Nurse-Involved Policy, Systems, and Environmental School-Based Interventions for Supporting Healthy Nutrition and Obesity Prevention Among Children and Adolescents: A Systematic Review.

Overweight and obesity are common in school-age children. Policy, system, and environmental (PSE) approaches-which entail making upstream changes to a school's context-can be leveraged to reduce childhood obesity. Nurses can advance PSE approaches in schools to promote healthy living habits. This review examines the effect of nurse-involved PSE interventions globally to promote healthy nutrition and reduce obesity in schools. We conducted a literature search using multiple databases from 2010 to 2023 for nurse-involved studies that implemented interventions focused on PSE change related to promoting healthy nutrition or reducing obesity in school settings. Twenty interventions globally were included in the systematic review synthesis. Improvements in anthropometrics, health and nutrition knowledge, attitudes, and beliefs were observed. PSE interventions can be leveraged to promote healthy nutrition and reduce obesity in school settings. Nurses in varying roles are uniquely qualified to advocate for and implement school-based interventions focused on PSE change.

Continuous glucose monitoring for black older adults with type 2 diabetes mellitus: Challenges, innovations and implications: A discursive review.

AIM: To conduct a discursive review on continuous glucose monitoring use among Black older adults and to address the issue of racial disparities in diabetes management and outcomes. Type 2 diabetes mellitus is a global health concern with significant complications and mortality rates. Black older adults are disproportionately affected. Initially designed for type 1 diabetes, continuous glucose monitoring has emerged as an innovative tool for type 2 diabetes mellitus management. Despite its potential, there are challenges related to adherence and digital literacy among Black older adults for managing Diabetes. DESIGN: A discursive review. METHODS: Searching literature in PubMed, Scopus, and Google Scholar for papers published from 2017 to 2023, we explored the use of continuous glucose monitoring in Black older adults with type 2 diabetes mellitus, examining barriers, facilitators and challenges. DISCUSSION: We highlight recommendations from the literature which included barriers, facilitators, and cultural factors associated with continuous glucose monitoring use. Findings underscore the importance of addressing these challenges to reduce racial-ethnic disparities in type 2 diabetes mellitus management among Black older adults. Nurses and advanced practice registered nurses are at the forefront and can play a pivotal role in exploring and implementing interventions to promote access and proper use of continuous glucose monitoring among Black older adult patients with type 2 diabetes mellitus.

Facilitators and Barriers to Pediatric Nurse Practitioner Practice in the United States: A Systematic Review.

INTRODUCTION: The pediatric nurse practitioner (PNP) workforce was designed to improve child health equity. We aimed to systematically review the evidence on facilitators and barriers to PNP practice. METHOD: We included empirical studies on PNP practice in the United States and excluded studies with non-identifiable PNP data. We applied Joanna Briggs Institute tools to appraise studies and applied critical interpretive synthesis principles to synthesize. RESULTS: The final sample is 26 studies, mostly published before 2013 and observational. Prescriptive privileges, training program availability, organizational climate, and telehealth are facilitators. Mandated physician supervision, reduced pediatric curricula, geographically disparate training programs, and poor data infrastructure are barriers. The sample is limited by a moderate to high risk of bias. DISCUSSION: Evidence suggests modifiable factors impact PNP practice and could have important implications for child health equity. We offer a theoretical model to guide robust research studying the PNP workforce and health equity.

A systematic appraisal of the information, engagement, aesthetic and functional quality of nutrition-related smartphone apps for children and adolescents.

OBJECTIVE: Nutrition-related smartphone applications (apps) could improve children's nutrition knowledge and skills. However, little is known about the quality of nutrition-related apps for children. This study aimed to identify and evaluate the quality of nutrition-related smartphone apps designed for children ages 4-17. DESIGN: This systematic appraisal is guided by the Protocol for App Store Systematic Reviews. SETTING: Using Google's Advanced Search, we identified 1814 apps/1184 additional apps in an updated search on iOS, of which twenty-four were eligible. The apps' objective and subjective quality were evaluated using the twenty-three-item, five-point Mobile App Rating Scale. The objective quality scale consists of four subscales: engagement, functionality, aesthetics and information. RESULTS: Most of the apps (75 %) focussed solely on promoting nutrition skills, such as making food dishes, rather than nutrition knowledge. Of the twenty-four apps, 83 % targeted children 4-8 years old. The app objective quality mean score was 3·60 ± 0·41. The subscale mean scores were 3·20 ± 0·41 for engagement, 4·24 ± 0·47 for functionality, 4·03 ± 0·51 for aesthetics and 2·94 ± 0·62 for information. The app subjective quality mean score was 2·10 ± 0·90. CONCLUSIONS: More robust approaches to app development leveraging co-design approaches, including involving a multidisciplinary team of experts to provide evidence-based nutrition information, are warranted.

