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BACKGROUND: Child sexual abuse (CSA) is a preventable national public health problem that results in adverse health consequences. Research suggests youth experiencing CSA are often of school age. Screening for early detection of health issues is integral to school nurse (SN) practice. Still, there is little evidence that routine screening when CSA is suspected is occurring in schools, despite recommendations that it should be. Lack of confidence and knowledge related to screening and reporting for CSA contribute to a SN's missed opportunity for early intervention. PURPOSE: The aim of this study was to describe SNs' knowledge and self-efficacy associated with screening for and reporting suspected CSA in school settings. METHODS: A descriptive cross-sectional survey design was employed. The Child Abuse Report Intention Scale was sent to over 2,000 members of the National Association of School Nurses. RESULTS: Among SN respondents (N = 123), the main findings showed almost half reported being concerned a youth was experiencing CSA but may have missed identifying it. Self-efficacy and professional responsibility were predictors of SNs' intention to screen as well as knowledge about obvious and serious signs of abuse were predictors of SNs' intention to report in this sample. IMPLICATIONS: An educational partnership between forensic nurse examiners and SNs can facilitate improving SNs' knowledge about nonspecific physical and behavioral indicators of abuse that are not overtly obvious. The development of a screening tool specific for use by SNs can empower their confidence to screen by providing a resource for them to use as a guide when they are uncertain about the evidence.
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BACKGROUND: Infectious disease exposures in early life are increasingly recognized as a risk factor for poor subsequent growth and neurodevelopment. We aimed to evaluate the association between cumulative illness with neurodevelopment and growth outcomes in a birth cohort of Guatemalan infants. METHODS: From June 2017 to July 2018, infants 0-3 months of age living in a resource-limited region of rural southwest Guatemala were enrolled and underwent weekly at-home surveillance for caregiver-reported cough, fever, and vomiting/diarrhea. They also underwent anthropometric assessments and neurodevelopmental testing with the Mullen Scales of Early Learning (MSEL) at enrollment, 6 months, and 1 year. RESULTS: Of 499 enrolled infants, 430 (86.2%) completed all study procedures and were included in the analysis. At 12-15 months of age, 140 (32.6%) infants had stunting (length-for-age Z [LAZ] score < -2 SD) and 72 (16.7%) had microcephaly (occipital-frontal circumference [OFC] < -2 SD). In multivariable analysis, greater cumulative instances of reported cough illness (beta = -0.08/illness-week, P = 0.06) and febrile illness (beta = -0.36/illness-week, P < 0.001) were marginally or significantly associated with lower MSEL Early Learning Composite (ELC) Score at 12-15 months, respectively; there was no association with any illness (cough, fever, and/or vomiting/diarrhea; P = 0.27) or with cumulative instances of diarrheal/vomiting illness alone ( P = 0.66). No association was shown between cumulative instances of illness and stunting or microcephaly at 12-15 months. CONCLUSIONS: These findings highlight the negative cumulative consequences of frequent febrile and respiratory illness on neurodevelopment during infancy. Future studies should explore pathogen-specific illnesses, host response associated with these syndromic illnesses, and their association with neurodevelopment.
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Microcefalia , Humanos , Lactente , Idoso de 80 Anos ou mais , Guatemala/epidemiologia , Tosse , Diarreia/epidemiologia , Transtornos do Crescimento/epidemiologia , VômitoRESUMO
Stunting (<-2 SD of length- or height-for-age on WHO growth curves) is the most used predictor of child neurodevelopmental (ND) risk. Occipitofrontal head circumference (OFC) may be an equally feasible, but more direct and robust predictor. We explored association of the two measurements with ND outcome, separately and combined, and examined if cutoffs are more efficacious than continuous measures in predicting ND risk. Infants and young children in rural Guatemala (n = 642; age range = 0.1-35.9 months) were enrolled in a prospective natural history study, and their ND was tested using the Mullen Scales of Early Learning (MSEL) longitudinally. Length- or height-for-age and OFC-for-age were calculated. We performed age-adjusted multivariable regression analyses to explore the association between 1) length or height and ND, 2) OFC and ND, and 3) both length or height and OFC combined, with ND; concurrently, predictively, and longitudinally, as continuous variables and using WHO z-score cutoffs. Continuous length- or height-for-age and OFC z-scores were more strongly associated with MSEL than the traditional -2 SD WHO cutoff. The combination of height-for-age z-score and OFC z-score was consistently, strongly associated with the MSEL Early Learning Composite concurrently (p-values 0.0004-0.11), predictively (p-value 0.001-0.07), with the exception of the 18-24 months age group which had very few records, and in the longitudinal model (p-value <0.0001-0.004). The combination of continuous length- or height-for-age and OFC shows additional utility in estimating ND risk in infants and young children. Measurement of OFC may improve precision of prediction of ND risk in infants and young children.
