me on Instagram @thepedsnppodcast. Email me at thepedsnp@gmail.com. Remember that this isn’t just a podcast, you’re listening for the kids.
Authors: (alphabetical) Becky Carson, DNP, APRN, CPNP-PC/AC and Mike Maymi, DNP, APRN, CPNP-AC, CCRN, CNE
References:
Barker, E., & Phillips, V.. (2021). Creating conference posters: Structure, form and content. Journal of Perioperative Practice, 31(7-8), 296–299. https://doi.org/10.1177/1750458921996254
Dave, T., Athaluri, S. A., & Singh, S. (2023). ChatGPT in medicine: an overview of its applications, advantages, limitations, future prospects, and ethical considerations. Frontiers in artificial intelligence, 6, 1169595. https://doi.org/10.3389/frai.2023.1169595
Drury, A., Pape, E., Dowling, M., Miguel, S., Fernández-Ortega, P., Papadopoulou, C., & Kotronoulas, G. (2023). How to Write a Comprehensive and Informative Research Abstract. Seminars in oncology nursing, 39(2), 151395. https://doi.org/10.1016/j.soncn.2023.151395
Freysteinson, W. M., & Stankus, J. A. (2019). The Language of Scholarship: How to Write an Abstract That Tells a Compelling Story. Journal of continuing education in nursing, 50(3), 107–108. https://doi.org/10.3928/00220124-20190218-04
Welcome back to The Peds NP Acute Care Faculty series! This series was created and peer-edited by national leaders in acute care PNP education collaborating with one another to meet the needs of our current and future colleagues. In the push for competency-based education where faculty verify the skills of what a student can do, rather than their knowledge, our series focuses on the application of didactic content with a practical approach so that you can learn nuances of clinical skills before you reach the bedside.
This episode guides the novice pediatric provider on creations of an acute care differential diagnosis. It starts with a story about a Southerner in a snowstorm and the unfortunate car problem that resulted from an unexpected guest in the engine. A clear parallel ties the mechanic’s diagnosis with a few amateur onomatopoeias (“clunk, clunk, clunk”) with the skills needed to form illness scripts and develop differentials. A brief case study on an adolescent with acidosis introduces the idea of broad differential formation and the importance of a complete evaluation before diagnoses are eliminated. Medical decision-making is difficult, and a systematic approach to differential diagnosis formation is essential. The episode uses simple examples to help listeners apply the concepts and form a differential in real time. The discussion covers the importance of careful accrual of information, initial differential creation using a systematic approach, how to narrow your differential based on key findings of the assessment, and how to approach an open-ended differential honestly with families while avoiding cognitive bias. With the understanding that, “disease exists on a continuum that evolves and we see the patient at a snapshot in time,” the episode offers a step by step guide on how to build a differential. Classic mantras of The Peds NP are finally explained and tied to the development of your acute care differential. Every novice needs to listen to this episode before ever stepping foot in the clinical setting to be prepared for diagnostic reasoning and the process of narrowing your differential.
This episode was peer reviewed by The Peds NP faculty series peer review team. You can read about our novel and scholarly approach to peer review, review our faculty lineup, and learn more about the series, competency mapping, references, and show notes at www.thepedsnp.com. There was no financial support or conflicts of interest to report. Follow me on Instagram @thepedsnppodcast. Email me at thepedsnp@gmail.com. Remember that this isn’t just a podcast, you’re listening for the kids.
Authors (alphabetical): Aimee Bucci DNP, APRN, CPNP-AC, Becky Carson, DNP, APRN, CPNP-PC/AC, & Dani Sebbens, DNP, CPNP-PC/AC
References:
Balogh, E. P., Miller, B. T., Ball, J. R., Committee on Diagnostic Error in Health Care, Board on Health Care Services, Institute of Medicine, & The National Academies of Sciences, Engineering, and Medicine (Eds.). (2015). Improving Diagnosis in Health Care. National Academies Press (US).
Brennan, M.M (2020). Teaching strategy 1: cultivating diagnostic decision-making with problem based learning: from most likely to least likely. Innovative Strategies in Teaching Nursing. doi: 10.1891/9780826161215
Carson, R. A., & Lyles, J. L. (2024). Cognitive Bias in an Infant with Constipation. The Journal of pediatrics, 113996. Advance online publication. https://doi.org/10.1016/j.jpeds.2024.113996
Hammond, M. E. H., Stehlik, J., Drakos, S. G., & Kfoury, A. G. (2021). Bias in Medicine: Lessons Learned and Mitigation Strategies. JACC. Basic to translational science, 6(1), 78–85. https://doi.org/10.1016/j.jacbts.2020.07.012Marshall, T. L., Rinke, M. L., Olson, A. P. J., & Brady, P. W. (2022). Diagnostic Error in Pediatrics: A Narrative Review. Pediatrics, 149(Suppl 3), e2020045948D. https://doi.org/10.1542/peds.2020-045948D
Marshall, T. L., Rinke, M. L., Olson, A. P. J., & Brady, P. W. (2022). Diagnostic Error in Pediatrics: A Narrative Review. Pediatrics, 149(Suppl 3), e2020045948D. https://doi.org/10.1542/peds.2020-045948D
Smith, S.K., Benbenek, M.M., Bakker, C.J., & Bockwoldt, D. (2022). Scoping review: diagnostic reasoning as a component of clinical reasoning in the U.S. primary care nurse practitioner education. Journal of Advanced Nursing, 78:3869-3896. doi: 10.1111/jan.15414
Welcome to The Peds NP Acute Care Faculty series! This collaborative series was created and peer-reviewed by national experts and leaders in acute care PNP education to meet the needs of our current and future colleagues. In the push for competency-based education where faculty verify the skills of what a student can do, rather than their knowledge, our series focuses on the application of didactic content with a conversational approach so that you can learn nuances of clinical skills before you reach the bedside.
This episode welcomes the acute care PNP student to clinical, where you’ll learn important bedside lessons that apply your knowledge to practical situations. Our faculty offered advice on preparation, clinical rotation best practices, and how to finish the rotation successfully. There are key pearls and pitfalls to guide the student toward gaining competency in their newfound skills. We acknowledge those pesky doubts that cause imposter syndrome, and encourage the role of the learner. Through it all, your clinical is what you make of it, and you can be confident that you have the skills to competently enter a new role.
