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In 2020, SPN initiated a project to define the construct of “pediatric nursing excellence”. Two years later, SPN published its Pediatric Nursing Excellence Model, consisting of a visual depiction accompanied by definitions of 16 concepts that comprise the PNE Model. This article presents the five stages of the development process, the components of a model of pediatric nursing excellence, and the potential uses of such a model.
The question of what makes an “excellent” pediatric nurse has been asked frequently by both pediatric and non-pediatric nurses for many years. Early efforts to differentiate the specialty of pediatric nursing included establishing the scope and standards of pediatric nursing practice (
). Parallel to that, Lewandowski and Tessler identified components of family centered care, a concept almost exclusive to pediatric nursing at that time (
). Two decades ago, the American Academy of Nursing's Child-Family Expert Panel worked with 12 subspecialty organizations including the Society of Pediatric Nurses (SPN) to reach consensus on the indicators of quality maternal-child care (
). One of the assumptions of this work focused on provision of developmentally appropriate care. The original indicators were expanded to guidelines that included questions for consumers to determine if quality pediatric care was being delivered (
). These guidelines were revised in 2014 and became the basis for the chapters in the Guidelines for Nursing Excellence in the Care of Children, Youth, and Families, 2nd edition text (
Advancing the development of the guidelines for the nursing of children, adolescents, and families: 2014 revision: Process, development, and dissemination.
Journal of Pediatric Health Care.2016; 30: 284-288
). Although all these activities were pivotal to identifying components of high-quality pediatric nursing care, SPN felt more specificity was needed to define the attributes of an excellent pediatric nurse.
Recent discussions of pediatric nursing excellence by members of the SPN offer longevity in the practice setting, increased formal education in the care of children and families, satisfaction surveys post encounter, professional presentations and publications and specialty certification as features of excellence. However, the construct of “pediatric nursing excellence” (PNE) is not well defined. Neither the American Nurses Credentialing Center (ANCC) Magnet® Recognition Program (
delineates the competent nurse rather than identifying the characteristics of excellent pediatric nursing. Recognition of nursing excellence advances the organization, nurses, and patients (
Several synonyms for “excellence” are in common use including “distinction”, “quality”, “merit”, “brilliance” and “accolade”. In the literature, nursing excellence is equated with exemplary professional practice (i.e., a Magnet component) when using the Synergy Model for Patient Care (
). The Synergy Model states that the “essence of nursing” is primarily focused on doing what “patients and families need using caring relationships to facilitate healing” (
presents strategies for enhancing recognition of nursing excellence in both academia and in the practice arena. She advocates using only nurse-sensitive indicators to assess patient needs and to measure nursing practice outcomes (pp. 175–176). NDNQI measures focus on outcomes in selected patient conditions or settings with few measures that address desirable pediatric outcomes (
; NDNQI, 2010). The current project concentrated on what excellence looks like for pediatric patients and families who may not resonate with lack of pressure injury for example as a measure of quality care. Clinical ladders address professional development of individual nurses over time rather than on the care that is provided and patient outcomes (
The American Association of Critical-Care Nurses (AACN) defines nursing excellence as: “helping nurses make their optimal contribution to patients and their work environments and the recognition of their efforts” (
American Association of Critical-Care Nurses (AACN). (n.d.). What is nursing excellence? Retrieved August 16, 2022, from https://www.aacn.org/nursing-excellence.
). Additionally, the American Nurses Credentialing Center (ANCC) recognizes excellence of healthcare organizations by two complementary mechanisms. The Magnet Recognition Program® emphasizes high quality outcomes and innovations in nursing practice, while the Pathway to Excellence® program acknowledges supportive practice environments that empower nursing staff (
). However, none of these programs describes pediatric nursing excellence.
In 2020, SPN initiated a project to define the construct of “pediatric nursing excellence” (PNE) by identifying essential concepts, developing definitions, and creating a model to represent PNE. The newly developed model of pediatric nursing excellence can be utilized by clinical and academic settings to set standards of practice, to develop professional practice models, to identify elements for clinical advancement programs, and to identify pediatric-specific quality indicators at a national level while aligning with the mission of SPN. This article presents the model development process undertaken by SPN, the components of the PNE Model, and its potential uses.