Addressing hypertension among Haitian adults with insufficient access to quality healthcare: A discursive review.

AIM: The purpose of this article is to summarize research targeting hypertension and healthcare access among adults living in rural Haiti. BACKGROUND: Hypertension is a significant public health problem that impacts one in five persons globally. It is the leading cause of cardiovascular-related conditions such as stroke and myocardial infarction and accounts for most global non-communicable disease-related deaths. Limited healthcare access and social determinants of health are known contributors to poor health outcomes among persons with hypertension. Among Haitians, there are stark health disparities between those who live in urban versus rural areas. DESIGN: A discursive review. RESULTS: Several issues are identified as barriers to proper hypertension prevention and management. However, after examining the effective interventions, we found that social determinants of health such as transportation costs, lack of field care facilities close to patients, roadway conditions, political disturbance, and ineffective leadership and policies are major barriers to controlling hypertension in Haiti. Although Haiti has received help from international organizations, strengthening its internal infrastructure is paramount in improving healthcare access. DISCUSSION: The review concludes that Haitians living in rural parts of Haiti are less likely to receive healthcare to manage non-communicable diseases such as hypertension. Similar to other developing countries, a heightened awareness is needed to address the lack of healthcare access for those living in rural communities. IMPACT TO NURSING PRACTICE: Nurses and other healthcare professionals working with populations in Haiti should become aware of the barriers and facilitators that promote sufficient healthcare access. To achieve this goal, nurses must understand the social determinants and other factors that serve as barriers for achieving access to quality care for this vulnerable population. NO PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public involvement in the design or drafting of this discursive paper.

An Update on State Legislation Supporting Menstrual Hygiene Products in US Schools: A Legislative Review, Policy Report, and Recommendations for School Nurse Leadership.

Access to menstrual products is important to support adolescent health. Advocacy to increase access to menstrual products in schools is growing; however, ideal access requires policies that will require schools to support the menstrual health of menstruating students. We conducted a legislative review on the existence and status of state legislation related to the provision of menstrual products in US schools and categorized by state's political control (political party affiliation of governors and state legislature). Of 50 states and 6 territories, 21 had legislation to support menstrual products in schools, 7 had bills pending, 10 had bills failed, and 18 states had no policies introduced in the state legislature. States with Democrat control have significantly more menstrual product state laws compared to states with Republican control [z = 2.54, p = 0.01]. There is a need, especially in Republican states, to accelerate efforts to pass laws that will support menstrual product access in schools.

Heterogeneity in Cardiovascular Disease Risk Factor Prevalence Among White, African American, African Immigrant, and Afro-Caribbean Adults: Insights From the 2010-2018 National Health Interview Survey.

Background In the United States, Black adults have higher rates of cardiovascular disease (CVD) risk factors than White adults. However, it is unclear how CVD risk factors compare between Black ethnic subgroups, including African Americans (AAs), African immigrants (AIs), and Afro-Caribbeans, and White people. Our objective was to examine trends in CVD risk factors among 3 Black ethnic subgroups and White adults between 2010 and 2018. Methods and Results A comparative analysis of the National Health Interview Survey was conducted among 452 997 participants, examining sociodemographic characteristics and trends in 4 self-reported CVD risk factors (hypertension, diabetes, overweight/obesity, and smoking). Generalized linear models with Poisson distribution were used to obtain predictive probabilities of the CVD risk factors. The sample included 82 635 Black (89% AAs, 5% AIs, and 6% Afro-Caribbeans) and 370 362 White adults. AIs were the youngest, most educated, and least insured group. AIs had the lowest age- and sex-adjusted prevalence of all 4 CVD risk factors. AAs had the highest prevalence of hypertension (2018: 41.9%) compared with the other groups. Overweight/obesity and diabetes prevalence increased in AAs and White adults from 2010 to 2018 (P values for trend <0.001). Smoking prevalence was highest among AAs and White adults, but decreased significantly in these groups between 2010 and 2018 (P values for trend <0.001), as compared with AIs and Afro-Caribbeans. Conclusions We observed significant heterogeneity in CVD risk factors among 3 Black ethnic subgroups compared with White adults. There were disparities (among AAs) and advantages (among AIs and Afro-Caribbeans) in CVD risk factors, suggesting that race alone does not account for disparities in CVD risk factors.