This episode was peer reviewed by The Peds NP faculty series peer review team. You can read about our novel and scholarly approach to peer review, review our faculty lineup, and learn more about the series, competency mapping, references, and show notes at www.thepedsnp.com. There was no financial support or conflicts of interest to report. Follow me on Instagram @thepedsnppodcast. Email me at thepedsnp@gmail.com. Remember that this isn’t just a podcast, you’re listening for the kids.
Authors (alphabetical): Becky Carson, DNP, APRN, CPNP-PC/AC, Brittany Christiansen, PhD, DNP, APRN, CPNP-PC/AC, FNP-C, AE-C, CNE, Julie Kuzin, DNP, APRN, CPNP-PC/AC, Priscila Reid, DNP, FNP-C, CPNP-AC, Dani Sebbens, DNP, CPNP-AC/PC
References:
Carley, A., & Garrett, L. (2022). Supporting Role Knowledge and Role Transition in Neonatal APRN Students. Neonatal network : NN, 41(3), 168–171. https://doi.org/10.1891/11-T-752
Clance, P. R., & Imes, S. A. (1978). The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy: Theory, Research & Practice, 15(3), 241–247. https://doi.org/10.1037/h0086006
Edwards-Maddox S. Burnout and impostor phenomenon in nursing and newly licensed registered nurses: A scoping review. J Clin Nurs. 2023 Mar;32(5-6):653-665. doi: 10.1111/jocn.16475. Epub 2022 Aug 2. PMID: 35918887.
Lee, T., Lee, S. J., Yoon, Y. S., Ji, H., Yoon, S., Lee, S., & Ji, Y. (2023). Personal Factors and Clinical Learning Environment as Predictors of Nursing Students' Readiness for Practice: A Structural Equation Modeling Analysis. Asian nursing research, 17(1), 44–52. https://doi.org/10.1016/j.anr.2023.01.003
Scanlan JM, Laurencelle F, Plohman J. Understanding the impostor phenomenon in graduate nursing students. Int J Nurs Educ Scholarsh. 2023 Dec 7;20(1). doi: 10.1515/ijnes-2022-0058. PMID: 38053510.
White, A., & Rivera, L. (2023). Increasing Student Confidence Prior to an Obstetric Clinical Practicum. Nurse educator, 48(6), E195. https://doi.org/10.1097/NNE.0000000000001381
At the peak of respiratory virus season, bronchiolitis is one of the most common presentations in infants and young toddlers. The characteristic wheeze and prolonged duration of illness can be distressing for parents, who may lack the practical knowledge of how to effectively implement supportive care. When the mainstay of treatment is supportive care without any single curative intervention, you need to be able to discuss the etiology, management, and anticipatory guidance on a level that the parents can understand. This episode introduces the idea of capacity-building family-centered care and takes a granular, detailed approach to improving family understanding and home care education so that you can facilitate better evidence-based care in the unrestricted environment of the home. By arming parents with the knowledge and skills needed to care for their infant at home and the clear, objective return criteria, you’re providing family-centered care and reducing unnecessary visits.
Instagram: @thepedsnppodcast
Show notes and references
thepedsnp.com
Disclaimer
References
Justice NA, Le JK. Bronchiolitis. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441959/
Rha, B., Curns, A. T., Lively, J. Y., Campbell, A. P., Englund, J. A., Boom, J. A., Azimi, P. H., Weinberg, G. A., Staat, M. A., Selvarangan, R., Halasa, N. B., McNeal, M. M., Klein, E. J., Harrison, C. J., Williams, J. V., Szilagyi, P. G., Singer, M. N., Sahni, L. C., Figueroa-Downing, D., McDaniel, D., … Gerber, S. I. (2020). Respiratory Syncytial Virus-Associated Hospitalizations Among Young Children: 2015-2016. Pediatrics, 146(1), e20193611. https://doi.org/10.1542/peds.2019-3611
Suh, M., Movva, N., Jiang, X., Bylsma, L. C., Reichert, H., Fryzek, J. P., & Nelson, C. B. (2022). Respiratory Syncytial Virus Is the Leading Cause of United States Infant Hospitalizations, 2009-2019: A Study of the National (Nationwide) Inpatient Sample. The Journal of infectious diseases, 226(Suppl 2), S154–S163. https://doi.org/10.1093/infdis/jiac120
In the eighth and final episode of the Health Equity in Pediatrics podcast series, the epilogue begins with my inspiration for the series, shares some parting sentiments, and discusses the results and conclusions of the cross-sectional study published in the special DEIB edition of Journal of Pediatric Health Care (March/April 2024). I’ll rewind to my childhood and walk you down the cobblestone brick paths of my hometown, the book that changed my perspective, and the words that helped a podcast create allies. I’ll share the results of the international series and post-survey cross-sectional study. The conclusions will fuel your soul about the series’ impact on listeners and implications for DEI education standardization. Now that you’ve listened, you can be confident that you can make a difference in the equitable care experienced by your patients. After touring the country talking about podcasting and health equity in pediatrics, I’m headed for one last stop in Denver. You’re invited to join me on March 13 at the NAPNAP national conference session 117 for “Scholarly Podcasting 101” where you can learn about quality standards and technology in podcasting, help decide the future of The Peds NP, and envision your own podcast.
Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant. For more information, please community.napnap.org/northcarolinachapter
References
Carson, R.A., Sobolewski, B., & Bowen, F. (2024). Evaluating a health equity podcast for provider practice change: A cross-sectional study. Journal of Pediatric Health Care, in press.
Kapur, G. (2021). To drink from the well: The struggle for equality at the nation’s oldest public university. Blair/Carolina Wren Press.
Nirsevimab is the new FDA-approved monoclonal antibody RSV vaccine for the prevention of severe lower respiratory illness in infants. In this episode, we discuss the current recommendations on who gets the vaccine and when, how to use a lens of health equity to approach the current vaccine shortages, and how to discuss safety and efficacy with vaccine hesitant parents. Now that nirsevimab is on the routine infant immunization schedule, it’s extremely important and pediatric providers understand the recommendations and science behind the monoclonal antibody to help vaccine acceptance that will undoubtedly reduce bronchiolitis hospitalization.