Development of the PNE Model
In April 2020, the SPN Board recruited six experienced pediatric nursing experts from across the United States to participate in a task force to carry out this project (See Box 1). The PNE Task Force members had an average of 37 years of experience (minimum 28 years, maximum 50 years) and represented acute, ambulatory, community, and academic settings. There were five phases to development of the Pediatric Nursing Excellence Model including 1) identification of possible concepts and definitions, 2) obtaining pediatric nurse feedback on the possible concepts, 3) identification of domains, final concepts, and relationships between model components, 4) verification of concepts of the model, and 5) final confirmation of the PNE Model including graphic depiction, domains, concepts, and definitions. This process was viewed as a membership survey comparable to SPN's educational needs assessment conducted every 2–3 years, with approval of the process provided by the SPN Board. Therefore, an outside ethics authorization was determined to be unnecessary.
Lori Williams, DNP, RN, RNC-NIC, CCRN, NNP-BC, University of Wisconsin Hospitals and Clinics, WI.
Kim Eskew, MBA, CAE, SPN Executive Director, Chicago, IL.
Phase 1: Identification of concepts and definitions
Phase 1 of the project included identification of concepts for consideration. To identify relevant concepts, the standards of practice and/or principles from seven professional nursing organizations were reviewed including the International Council of Nurses, American Association of Critical Care Nurses, National Association of Neonatal Nurses, American Association of Colleges of Nursing, American Academy of Ambulatory Care Nursing, Association of Pediatric Hematology/Oncology nurses, and the National Organization of Nurse Practitioner Faculties. Concepts from two multidisciplinary organizations also were reviewed, including the Institute of Patient-Family Centered Care and Healthcare Without Harm. Additionally, concepts from the
The review of professional organizations and multidisciplinary organizations initially yielded 65 concepts for consideration. Upon careful consideration through discussion and consensus of the task force, it was determined there were 23 unique concepts relevant to pediatric nursing excellence that should be further explored. Once agreement was reached on the possible concepts to be included, definitions were developed which were adapted from the literature, professional organizations, and expert opinion (
Greiner A.C. Knebel E. Health professions education: A bridge to quality. Board on Health Care Services,
Committee on Health Professions Education Summit, Institute of Medicine2003
). All definitions were edited as necessary to apply to care of children and their families.
Phase 2: Collection of pediatric nurse feedback
Phase 2 of the project was to obtain reactions to the possible PNE concepts and definitions from pediatric nurses. To collect this feedback, a survey was developed using an online survey tool which included the 23 proposed concepts and associated definitions. The survey included Likert-type questions to collect these responses, asking respondents to rank each concept on a 1 to 5 scale, with 1 indicating “definitely not a concept of pediatric nursing excellence” and 5 indicating “definitely a concept of pediatric nursing excellence”. The nurses also were asked to select the top 10 concepts to be included in PNE. Optional free-text comments associated with each concept were solicited. Finally, respondents were asked to list any concepts of pediatric nursing excellence that were missing from the initial list of 23.
Demographic information collected included the practice setting, professional position, specialization, years of experience as a nurse, years of experience as a pediatric nurse, highest education preparation, and certification status. The survey invitation was sent as two emails to the full SPN membership, included in “SPN Member Digests”, and forwarded to other pediatric nursing organizations asking them to distribute the survey to their members. The Pediatric Nursing Certification Board [PNCB] and the Association of Pediatric Gastroenterology and Nutrition Nurses [APGNN] agreed to share the survey with their memberships. The survey was open for approximately seven weeks.
A total of 1046 responses to the survey were received. As the project sponsor, the response rate for SPN members was 9.1%, which is higher than the typical SPN response rate of 4% (Kim Eskew, personal communication, March 2, 2021). With members of PNCB, SPN, and APGNN, this reflects a response rate of 3.3% of the 31,631 members. (No respondents indicated participation through any other pediatric nursing organization.)
Almost half the respondents (48.46%) identified their practice setting as acute care, followed by ambulatory (29.38%), teaching/academia (9.5%) and the remainder were evenly spread between community, post-acute care and retired. Most were either clinical nurses (37.42%) or nurse practitioners (27.29%), followed by instructor/educator (11.38%) with the remainder spread across 10 other roles. The highest number of respondents identified their specialty area as general pediatrics/medical surgical (44.28%), followed by ambulatory (20.83%), critical care (15.12%), NICU/newborn/fetal health (7.75%), with the remainder spread across emergency, hematology/oncology, mental/behavioral health, perioperative and “other.” Most reported the same years of total nursing experience and years as a pediatric nurse, indicating they had all their experience in pediatrics. The majority had at least 20 years of experience (53.31%), followed by 11–20 years (26.08%) and 0–10 years (20.61%) respectively. Most respondents held master's degrees (42.33%), followed by bachelor's degrees (35.31%), doctorates (12.87%) and diploma/ADN degrees (7.20%). Nearly all respondents held at least one pediatric nursing certification (85%).