Food Desert Status of Family Child Care Homes: Relationship to Young Children's Food Quality.

Family child care homes (FCCHs) are a favored child care choice for parents of young children in the U.S. Most FCCH providers purchase and prepare foods for the children in their care. Although FCCH providers can receive monetary support from the Child and Adult Care Food Program (CACFP), a federal subsidy program, to purchase nutritious foods, little is known about FCCH providers' access to nutritious foods, especially among FCCH providers serving children from communities that have been historically disinvested and predominantly Black. This study aims to describe the food desert status of FCCHs in Baltimore City, Maryland, and examine the relationship between food desert status and the quality of foods and beverages purchased and provided to children. A proportionate stratified random sample of 91 FCCH providers by CACFP participation status consented. Geographic information system mapping (GIS) was used to determine the food desert status of each participating FCCH. Participants reported on their access to food and beverages through telephone-based surveys. Nearly three-quarters (66/91) of FCCHs were located in a food desert. FCCH providers working and living in a food desert had lower mean sum scores M (SD) for the quality of beverages provided than FCCH providers outside a food desert (2.53 ± 0.81 vs. 2.92 ± 0.70, p = 0.036, respectively). Although the significant difference in scores for beverages provided is small, FCCH providers working in food deserts may need support in providing healthy beverages to the children in their care. More research is needed to understand food purchases among FCCH providers working in neighborhoods situated in food deserts.

Lessons learned from implementing SNAP-Ed in a nursing/K-8 partnership school during the pandemic.

The COVID-19 pandemic had forced schools and school-based partnerships in the US to re-imagine extracurricular activities while schools were closed for in-person learning. We highlight lessons learned from implementing the Supplemental Nutrition Assistance Education Program (SNAP-Ed) virtually, a nutrition education program to improve nutrition literacy and skills among children, in a Maryland School of Nursing/K-8 Partnership school amid in-person school closures.

Mealtime Environment and Feeding Practices in Urban Family Child Care Homes in the United States.

Background: Family Child Care Homes (FCCHs) are the second-largest childcare option in the US. Given that young children are increasingly becoming overweight and obese, it is vital to understand the FCCH mealtime environment. There is much interest in examining the impact of the Child and Adult Care Food Program (CACFP), a federal initiative to support healthy nutrition, by providing cash reimbursements to eligible childcare providers to purchase nutritious foods. This study examines the association among the FCCH provider characteristics, the mealtime environment, and the quality of foods offered to 2-5-year-old children in urban FCCHs and examines the quality of the mealtime environment and foods offered by CACFP participation. Methods: A cross-sectional design with a proportionate stratified random sample of urban FCCHs by the CACFP participation status was used. Data were collected by telephone using the Nutrition and Physical Activity Self-Assessment for Child Care survey. Results: A total of 91 licensed FCCHs (69 CACFP, 22 non-CACFP) participated. FCCH providers with formal nutrition training met significantly more of the quality standards for foods offered than providers without nutrition training (ß = 0.22, p = 0.034). The mealtime environment was not related to any FCCH provider characteristics. CACFP-participating FCCH providers had a healthier mealtime environment (ß = 0.326, p = 0.002) than non-CACFP FCCHs. Conclusions: Findings suggest that nutrition training and CACFP participation contribute to the quality of nutrition-related practices in the FCCH. We recommend more research on strengthening the quality of foods provided in FCCHs and the possible impact on childhood obesity.

A mixed-methods systematic review identifying, describing, and examining the effects of school-based care coordination programs in the US on all reported outcomes.

Children learn best when they are healthy. Therefore, access to school-based health and providing family support for social needs play an essential role in shaping a child's ability to succeed academically. The purpose of this mixed-methods review, which considers studies with all methods, is to describe and examine the effect of US school-based care coordination programs on all the outcomes reported. Care coordination is an organized approach to connect families to resources in the community to address social needs. The literature search identified 260 papers published since 2012 through CINAHL, ERIC, EMBASE, MEDLINE, Social Sciences Full Text, and Web of Science, from which 11 were included that described a US school-based care coordination program. An a priori organizing framework: Program Development, Implementation, and Evaluation were used to organize the findings. Whether quantitative or qualitative, all evaluation results were transformed into qualitative texts, then converted into codes then themes. Various health and learning issues such as asthma and vision screening were addressed. More than half of the care coordination programs were nurse-led. Parents and students characterized care coordination activities as convenient, trusting, and perceived to improve parent-teacher engagement. They also enhanced asthma knowledge and management, immunization adherence, follow-up care for vision and hearing, mental health, and school attendance. Nevertheless, challenges included staff shortages, unmet family needs, privacy laws regarding student data, and lack of resources (i.e., medications). This review highlights the need to expand school-based care coordination programs in the US and conduct robust program evaluations to assess their effectiveness.

