- Email: [email protected]
Anticipatory guidance—it's worth the effort!
PH C
EDITORIAL
B o b b i e C rew N e l m s , P h D, R N , C P N P
Anticipatory Guidance—It’s Worth the Effort!
D
uring the past 2 years I have had the wonderful clinical opportunity to care for children from a variety of countries and socioeconomic backgrounds. These children were hospitalized for a variety of severe burn injuries, as well as numerous orthopedic problems. As I explored the reasons for their medical problems, it became apparent that many of these conditions could have been prevented. This experience reaffirmed for me that we must continue to provide children with the best anticipatory guidance possible and that we must expand our efforts to reach children in other countries. Some of the injuries and problems I have seen in children include a major burn from a hot water humidifier, a burn from turning on hot water while taking a bath, and a burn that occurred when the oil for a heater ignited. In addition, I encountered a school-aged child who had become deaf as a result of Haemophilus influenzae type b meningitis and numerous children with myelodysplasia who were from Mexico (where folic acid is not routinely added to foods). Other children had sustained burns as a result of contact with products that, because of safety reasons, could not be sold in the United States. Of course, some patients had sustained injuries because of incidents that can occur anywhere: one child was hit by a car while walking along the street, and another child was attacked by a dog. I also encountered a large number of children who had not been screened for tuberculosis and, when finally screened, their test results were positive. This is just a short list of some of the problems that these children faced. Many of them had to undergo numerous painful surgeries and procedures as a result of these conditions. In some cases they will be affected by their in-
March/April 2000
juries as long as they live, as they deal with physical problems such as scars, paralysis, and deafness, not to mention the psychologic sequelae.
W
e must examine the
experience a child and family has from the moment they reach the receptionist desk until they check out at the end of the visit. Have we taken every opportunity to provide the needed education?
Just thinking about these children has given me a new passion for the importance of providing good anticipatory guidance. We must make sure that we take every opportunity to give children and families the education they need to prevent problems such as those previously mentioned. I myself—and, I am sure, many of you—have worked with children and families who have sustained injuries relating to a lack of safety and nutrition counseling. The parents
whose children are injured following such accidents feel tremendous guilt. Indeed, entire families can be negatively affected by such injuries. Siblings may be ignored while parents focus on the injured child, and it may be necessary for one parent to be separated from the family while he or she is with the injured child during hospitalizations. Other possible repercussions include financial, emotional, and psychological problems that can result from a major injury to a child. I do not mean to imply that we can totally eliminate these problems through education and anticipatory guidance, but we can certainly try to reduce the number of these injuries when we have a chance to do so. Anticipatory guidance has traditionally focused on the areas of safety, nutrition, growth, and developmental issues as well as immunizations. We must ensure that each one us is fulfilling the need to provide this information whenever we can. We must examine the experience a child and family has from the moment they reach the receptionist desk until they check out at the end of the visit. Have we taken every opportunity to provide the needed education? For example, the receptionist can provide the child and/or family with reading materials, as appropriate for the family’s level of education and reading abilities. A great deal can be communicated with pictures, diagrams, and very few words if necessary. The child and/or family may also be given the opportunity to watch videos that provide information that can then be reinforced by the health care provider. The persons who weigh and measure the children and
J Pediatr Health Care. (2000). 14, 43-44. Copyright © 2000 by the National Association of Pediatric Nurse Associates & Practitioners. 0891-5245/2000/$12.00 + 0 25/8/104539 doi:10.1067/mph.2000.104539
43
PH EDITORIAL C
Nelms
accompany them to the examination room can also play an important role in providing anticipatory guidance. They
W
e must continue to
provide anticipatory guidance, even if it means being more creative in how we do so; this content is very important, and in some situations, it saves lives.