The concepts of “advocacy” and “family-centered care” were the top ranked concepts with greater than 90% of respondents rating them as 5 (see Table 1: Concept Rankings 1–5). These two concepts were also the top ranked concepts in the top 10 list (See Table 2: Percent of Top 10 Responses). The concepts of “evidence-based practice” (EBP), “collaboration”, “professionalism”, “health promotion”, “ethics” and “care coordination” were highly ranked with at least 80% of respondents ranking them as 5. Though all were included in the top 10 list, only “collaboration”, “care coordination” and “health promotion” were identified by at least half of the respondents. “Equity/diversity/inclusion”, “quality of life”, “outcomes”, “holistic care”, “quality standards”, “care planning” and “professional development” were ranked as 5 by roughly 70% of the respondents which provided a natural cutoff point.
Table 1Concept Rankings, 1–5 Presented as Percentages.
Concept
1
2
3
4
5
Advocacy
0.41%
0.21%
0.82%
4.42%
94.14%
Family-centered care
0.21%
0.31%
1.13%
5.65%
92.7%
Evidence-Based Practice
0.21%
0.31%
0.72%
10.69%
88.08%
Collaboration
0.1%
0
1.85%
12.54%
85.51%
Professionalism
0.21%
0.92%
2.67%
13.57%
82.63%
Health Promotion
0.21%
0.41%
2.57%
14.39%
82.43%
Ethics
0.1%
0.1%
2.98%
15.21%
81.6%
Care Coordination
0.21%
0.31%
3.49%
15.72%
80.27%
Equity/Diversity/Inclusion
0.51%
1.23%
4.83%
13.98%
79.45%
Quality of Life
0.51%
0.21%
3.7%
17.47%
78.11%
Outcomes
0.41%
0.51%
4.32%
19.22%
75.54%
Holistic Care
0.31%
0.62%
4.42%
20.04%
74.61%
Quality Standards
0.31%
0.72%
4.52%
23.02%
71.43%
Care Planning
0.31%
0.41%
4.21%
20.04%
70.03%
Professional Development
0.41%
1.54%
5.34%
22.82%
69.89%
Leadership
0.1%
1.64%
6.47%
24.77%
67.01%
Mentoring
0.31%
1.23%
7.3%
27.13%
64.03%
Resource Utilization
0.41%
1.64%
11.82%
32.17%
53.96%
Population Health
0.92%
3.19%
12.33%
35.77%
47.79%
Innovation
0.41%
2.26%
13.87%
35.87%
47.58%
Technology
1.34%
2.57%
14.49%
36.69%
44.91%
Informatics
1.64%
4.83%
21.48%
39.36%
32.68%
Environmental Sustainability
3.08%
6.37%
28.16%
32.99%
29.39%
Key: 1 = definitely not a concept of pediatric nursing excellence.
5 = definitely a concept of pediatric nursing excellence.
In addition to the quantitative responses, a total of 830 comments were associated with specific concepts, with 21 to 69 comments per concept. An additional 87 comments addressed missing concepts. To consider all feedback, the task force members divided up the 23 concepts and carefully reviewed all comments to determine if any concepts should be deleted, revised, re-defined or added to the list of 23. Although most comments supported the defined concepts, some feedback led to revisions. The definitions for six concepts were revised with minor changes, mostly for consistency of language. Three concept definitions were revised for content including 1) “equity/diversity/inclusion” by adding gender identity, 2) “health promotion” by adding a lifespan component, and 3) “outcomes” which was shortened. Additional concepts were suggested by the respondents and reviewed by the PNE Task Force but were not added as the existing concepts already encompassed the suggestions. Ultimately, no additional concepts were added to the list.
Phase 3: Identification of domains, concepts, and relationships between PNE components
After the surveys were returned, the 15 concepts that received the highest percentage of the score of 5, “definitely a component of pediatric nursing excellence”, (i.e., approximately 70% of the respondents) were selected for final inclusion in the PNE model. Based on comments from the survey, the definitions of “advocacy”, “care planning”, “EBP”, “holistic care”, “equity/diversity/inclusion”, “ethics”, “professional development”, and “care coordination” were adopted. Proposed edits were made to the definitions of “professionalism” and “quality standards” before they were adopted. The group discussed the definitions of “collaboration”, “family-centered care”, “health promotion”, “outcomes”, and “quality of life” and reached a consensus to adopt them also (See Table 1).