Heterogeneity of Cardiovascular Disease Risk Factors Among Asian Immigrants: Insights From the 2010 to 2018 National Health Interview Survey.

Background The Asian population is the fastest-growing immigrant population in the United States. Prior studies have examined the Asian immigrant population as a homogenous group. We hypothesized that there will be heterogeneity in cardiovascular disease risk factors among Asian immigrant subgroups (Indian subcontinent, Southeast Asia, Asia) compared with the non-Hispanic White population. Methods and Results A cross-sectional analysis of the 2010 to 2018 National Health Interview Survey was conducted among 508 941 adults who were born in Asian regions or were non-Hispanic White and born in the United States. Generalized linear models with Poisson distribution were fitted to compare the prevalence of self-reported hypertension, overweight/obesity, diabetes mellitus, high cholesterol, physical inactivity, and current smoking among Asian immigrants compared with White adults, adjusting for known confounders. We included 33 973 Asian immigrants from Southeast Asia (45%), Asia (29%), the Indian subcontinent (26%), and 474 968 White adults. Compared with non-Hispanic White adults, Indian subcontinent immigrants had the highest prevalence of overweight/obesity (prevalence ratio, 1.22; 95% CI, 1.19-1.25); Southeast Asian immigrants had the highest prevalence of high cholesterol (prevalence ratio, 1.16; 95% CI, 1.10-1.23); Indian subcontinent (prevalence ratio, 1.69; 95% CI, 1.49-1.93) and Southeast Asian (prevalence ratio, 1.38; 95% CI, 1.26-1.52) immigrants had a higher prevalence of diabetes. All Asian immigrant subgroups were more likely to be physically inactive and less likely to smoke than White adults. Conclusions We observed significant heterogeneity in cardiovascular disease risk factors among Asian immigrants and a varied prevalence of risk factors compared with non-Hispanic White adults. Providers caring for Asian immigrants should provide tailored and culturally informed care to improve the cardiovascular health of this diverse group.

Perceived Leadership Styles, Outcomes of Leadership, and Self-Efficacy Among Nurse Leaders:: A Hospital-Based Survey to Inform Leadership Development at a US Regional Medical Center.

In response to improving upon a leadership development program at a US regional medical center, coupled with the understanding that transformational leadership is linked with better outcomes, as a first step, we examined the perceived leadership styles, outcomes of leadership, and level of self-efficacy among nurse leaders, namely nurse managers, clinical supervisors, and nurse directors. Twenty-three hospital-based nurse leaders completed the surveys with a response rate of 57.5%. The majority of the leadership styles aligned with that of transformational. However, the items with the 3 lowest average frequency ratings within the transformational leadership style were in the areas of communication and showing confidence. Additionally, the perceived median self-efficacy score was low. Organizational support by way of providing continuous, sustainable professional leadership development, especially in the area of communication, and building self-efficacy is needed to ensure leader effectiveness, and improvement in staff and patient outcomes.

Examining Nutrition and Physical Activity Policies and Practices in Maryland's Child Care Centers.

BACKGROUND: Child care settings provide opportunities for obesity prevention by implementing nutrition/physical activity best practices. This study examines how center policies, provider training, family education, and center demographics relate to best practices for nutrition/physical activity in Maryland's child care centers. METHODS: A survey, including minor modifications to The Nutrition and Physical Activity Self-Assessment for Child Care (Go NAP SACC), was sent by e-mail to center directors statewide. Best practice sum scores (dependent variable) were calculated, including physical activity (17 items), feeding environment (18 items), and food served (19 items). Adjusted regression models analyzed the number of nutrition/physical activity policies, provider training topics, and family education opportunities related to best practice scores. RESULTS: Response rate was 40% (n = 610/1506) with 69% independent centers (vs. organization sponsored), 19% with Child and Adult Care Food Program (CACFP enrolled), and 50.2% centers with majority (≥70%) Caucasian children and 16.8% centers with majority African American children. Centers reported 40.8% of physical activity best practices, 52.0% of feeding environment best practices, and 51.6% of food served best practices. Centers reported (mean) 7.9 of 16 nutrition/physical activity-relevant policies, 6.9 of 13 provider training topics, and 4.4 of 8 family education opportunities. Regression models yielded associations with best practices: policies and provider training with feeding environment (B = 0.26, p < 0.001; B = 0.26, p = 0.001, respectively); policies with foods served (B = 0.22, p = 0.002); and policies, provider training, and feeding environment with physical activity (B = 0.19, p = 0.001; B = 0.24, p = 0.010; B = 0.38, p < 0.001). CONCLUSIONS: Nutrition/physical activity best practices in child care are supported by specific policies, provider training, and family education activities.