Instagram: @thepedsnppodcast
Show notes and references
thepedsnp.com
Disclaimer
References:
CDC Health Alert Network. (2023). Limited availability of nirsevimab in the United States—Interim CDC recommendations to protect infants from Respiratory Syncytial Virus (RSV) during the 2023–2024 respiratory virus season. Emergency Preparedness and Response. https://emergency.cdc.gov/han/2023/han00499.asp?c
Centers for Disease Control and Prevention. (2023). Frequently asked questions about RSV immunization with monoclonal antibody for children 19 months and younger. Vaccines and Preventable Diseases. https://www.cdc.gov/vaccines/vpd/rsv/hcp/child-faqs.html
Centers for Disease Control and Prevention. (2022). Vaccines for Children Program. https://www.cdc.gov/vaccines/programs/vfc/index.html
Centers for Disease Control and Prevention. (2023). General best practice guidelines for immunization. Vaccine Recommendations and the Guidelines of the ACIP. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html
Jones, J. M., Fleming-Dutra, K. E., Prill, M. M., Roper, L. E., Brooks, O., Sánchez, P. J., Kotton, C. N., Mahon, B. E., Meyer, S., Long, S. S., & McMorrow, M. L. (2023). Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR. Morbidity and mortality weekly report, 72(34), 920–925. https://doi.org/10.15585/mmwr.mm7234a4
Hill, D., & Parga-Belinkie, J. (Host). (2023, August 29). Immunizations special: RSV, Covid, pneumococcal disease, influenza (No. 170) [Audio podcast episode]. In Pediatrics on call. American Academy of Pediatrics. www.aap.org/podcast
Rha, B., Curns, A. T., Lively, J. Y., Campbell, A. P., Englund, J. A., Boom, J. A., Azimi, P. H., Weinberg, G. A., Staat, M. A., Selvarangan, R., Halasa, N. B., McNeal, M. M., Klein, E. J., Harrison, C. J., Williams, J. V., Szilagyi, P. G., Singer, M. N., Sahni, L. C., Figueroa-Downing, D., McDaniel, D., … Gerber, S. I. (2020). Respiratory Syncytial Virus-Associated Hospitalizations Among Young Children: 2015-2016. Pediatrics, 146(1), e20193611. https://doi.org/10.1542/peds.2019-3611
Suh, M., Movva, N., Jiang, X., Bylsma, L. C., Reichert, H., Fryzek, J. P., & Nelson, C. B. (2022). Respiratory Syncytial Virus Is the Leading Cause of United States Infant Hospitalizations, 2009-2019: A Study of the National (Nationwide) Inpatient Sample. The Journal of infectious diseases, 226(Suppl 2), S154–S163. https://doi.org/10.1093/infdis/jiac120
Mental health is one of the greatest health risks encountered by children and adolescents in today’s world. Stigma can be one of the biggest barriers to children being evaluated and treated for mental health problems, particularly in communities that are marginalized. In the final episode of the miniseries on Health Equity in Children, we bring mental health into your everyday conversations to diminish stigma and give mental health the time it deserves to help your patients grow up happy and healthy.
Want to make a bigger difference in health equity? Complete an anonymous survey here after you listen to the episode or visit www.thepedsnp.com and click the “Complete a Survey” button at the top of the page. The responses will provide greater insight into how podcasts impact education and behavior through microlearning of health equity concepts. After you complete a survey, you’ll receive a separate link to enter your email to a raffle for a $15 Amazon gift card. Winners will be chosen at random and notified by email one week after the original publication date. This raffle was made possible by grant funding from the sources below.
Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant. For more information, please community.napnap.org/northcarolinachapter.
References
Bureau of Health Workforce, Health Resources and Services Administration, U. S. Department of Health & Human Services. (2019). Designated health professional shortage areas statistics. Retrieved from https://bhw.hrsa.gov/shortage-designa tion/hpsa-criteria
Cotton, N. K., & Shim, R. S. (2022). Social Determinants of Health, Structural Racism, and the Impact on Child and Adolescent Mental Health. Journal of the American Academy of Child and Adolescent Psychiatry, 61(11), 1385–1389. https://doi.org/10.1016/j.jaac.2022.04.020
Cross, T. L. (1989). Towards a culturally competent system of care: A monograph on effective services for minority children who are severely emotionally disturbed.
Harris, T. B., Udoetuk, S. C., Webb, S., Tatem, A., Nutile, L. M., & Al-Mateen, C. S. (2020). Achieving Mental Health Equity: Children and Adolescents. The Psychiatric clinics of North America, 43(3), 471–485. https://doi.org/10.1016/j.psc.2020.06.001
Nápoles-Springer, A. M., Santoyo, J., Houston, K., Pérez-Stable, E. J., & Stewart, A. L. (2005). Patients' perceptions of cultural factors affecting the quality of their medical encounters. Health expectations : an international journal of public participation in health care and health policy, 8(1), 4–17. https://doi.org/10.1111/j.1369-7625.2004.00298.x
National Association of Pediatric Nurse Practitioners, Developmental and Behavioral Health Special Interest Group, Frye, L., Van Cleve, S., Heighway, S., & Johnson-Smith, A. (2020). NAPNAP position statement on the integration of mental health care in pediatric primary care settings. Journal of Pediatric Health Care, 34(5), p. 514-517, https://doi.org/10.1016/j.pedhc.2020.04.013
Pumariega, A. J., Rothe, E., Mian, A., Carlisle, L., Toppelberg, C., Harris, T., Gogineni, R. R., Webb, S., Smith, J., & American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI) (2013). Practice parameter for cultural competence in child and adolescent psychiatric practice. Journal of the American Academy of Child and Adolescent Psychiatry, 52(10), 1101–1115. https://doi.org/10.1016/j.jaac.2013.06.019
Song, J., Mailick, M. R., & Greenberg, J. S. (2018). Health of parents of individuals with developmental disorders or mental health problems: Impacts of stigma. Social science & medicine (1982), 217, 152–158. https://doi.org/10.1016/j.socscimed.2018.09.044
Telesia, L., Kaushik, A., & Kyriakopoulos, M. (2020). The role of stigma in children and adolescents with mental health difficulties. Current opinion in psychiatry, 33(6), 571–576. https://doi.org/10.1097/YCO.0000000000000644
Waid, J., & Kelly, M. (2020). Supporting family engagement with child and adolescent mental health services: A scoping review. Health & social care in the community, 28(5), 1333–1342. https://doi.org/10.1111/hsc.12947
Walter, H. J., Vernacchio, L., Trudell, E. K., Bromberg, J., Goodman, E., Barton, J., Young, G. J., DeMaso, D. R., & Focht, G. (2019). Five-Year Outcomes of Behavioral Health Integration in Pediatric Primary Care. Pediatrics, 144(1), e20183243. https://doi.org/10.1542/peds.2018-3243
It’s good advice for any pediatric provider to never assume anything. In the sixth episode of the series on Health Equity in Children, we understand how not making assumptions is a best practice for pediatric providers from the evaluation and management of LGBTQ patients, to communicating with diverse families, and serving as an ally in health promotion.