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Desenvolvimento Infantil , Transtornos do Crescimento , Lactente , Humanos , Criança , Pré-Escolar , Recém-Nascido , Estudos Prospectivos , Antropometria , Transtornos do Crescimento/diagnóstico , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Análise de RegressãoRESUMO
Nursing is in a challenging place, and we are facing many incredibly complex issues that are steeped in culture and tradition. These "wicked problems" often arise when organizations face constant change or unprecedented challenges. In this article, we discuss current issues that hinder all nurse leaders from elevating nursing as a profession, with a particular focus on the role and contributions of the academic nurse leader in creating and sustaining positive change. By prioritizing meaningful collaboration, reimagining education for nursing outside the hospital walls, investing in evidence for practice, and advocating by amplifying new voices, we can identify shared goals and develop coordinated plans of action. The goal of academic nursing is to work to understand wicked disciplinary problems while also analyzing and critiquing what is not working, articulating possible solutions, and collaborating with other nurse leaders to address these complex issues. This also means that academic nursing should be held equally accountable for delivering results.
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Liderança , HumanosRESUMO
Child sexual abuse (CSA) is a pervasive public health problem. If left undetected, CSA can result in immediate and long-term health problems, which can be mitigated through early identification. Schools are an ideal environment to implement screening measures, and school nurses (SN) are uniquely poised to intervene and respond early. The aim of this review was to systematically examine and synthesize the international evidence related to screening for early identification of CSA in schools. Themes emerging from the analysis were SN behaviors relative to screening, potential instruments or approaches for screening, and SN and school professionals' beliefs about CSA screening practices. This review found little evidence that CSA screening is occurring in schools. However, SNs are aware that screening falls within their scope of practice and many SNs feel they should be screening for it. A constant proactive approach by SNs is necessary to improve early identification and subsequent intervention.
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Microcephaly, an anthropometric marker of reduced brain volume and predictor of developmental disability, is rare in high-income countries. Recent reports show the prevalence of microcephaly to be much higher in lower resource settings. We calculated the prevalence of microcephaly in infants and young children (n = 642; age range = 0.1-35.9 months), examined trends in occipitofrontal circumference (OFC) growth in the year after birth and evaluated the relationship between OFC and performance on the Mullen Scales of Early Learning (MSEL) in rural Guatemala. Multivariable regression analyses adjusted for age were performed: (1) a model comparing concurrent MSEL performance and OFC at all visits per child, (2) concurrent OFC and MSEL performance by age group, and (3) OFC at enrollment and MSEL at final visit by age group. Prevalence of microcephaly ranged from 10.1% to 25.0%. OFC z-score decreased for most infants throughout the first year after birth. A significant positive association between continuous OFC measurement and MSEL score suggested that children with smaller OFC may do worse on ND tests conducted both concurrently and â¼1 year later. Results were variable when analyzed by OFC cutoff scores and stratified by 6-month age groups. OFC should be considered for inclusion in developmental screening assessments at the individual and population level, especially when performance-based testing is not feasible.
