The Peds NP: Pearls of Pediatric Evidence-Based Practice – Details, episodes & analysis

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

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