Want to make a bigger difference in health equity? Complete an anonymous survey here after you listen to the episode or visit www.thepedsnp.com and click the “Complete a Survey” button at the top of the page. The responses will provide greater insight into how podcasts impact education and behavior through microlearning of health equity concepts. After you complete a survey, you’ll receive a separate link to enter your email to a raffle for a $15 Amazon gift card. Winners will be chosen at random and notified by email one week after the original publication date. This raffle was made possible by grant funding from the sources below.
Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant. For more information, please community.napnap.org/northcarolinachapter.
References
Brown, C., Frohard-Dourlent, H., Wood, B. A., Saewyc, E., Eisenberg, M. E., & Porta, C. M. (2020). "It makes such a difference": An examination of how LGBTQ youth talk about personal gender pronouns. Journal of the American Association of Nurse Practitioners, 32(1), 70–80. https://doi.org/10.1097/JXX.0000000000000217
Centers for Disease Control and Prevention. (2019). Health disparities among LTGBQ youth. Adolescent and School Health. https://www.cdc.gov/healthyyouth/disparities/health-disparities-among-lgbtq-youth.htm
Coulter-Thompson, E. I., Matthews, D. D., Applegate, J., Broder-Fingert, S., & Dubé, K. (2023). Health Care Bias and Discrimination Experienced by Lesbian, Gay, Bisexual, Transgender, and Queer Parents of Children With Developmental Disabilities: A Qualitative Inquiry in the United States. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners, 37(1), 5–16. https://doi.org/10.1016/j.pedhc.2022.09.004
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., Lowry, R., Chyen, D., Whittle, L., Thornton, J., Lim, C., Bradford, D., Yamakawa, Y., Leon, M., Brener, N., & Ethier, K. A. (2018). Youth Risk Behavior Surveillance - United States, 2017. Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002), 67(8), 1–114. https://doi.org/10.15585/mmwr.ss6708a1
Kyriakou, A., Nicolaides, N. C., & Skordis, N. (2020). Current approach to the clinical care of adolescents with gender dysphoria. Acta bio-medica : Atenei Parmensis, 91(1), 165–175. https://doi.org/10.23750/abm.v91i1.9244
National Association of Pediatric Nurse Practitioners, Evans, S.C., Derouin, A.L., Fuller, M.G., Heighway, S., & Schapiro, N.A. (2018). NAPNAP position statement on health risks and needs of lesbian, gay, bisexual, transgender, and questioning youth. The Journal of Pediatric Health Care, 33(2), p. A12-A14. doi: https://doi.org/10.1016/j.pedhc.2018.12.005
Roth, L. T., Friedman, S., Gordon, R., & Catallozzi, M. (2020). Rainbows and "Ready for Residency": Integrating LGBTQ Health Into Medical Education. MedEdPORTAL : the journal of teaching and learning resources, 16, 11013. https://doi.org/10.15766/mep_2374-8265.11013
Simons, L. K., Leibowitz, S. F., & Hidalgo, M. A. (2014). Understanding gender variance in children and adolescents. Pediatric annals, 43(6), e126–e131. https://doi.org/10.3928/00904481-20140522-07
The seminal publication of the AAP’s Guideline on the Evaluation and Treatment of Children and Adolescents with Obesity serves as the source of our fifth episode in the series on Health Equity in Children. The best practices for managing obesity go beyond discussions of beauty and body image to include systemic racism, obesity as a chronic disease, and the reckoning that children and adolescents with obesity are people first.
Want to make a bigger difference in health equity? Complete an anonymous survey here after you listen to the episode or visit www.thepedsnp.com and click the “Complete a Survey” button at the top of the page. The responses will provide greater insight into how podcasts impact education and behavior through microlearning of health equity concepts. After you complete a survey, you’ll receive a separate link to enter your email to a raffle for a $15 Amazon gift card. Winners will be chosen at random and notified by email one week after the original publication date. This raffle was made possible by grant funding from the sources below.
Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant. For more information, please community.napnap.org/northcarolinachapter.
References
Bell, C. N., Kerr, J., & Young, J. L. (2019). Associations between Obesity, Obesogenic Environments, and Structural Racism Vary by County-Level Racial Composition. International journal of environmental research and public health, 16(5), 861. https://doi.org/10.3390/ijerph16050861
Centers for Disease Control and Prevention. (2022). Inclusive communication principles. Gateway to Health Communication. https://www.cdc.gov/healthcommunication/Key_Principles.html
Gmeiner, M. S., & Warschburger, P. (2020). Intrapersonal predictors of weight bias internalization among elementary school children: a prospective analysis. BMC pediatrics, 20(1), 408. https://doi.org/10.1186/s12887-020-02264-w
Hadjiyannakis, S., Ibrahim, Q., Li, J., Ball, G. D. C., Buchholz, A., Hamilton, J. K., Zenlea, I., Ho, J., Legault, L., Laberge, A. M., Thabane, L., Tremblay, M., & Morrison, K. M. (2019). Obesity class versus the Edmonton Obesity Staging System for Pediatrics to define health risk in childhood obesity: results from the CANPWR cross-sectional study. The Lancet. Child & adolescent health, 3(6), 398–407. https://doi.org/10.1016/S2352-4642(19)30056-2
Hampl, S. E., Hassink, S. G., Skinner, A. C., Armstrong, S. C., Barlow, S. E., Bolling, C. F., Avila Edwards, K. C., Eneli, I., Hamre, R., Joseph, M. M., Lunsford, D., Mendonca, E., Michalsky, M. P., Mirza, N., Ochoa, E. R., Sharifi, M., Staiano, A. E., Weedn, A. E., Flinn, S. K., Lindros, J., … Okechukwu, K. (2023). Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics, 151(2), e2022060640. https://doi.org/10.1542/peds.2022-060640
Haqq, A. M., Kebbe, M., Tan, Q., Manco, M., & Salas, X. R. (2021). Complexity and Stigma of Pediatric Obesity. Childhood obesity (Print), 17(4), 229–240. https://doi.org/10.1089/chi.2021.0003
Puhl, R. M., & Himmelstein, M. S. (2018). Adolescent preferences for weight terminology used by health care providers. Pediatric obesity, 13(9), 533–540. https://doi.org/10.1111/ijpo.12275
Puhl, R. M., Peterson, J. L., & Luedicke, J. (2011). Parental perceptions of weight terminology that providers use with youth. Pediatrics, 128(4), e786–e793. https://doi.org/10.1542/peds.2010-3841
Yan J, Liu L, Zhu Y, Huang G, Wang PP. The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health. 2014 Dec 13;14:1267. doi: 10.1186/1471-2458-14-1267. PMID: 25495402; PMCID: PMC4301835.
