Today, pediatric nurses practice in a variety of settings providing non-specialized, general pediatric nursing care. Just as all aspects of nursing care have evolved, the range of knowledge, skills, and abilities needed to provide expert pediatric nursing care has expanded. In our international review of the role of the general pediatric nurse in the U.S. and Canada, we were impressed with the variety of new knowledge and skills the pediatric nurse has mastered, including knowledge of complex psychosocial and behavioral issues as well as complex technology monitoring. The new aspect of pediatric nursing care was apparent in our review of pediatric nursing curricula in the U.S. and Canada, from job interviews and analysis of recorded nursing practice activity logs, and through analysis of our comprehensive international survey. Details of this unique international role delineation survey can be found in the article 'What Do Pediatric Nurses Do? Results of the International Role Delineation Study' (Pediatric Nursing, vol. 28, no. 2, pages 165-170).
As a final product of this historic survey, an expert panel of pediatric nurses from the U.S. and Canada forged a new national pediatric nursing exam content outline from analysis of survey results and all aspects of the role delineation research.
The unique and comprehensive outline (see Table 1) reflects the nature of general pediatric nursing practice in the U.S. and Canada today. While there may be some disagreement as to the percent allocation of content within the outline, this new national exam outline reflects a comprehensive scope of pediatric nursing practice and is endorsed by representatives to the National Certification Board of Pediatric Nurse Practitioners and Nurses (NCBPNP/N) from the following organizations: (a) American Academy of Pediatrics (AAP), (b) National Association of Pediatric Nurse Practitioners (NAPNAP), (c) Society of Pediatric Nursing (SPN), and (d), the Canadian Nurses Association (CNA).
The NCBPNP/N will launch this new exam content outline in 2002-2003. We invite all pediatric nurses seeking national recognition for their pediatric nursing expertise to apply for national certification. To learn more about national certification in pediatric nursing contact the NCBPNP/N at (888) 641-2767 or www.pnpcert.org.
Table 1. The NCBPNP/N National Certification Examination Content Outline for the Certified Pediatric Nurse (CPN[TM]) Exam
General pediatric nurses provide care to children * and their families across the health care continuum, including health promotion, illness management, and health restoration. Pediatric nurses may practice in a variety of settings and roles, including direct caregiver, educator, counselor, consultant, advocate, care coordinator, or health systems manager. Pediatric nurses have the ability to assess, plan, and implement nursing interventions, evaluate nursing care, and incorporate research findings.
* Ages 0-21 and beyond in special situations.
I. Developmental--Biologic and cognitive development and growth parameters used to determine how the child is functioning. Implementation of appropriate counseling/education and anticipatory guidance for the child and family (22% of the examination).
A. Assessment--Collection of data about/from the child and family. It is a continuous ongoing process.
1. Assess child and family using various growth and developmental theories and other cognitive screening procedures.
2. Interpret developmental history and influencing environmental variables as a part of a comprehensive age-specific assessment.
3. Identify the usual progression of growth and development throughout the early stages of the life cycle, including adolescence.
4. Assess growth parameters (e.g., growth chart, height, weight, FOC).
5. Assess child's understanding of the health/disease process.
6. Assess child's barriers to learning.
B. Planning--Clearly defined plan of action developed with the child/family.
1. Develop an individualized plan of care that addresses developmental needs.
2. Formulate individualized teaching plan based on child/family assessment.
3. Determine age and developmentally appropriate equipment and supplies.
C. Implementation: Actions taken by the nurse to put into effect the care plan developed during the planning phase.
1. Implement developmentally appropriate creative teaching strategies to meet child/family needs.
2. Implement communication strategies appropriate to child's age and cognitive development.
3. Encourage age-appropriate play.
4. Implement appropriate counseling/education to prevent accidents and injuries.
5. Implement appropriate counseling/education to facilitate life choices for youth.
6. Provide anticipatory guidance for the child and family (e.g., regarding speech/language development, peers, school, socialization, multimedia, transition of care, procedures, and treatment).