Unique experiences of direct entry BSN/BS-PhD nursing students: A Delphi study.

BACKGROUND: Given the aging nursing education workforce and the persistent high demand for doctorally-prepared nursing faculty, there is a critical need to increase the number of nurses entering and completing PhD programs. To fill this need, accelerated PhD education pathways, such as the direct entry BSN/BS-PhD education pathway, have become popular. OBJECTIVE: The objective of this study was to explore the unique characteristics of the direct entry BSN/BS-PhD student experience. This study defines and details the experiences of current and past direct entry BSN/BS-PhD students. DESIGN: This was a qualitative, descriptive study. SETTING: Web-based journals and feedback. PARTICIPANTS: Our sample includes four former and current direct entry BSN/BS-PhD students. METHODS: We used the Delphi method to first analyze participants' journal entries on their lived experiences, and then iteratively summarize and classify the experiences into summative themes. RESULTS: We found four themes unique to participants' experiences: commitment to science, nursing identity, exploring prospects, and balancing family and student expectations. CONCLUSIONS: To ensure that BSN/BS-PhD students have a high-quality education, nurse leaders should be aware of the unique perspectives of direct entry BSN/BS-PhD students. Results from this study can be used to evaluate BSN/BS-PhD programs from students' perspectives.

Examining the Obesogenic Attributes of the Family Child Care Home Environment: A Literature Review.

Childhood obesity is a major public health concern in the US. More than a third of young children 2-5 years old are placed in nonrelative child care for the majority of the day, making the child care setting an important venue to spearhead obesity prevention. Much of the obesity research in child care has focused on center-based facilities, with emerging research on Family Child Care Homes (FCCHs)-child care operated in a home setting outside the child's home. The purpose of this review was to assess the obesogenic attributes of the FCCH environment. A search of the PubMed, Embase, CINHAL, and PsycINFO electronic databases identified 3,281 citations; 35 eligible for full-text review, and 18 articles from 17 studies in the analysis. This review found a lack of comprehensive written nutrition and physical activity policies within FCCHs, lack of FCCH providers trained in nutrition and physical activity best practices, lack of adequate equipment and space for indoor and outdoor playtime activities in FCCHs, inaccurate nutrition-related beliefs and perceptions among FCCH providers, poor nutrition-related communication with families, and poor feeding practices. Future research focusing on interventions aimed at addressing these problem areas can contribute to obesity prevention.

Child Poverty, Toxic Stress, and Social Determinants of Health: Screening and Care Coordination.

Social determinants of health (SDOH) refer to the social, economic, and physical conditions in which people live that may affect their health. Poverty, which affects nearly 15 million children in the United States, has far-reaching effects on children's physical and mental health. Although it is difficult to change a family's economic circumstances, nurses can play a critical role to address SDOH through screening and effective coordination of care. As nurses, our role is to minimize the effects of SDOH, including poverty, on child health and well-being through our practice, research, and professional education. We present three exemplars of child poverty to demonstrate the impact on child health and well-being and propose a model of care for nurses to assess and address SDOH in the pediatric clinical setting.

Randomized Trials of Nurse-Delivered Interventions in Weight Management Research: A Systematic Review.

The purpose of this systematic review was to determine whether nurse-delivered weight management interventions improve weight outcomes across the life span. We conducted a comprehensive search of the PubMed, CINAHL, and PsycINFO electronic databases. We graded the trials using an adapted Jadad approach for methodological quality. The search identified a total of 1,159 citations; 23 articles from 20 studies were eligible for this review. Sixty-five percent of the studies reported significant findings related to body mass index (BMI) or weight reduction. Studies that were particularly successful at helping participants reduce weight and/or BMI involved nurses engaged in health promotion activities, operating within multidisciplinary teams and/or providing consultations, physical activity education, and coaching over the phone. Of the studies that involved long-term follow-up assessments, three out of nine studies showed a significant loss in weight or BMI between the intervention and control groups at follow-up times ranging from 12 months to 2 years.