Meeting the Needs of Children in Partnership with Nurses and Nurse Practitioners
Sunny G. Hallowell, PhD, APRN, is a postdoctoral fellow, and Danielle Altares Sarik, MSN, APRN, a predoctoral fellow, at the Robert Wood Johnson Foundation-funded Center for Health Outcomes and Policy Research at the School of Nursing at the University of Pennsylvania. Hallowell is also a Leonard Davis Institute Fellow. Both are pediatric nurse practitioners serving on the executive board of the National Association of Pediatric Nurse Practitioners, Pennsylvania Delaware Valley Chapter. Monday, October 6, is National Child Health Day.
Many Americans may not know that children born in the United States are less likely to survive to their fifth birthday than children born in other high-income peer countries. The United States falls at the bottom of the Commonwealth Fund’s recently released “Mirror, Mirror” report, ranking last out of 11 countries for infant mortality.
As children hold the greatest potential to achieve good health, high infant and child mortality may be particularly surprising. Early lifestyle and health care decisions can set children on a trajectory that determines their health for a lifetime.
As a country, we can do more to ensure the health of our youngest and most vulnerable population. Using nurses and nurse practitioners (NP) to the highest level of their education and training is one strategy. Robust use of nurses and NPs can offer solutions to improve infant and child survival rates through prenatal, postnatal and early childhood health surveillance.
Nurses a Part of the Solution
Below, we highlight four areas where research has shown that nurses make a difference in the lives of children and their families: early and adequate prenatal care, supporting transition from hospital to home, providing increased access to care, and childhood support and health surveillance.
For children, access to health care is important even before they are born. Early prenatal care and ongoing support throughout pregnancy are imperative to successful maternal-infant outcomes. An increasing number of women in the United States receive prenatal care from a midwife, NP or physician assistant, indicating a growing reliance on and acceptance of these providers. 1 Additionally, studies have shown improved pregnancy and birth outcomes in models that use NPs to provide care to pregnant adolescents2—a population at high risk for infant and maternal complications.
Programs that send a nursing professional to provide transitional care for mothers and infants in the postnatal period have demonstrated a decrease in all-cause mortality for mothers and preventable cause mortality in firstborn children in disadvantaged settings.3 In addition, these programs decrease emergency room visits and hospitalizations by 50 percent in the first year of life,4 and are associated with higher 12-month infant mental development scores5 and increased receptive language skills at 2, 4 and 6 years.6 These nurse-led interventions have the potential to improve under-five mortality and the early care of U.S. infants. The Affordable Care Act recognizes the success and importance of nurse visiting and transition programs and has allocated more than $1.5 billion to continue these cost-effective programs through 2015.
Almost one in every ten children in this country is uninsured. Thirty-five percent of children with insurance are covered through Medicaid programs. NPs often work in settings such as federally qualified health centers and nurse-managed health clinics where many patients who are uninsured or under-insured seek care, including women and children. NPs also are more likely than other providers to work in rural and remote areas, which may increase access to healthcare.
The American Association of Pediatrics recommends seven preventative appointments during the first year of life and children are often seen many more times for coughs, colds, rashes and bumps during that same time period. Each of these appointments offers an opportunity for health surveillance and is an ideal time for teaching. NPs are trained to provide holistic, comprehensive health care services, with a special emphasis on education, health promotion and disease prevention. Therefore, NP care is ideal for the ongoing guidance, developmental monitoring, and lifestyle support needed by young children and their parents.
Moving Forward and Growing Up
The leadership of nurses and NPs in collaboration with all health care professionals will be key to improving the health of future generations. While we still have room for health care improvement in the United States, many of our existing programs and established systems of care may offer solutions that improve children’s health. It is important to continue to support these evidence-based models of care.
2. Neeson JD, Patterson KA, Mercer RT, May KA. Pregnancy outcome for adolescents receiving prenatal care by nurse practitioners in extended roles. Journal of Adolescent Health Care. 6// 1983;4(2):94-99.
3. Olds DL, Kitzman H, Knudtson MD, Anson E, Smith JA, Cole R. Effect of Home Visiting by Nurses on Maternal and Child Mortality: Results of a 2-Decade Follow-up of a Randomized Clinical Trial. JAMA pediatrics. Jul 7 2014.
5. Norr KF, Crittenden KS, Lehrer EL, et al. Maternal and infant outcomes at one year for a nurse-health advocate home visiting program serving African Americans and Mexican Americans. Public health nursing (Boston, Mass.). May-Jun 2003;20(3):190-203.
6. Olds DL, Holmberg JR, Donelan-McCall N, Luckey DW, Knudtson MD, Robinson J. Effects of home visits by paraprofessionals and by nurses on children: follow-up of a randomized trial at ages 6 and 9 years. JAMA pediatrics. Feb 2014;168(2):114-121.
This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.