Acute Care Pediatric Nurse Practitioner These are entry-level competencies for the acute care pediatric nurse practitioner (ACPNP) and supplement the core competencies for all nurse practitioners. The graduate of an ACPNP program is prepared to care for children with complex acute, critical and chronic illness across the entire pediatric age spectrum, from birth to young adulthood. Circumstances may exist in which a patient, by virtue of age, could fall outside the traditionally defined ACPNP population but by virtue of special need, the patient is best served by the ACPNP. The ACPNP implements the full scope of the role through assessment, diagnosis and management with interventions for patients and their families. The ACPNP implements the full scope of the role through assessment, diagnosis and management with interventions for patients and their families. The ACPNP provides care to patients who are characterized as physiologically unstable, technologically dependent, and/or are highly vulnerable to complications (AACN Scope and Standards, 2006, p 9), and a continuum of care ranging from disease prevention to critical care in order to stabilize the patient s condition, prevent complications, restore maximum health and/or provide palliative care (AACN p. 10). Patients may be encountered across the continuum of care settings and require ongoing monitoring and intervention. See the Introduction for how to use this document and to identify other critical resources to supplement these competencies. Competency Area NP Core Acute Care Pediatric NP Scientific Foundation 1. Critically analyzes data and evidence for improving advanced nursing practice. 2. Integrates knowledge from the humanities and sciences within the context of nursing science. 3. Translates research and other forms of knowledge to improve 1. Contributes to knowledge development for improved child and family-centered care. 2. Participates in child and family focused quality improvement, program evaluation, translation, and dissemination of evidence into practice. 3. Delivers of evidence-based practice for pediatric patients. The following curriculum considers advanced pathophysiology; advanced physical examination findings; and advanced pharmacology (kinetics, dynamics, genomics) that pertains to the unique aspects of the infant, child, and adolescent. 39 Population-Focused Nurse Practitioner
Competency Area NP Core Acute Care Pediatric NP practice processes and outcomes. 4. Develops new practice approaches based on the integration of research, theory, and practice knowledge Scientific Foundations Clinical practice guidelines Evidence based care Translational research Vulnerable and diverse populations and cultures Leadership 1. Assumes complex and advanced leadership roles to initiate and guide change. 2. Provides leadership to foster collaboration with multiple stakeholders (e.g. patients, community, integrated health care teams, and policy makers) to improve health care. 3. Demonstrates leadership that uses critical and reflective thinking. 4. Advocates for improved access, quality and cost effective health care. 5. Advances practice through the development and implementation of innovations incorporating principles of change. 6. Communicates practice knowledge effectively both orally and in writing. 7. Participates in professional organizations and activities that influence advanced practice 1. Advances the knowledge of the interprofessional team to improve pediatric healthcare delivery and patient outcomes. 2. Participates actively in pediatric focused professional organizations that promote optimal health care for children and their families. 3. Advocates within health care agencies for unrestricted access to all health care providers that provide quality, cost effective care to children and families. Professional Role Professional accountability Role theory Role of the ACPNP Scope & standards of practice of the ACPNP Professional regulation and licensure Credentialing and certification Clinical decision making and problem solving Professional scholarship Engagement in Professional organizations Advocacy Self-evaluation and peer review Teaching and Education Theories - change, education, communication, family Cultural sensitivity Communication Communication theory Collaboration Conflict resolution Collaborative practice models 40 Population-Focused Nurse Practitioner
Competency Area NP Core Acute Care Pediatric NP nursing and/or health outcomes of a population focus. Simulation with role-playing for learning skills such as history taking as well as for more complex communication techniques such as sharing bad news or potential poor outcomes with patients and families. Quality 1. Uses best availablye evidence to continuously improve quality of clinical practice. 2. Evaluates the relationships among access, cost, quality, and safety and their influence on health care. 3. Evaluates how organizational structure, care processes, financing, marketing and policy decisions impact the quality of health care. 4. Applies skills in peer review to promote a culture of excellence. 5. Anticipates variations in practice and is proactive in implementing interventions to ensure quality. Articulates the importance of collaborating with local, state and national child organizations to foster best practices and child safety. Clinical practicum Incorporation into interprofessional team member. Quality improvement initiatives Safety Continuous Quality Improvement Replication of clinical scenarios with a focus on team training for the purpose of learning leadership, followership, and team concepts. Healthcare Policy and Advocacy Economics of health care Safety (local, state, national) Quality Improvement Process in measuring outcomes 41 Population-Focused Nurse Practitioner