7. Modify nursing interventions for a child with special needs.
D. Evaluation: Determining the effectiveness of the care plan in solving identified problems or meeting the child/family needs. It is a continuous ongoing process.
1. Analyze the outcomes of age and developmentally appropriate interventions.
II. Psychosocial/Behavioral--Social, environmental, and cultural influences on mental health and quality of life (15% of the examination).
A. Assessment
1. Use appropriate interview techniques to gather psychosocial data from the child.
2. Assess behavioral reaction to stressful events.
3. Identify the emotions and/or temperament of the child and how they are affected by parenting styles.
4. Identify physical, psychological, and environmental influences that lead to unhealthy behaviors (e.g., violence, addictive behaviors).
5. Determine patient needs pertaining to discharge planning.
6. Assess for abuse and neglect.
7. Differentiate between normal and abnormal psychosocial findings and communicate to appropriate health care professionals.
8. Analyze situations to anticipate potential psychosocial problems and detect changes in patient status.
B. Planning
1. Partner/collaborate in development of the plan of care for children and youth with abnormal psychosocial findings.
2. Develop an individualized plan of care that addresses psychosocial needs.
C. Implementation
1. Serve as a child advocate.
2. Facilitate the incorporation of self-care strategies to promote health.
3. Foster independence through capacity building: self-esteem and positive decision making.
4. Facilitate child/family adjustment to hospitalization/illness.
5. Implement appropriate counseling strategies based on child and family health needs.
6. Maintain privacy and confidentiality in the nurse/child relationship within legal constraints.
7. Provide supportive care for child and family during grief and loss.
D. Evaluation
1. Identify child and family behavioral responses when managing complicated therapies.
2. Assess for adherence with therapeutic regimen (e.g., medication).
3. Identify barriers to full participation in health restoration plan.
III. Family Centered Care--Family and professional partnerships related to family and child needs (18% of the examination).
A. Assessment
1. Identify cultural/spiritual factors that influence child and family health care practices.
2. Identify the major factors that determine the type of relationship children and youth have with their parents.
3. Identify educational needs for parenting.
4. Recognize aspects of patient status, family integrity, family role functions, and coping that vary from normal development.
5. Identify child and family responses to living with a chronic condition or special need(s).
6. Identify factors affecting parent-child attachment.
B. Planning
1. Formulate family needs based on the existing family situation.
2. Incorporate cultural, social, political, economic, demographic, and ecological variables that affect delivery of nursing care to children and families.
