For Parish Nurses

Parish Nurse Research Update

Dear Parish Nurses:  So summer is half over and school will be starting very soon. If you have bogged down in summer activities, set aside time to plan your educational programs for this fall - or maybe you already have that done.  In either case, consider the following interesting articles.

  1. Norra MacReady, writing in Medscape, July 10, 2018, critiques a study that investigated the rates of developmental screening done on young children by their pediatricians.  The reseracher, publishing their article in JAMA Pediatrics, stated that fewer than one third of young children receive a recommended parent- completed developmental screening, and only 1 in 5 children received both screening and surveillance even though developmental screening for children from 9 through 35 months of age is recommended by several professional and policy-making organizations.  Parental education, marital status, English langauge and private insurance were factors that influenced whether the child would have the screening/surveillance.  Without the screening/surveillance, a comprehensive primary care plan could not be put in place that would address any developmental needs the infant/child might have.

Parish nurses, talk with the parents in your congregation who have infants/children about the well-baby visits to their doctor.  These screening can identify specific health issues that might be addressed through early care and treatment.  Also note, if your congregation has non-English speaking parents or non-white ethnicity,  screening/survillance of these children may lacking.

2.  Seabury, S. A. , et al. (2018). Assessment of follow-up care after emergency department presentation for mild traumatic brain injury and concussion. JAMA Newtork Open, doi:10.1001/jamanetworkopen.2018.0210.  Less than half of people treated for a mild traumatic brain injury at major trauma centers received follow-up care three months after discharge.  This lack of care suggests that people with persistent symptoms from concussions may not be receiving treatments that could improve their physical and mental health. It have been recognized that concussions can have long-term effects that decrease quality of life; this includes headaches, trouble with memory and reasoning, difficulty sleeping, and depression which may last for up to one year.   This study showed that 61% of those with the more serious injuries were somewhat more likely to reveive follow-up care,  but that left 39% that did not receive any care.  The authors concluded that concussions, for may patients, are being treated as a minor injury, even though many patients experienced moderate to sever symptoms three months later.

Do you have members in your congregation who have experienced a concussion - think about all the youth playing contact sports.  Perhaps an article in your newsletter or bulletin about the after effects of concussions would be an important learning opportunity for these members or their parents. With the current research on the lasting effects of continual concussions, being informed is important.

3. Luby, J. L. et al. (2018). A randomized controlled trial of parent-child psychotherapy targeting emotion development for early childhood depression. Am J Psychiatry. doi: 10.1176/appl.ajp.2018.18030321.  Researchers found that a therapy-based approach focused on emotional development may be an effective option for treating early childhood depression.  The authors suggested that the treatment options used with teen and adults were not appropriate for young children and that alternatives that are more suitable for working with young children and their parents were needed. One type of treatment was investigated, Parent-Child Interaction Therapy (PCIT).  The study participants were randomly divided into a treatment and waitlist group.  Since there is no currently proven treatments for early childhood depression, the children in the waitlist group were monitored but received no active intervention during the study.  The treatment group participated in PCIT which included 12 treatment sessions plus an added 8 sessions to train parents to be more effective at helping their children regulate emotions.  Per and post study period assessments were completed.  At the end of the study, children in the treatment group were less likely to meet the criteria for depression and scored lower on depression severity that children in the waitlist group.  The treatment children also had improved functioning, greater emotional regulation skills and greater "guilt reparation" (e.g. spontaneously saying "sorry" after having done something wrong).   The authors concluded that this study "provided evidence that an early and brief psychotherapeutic intervention that focuses on the parent-child relationship and on enhancing emotion development may be a powerful and low-risk approach to the treatment of depression" in young children. 

You may have some child in your congregation that would benefit from this therapy.  Depression in young children is difficult to identify but questions from parents that would suggest their child is experiencing depression might be a clue that something is wrong.  If that occurs, investigate local healthcare professionals that might offer this therapy.

4. Brous, E. (2018). Legal issues in dismissing unvaccinated patients. AJN, 118(6), 64-66. School is right around the corner and with children going to kindergarten/first grade for the first time, documentation of vaccinations will be requested. This article outlines the legal issues involved in dismissing unvaccinated patients.  The author outlines the public health issues such as outbreaks of preventable diseases; those most effected are children who have chronic medical conditions that prohibits the administration of vaccines.  Interestingly, the parents most likely to be "vaccine refusers" are well-educated, higher-income parents.   The reasons healthcare providers are dismissing these patients revolve around several issues, they do not believe the parents trust them, they have an obligation to protect their patients who cannot be vaccinated are are vulnerable and the liability concerns.

This article provides valuable information for the parish nurse to use in talking with parents about vaccination of their children.

Have a great, rest of the summer.

Andrea West, FCN