The initial version of the model of 15 concepts was drafted by a task force member into a visual design of five domains of pediatric nursing excellence, with each domain containing three of the 15 concepts. Through virtual discussions, the task force members negotiated the placement of the concepts that have a contextual relationship with each other into one of five specific domains (
). The related concepts do not have to occur at the same time within pediatric nursing excellence, yet the domains and concepts mutually influence each other and PNE. An excellent pediatric nurse does not need to exemplify all of these concepts simultaneously to be considered excellent while delivering nursing care based on the patient and family needs. The original domains included Values, Principles, Professional Presence, Continuous Improvement, and Care Delivery.
The initial groupings of the 15 defined concepts into the five domains of pediatric nursing excellence included the following: (1) the Values domain contained “advocacy”, “ethics”, and “quality of life”; (2) the Principles domain contained “equity/diversity/inclusion”, “holistic care”, and “family centered care”; (3) the Care Delivery domain contained “care coordination”, “care planning”, and “health promotion”; (4) the Continuous Improvement domain contained “evidence-based practice”, “outcomes”, and “quality standards”; and (5) the Professional Presence domain contained “collaboration”, “professionalism”, and “professional development”. Visually, the construct of Pediatric Nursing Excellence was presented as a central circle surrounded by the five domains which were depicted as ovals, each containing three concepts and connected by bidirectional arrows with the central circle to indicate the mutual relationship between them.
Phase 4: Verification of model concepts
Once the initial domains, concepts (with definitions), and relationships within PNE were determined, verification of the concepts of the model was established using focus groups and thematic analysis. The task force sent an email request to the full SPN membership to recruit individuals to participate in virtual focus groups for feedback on the components of the PNE Model.
The task force received confirmation from 32 SPN members to participate in one of the four one-hour virtual focus groups. Box 2 presents the questionnaire script that was used for each of the focus groups. Two task force members staffed each focus group, one as the lead spokesperson/facilitator to direct the scripted questions and the other member to provide clarification and take notes. (A third task force member served as technical specialist during each focus group.) Twenty-nine of the 32 confirmed focus group members (90.63%) attended the virtual sessions.
Goal for development of this model: To define pediatric nursing excellence Components of the model: Pediatric Nursing Excellence is placed in the center as the core of the model. Pediatric Nursing Excellence consists of five domains surrounding the core. Each domain contains three distinctive concepts for a total of 15 concepts included in the model. Bidirectional arrows illustrate the reciprocal relationship between the Pediatric Nursing Excellence core and each domain, since the 15 concepts contribute to Pediatric Nursing Excellence and Pediatric Nursing Excellence in turn influences the 15 concepts.
Questions:
1.
During the development of this model, the feedback clearly identified that certain attributes are expected of all pediatric nurses. Do you feel the 15 concepts outlined in the model reflect the unique qualities of pediatric nursing excellence? Why?
2.
When looking at the five domains, can you explain why you believe they are accurate and clear?
a.
If they say no, please ask them to explain why.
3.
Domain/Concept validity
a.
Do the three concepts under the Values domain fit where placed or should they be under a different domain?
b.
Do the three concepts under the Principles domain fit where placed or should they be under a different domain?
c.
Do the three concepts under the Professional Presence domain fit where placed or should they be under a different domain?
d.
Do the three concepts under the Continuous Improvement domain fit where placed or should they be under a different domain?
e.
Do the three concepts under the Care Delivery domain fit where placed or should they be under a different domain?
4.
Are the bidirectional arrows between pediatric nursing excellence and each domain appropriate; why?
5.
Do you feel Growth and Development should be incorporated into this model?
a.
If yes, how do you feel it should be incorporated?
b.
If no, what makes you feel that it should not be incorporated?
6.
Think of an excellent pediatric nurse in your practice. Does the proposed model express their attributes, concepts, or term? Is any attribute missing from the model?
The focus group participants identified their practice settings as acute care (50%), followed by ambulatory (18.75%), community (12.5%), teaching/academia (12.5%), and post-acute (6.25%). Participant years of nursing experience ranged from novice/early career to experienced nurses, including 1–2 years (9%), 3–5 years (16%), 6–10 years (25%), 11–15 years (22%), 16–20 years (9%) and more than 20 years (19%).