The fourth episode in our Health Equity in Pediatrics series highlights one of the simplest individual actions a provider can take to be an ally in health equity: Say your patients’ names correctly. Saying a person’s name correctly validates their identity, family, culture, and heritage. Whether the name is difficult to pronounce or varies from the name given at birth, providers can use simple tools to correctly pronounce names and address their patients in a way that honors both the patient and their caregivers. Together we can answer William Shakespeare’s question, “What’s in a name?” with a lens of health equity.
Want to make a bigger difference in health equity? Complete an anonymous survey here after you listen to the episode or visit www.thepedsnp.com and click the “Complete a Survey” button at the top of the page. The responses will provide greater insight into how podcasts impact education and behavior through microlearning of health equity concepts. After you complete a survey, you’ll receive a separate link to enter your email to a raffle for a $15 Amazon gift card. Winners will be chosen at random and notified by email one week after the original publication date. This raffle was made possible by grant funding from the sources below.
Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant. For more information, please community.napnap.org/northcarolinachapter.
References
Dali, S., Atasuntseva, A., Shankar, M., Ayeroff, E., Holmes, M., Johnson, C., Terkawi, A. S., Beadle, B., Chang, J., Boyd, K., & Dunn, T. (2022). Say My Name: Understanding the Power of Names, Correct Pronunciation, and Personal Narratives. MedEdPORTAL : the journal of teaching and learning resources, 18, 11284. https://doi.org/10.15766/mep_2374-8265.11284
Keister, A. (2022). Can I still use sir and ma’am? When should I use Mr., Mrs., Ms., and Mx? What to do when you don’t know someone’s gender. The Diversity Movement. Retreived from https://thediversitymovement.com/sir-maam-mr-mrs-ms-mx-what-to-do-when-you-dont-know-someones-gender/
Lebensohn-Chialvo F. (2021). That's not my name. Families, systems & health : the journal of collaborative family healthcare, 39(1), 163–164. https://doi.org/10.1037/fsh0000588
The third episode in the Health Equity in Pediatrics series focuses on microaggressions, which are subtle slights, snubs, and digs that are seemingly innocent, innocuous, and naïve at first glance. But their roots in harmful stereotypes and assumptions are psychologically disparaging and invalidating to the people from marginalized groups they offend. They reflect implicit bias that is unconsciously embedded into language and behavior. As an ally, interrupting microaggressions can be a challenge that requires curiosity to confront. The decision to interrupt is individual and complex, but this episode will provide allies with the skills to intervene through role play in several scenarios.
Want to make a bigger difference in health equity? Complete an anonymous survey here after you listen to the episode or visit www.thepedsnp.com and click the “Complete a Survey” button at the top of the page. The responses will provide greater insight into how podcasts impact education and behavior through microlearning of health equity concepts. After you complete a survey, you’ll receive a separate link to enter your email to a raffle for a $15 Amazon gift card. Winners will be chosen at random and notified by email one week after the original publication date. This raffle was made possible by grant funding from the sources below.
Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant. For more information, please community.napnap.org/northcarolinachapter.
References:
Acholonu, R. G., Cook, T. E., Roswell, R. O., & Greene, R. E. (2020). Interrupting Microaggressions in Health Care Settings: A Guide for Teaching Medical Students. MedEdPORTAL : The journal of teaching and learning resources, 16, 10969. https://doi.org/10.15766/mep_2374-8265.10969
FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC medical ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8
Kanter, J. (2020). Microaggressions aren’t just innocent blunders– research links them with racial bias. The Conversation. https://theconversation.com/microaggressions-arent-just-innocent-blunders-research-links-them-with-racial-bias-145894
Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: implications for clinical practice. The American psychologist, 62(4), 271–286. https://doi.org/10.1037/0003-066X.62.4.271
Sue, D. W., Alsaidi, S., Awad, M. N., Glaeser, E., Calle, C. Z., & Mendez, N. (2019). Disarming racial microaggressions: Microintervention strategies for targets, White allies, and bystanders. The American psychologist, 74(1), 128–142. https://doi.org/10.1037/amp0000296
Turner, J., Higgins, R., & Childs, E. (2021). Microaggression and Implicit Bias. The American Surgeon, 87(11), 1727–1731. https://doi.org/10.1177/00031348211023418
In the second episode of the Health Equity in Pediatrics series, we explore implicit bias as unconscious attitudes and stereotypes held against a group that may even be contrary to one’s stated beliefs. Identifying your implicit bias is a best practice that can enable you to limit its impact on your behavior and prevent harm from altered clinical decision making that is based on preconceived notions. In this episode, we discuss examples of how implicit bias can impact health care in children and the skills that provider’s can hone to combat its influence.
Want to make a bigger difference in health equity? Complete an anonymous survey here after you listen to the episode or visit www.thepedsnp.com and click the “Complete a Survey” button at the top of the page. The responses will provide greater insight into how podcasts impact education and behavior through microlearning of health equity concepts. After you complete a survey, you’ll receive a separate link to enter your email to a raffle for a $15 Amazon gift card. Winners will be chosen at random and notified by email one week after the original publication date. This raffle was made possible by grant funding from the sources below.
Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant. For more information, please community.napnap.org/northcarolinachapter.