can follow up on questions from the reading materials or videos or start to talk about issues pertinent to the child’s
age and level of development. The health care provider who then examines the child can reinforce that education and focus on problem areas. Recently, because of the demands of managed care and other changes in the provision of health care, most of us have found that we have very little time to provide our patients with education and counseling. The length of visits has been cut, and we have to make every minute count! Despite these constraints, we must continue to provide anticipatory guidance, even if it means being more creative in how we do so; this content is very important, and in some situations, it saves lives. If necessary we will have to wage a fight for the time to provide anticipatory guidance, as we know we should. The approaches that I previously described will, I hope, work in the traditional settings in which we provide well child care in the United States, such as school-based clinics, outpatient clinics, and private practice settings. However, such efforts may not be sufficient in
other countries. To make a difference, we need to join international efforts to improve health care and to attack such problems as folic acid deficiency during pregnancy and safety needs, particularly product safety that we may take for granted here in the United States. Some of us may be able to join volunteer programs that travel to other countries and directly provide care; others may support efforts financially and through awareness campaigns sponsored by agencies such as the World Health Organization and UNICEF. I hope you will join me in this effort to improve anticipatory care. If nothing else, I hope you will review the way you provide education and counseling and determine if you can find ways to improve your approach to care. The efforts will be worth it if we can save a child and his or her family from injury or deformity and the pain that accompanies such conditions. Believe me, it is worth the time. —Bobbie Crew Nelms, PhD, RN, CPNP
CALL FOR ABSTRACTS Intensive Workshops and Concurrent Sessions NAPNAP’s 22st Annual Nursing Conference on Pediatric Primary Care Phoenix, Arizona March 14-17, 2001 NAPNAP’s Program Committee is now accepting applications for presentations for the 22nd Annual Conference. Preference will be given to topics with immediate clinical application, changing and current pharmacology, and innovative ways to manage illness or promote health in the pediatric population. We are looking for topics for both novice and advanced practitioners. Deadline for submission is May 1, 2000. To obtain an application for educational presentations (Intensive Workshops and Concurrent Sessions) contact: NAPNAP National Office 1101 Kings Highway, North, Suite 206 Cherry Hill, NJ 08034-1912 Phone: (856) 667-1773 Fax: (856) 667-7187 E-mail: [email protected]
44
Volume 14 Number 2
JOURNAL OF PEDIATRIC HEALTH CARE
EDITORIAL
B o b b i e C rew N e l m s , P h D, R N , C P N P
Anticipatory Guidance—It’s Worth the Effort!
D
uring the past 2 years I have had the wonderful clinical opportunity to care for children from a variety of countries and socioeconomic backgrounds. These children were hospitalized for a variety of severe burn injuries, as well as numerous orthopedic problems. As I explored the reasons for their medical problems, it became apparent that many of these conditions could have been prevented. This experience reaffirmed for me that we must continue to provide children with the best anticipatory guidance possible and that we must expand our efforts to reach children in other countries. Some of the injuries and problems I have seen in children include a major burn from a hot water humidifier, a burn from turning on hot water while taking a bath, and a burn that occurred when the oil for a heater ignited. In addition, I encountered a school-aged child who had become deaf as a result of Haemophilus influenzae type b meningitis and numerous children with myelodysplasia who were from Mexico (where folic acid is not routinely added to foods). Other children had sustained burns as a result of contact with products that, because of safety reasons, could not be sold in the United States. Of course, some patients had sustained injuries because of incidents that can occur anywhere: one child was hit by a car while walking along the street, and another child was attacked by a dog. I also encountered a large number of children who had not been screened for tuberculosis and, when finally screened, their test results were positive. This is just a short list of some of the problems that these children faced. Many of them had to undergo numerous painful surgeries and procedures as a result of these conditions. In some cases they will be affected by their in-
March/April 2000
juries as long as they live, as they deal with physical problems such as scars, paralysis, and deafness, not to mention the psychologic sequelae.
W
e must examine the
experience a child and family has from the moment they reach the receptionist desk until they check out at the end of the visit. Have we taken every opportunity to provide the needed education?