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Microcefalia , Lactente , Criança , Humanos , Pré-Escolar , Recém-Nascido , Microcefalia/epidemiologia , Estudos Prospectivos , Guatemala/epidemiologia , População RuralAssuntos
Estupro , Delitos Sexuais , Enfermagem Forense , Humanos , Estados Unidos , Recursos HumanosRESUMO
INTRODUCTION: Lack of preceptors and hands-on training opportunities has long been an impediment to nurses pursuing sexual assault nurse examiner (SANE) practice and certification after completing a SANE didactic course. In addition, nurses in rural and underserved areas often lack the professional support and mentoring needed. To address this gap and increase the number of certified practicing SANEs, the Duquesne University School of Nursing (DUSON) received funding from the Department of Health Resources and Services Administration for a program designed to provide advanced nursing education to increase the number of nurses who are trained and certified as nurse examiners. APPROACH: The DUSON developed a hands-on clinical preceptor course and other support programming to supplement the existing SANE didactic course training. The goal was to create a comprehensive model that took students from initial SANE training through to certification. LESSONS LEARNED: In the first two- and three-quarter years of the program, 36 nurses achieved certification, and another 116 completed a didactic course and initial hands-on skills training and are preparing for certification. Approximately 41.5% of participants are from rural and/or underserved areas. Challenges included the adaptations required by the COVID-19 pandemic and engagement of nurses once they returned to their home institution to complete additional hours. CONCLUSIONS: The DUSON comprehensive model provides a solid pathway for nurses who want to become SANEs, and the structure of the program seems especially conducive for training nurses in rural and underserved areas.
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COVID-19 , Delitos Sexuais , Humanos , Pandemias , SARS-CoV-2 , UniversidadesRESUMO
Caregiver report is the most feasible way to assess early childhood development but is susceptible to the influences of response style and sociodemographic factors. In a sample of 571 caregiver-infant dyads (47.8% female; 48% White), we compared caregiver reports on the Ages and Stages Questionnaire-Third Edition (ASQ-3) with reports on a novel, web-based assessment, PediaTrac™. Ratings on PediaTrac correlated with ratings on the ASQ-3 at all time points (2, 4, 6, and 9 months). Caregiver age, response style, and sociodemographic factors accounted for significant variance on both measures. Developmental reporting of early childhood skills is influenced by caregiver response style and sociodemographic factors. These influences must be considered in order to ensure the accurate identification of infant developmental status.
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BACKGROUND: Although performance-based assessment of early childhood development is preferred, there are a number of limitations to this methodology in low resource settings (LRSs). Hence, clinicians and researchers often rely on caregiver report screening tools. The Ages and Stages Questionnaire 3 (ASQ) is one of the most widely used caregiver report measures globally. Adequate psychometric properties have been demonstrated in high income settings, especially when used in older children, high- risk children, or those with severe neurodevelopmental delays. However, its utility is more variable within very young children and for use in LRSs. METHODS: The reliability and validity of the ASQ was determined for children ages 0-5 years living in rural Guatemala. Internal consistency and test-retest reliability were assessed, as well as concurrent and predictive validity. Sensitivity, specificity, positive and negative predictive values related to performance-based developmental assessment (Mullen Scales of Early Learning; MSEL) and growth status (i.e. stunting) were also calculated. RESULTS: Internal consistency reliability for the ASQ was adequate, except when results were limited by small sample size. Test-retest reliability ranged from low to moderate (r = 0.08-0.43; p < 0.05-0.01). However, there was significant variability in mean scores over time across ASQ domain scores. In terms of validity, the ASQ did not discriminate adequately between children who performed within or below age-expectations on performance-based developmental testing or those with and without stunting. CONCLUSIONS: The ASQ did not demonstrate adequate psychometric properties in rural Guatemala, consistent with concerns documented in other LRSs. These results indicate that existing caregiver report screening measures of early childhood development should be utilized with caution in LRSs, and alternative methods for assessment or in the development and utilization of caregiver report measures should be considered.
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Cuidadores , Desenvolvimento Infantil , Criança , Pré-Escolar , Guatemala , Humanos , Lactente , Recém-Nascido , Psicometria , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
In this study, we review the implementation, reliability, and validity of the Pediatric Quality of Life Inventory (PedsQL), a measure of health-related quality of life, in young children in rural Guatemala. Mothers of 842 children (age range = 1-60 months) completed the PedsQL Generic Core Scales 4.0 serially for 1 year. Low (Pearson's r = 0.28, P < .0001) to moderate (Pearson's r = 0.65, P < .0001) consistency in responding over time was shown. The PedsQL did not discriminate reliably between healthy children and those with stunting or wasting. PedsQL scores were not lower during the time of an acute illness. While we found low to moderate evidence for the reliability of the PedsQL in healthy children, it did not discriminate between healthy children and those with stunting, wasting or other acute illness.