References:
FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC medical ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8
Gonzalez, C. M., Lypson, M. L., & Sukhera, J. (2021). Twelve tips for teaching implicit bias recognition and management. Medical teacher, 43(12), 1368–1373. https://doi.org/10.1080/0142159X.2021.1879378
Goyal, M. K., Johnson, T. J., Chamberlain, J. M., Cook, L., Webb, M., Drendel, A. L., Alessandrini, E., Bajaj, L., Lorch, S., Grundmeier, R. W., Alpern, E. R., & PEDIATRIC EMERGENCY CARE APPLIED RESEARCH NETWORK (PECARN) (2020). Racial and Ethnic Differences in Emergency Department Pain Management of Children With Fractures. Pediatrics, 145(5), e20193370. https://doi.org/10.1542/peds.2019-3370
Greenwald, A. G., Dasgupta, N., Dovidio, J. F., Kang, J., Moss-Racusin, C. A., & Teachman, B. A. (2022). Implicit-Bias Remedies: Treating Discriminatory Bias as a Public-Health Problem. Psychological science in the public interest : a journal of the American Psychological Society, 23(1), 7–40. https://doi.org/10.1177/15291006211070781
Jindal, M., Trent, M., & Mistry, K. B. (2022). The Intersection of Race, Racism, and Child and Adolescent Health. Pediatrics in review, 43(8), 415–425. https://doi.org/10.1542/pir.2020-004366
Mossey J. M. (2011). Defining racial and ethnic disparities in pain management. Clinical orthopaedics and related research, 469(7), 1859–1870. https://doi.org/10.1007/s11999-011-1770-9
Pediatric Nursing Certification Board. (2022). Pediatric Nursing Workforce Report 2022: A Demographic Profile of 53,000 PNCB-Certified Nursing Professionals. https://pncb.org/ sites/default/files/resources/PNCB_2022_Pediatric_Nursing_Workforce_Demographic_ Report.pdf
Project Implicit. (2011). Take a test. https://implicit.harvard.edu/implicit/takeatest.html
Raphael, J. L., & Oyeku, S. O. (2020). Implicit Bias in Pediatrics: An Emerging Focus in Health Equity Research. Pediatrics, 145(5), e20200512. https://doi.org/10.1542/peds.2020-0512
Sabin J. A. (2022). Tackling Implicit Bias in Health Care. The New England journal of medicine, 387(2), 105–107. https://doi.org/10.1056/NEJMp2201180
Smiley, R. A., Ruttinger, C., Oliveira, C. M., Hudson, L. R., Allgeyer, R., Reneau, K. A., Silvestre, J. H., & Alexander, M. (2021). The 2020 National Nursing Workforce Survey. Journal of Nursing Regulation, 12(1). https://doi.org/10.1016/s2155-8256(21)00027-2.
U.S. Equal Employment Opportunity Commission. (2023). Religious garb and grooming in the workplace: Rights and responsibilities. https://www.eeoc.gov/laws/guidance/religious-garb-and-grooming-workplace-rights-and-responsibilities#_ftn17
Welcome to the Health Equity in Pediatrics series! In the first installment of our series, we define health equity and review some communities often affected by health disparities that limit a person’s opportunity to be as healthy as possible. While health equity can seem like a seismic public health crisis that is too big for one person to tackle, each episode in this series will give listeners tangible best practices that can be implemented immediately to provide more equitable care in your workplace. As you learn to view every patient encounter through a lens of health equity, you’ll be able to apply these concepts to the evaluation and management of the diverse children for whom you care and improve their journey toward health. When you become a partner in the health equity care plan, rather than just an authority in health care, you bring practicality to your recommendations and interventions that augment the expert knowledge you share. In this episode we will apply these concepts to a challenging example with a historical precedent that will shape how you understand the approach to overcoming obstacles on the journey to health equity.
Want to make a bigger difference in health equity? Complete an anonymous survey here after you listen to the episode or visit www.thepedsnp.com and click the “Complete a Survey” button at the top of the page. The responses will provide greater insight into how podcasts impact education and behavior through microlearning of health equity concepts. After you complete a survey, you’ll receive a separate link to enter your email to a raffle for a $15 Amazon gift card. Winners will be chosen at random and notified by email one week after the original publication date. This raffle was made possible by grant funding from the sources below.
Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant. For more information, please community.napnap.org/northcarolinachapter.
References:
American Psychological Association. (2022). Racial and ethnic identity. https://apastyle.apa.org/style-grammar-guidelines/bias-free-language/racial-ethnic-minorities
Braveman, P., Arkin, E., Orleans, T., Proctor, D., & Plough, A. (2017). What is health equity? Achieving health equity. The Robert Wood Johnson Foundation. https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html
Centers for Disease Control and Prevention. (2022, August 2). Health equity guiding principles for inclusive communication. https://www.cdc.gov/healthcommunication/Health_Equity.html
Duke Health. (2020). Weight management for children and teens. Duke Health. https://www.dukehealth.org/pediatric-treatments/childhood-obesity
Jindal, M., Trent, M., & Mistry, K. B. (2022). The Intersection of Race, Racism, and Child and Adolescent Health. Pediatrics in review, 43(8), 415–425. https://doi.org/10.1542/pir.2020-004366
Pediatric Nursing Certification Board. (2022). Pediatric Nursing Workforce Report 2022: A Demographic Profile of 53,000 PNCB-Certified Nursing Professionals. https://pncb.org/ sites/default/files/resources/PNCB_2022_Pediatric_Nursing_Workforce_Demographic_ Report.pdf
Zippia. (2022, September 9). Family nurse practitioner demographics and statistics in the US. https://www.zippia.com/family-nurse-practitioner-jobs/demographics/
Got milk? The answer is complicated. While plant-based beverages are accused of posing as animal by-product imposters, the FDA claims that consumers know the difference. But most parents don't recognize that plant-based milks lack the same micro and macronutrient profile as cow's milk or soy milk. This leaves pediatric providers with the very important job of assessing nutrition and guiding parents on what beverages their infants and toddlers should be drinking.
Just because you can, doesn't mean you should. In the depths of respiratory virus season, providers often order unnecessary tests that won't alter the course of treatment for the child presenting with upper respiratory symptoms. This episode covers 5 common pathogens, the indications to test a child presenting with symptoms, and how to talk to families requesting tests.
Not all bacterial infections need an antibiotic. It may sound hard to believe, but if we all followed the AAP guidelines on the management of otitis media in children and actually used a watch-and-wait approach in appropriate patients, upwards of 75% of the antibiotics prescribed for otitis media could be avoided. Why? Because the microbiology of AOM has changed, but our prescribing practices haven't. This episode is a great guideline refresher and microbiology update while learning how to talk parents into partnership on watchful waiting.
