Acute Care Faculty Series: Delivering Bad News (S11 Ep. 71)

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.    Authors: Becky Carson, DNP, APRN, CPNP-PC/AC, Bridget Sullivan Garmisa, MSN, MS, CRNP, RD 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 Robyn 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 Robyn 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 [email protected].  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 [email protected].  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 [email protected].  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