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OBJECTIVE: This review examines trauma from violence as a risk factor for sexually transmitted diseases (STDs) among women attending STD clinics. The review also aims to suggest trauma informed care (TIC) integrated into STD clinics might more effectively address traumatic effects of violence linked to sexual risk behaviors among this population. DESIGN AND SAMPLE: A systematic literature review was conducted to identify empirical studies examining the relationship between multiple forms of violence and sexual risk behaviors among women attending STD clinics. RESULTS: All studies found high rates of violence including childhood sexual abuse, intimate partner violence, and/or community violence associated with high rates of sexual risk behaviors among women attending these settings. Researchers recommend screening for multiple forms of violence, interdisciplinary STD clinic services, and more trauma informed sexual risk reduction interventions to address multiple forms of violence found prevalent among this population. CONCLUSION: Women attending STD clinics very often experience multiple forms of violence during their lifetime. TIC to address traumatic effects of violence might reduce sexual risk behaviors and sexually transmitted disease rates for improved health outcomes among this population.
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Instituições de Assistência Ambulatorial/organização & administração , Necessidades e Demandas de Serviços de Saúde , Trauma Psicológico/terapia , Infecções Sexualmente Transmissíveis/terapia , Violência/psicologia , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: The aim of this study was to describe the complex relationships among patient safety culture, nurse demographics, advocacy, and patient outcomes. BACKGROUND: Why has healthcare lagged behind other industries in improving quality? Little nursing research exists that explores the multifactorial relationships that impact quality. METHODS: A convenience sample of 1045 nurses from 40 medical/surgical units was analyzed using a correlational cross-sectional design with secondary data analysis. Data sources included survey results for patient safety culture, nurse perceptions of patient advocacy, and patient experience and fall and pressure ulcer rates. RESULTS: Significant findings included a positive correlation between patient safety culture and advocacy and a negative correlation between safety culture, advocacy, and years of experience as a nurse. No significant correlations were found between safety culture and patient outcomes or advocacy and patient outcomes. CONCLUSIONS: Newer nurses were more positive about safety culture and advocacy, whereas experienced nurses were overall less positive.
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Recursos Humanos de Enfermagem Hospitalar/normas , Cultura Organizacional , Avaliação de Resultados em Cuidados de Saúde , Segurança do Paciente/normas , Assistência Centrada no Paciente/normas , Comportamento Cooperativo , Estudos Transversais , Humanos , Relações Interprofissionais , Qualidade da Assistência à Saúde , Estados UnidosRESUMO
BACKGROUND: Human sex trafficking is a major public health issue. The United States is the second largest market for sex-trafficked women, yet few healthcare interventions, designed for women specifically, have been identified. The purpose of this review was to present a systematic review of the literature on the characteristics and healthcare needs of women who have been trafficked for sex in the United States. METHODS: This literature review was conducted following the methodology outlined by Whittmore and Knalf and written using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Cumulative Index to Nursing & Allied Health, PsychInfo, PubMed, and Scopus databases were searched. A quality assessment tool was used to determine rigor of the studies included in this review. RESULTS: Nine publications met the inclusion criteria. Three studies specifically explored health. Four studies were composed solely of women born outside the United States, and two studies reported differences across many variables, including overall health, between women born outside the United States and women born within the United States. A lack of resources and an inadequate response by the health system resulted in care that was not optimal. CONCLUSION: There are differences between U.S.-born and non-U.S.-born victims. Evidence on the healthcare needs of U.S.-born women trafficked for sex in the United States is extremely limited. Research focusing on the health perceptions of women survivors of human sex trafficking may shed light on how they perceive health, care, and the health system and what they identify as important for key stakeholders to understand.