If you've been looking for a New Year's Resolution to make a real difference in your practice, stop prescribing diphenhydramine. Despite being a common over-the-counter medication, its potent anticholinergic side effects and sedation make it a poor choice for children. Review the common misuses for the drug and practical, evidence-based alternatives to help get diphenhydramine out of your prescribing practice in 2023.
In the last case study in our series on Cognitive Bias in Healthcare, attribution error (among others) of an adolescent female with foot burning reveals how two more best practices for avoiding cognitive bias can help providers think metacognitively. Review all 8 best practices and start to implement them to reduce diagnostic error.
The next case study in our series on cognitive bias in healthcare follows an obese adolescent female with arm and neck pain who felt unheard during the 4 prior emergency room visits that week. Listen as the differential diagnosis takes on a completely different angle and the pressure of making the diagnosis goes sky high! We will unpack additional forms of cognitive bias and 2 more best practices for avoiding diagnostic error in the clinical setting.
In the first case study of our mini-series on Cognitive Bias in Health Care, we meet a 4 month old female referred to the emergency department for constipation. Spoiler alert: We know it's not constipation... so we explore how her presentation and physical exam clash with the initial medical decision making. Try to spot the cognitive bias and test yourself on building a differential diagnosis. Lastly, we explore 4 best practice techniques to help you avoid bias in the first place.
There are many factors that contribute to the way we perceive and interpret information... and lots of ways that our brains skew our perspectives that can lead to cognitive bias. The second episode in our Cognitive Bias in Healthcare mini-series discusses the features of information delivery that impact our decision-making and how our brains distort them to cause diagnostic error.
This episode is the first installment on a new mini series on cognitive bias in pediatric healthcare. We begin by discussing what cognitive bias is, how it becomes diagnostic error, and the impact on healthcare in America. Begin to think about how you think and explore the interesting ways our brains use mental shortcuts to arrive at an answer.
Developmental surveillance and screening work best to identify delays when used together. The AAP and CDC teamed up to create a standardized developmental milestone checklist in order to improve the longitudinal monitoring of pediatric milestones at home by caregivers. This episode reviews their publication and discusses what went into the checklist, its strengths, and areas for further research. View the CDC's website for the full checklist and read the article here.
When accelerated BSN student Sam Mahaney wanted more practical bedside application of his knowledge of pediatric cardiology, we sat down to discuss the approach to assessment and management of undiagnosed and undifferentiated congenital heart disease from a primary care perspective. The primary care clinician should be on the lookout for red flags in the history and physical exam that might suggest critical congenital heart disease and screen appropriately. This episode has helpful perspectives for both the nurse and advanced practice provider.
Infant dyschezia refers to the discomfort an infant experiences when bearing down against a closed anal sphincter, and is often misidentified as constipation by parents. As long as red flags are absent, this functional, self-limited condition is easily diagnosed using the Rome IV Criteria. In this episode, you will learn how to reassure parents and what contraindicated treatments should be discussed.
Vision screening is one of the most important preventative health screenings that a primary care provider does at well visits. But the infant eye exam can feel obtuse and complicated if you don't understand vision development, physical exam maneuvers, and red flags for referral. Because of the risk of significant amblyopia if ocular pathology is left untreated, every pediatric provider should know how to complete an age-appropriate vision screening in an infant.
With national formula shortages over 40% and growing, the pediatric provider can encourage the establishment and maintenance of breastfeeding in moms who have chosen this path. Breastfeeding isn't without struggles and woes, so providers can help support mothers by understanding these tips based on breastfeeding physiology and advising the pair when the process isn't as easy as it seems.
Two of the most common over-the-counter medications in pediatrics are not as simple and benign as you might think. This episode uncovers the dark past of acetaminophen, the pearls and pitfalls of prescribing them, and how to talk to families about giving the medications safely.
Children with acute gastroenteritis and mild or moderate dehydration can be managed at home with oral rehydration. Learn how to partner with families and take an extra five minutes in your visit to explain the reasoning, detailed instructions, and expectations of home care as we discuss the evidence behind the rationale.
The well visit is time to screen for issues in primary care, which includes diet and nutrition. Picky eating is a common problem that often plagues parents, especially when parenting styles or child development clashes with recommended feeding practices. Dr. John Lyles joins The Peds NP to discuss evaluation and recommendations for feeding difficulties in primary care.
Dr. Mansi Kotwal, Allergy and Immunology fellow at Johns Hopkins, joins The Peds NP podcast again to talk about a few dermatologic manifestations of allergy. She discusses how history is an essential component of diagnosis and goes on to discuss management of these common and benign conditions in pediatrics.
Season 5 of The Peds NP returns with an introduction to the first exam a person will ever get: The newborn exam. This episode focuses on that first encounter from the prenatal and birth history to the exam and screenings. Learn to concentrate on the unique features of a newborn and consider how to document the findings on this ever-changing patient.
Provider variation has plagued the management of febrile neonates for decades, but the wait for standardization is over! The AAP published its long-awaited recommendations on the evaluation and management of well-appearing febrile infants 8 to 60 days old in August 2021. This episode picks apart the nuances and key features to help pediatric providers provide fast, safe, and effective care to this population. Follow along with full guideline available at https://doi.org/10.1542/peds.2021-052228
Human trafficking, specifically sex trafficking, is a worrisome reality that pediatric providers need to recognize and manage with speed and grace. With tools to better understand the at risk populations that may present as hidden victims of this terrible human rights violation, we can better protect our vulnerable child and youth populations.
Recognition of anaphylaxis can be difficult for some providers, and the courage to give epinephrine for treatment can be even more so. Johns Hopkins Allergy & Immunology fellow, Dr. Mansi Kotwal, discusses the anaphylaxis presentation and diagnosis in ways you may not have considered. And she reviews adjunct drugs for management in a way that might just change your practice.
Infections in the central nervous system can be very dangerous in children, so prompt recognition and treatment is important to avoid morbidity and mortality. A review of various etiologies of CNS infections and their workup yields a valuable discussion on a pearl of wisdom that any provider needs to understand.
In the first ever guest interview on The Peds NP, pediatric gastroenterologist John Lyles talks with us about pathologic hyperbilirubinemia and inflammatory bowel disease.
