Comparative study of the nurse and the physician giving primary care at the well-child conference
Creators: name: Shiramizu, Elsie Masaye
Publisher: name: University of Utah
Year: 2012

description: The findings indicate (1) the nurse is capable of giving primary care which consists of doing physical examination, assessing the growth and development of the child, giving nutritional guidance, and interviewing the parents for developmental, medical, and family history; (2) the nurse was able to identify more significant findings than the physician in special areas such as nutritional, developmental lag, and history; and (3) there was no significant difference between the nurse's findings and the physicians' findings in Group II, therefore, it was concluded that the nurse was as capable of giving primary care at the routine well-baby visit as the physician.  Out of 30 infants, six infants (20%) were assessed by both the physician and the nurse as not having any physical or developmental problems at the time of the examination.  These were noted as "well-baby" in the charts.  Although the remaining 24 infants came in for well-child care, they were found to have medical or developmental problems which needed attention from the physician or the nurse.  Since 80% had medical or developmental problems, it would appear that either the mothers made the appointments because of the problems or they were able to cope with them until the visit.  Further study is indicated to determine the parent's concept of the purpose of the well-baby visit.  The nurse identified on abnormal sign in physical examination and two nutritional problems which the physician did not mention in the charts, although they were discussed with him previously.  This could be because they were already in the chart by the nurse after she had discussed them with him.  It is interesting to note that the nurse was able to identify a specific developmental lag using DDST while the physician used the general term "brain-damaged" in his assessment.  It identifying the specific problems at an earlier time, better counseling an be giving to the mother regarding the care of the child.  If a specific developmental lag is known, attention can be focused in that area.  The mother could be taught to work with the child in order to compensate for his sensory deficiencies.  One child diagnosed as "brain-damaged" by the physician earlier was found to be blind or have a visual defect at age six months by the nurse using the DDST.  This identification of the specific problem was very important in implementing correct health care for the child.  In order to assist this child, the mother was taught how to simulate the child's tactile senses and to help him make full use of his intact auditory senses.  This study was only concerned with the identification of problems.  A longitudinal follow-up study should be done to evaluate the effectiveness of the health counseling given by the pediatric nurse practitioner and its correlation to the child's performance later in the academic setting.  For collaborative nurse-physician care, the nurse gives primary care and refers medial problems to the physician.  The physician does not give primary care.  For this study, both groups received primary care from the nurse and the physician so that the results could be correlated.  The effectiveness of collaborative nurse-physician care cannot be ascertained by this study.  Further study should be done to see if a nurse with less than  graduate preparation in child nursing could give primary care at the well-child clinics and to find what additional background she will need to function adequately in the expanded role.  This has implication for future nursing conferences of the Public Health Nurses in Utah.