Although virtual, the format of the focus groups was like that used for in-person focus groups. All individuals were expected to contribute to the conversation and the facilitator called on individuals to make sure everyone had the opportunity to share. The audio recordings of the focus groups were transcribed verbatim, maintaining anonymity of contributor feedback. Two task force members independently reviewed all four of the transcripts, with each reviewer performing a qualitative thematic analysis of the aggregated transcriptions. Using an inductive approach, the reviewers allowed the transcript data to identify feedback themes of the initial pediatric nursing excellence model and components (
). The two task force members compared their findings and agreed upon the following four themes.
1.
Feedback was consistent that the five domains and 15 concepts were accurate reflections of pediatric nursing excellence. The domain Professional Presence was noted as awkward since two of its three concepts began with “professional”, so it was modified to Engagement as a more descriptive term of the associated concepts.
2.
The graphic design of the model needed to better reflect pediatric nursing practice, including more colors and aspects of playfulness, such as images that would represent childhood or children.
3.
The directions of the arrows could be altered depending on the final configuration of the model to reflect linkage of model components.
4.
Growth and development must be incorporated and visualized in the model.
Based on the responses of the focus groups, “developmentally appropriate care” became the 16th concept of the PNE Model, and a definition was drafted by the task force (
Developmentally appropriate practice: A position statement of the National Association for education of young children. National Association for Education of Young Children (NAEYC),
2020
). The concept was placed in the center of the PNE Model serving as a hallmark of pediatric nursing. Additionally, the concept of “family-centered care” was changed to “patient- and family-centered care” based on current usage in the literature.
The task force met virtually with SPN's Creative Team to discuss the group's vision of the visual PNE Model concepts, domains, and relationships. The following month, the task force considered two professionally produced versions of the model and selected one to serve as the official graphic depiction of the PNE Model. Further edits suggested by task force members were incorporated into the selected graphic design. The second version of the proposed PNE Model consisted of a center circle of “developmentally appropriate care” with the five domains plus the construct of PNE comprising wedges intersecting in the middle circle.
Phase 5: Final verification of the PNE model
Once the task force reached consensus about the tentative PNE Model, an open/public comment period on the proposed model was conducted virtually for 4 weeks. Feedback was solicited with eight open-ended questions focusing on each of the five domains and corresponding concepts, on the concept of “developmentally appropriate care”, on the general reaction to the components of the PNE Model, and on whether the proposed model reflected PNE. The invitation for public comment was sent via mass emails to all SPN members; recipients could share the feedback link with any pediatric nurses. Feedback could be provided by individual pediatric nurses or on behalf of a group of nurses such as an SPN chapter.
A total of 76 individual nurses replied with 84 total comments. No respondent indicated they were submitting comments on behalf of a group. An overwhelming number of respondents, 72 (95%), answered “Yes” that the proposed model reflected PNE, while the rest, 4 (5%), answered “No”. There were 53 observations about the central concept and definition of “developmentally appropriate care” which was not included in earlier versions of the PNE Model. Most of the comments were positive although a few respondents suggested a different placement for a concept. There were 44 points of general feedback made about the entire process and/or proposed PNE Model which were overwhelmingly positive.
The PNE Task Force considered the anonymous public feedback and formally discussed suggestions. As previously, the task force felt several suggestions were already reflected in the PNE Model via related concepts, were expectations of all pediatric nurses or were too narrow to be included. As a result, no changes in the components of the proposed PNE Model were necessary. Minor grammatical and formatting changes to the final graphic of the model and to the concept definitions were made.
The Pediatric Nursing Excellence Model
The final visual depiction of the PNE Model is presented in Fig. 1 and is copyrighted by SPN. It is an overall circular design consistent with SPN's Core Competencies documents. “Developmentally appropriate care” comprises the core of the model. The five domains each with three concepts are depicted as wedges that surround the core while also overlapping it. Each domain is represented by its own color and icon. The sixth wedge (white) is located at the base of the circle, is slightly larger than the others, depicts Pediatric Nursing Excellence, and its apex overlaps the core of the model. The overlaps in the model indicate bidirectional relationships between the domains, the central core, and the construct of PNE. The final definitions of the 16 concepts included in the model are presented in Fig. 2; they also are copyrighted by SPN. The complete SPN Pediatric Nursing Excellence Model consists of this visual depiction plus the concept definitions used in the model.