Competency Area NP Core Acute Care Pediatric NP Practice Inquiry 1. Provides leadership in the translation of new knowledge into practice. 2. Generates knowledge from clinical practice to improve practice and patient outcomes. 3. Applies clinical investigative skills to improve health outcomes. 4. Leads practice inquiry, individually or in partnership with others. 5. Disseminates evidence from inquiry to diverse audiences using multiple modalities. 6. Analyze clinical guidelines for individualized application into practice Ensures pediatric assent and consent, and/or parental permission when conducting clinical inquiry. Aspects of conducting research with children. Application of research and EBP findings pertinent to pediatric patients and their families to improve outcomes. Technology and Information Literacy 1. Integrates appropriate technologies for knowledge management to improve health care. 2. Translates technical and scientific health information appropriate for various users needs. 2.a Assesses the patient s and caregiver s educational needs to provide effective, personalized health care. 2.b Coaches the patient and caregiver for positive behavioral change. 3. Demonstrates information literacy skills in complex decision making. 1. Considers developmental level of child and the family when translating health information to support positive health outcomes. 2. Uses pediatric focused simulation based learning to improve practice. 3. Evaluates information systems to assure the inclusion of data appropriate for pediatric patients. Educational initiatives that translate health information to children and families. Integration of hospital information systems and evaluation appropriateness for pediatric patients. Distance linked services. Use of electronic information to enhance patient care and outcomes. Technology that enhances safety, such as with information databases. 42 Population-Focused Nurse Practitioner
Competency Area NP Core Acute Care Pediatric NP Policy 4. Contributes to the design of clinical information systems that promote safe, quality and cost effective care. 5. Uses technology systems that capture data on variables for the evaluation of nursing care. 1. Demonstrates an understanding of the interdependence of policy and practice. 2. Advocates for ethical policies that promote access, equity, quality, and cost. 3. Analyzes ethical, legal, and social factors influencing policy development. 4. Contributes in the development of health policy. 5. Analyzes the implications of health policy across disciplines. 6. Evaluates the impact of globalization on health care policy development. 1. Demonstrates an understanding of pediatric and acute care advocacy/ legislation and policy statements. 2. Uses relevant policy specific to children to direct appropriate patient care. 3. Advocates for unrestricted financial and legislative access for children and families to quality, cost effective healthcare. Healthcare Policy and Advocacy Process of healthcare legislation Child and family health legislation Implications of healthcare policy Third-party reimbursement Legislation and regulations concerning advanced practice Resource allocation Health Delivery System 1. Applies knowledge of organizational practices and complex systems to improve health care delivery. 2. Effects health care change using broad based skills including negotiating, consensus-building, 1. Serves as an advocate for the needs of children and their families within the health care system including facilitating transitions across settings. 2. Applies knowledge of family, child development, healthy work environment standards, and organizational theories and Management and Organization Organizational theory Models of planned change Healthcare system financing Reimbursement systems Resource management 43 Population-Focused Nurse Practitioner
Competency Area NP Core Acute Care Pediatric NP and partnering. 3. Minimizes risk to patients and providers at the individual and systems level. 4. Facilitates the development of health care systems that address the needs of culturally diverse populations, providers, and other stakeholders. 5. Evaluates the impact of health care delivery on patients, providers, other stakeholders, and the environment. 6. Analyzes organizational structure, functions and resources to improve the delivery of care. 7. Collaborates in planning for transitions across the continuum of care. systems to support safe, high quality, and cost effective care within health care delivery systems. Informatics Collaboration and planning for transition to adult health care. Integration of palliative and end-of-health care. Ethics 1. Integrates ethical principles in decision making. 2. Evaluates the ethical consequences of decisions. 3. Applies ethically sound solutions to complex issues related to individuals, populations and systems of care. Ethical and Legal Issues Ethical decision making Ethical use of information Bioethics committees Clinical research, including informed consent/assent Clinical trials for therapeutic management Legal issues affecting patient care and professional practice Cultural sensitivity Strategies for connecting the student to the 44 Population-Focused Nurse Practitioner
