The Peds NP: Pearls of Pediatric Evidence-Based Practice Becky Carson

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., & Brad

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 men