The completed PNE Model was presented officially at the 2022 SPN Conference in Anaheim, California. Audience comments during the presentation were primarily positive and centered around support for creating a culture of pediatric nursing excellence and the ability to measure outcomes for pediatric-specific indicators. Potential uses of the model were solicited by a virtual survey during the presentation.
Potential uses of the PNE Model
Respondents envisioned limitless applications of the PNE Model within all aspects of pediatric nursing. Pediatric nurses can incorporate the PNE Model when developing direct patient care policies and procedures and setting best practices. Nurse preceptors or mentors can utilize the PNE Model when evaluating and mentoring nurses at all levels in the patient care they provide in both inpatient and community settings. Several nurses emphasized how the concept of developmentally appropriate care is particularly useful for pediatric units located within adult facilities.
Administratively, the PNE Model offers a framework to use when developing position descriptions, the hiring process, orienting new nurses, annual evaluations, and writing letters of recommendation. Additionally, this framework provides a clear guide for nursing strategic plans, setting unit goals, and developing shared governance process The PNE Model provides a primary clinical practice model, a supplement to an existing model, or a set of guiding principles. It offers a framework to guide specific pediatric examples of excellent care that feed into a Magnet designation and/or redesignation document.
The PNE Model furnishes the structure for clinical advancement portfolios where nurses include exemplars of how they demonstrate the various components of the model. It functions as the basis for a designation of excellence for individual nursing units such as the Beacon Award for excellent critical care units (
), or for entire pediatric facilities. The PNE Model provides a foundation for pediatric nursing recognition programs at the local level like the DAISY Award® (
The PNE Model can be incorporated into the curricula for prelicensure nursing education and pediatric nurse residency programs. There is the additional possibility of using the model to structure one's DNP journey or an advanced certification program. Clinical educators can weave the model with clinical competencies and when creating exemplars for clinical simulations to ensure each nurse achieves excellence. The PNE model would be valuable for nurses who are transitioning from caring for adults to caring for children and families.
Linking SPN's Annual Conference abstracts and EBP/research project proposals to PNE Model components is possible using the model. The PNE Model fits in model-based nursing research for validation of the model. Using the PNE Model allows movement from patient satisfaction scores to research-based outcomes impacted by the pediatric nurse. Lastly, the PNE Model would be helpful in social media/public relations campaigns to describe pediatric nursing.
Recommendations for the future
From the beginning of this process, SPN's goal has been to determine the characteristics of pediatric nursing excellence to provide the basis for identifying pediatric-specific quality indicators. Establishing the PNE Model ends the first step of that goal and provides the foundation for the next step, integrating the PNE Model through all aspects of caring for children and families. Once the PNE Model has been woven through pediatric nursing, optimal nursing care for children and families can be actualized.
CRediT authorship contribution statement
Betsy M. McDowell: Conceptualization, Methodology, Writing – original draft, Writing – review & editing, Supervision, Visualization. Rhonda Cooper: Methodology, Writing – original draft, Writing – review & editing, Visualization. Ann M. Bowling: Conceptualization, Methodology, Writing – original draft, Writing – review & editing, Supervision, Visualization. Kay J. Cowen: Methodology, Writing – original draft, Writing – review & editing, Visualization. Kim Eskew: Conceptualization, Methodology, Writing – review & editing, Resources, Project administration. Rae Ann Kingsley: Methodology, Writing – original draft, Writing – review & editing, Visualization. Debra Ridling: Methodology, Writing – original draft, Writing – review & editing, Visualization. Lori Williams: Methodology, Writing – original draft, Writing – review & editing, Visualization.
Conflict of interest statement
The authors report no financial and/or personal conflicts of interest in preparation of this manuscript.
References
Agency for Healthcare Research and Quality (AHRQ). (2018). Care coordination. https://www.ahrq.gov/.
American Association of Critical-Care Nurses (AACN). (n.d.). What is nursing excellence? Retrieved August 16, 2022, from https://www.aacn.org/nursing-excellence.
Advancing the development of the guidelines for the nursing of children, adolescents, and families: 2014 revision: Process, development, and dissemination.
Journal of Pediatric Health Care.2016; 30: 284-288
Greiner A.C. Knebel E. Health professions education: A bridge to quality. Board on Health Care Services,
Committee on Health Professions Education Summit, Institute of Medicine2003
Developmentally appropriate practice: A position statement of the National Association for education of young children. National Association for Education of Young Children (NAEYC),
2020
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