3. Involve child and family in decision making related to the plan of care.
C. Implementation
1. Assist child and family in implementing their role in the plan or care.
2. Advocate for the child and family during interdisciplinary rounds and/or patient-care conferences.
3. Teach child and family about community resources.
4. Facilitate change in family dynamics to promote child's health.
5. Facilitate the transition (flow) of child and family through the care continuum.
6. Promote parent-child attachment.
7. Communicate concerns regarding negative parenting to appropriate resources.
8. Provide supportive care for child and family during end of life. *
D. Evaluation
1. Alter nursing interventions based upon the patient/family responses and health needs.
2. Identify changes in parent-child interaction and attachment.
IV. Health Promotion and Maintenance--Wellness management of child and family (20% of the examination).
A. Assessment
1. Identify nutritional requirements and dietary patterns and perform nutritional screening.
2. Identify unique behavioral characteristics of the child and implications for care.
3. Assess for immunization status and adverse reactions.
4. Assess for health maintenance and promotion needs of the child
B. Planning
1. Determine patient needs pertaining to nutritional counseling.
2. Develop plan to meet the child's health maintenance and health promotional needs to maximize positive self-care.
C. Implementation
1. Teach families infectious disease prevention principles.
2. Provide anticipatory guidance regarding health issues for the child and family.
3. Facilitate feeding practices, including breast feeding to support optimal development of the child.
4. Provide anticipatory guidance for the child and family regarding immunizations.
D. Evaluation
1. Evaluate adherence to health maintenance and promotion practices.
2. Identify barriers to full participation in health maintenance and promotion practices.
V. Physiology/Pathophysiology--Normal and abnormal physiological principles and processes (25% of the examination).
A. Assessment
1. Identify the unique physiological and/or pathophysiological characteristics of the child and implications for care.
2. Assess for nursing procedures/interventions using age appropriate guidelines.
3. Assess the development of the nervous system by the presence or absence of reflexes (newborn).
4. Interpret observations, history data, physical examination results, and cultural and genetic influences as a part of a comprehensive, age-specific assessment.
5. Assess immunologic status.
6. Identify changes in signs and symptoms in emergent situations.
7. Analyze results of diagnostic testing.
8. Differentiate between normal and abnormal physical findings.
B. Planning
1. Develop plan of care based on child's functional status.
2. Develop plan of care based on analysis of symptoms.
3. Develop plan of care based on needs pertaining to pain management. *
4. Select appropriate monitoring technology as an adjunct to child assessment (e.g., ECG, pulse oximetry, apnea monitor).
5. Prioritize and delegate interventions and therapies.
6. Plan for the following health care interventions:
a. Feeding adjuncts.
b. Specimen collection.
c. Skin care.
d. Medication administration, including oxygen. *
e. Mobility and positioning.
f. Phototherapy.
g. Neutral thermal environments (thermal regulation).
h. Conscious sedation.
i. Suctioning.
j. Line maintenance (e.g., vascular, drainage, feeding).
k. Blood administration.
l. Fluid and electrolytes.
m. Infection control.
7. Develop an individualized plan of care that addresses physical needs.
8. Plan for consistent safe environment using alternatives and/or least restrictive measures.
9. Anticipate potential pathophysiological problems and detect changes in child's status.
C. Implementation
1. Intervene in emergent situations.
2. Implement interdisciplinary discharge/transfer plan.
3. Manage the nursing care of children receiving the following procedures/interventions using age appropriate guidelines:
a. Feeding adjuncts.
b. Specimen collection.
c. Skin care.
d. Medication administration, including oxygen. *
e. Mobility and positioning.
f. Phototherapy.
g. Neutral thermal environments (thermal regulation).
h. Conscious sedation.
i. Suctioning.
j. Line maintenance (e.g., vascular, drainage, feeding, oxygen).
k. Blood administration.
l. Fluid and electrolytes.
m. Infection control/transmission of communicable pathogens.
4. Provide interventions to prevent transmission of communicable disease.
5. Communicate abnormal physical findings to appropriate health care professionals.
6. Participate in activities to manage child's pain. *
D. Evaluation
1. Differentiate between normal and abnormal physical findings and communicate findings to appropriate health care professionals.
2. Evaluate the following nursing procedures/interventions using age appropriate guidelines:
a. Nutrition support.
b. Specimen collection.
c. Skin care.
d. Medication administration, including oxygen. *
e. Restraints.
f. Phototherapy.
g. Neutral thermal environments (thermal regulation).
h. Conscious sedation.
i. Suctioning.
j. Line maintenance (e.g., vascular, drainage, feeding, oxygen).
k. Blood administration.
l. Fluid and electrolytes.
3. Adapt the plan of care based on child and family needs while managing complicated therapies.
4. Modify plan of care to accommodate a child's sensory and motor deficits.
5. Evaluate for variance in the interdisciplinary plan of care.
6. Evaluate the effectiveness of pharmacological and nonpharmacological pain management interventions. *
* Required element
Janet S. Wyatt, PhD, RN, CRNP, is Executive Director of the National Certification Board of Pediatric Nurse Practitioners and Nurses (NCBPNP/N) and Editorial Board member for Pediatric Nursing.
