Factors Influencing Confidence in Caring for Pediatric Mental Health Disorders in Primary Care
Open Access DepositedA National Survey of Family Nurse Practitioners
The United States (US) has long faced a deficit in addressing pediatric mental health and behavioral disorders, with COVID-19 further expanding this care gap. Nurse practitioners (NPs) have reported minimal training during training and clinical experiences. Limited research has been conducted to describe family nurse practitioner (FNP) clinical practice, the specific details of their pediatric and mental health patients, or their perceived confidence in treating these disorders. This study aims to examine the overall prevalence of pediatric patient care provided by FNPs in the primary care setting and explore the incidence of mental health and behavioral disorders among these patients. The study will also explore factors affecting perceived confidence in FNPs’ care for pediatric patients with mental health and behavioral disorders in primary care settings. This study used a cross-sectional quantitative survey to describe the overall pediatric practices of FNPs and the prevalence of pediatric mental and behavioral health disorders. Furthermore, this study explored factors affecting overall confidence in caring for these disorders. The study sampled 141 FNPs within their first eleven years of practice and demonstrated that depression was the most commonly encountered mental health disorder at the treatment phase of the care process. A bivariate exploration was performed on various potential predictors, which determined that the percentage of pediatric practice composition, practice location, and frequency of pediatric depression visits were statistically significant. Four predictors were included in the multiple linear regression. Pediatric depression encounters had the highest influence on increased perceived confidence. The providers in a family medicine location only perceived a positive improvement in overall confidence during the assessment and screening phase model but not in the other models (for example, diagnosis, treatment, and evaluation). Although limitations exist with respect to the statistical model and research design, this study provides insights for entry-to-practice and education programs to consider additional training experiences for FNPs to better train them to address pediatric mental health disorders. In this context, increasing pediatric clinical composition and student FNP exposures are not feasible, but augmenting education and training programs with simulations can be a sustainable option. Additional research should define whether practice restrictions contribute to reduced confidence, competence, and access to care for pediatric mental health disorders. Herein, the policy implications are that the restrictions on FNPs practicing to the full extent of their license impact FNPs’ ability to practice confidently and create unnecessary barriers that reduce access to care for patients, especially those in rural areas.
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