Page 423 - Encyclopedia of Nursing Research

390 n PeDIATRIC PRIMARY CARe

This can be explained by the lack of theoreti- 25 years, primary care has changed to include
cal models of patient satisfaction. pediatric nurse associates who are now
P One issue related to measurement of called pediatric nurse practitioners (PNPs).
patient satisfaction with nursing care is the PNPs were the first nurse practitioners; they
lack of psychometrically tested, valid, and are advanced practice nurses who are edu-
reliable instruments (lynn & McMillen, 2004; cated to provide primary care services to
Urden, 2003; Woodring et al., 2004; Yellen, children. Dr. Henry K. Silver and Dr. loretta
2003). A second issue is the lack of consid- Ford started the PNP program in Colorado
eration for demographic factors such as age, in 1964. Although the role has remained
educational level, and ethnic and cultural much the same from its inception, one major
background in the development of instru- change is the level of education required.
ments. A third issue is the development of Originally, it was a 4-month continuing edu-
instrument from the perspective of the pro- cation program and now it is a 2-year educa-
vider and not the patient (lynn & McMillen, tional program culminating with a master’s
2004). Finally, issues related to methodology, degree. National certification is required in
survey design, administration techniques, some states to allow PNPs to practice. There
and timing are of concern (Urden, 2003). are two certifying organizations for PNPs: the
These issues need to be addressed. American Nurses Credentialing Center and
An issue not directly related to concep- the Pediatric Nursing Certification Board.
tualization and measurement of patient satis- Currently, there are differences in health
faction is the lack of inclusion of nurses in the care outcomes between minority and majority
development of instruments and the exclu- ethnic groups. Children in minority groups
sion of nurse-sensitive indicators in hospital are at much greater risk for poor health care
quality reports (Yellen, 2003). There is a high factors, and there is a lack of culturally com-
correlation between patient satisfaction with petent health care providers. Hispanic and
nursing care and satisfaction with overall care Black children are more likely to be uninsured
(Beck & larrabee, 1996; Jacox et al., 1997). For and receive lower quality primary care than
this reason, nurses need to be active partici- White children (Flores & the Committee on
pants in quality reporting and in the develop- Pediatric Research, 2010). In 1998, President
ment of patient satisfaction instruments. Clinton presented the Initiative to eliminate
In summary, patient satisfaction is a crit- Racial and ethnic Disparities in Health. This
ical outcome indicator. It impacts both the proposal seeks to eliminate disparities by the
quality and financial aspects of health care year 2010 and focuses on the same goals and
organizations. Nurses are major contribu- outcomes as Health People 2010: infant mor-
tors to the level of patient satisfaction. These tality, child and adult immunizations, HIv/
contributions need to be measured and AIDS, diabetes, cardiovascular disease and
recognized. stroke, and cancer screening and manage-
ment. Access to health care and quality of
Cecilia D. Alvarez health care are also part of the focus.
Childhood immunizations, particularly
in children less than 2 years of age, con-
tinue to be a major health concern in primary
PeDiatriC Primary Care care. Health People 2010 and the President’s
Childhood Immunization Initiative man-
dated a goal of 90% immunizations for chil-
Pediatric primary care has existed for a long dren younger than 2 years by the year 2000.
time and has been provided by family prac- In 1992, only 55% of children under the age
tice physicians and pediatricians. In the last of 2 years had received an adequate number