Competency Area NP Core Acute Care Pediatric NP local, national and international community. Independent Practice 1. Functions as a licensed independent practitioner. 2. Demonstrates the highest level of accountability for professional practice. 3. Practices independently managing previously diagnosed and undiagnosed patients. 3.a Provides the full spectrum of health care services to include health promotion, disease prevention, health protection, anticipatory guidance, counseling, disease management, palliative, and end of life care. 3.b Uses advanced health assessment skills to differentiate between normal, variations of normal and abnormal findings. 3.c Employs screening and diagnostic strategies in the development of diagnoses. 3.d Prescribes medications within scope of practice. 3.e Manages the health/illness status of patients and families over time. 4. Provides patient-centered care 1. Recognizes the importance of interprofessional team practice in providing safe, comprehensive clinical care. 2. Obtains relevant comprehensive problem focused health histories for children with complex acute, critical, and chronic conditions. 3. Applies advanced assessment skills to determine appropriate management in the care of children with single and/or multi system organ dysfunction. 4. Integrates knowledge of pathophysiology to anticipate and identify rapidly changing physiologic conditions and organ system failure in children. 5. Responds to children with complex acute, critical, and chronic problems to address rapidly changing conditions, including the recognition and management of emerging health crises, and organ dysfunction using both physiologically and technology derived data. 6. Prioritizes data recognizing the dynamic nature of a child with a complex acute, critical, and chronic condition. 7. Interprets age, developmental and situational appropriate screening and diagnostic studies essential in the diagnosis and management of the child with a complex acute, critical, or chronic health condition. Consider the unique aspects of the infant, child, and adolescent as they pertain to: Advanced Pathophysiology Advanced Physical Assessment Advanced Pharmacology (kinetics, dynamics, genomics) Genetics Principles of human genetics Genetic testing and screening Genetic abnormalities Human Genome Project Gene therapy Genetic Counseling Foundational concepts of the child & family Health and family assessment with emphasis on normal and abnormal growth and development Behavioral assessment Health promotion and disease prevention Common acute and chronic conditions Assessment of family adaptation, coping skills, and resources Sociocultural Assessment Family assessment Family function 1. roles 2. interactions 45 Population-Focused Nurse Practitioner
Competency Area NP Core Acute Care Pediatric NP recognizing cultural diversity and the patient or designee as a full partner in decision-making. 4.a Works to establish a relationship with the patient characterized by mutual respect, empathy, and collaboration. 4.b Creates a climate of patientcentered care to include confidentiality, privacy, comfort, emotional support, mutual trust, and respect. 4.c Incorporates the patient s cultural and spiritual preferences, values, and beliefs into health care. 4.d Preserves the patient s control over decision making by negotiating a mutually acceptable plan of care. 8. Develops appropriate differential diagnosis with an understanding of new or exacerbation of complex acute, critical, and chronic conditions. 9. Provides ongoing monitoring of children with single or multi-system organ dysfunction. 10. Seeks and integrates the perspectives of interprofessional team members in developing and implementing the plan of care. 11. Performs specific diagnostic maneuvers and/or technical skills to monitor and sustain physiological function. 12. Appropriately orders and performs interventions to monitor, sustain and restore stability in children with deteriorating conditions. 13. Understands the complexity and interaction of prescribing pharmacologic and nonpharmacologic therapies required in the care of children with complex acute, critical, and chronic conditions. 14. Prescribes medications and complex medical regimes monitoring for adverse outcomes specific to the child with high risk complex acute, critical, and chronic conditions. 15. Manages the medically fragile technology dependent child who presents with complex acute, critical, and chronic illness and injury 16. Stabilizes children in emergent and life threatening situations. 17. Performs consultations in a variety of settings for children with complex acute, Social, cultural, and spiritual variations Support systems Families in crisis Crisis theory Principles of intervention Grief 1. stages 2. factors influencing grieving process 3. pathologic grief 4. sibling reactions Principles of family-centered care Foundational concepts of the acutely ill child Responding to rapidly changing clinical conditions, including the recognition and management of emerging crises and organ dysfunction and failure. Complex monitoring and ongoing management of intensive therapies in a variety of settings, including but not limited to: inpatient and outpatient hospital settings specialty services emergency departments home care settings Essential knowledge of unique challenges and management of the chronically ill child and their family. Assessment of clinical laboratory and diagnostic imaging; including but not limited to: 46 Population-Focused Nurse Practitioner
