Nurses need to understand the complexity of the parents' straddling their roles and tasks. They can provide needed emotional support by allowing parents to express their fears and feelings in an atmosphere of nonjudgmental acceptance. Nurses can prepare parents for anticipated grief work, reassure them that their experiences are expected and normal, reinforce their use of normalization strategies, and help them separate their own from their child's issues and feelings.

Objective: To determine the value of neurologist ambulatory care in chronic neurologic diseases in a large administrative claims dataset detailing costs, adverse events, and health care utilization. Methods:The Optum proprietary claims dataset (2010)(2011)(2012) was examined to describe direct health care costs, as well as specific outcome metrics for a large population of persons with chronic neurologic illnesses. In phase I of the study, we detail neurologist involvement and differences in annualized allowed third-party payments within episode treatment groups (ETGs) for 10 neurologic illnesses. For phase II, we examined health care utilization for ETGs of epilepsy, Parkinson disease (PD), stroke, and multiple sclerosis (MS) with and without neurologist involvement. Reported outcomes were unadjusted differences and odds ratios between treatment groups.Results: For phase I, a total of 1,913,605 ETGs for 10 neurologic conditions were identified, 30.1% meeting criteria for neurologist involvement. All conditions had higher direct costs when neurologists were involved with care, ranging from a 25% increase for Alzheimer dementia to 100% more for MS care. In phase II, fractures, infections, emergent care, and inpatient admission were less with neurologist ambulatory care, while neurologist care was associated with greater utilization of disease-specific treatments (immunotherapies in MS anticoagulation in atrial fibrillation-associated stroke, deep brain stimulation and dopaminergic therapies in PD). Conclusion:Neurologist involvement with care is associated with greater unadjusted allowed payments, but fewer adverse events and less acute care utilization. The effect of neurologist care on health care costs and utilization outcomes in persons with chronic neurologic illness is not well-characterized. Aggregation of health care information in large administrative claims datasets presents an opportunity to assess the effect of specialist physicians on downstream usage of health resources related to the diseases they treat. Payers, from the US Government to third-party private insurers and employers, are looking to this kind of big data analysis to inform coverage, decisions, regulatory actions, and policymaking decisions. 1-5Exploration of large datasets requires access to specialized expertise, programmers, and computing unavailable to clinicians in daily practice. Physician professional organizations, on behalf of their members, have the resources to engage in analysis of these data and advocate for value and quality.6 Therefore, the American Academy of Neurology (AAN) engaged Optum, Inc. (Philadelphia, PA), a health care consulting firm, for a guided exploratory analysis of their proprietary administrative claims dataset to assess the value of neurologist care.

The authors describe a clinical peer mentoring (CPM) program that partnered 16 pairs of senior (mentors) and sophomore (novices) BSN students to provide patient care on a dedicated education unit at a VA Medical Center. Situated learning theory and Tanner's Clinical Judgment Model provided frameworks for CPM implementation. Survey findings suggested novices and mentors perceived improvements in self-confidence, prioritization, time management, clinical judgment, and evidence-based practice use. Many mentors spontaneously expressed an interest in becoming a preceptor or nurse educator.