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Vítimas de Crime , Necessidades e Demandas de Serviços de Saúde , Tráfico de Pessoas , Sobreviventes , Saúde da Mulher , Adultos Sobreviventes de Eventos Adversos na Infância , Atitude do Pessoal de Saúde , Continuidade da Assistência ao Paciente , Vítimas de Crime/psicologia , Cultura , Emigrantes e Imigrantes , Feminino , Humanos , Abuso Físico , Pobreza , Sobreviventes/psicologia , Estados Unidos , Populações VulneráveisRESUMO
BACKGROUND: A growing literature base supports the use of tests developed in high-income countries to assess children in low resource settings when carefully translated, adapted, and applied. Evaluation of psychometric properties of adapted and translated measures within populations is necessary. The current project sought to evaluate the reliability and validity of an adapted and translated version of the Mullen Scales of Early Learning (AT-MSEL) in rural Guatelama. METHODS: The reliability and validity of the AT-MSEL in rural Guatemala were analyzed for children ages 0-5 years. RESULTS: Interrater reliability coefficients (ICC = 0.99-1.0) and internal consistency (Cronbach's alpha = 0.91-0.93) were excellent for all subscales. General linear models utilizing paired data showed consistency between standard scores (p < 0.0001). Mean raw scores increased with chronological age, as expected. Across age groups, subscales were significantly, positively correlated with one another (p < 0.05 - < 0.001) with one exception, visual reception and expressive language at the 0-10 month age range (p = 0.43). CONCLUSIONS: The AT- MSEL showed strong psychometric properties in a sample of young children in rural Guatemala. Findings demonstrate that the AT-MSEL can be used validly and reliably within this specific population of children. This work supports the concept that tests developed in high-income countries can be used to assess children in low resource settings when carefully translated, adapted and applied.
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Desenvolvimento Infantil , Aprendizagem , Destreza Motora , Pré-Escolar , Estudos de Coortes , Feminino , Guatemala , Humanos , Lactente , Masculino , Testes Neuropsicológicos , Psicometria , Reprodutibilidade dos Testes , População Rural , TraduçõesRESUMO
BACKGROUND: People with disabilities (PWDs) experience significant health disparities. The complex experience of disability requires that nurses are adequately and deliberately prepared to care for PWDs. However, there are no recognized nursing competencies to direct education and care. PURPOSE: The purpose of this study was to develop a set of nursing competencies to better prepare prelincensure nursing students to provide competent care to PWDs. METHODS: A 2-round Delphi survey was administered to experts in the field of disabilities (n = 47, n = 35). Quantitative and qualitative methods were used to analyze data. RESULTS: Three major themes emerged: unique knowledge, volume and repetition, and distinct disability culture. Competencies were reduced with a focus on 4 dimensions: environment and care, communication, culture, and referral. CONCLUSIONS: The 12 new competencies can serve as the foundation for the inclusion of disability content in nursing curricula.
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Competência Clínica/normas , Pessoas com Deficiência , Bacharelado em Enfermagem/normas , Licenciamento em Enfermagem/estatística & dados numéricos , Licenciamento em Enfermagem/normas , Cuidados de Enfermagem/estatística & dados numéricos , Cuidados de Enfermagem/normas , Adulto , Competência Clínica/estatística & dados numéricos , Currículo , Técnica Delphi , Bacharelado em Enfermagem/estatística & dados numéricos , Feminino , Humanos , Masculino , Pesquisa em Educação em Enfermagem , Estudantes de Enfermagem , Estados Unidos , Adulto JovemRESUMO
Many youth with significant medical needs have difficulty attending traditional schools due to academic, physical, and psychosocial challenges. To meet the needs of these youth and prepare them for a successful transition to a traditional school, a multidisciplinary school program (MSP) provides support in these three domains. The aims of this program evaluation are to describe the operation of the novel MSP, characterize participants, and determine the impact of participation as related to school attendance and health-related quality of life (HRQoL). Attendance in the MSP was significantly higher than school attendance estimates provided by caregivers prior to participation in the program. Youth reported significant improvement in physical functioning and total HRQoL. Caregivers reported significant improvement in academic functioning and total HRQoL of youth. The MSP represents a unique educational model for youth with significant medical issues that also provides physical and psychosocial support. Initial findings highlight the potential positive impact of this model for this population of youth.