Competency Area NP Core Acute Care Pediatric NP critical and chronic conditions based on knowledge and expertise. 18. Initiates and facilitates the child s transition within and outside of the health care setting and across all levels of care including admission, transfer and discharge. Microbiologic, biochemical, hematologic, and other relevant test. Diagnostic imaging studies Indications Reliability Advantages and disadvantages Cost-effectiveness Interpretation of results Screening tests, such as: Auditory, visual, and others as indicated. Indication for and principles of procedures, including but not limited to: Lumbar puncture Percutaneous arterial and venous catheters Arterial puncture Endotracheal intubation Laryngeal mask airway placement Assisted ventilation Intraosseous Needle aspiration of pneumothorax Chest-tube insertion and removal Fluid and electrolytes: Physiology 1. Electrolyte homeostasis 2. Body 3. Transitional changes 4. Insensible water loss 5. Endocrine control Renal function, physiology 47 Population-Focused Nurse Practitioner
Competency Area NP Core Acute Care Pediatric NP Calcium and phosphorus homeostasis Principles of fluid therapy 1. Assessment of hydration 2. Maintenance requirements 3. Factors affecting total fluid requirements Disorders of fluids and electrolytes Nutrition Caloric and nutritional requirements Feeding methods 1. Human milk 2. Bottle 3. Gavage 4. Gastrostomy 5. Transpyloric 6. Trophic Human milk, common formulas, specialty formulas 1. Composition 2. Benefits 3. Indication/contraindications Parenteral nutrition 1. Composition 2. Indications 3. Benefits 4. Complications 5. Monitoring Dietary supplementation Dietary adjustments in special circumstances Discharge planning Discharge planning process 48 Population-Focused Nurse Practitioner
Competency Area NP Core Acute Care Pediatric NP Technologically dependent children Parent education Community resources Home care and follow-up Assessment, diagnosis, and management of the following system specific problems: Cardiology: Arrhythmias Cardiomyopathy Cardiogenic Shock Congenital heart lesions Congestive heart failure Postpericardiotomy syndrome Pulmonary hypertension Rheumatic fever Syncope Transplantation Gastroenterology: Abdominal injuries Appendicitis Esophageal disorders Foreign Body Gastroenteritis Gastrointestinal bleeding Hepatitis Hyperbilirubinemia in the neonate Ingestions Inflammatory bowel disease 49 Population-Focused Nurse Practitioner
Competency Area NP Core Acute Care Pediatric NP Intestinal obstructions Hepatic insufficiency/failure Pancreatitis Superior mesenteric artery syndrome Genito-urinary/ Nephrology: Dialysis Female genitorurinary disorders (e.g. pelvic inflammatory disease, ovarian torsion) Hematuria Hypertension Renal Insufficiency/failure Male genitorurinary disorders (e.g. testicular torsion) Nephrotic syndrome Pylenonephritis/nephritis Renal tubular acidosis Transplantation Urosepsis Infectious Diseases: Bacterial infections (e.g. apparent lifethreatening events, bacteremia, epiglottitis, tracheitis) Health care associated infections Fever Fungal infections Multiple organ dysfunction syndrome Opportunistic infections Parapneumonic infections Resistant organisms 50 Population-Focused Nurse Practitioner
Competency Area NP Core Acute Care Pediatric NP Septic shock Systemic inflammatory response syndrome Travel Associated Infection Tuberculosis Viral infections (e.g. CMV, EBV, H1N1, RSV) Neurology: Arteriovenous malformation Brain death Cerebral palsy Cerebral vascular accidents Encephalopathy Hydrocephalus Hypotonia Meningitis Muscular dystrophies Neuropathy Spinal Cord Injury Status Epilepticus Submersion injuries Traumatic Brain Injury Pulmonary: Acute respiratory distress syndrome Air leak syndromes Airway obstructive/failure disorders Bronchiolitis Chronic lung disease Congenital central hypoventilation syndrome 51 Population-Focused Nurse Practitioner
Competency Area NP Core Acute Care Pediatric NP Cystic fibrosis Obstructive sleep apnea Pertussis Pneumonia Pulmonary edema Smoke inhalation Status asthmaticus Transplantation Congenital central hypoventilation syndrome Obstructive sleep apnea Pulmonary edema Smoke inhalation Status asthmatic Transplantation Oncology: Blood cell tumors Graft versus host disease Long-term effects of cancer therapy Solid tumors Transplant Tumor lysis syndrome Endocrine and Metabolic Adrenal disorders Cerebral salt wasting syndrome Diabetes I & II Diabetic ketoacidosis Diabetes insipidus Inborn errors of metabolism Metabolic syndromes 52 Population-Focused Nurse Practitioner
Competency Area NP Core Acute Care Pediatric NP Syndrome of inappropriate antidiuretic hormone Thyroid/parathyroid disorders Hematology: Anemias (e.g. aplastic, sickle cell) Coagulation disorders (e.g. disseminated intravascular coagulation, hemophilia, Henoch Schönlein purpura, heparin induced thrombocytopenia, idiopathic thrombocytopenia purpura) Thrombotic disorders (e.g. deep vein thrombosis) Inflammatory: Anaphylaxis Immunodeficiencies Juvenile Idiopathic Arthritis, Systemic Lupus Erythematosus Vasculitis Otolaryngology: Laryngomalacia Mastoiditis Orbital/periorbital cellulitis Retropharyngeal abscess Vocal cord paralysis Musculoskeletal: Compartment syndrome Legg-Calvé-Perthes disease Myositis Osteomyelitis Rhabdomyolisis 53 Population-Focused Nurse Practitioner
Competency Area NP Core Acute Care Pediatric NP Septic arthritis Spinal fusion Pain management: Physiology of pain Pain management 1. Nonpharmacologic 2. Pharmacologic Palliative and end-of-life care: Ethical considerations Pain management at end of life Hospice care Bereavement 54 Population-Focused Nurse Practitioner