Cardiogenic shock occurs in children for a variety of reasons, and there are a variety of vasoactive drugs available to treat the critical condition. But first we need to understand the pathophysiology and pharmacology to best select the drug for the job, which is no easy task.
The 2014 AAP guidelines on the treatment of bronchiolitis are a provider's medical decision-making compass, but how can we interpret the vague or absent recommendations involving advanced care of patients requiring hospitalization? This episode covers the recent evidence published since the 2014 guidelines and helps to provide some direction on key issues for patients in need of greater respiratory support.
Nutrition is arguably the most important component of care in children with critical illness, yet its importance often falls down the list of priorities. Many questions remain on how best to manage nutrition in pediatric critical care, but this episode addresses many best practices from the SCCM and ASPEN's Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient.
Whether you're presenting in class, for colleagues, or on a national stage, it's important to have the tools and skills to disseminate your work in a scholarly way. This week's show focuses on helping you with presentation format, PowerPoint visuals, and presentation skills to help you stand out and confidently demonstrate your expertise.
"What's wrong with your legs?' 'Nothin' at all, thank you. My legs are just fine and dandy.'" This episode takes a line from Forrest Gump and RUNS with it. It's important for providers to know normal MSK development from an intrauterine fetus to the running child so that you can give parents reassurance for normal, expected defects while referring true deformities.
Ten percent of Americans report an allergy to amoxicillin, yet most of these don't represent a true allergy. Today we discuss the types of drug allergies, how to determine if the allergy can be removed, and second line drugs for true PCN allergy with the goal of being outstanding stewards of antimicrobial stewardship.
I've got incredible burrito-eating skills like you've never seen. These epic Tex-Mex talents translate to test-taking strategies that are a sure-fire way to effectively implement critical thinking.
When patients (or parents!) use unique phrasing of a phenomenon, we must interpret their description of the experience in laymen's terms using clarifying questions while being attentive to inaccurate use of medical terms. Let a kid tell you their story and you'll learn everything you need to know. Hear what I mean with a couple of real GI examples from my week.
Having a sense of fashion and listening to what the style gurus tell us "what not to wear" is similar to provider practice and the clinical practice guidelines published by our national authorities. Yet, somehow jorts came back into fashion and albuterol trials remain common practice for bronchiolitis. What will you wear and do?
As the hottest part of summer approaches and kids spend more time playing outside, pediatric providers need to be ready to recognize heat-related illness and offer savvy perspectives on how to protect kids from the sun's harmful rays.
Thank you preceptors for your tireless support of students who cannot learn the art of pediatric healthcare without your bedside teaching. This relationship born out of duty, generosity, and mutual respect can create lifelong collegial friendships. But what should students do if they notice problems in clinical? Today we explore how you should think, do, and say when evidence-based practice gets put in a corner.
On this Mother's Day edition of The Peds NP podcast, we consider the perfect baby shower gift for an expecting mother. By using your knowledge of pediatric physiology, growth, and development, you can turn that baby registry into an educational opportunity to promote health and wellness for a new family.
Once the exams are all taken, the papers submitted, and the grades are in... you've still got work to do. Healthcare professions require career-long learning, so join me as I discuss some options for staying current and engaged in pediatric learning after you walk off the stage and into clinical practice.
Whatever your social life looks like when you go home, I want you to know how important your work in pediatrics is to so many children! Fever is common, the presentation is simple, and this episode reinforces the management of simple febrile seizures according to the 2011 AAP guidelines.
A novel is to the clinical note what a summary statement is to Cliff's Notes. A summary statement is a concise phrase of synthesized patient information that transforms your assessment, and formulating one is a critical skill for any provider to learn. Understand the essential components of a summary statement and hear a few good and bad examples on this episode.
Patients with acute diagnoses often start, and always end, in primary care. Today we discuss primary care implications of cardiac disease in children.
What's the difference between a pediatric patient who needs an LP and one that goes home? Find out on today's episode as we pick apart the presentation of fever without source.
What is one of the unique features of pediatric health care? Monitoring their growth! Join us today as we discuss important primary and acute care issues surrounding pediatric growth.
Diagnosis is the easy part. Deciding whether to send the comfortably tachypneic bronchiolitic is the hard part. Join us today as we unpack how to make that very decision and hear some pearls on supportive care.
Join us today as we discuss how to identify acute disease by recognizing illness scripts written in test questions or in the medical record, then apply these concepts beyond the classroom.
Prick up your ears for this week's discussion on some favorite principles at The Peds NP. We use acute otitis media as an example of taking it back to the patho and spending an extra 5 minutes teaching the parents.
Join us as we unpack the ddx and discuss common and severe problems of the eye in pediatric patients. Later, we talk about journal club reviews of the literature and note one of my favorite ways to appraise an article.
Join us as we pick apart the pieces of a well child check and discuss the ideal head-to-toe exam.
As my primary care pediatrics students finish their first week of class, we review some questions on the newborn and discuss some key principles of clinical notes to get ready for next week.
In this episode of The Peds NP we use a bad example of calling a consult to demonstrate "what not to do" before discussing some good examples and help to develop the critical skill of asking a clinical question.
Get started on documentation with pearls of wisdom on the different pieces of an outpatient note.
Practical tips for the APRN student on selecting the article, reading it, then writing a literature review for discussion with classmates or colleagues.
Vaccine hesitancy has become a controversial and highly politicized topic in healthcare today. Join us as we discuss the history on how we got here, the current literature and obstacles facing the perpetuation of the issue, and how to talk with vaccine hesitant parents.
When a marital argument seeks to justify the use of a seemingly antiquated healthcare learning exercise, we find ourselves at the center of an existential question: Is the keyboard mightier than the mouse click?
Rabies is one of those scary words associated with animal bites. But not every situation requires post-exposure prophylaxis. Join us today as we talk about rabies exposure, risk, and post-exposure management in the pediatric patient.
Today we talk through the tough decision on what to do when a patient presents at the most inconvenient time with Fever Without Source. Why is this a hard decision? What are the things that you should be thinking about? We review the literature, the rationale, and the options of how to manage these patients using evidence-based practice to guide us.
When constipation enters the acute care setting or is difficult to manage in primary care, use this podcast to consider the evidence-based practice guidelines and a few pearls of wisdom to assess a child’s presentation, diagnose constipation, and manage the cleanout at home with two essential medications.