Just thinking about these children has given me a new passion for the importance of providing good anticipatory guidance. We must make sure that we take every opportunity to give children and families the education they need to prevent problems such as those previously mentioned. I myself—and, I am sure, many of you—have worked with children and families who have sustained injuries relating to a lack of safety and nutrition counseling. The parents
whose children are injured following such accidents feel tremendous guilt. Indeed, entire families can be negatively affected by such injuries. Siblings may be ignored while parents focus on the injured child, and it may be necessary for one parent to be separated from the family while he or she is with the injured child during hospitalizations. Other possible repercussions include financial, emotional, and psychological problems that can result from a major injury to a child. I do not mean to imply that we can totally eliminate these problems through education and anticipatory guidance, but we can certainly try to reduce the number of these injuries when we have a chance to do so. Anticipatory guidance has traditionally focused on the areas of safety, nutrition, growth, and developmental issues as well as immunizations. We must ensure that each one us is fulfilling the need to provide this information whenever we can. We must examine the experience a child and family has from the moment they reach the receptionist desk until they check out at the end of the visit. Have we taken every opportunity to provide the needed education? For example, the receptionist can provide the child and/or family with reading materials, as appropriate for the family’s level of education and reading abilities. A great deal can be communicated with pictures, diagrams, and very few words if necessary. The child and/or family may also be given the opportunity to watch videos that provide information that can then be reinforced by the health care provider. The persons who weigh and measure the children and
J Pediatr Health Care. (2000). 14, 43-44. Copyright © 2000 by the National Association of Pediatric Nurse Associates & Practitioners. 0891-5245/2000/$12.00 + 0 25/8/104539 doi:10.1067/mph.2000.104539
43
PH EDITORIAL C
Nelms
accompany them to the examination room can also play an important role in providing anticipatory guidance. They
W
e must continue to
provide anticipatory guidance, even if it means being more creative in how we do so; this content is very important, and in some situations, it saves lives.
can follow up on questions from the reading materials or videos or start to talk about issues pertinent to the child’s
age and level of development. The health care provider who then examines the child can reinforce that education and focus on problem areas. Recently, because of the demands of managed care and other changes in the provision of health care, most of us have found that we have very little time to provide our patients with education and counseling. The length of visits has been cut, and we have to make every minute count! Despite these constraints, we must continue to provide anticipatory guidance, even if it means being more creative in how we do so; this content is very important, and in some situations, it saves lives. If necessary we will have to wage a fight for the time to provide anticipatory guidance, as we know we should. The approaches that I previously described will, I hope, work in the traditional settings in which we provide well child care in the United States, such as school-based clinics, outpatient clinics, and private practice settings. However, such efforts may not be sufficient in
other countries. To make a difference, we need to join international efforts to improve health care and to attack such problems as folic acid deficiency during pregnancy and safety needs, particularly product safety that we may take for granted here in the United States. Some of us may be able to join volunteer programs that travel to other countries and directly provide care; others may support efforts financially and through awareness campaigns sponsored by agencies such as the World Health Organization and UNICEF. I hope you will join me in this effort to improve anticipatory care. If nothing else, I hope you will review the way you provide education and counseling and determine if you can find ways to improve your approach to care. The efforts will be worth it if we can save a child and his or her family from injury or deformity and the pain that accompanies such conditions. Believe me, it is worth the time. —Bobbie Crew Nelms, PhD, RN, CPNP
CALL FOR ABSTRACTS Intensive Workshops and Concurrent Sessions NAPNAP’s 22st Annual Nursing Conference on Pediatric Primary Care Phoenix, Arizona March 14-17, 2001 NAPNAP’s Program Committee is now accepting applications for presentations for the 22nd Annual Conference. Preference will be given to topics with immediate clinical application, changing and current pharmacology, and innovative ways to manage illness or promote health in the pediatric population. We are looking for topics for both novice and advanced practitioners. Deadline for submission is May 1, 2000. To obtain an application for educational presentations (Intensive Workshops and Concurrent Sessions) contact: NAPNAP National Office 1101 Kings Highway, North, Suite 206 Cherry Hill, NJ 08034-1912 Phone: (856) 667-1773 Fax: (856) 667-7187 E-mail: [email protected]
44
Volume 14 Number 2
JOURNAL OF PEDIATRIC HEALTH CARE