Health and education passport and the role of the foster care public health nurse.

AIM: The aim of this study is to explore the practical use of Health and Education Passport (HEP) for children in foster care and the role of the Foster Care Public Health Nurse (FCPHN) in tracking health and education records. BACKGROUND: Children in foster care have complex health problems and experience frequent changes in home and school placements that result in gaps documentation. California mandates an HEP for every child in foster care. DESIGN: Utilizing an online survey, PHNs describe their agency's use of the HEP, reported how they obtain health and education records for the HEP. RESULTS: Social workers, PHNs and mental health providers were main HEP users, less so for foster parents and youth who age out of foster care. The HEP was used at medical and dental visits. PHNs reported little to no participation in updating educators. The HEP may be most useful when the child moves to a new placement or school. CONCLUSION: The HEP is a critical document that ties a fragmented health history together. RELEVANCE TO CLINICAL PRACTICE: This study describes the foster care PHN role in updating the HEP and accessing health services and establishing a medical home.

LGBT youth in foster care and the critical advocacy role of Public Health Nurses.

AIMS AND OBJECTIVES: The purpose of this study was to describe the role of public health nurses working with lesbian, gay, bisexual, and transgender (LGBT) children in foster care in the San Francisco Bay Area. BACKGROUND: LGBT youth are disproportionately represented in foster care and experience poor health and education outcomes. Foster care public health nurses (FCPHN) are in a unique position to address disparities with timely and appropriate referrals and advocate for policy changes. DESIGN: An online survey was developed to describe FCPHN responsibilities in case managing LGBT children. METHOD: In all, 39 FCPHNs completed the survey. RESULTS: Most FCPHN did not know the number of LGBT youth in their caseload and reported that there was no systematic method of collecting this data. Few FCPHN had received training in LGBT health issues. CONCLUSION: This study confirms reports from other studies regarding lack of systematic data collection to deliver appropriate services to LGBT youth. It reports FCPHN lack of training as well as their assessment of the most important needs of this population. RELEVANCE TO CLINICAL PRACTICE: FCPHNs are in a unique position to advocate by promoting gender inclusive forms in child welfare agencies and addressing disparities in access to care.

PART I: The role of public health nursing in addressing health care needs of children in foster care.

AIMS AND OBJECTIVES: The purpose of this study was to describe the role of Public Health Nurses (PHN) addressing the needs of children and adolescents in foster care. BACKGROUND: Children in foster care have more physical, mental, dental, developmental health problems than the general pediatric population. National data indicate that between 30%-80% of children come into foster care with at least one physical health problem. DESIGN: An online survey was developed to describe PHN day-to day activities, PHN funding, case load and case management responsibilities. METHOD: Thirty-nine PHNs completed the survey (72% response rate). RESULTS: Nurses described the most important needs as being mental and emotional health services, self-esteem/self-worth and dental care. Care coordination, case management and monitoring/oversight of psychotropic medications were the top responsibilities. CONCLUSION: The study demonstrated that public health nursing expertise is an essential part of the child welfare team in addressing medical, dental, mental and developmental needs of children in foster care. RELEVANCE TO CLINICAL PRACTICE: There is an expanding role of Public Health Nurses in non-health care settings to intervene at the system level of the Intervention Wheel that includes policy development and enforcement, community organizing, and coalition building.

'Nurses don't deal with these issues': nurses' role in advance care planning for lesbian, gay, bisexual and transgender patients.

AIMS AND OBJECTIVES: We used a question from the Healthcare Equality Index to explore nurses' knowledge and understanding of medical advance directives, medical power of attorney and other legal documents for lesbian, gay, bisexual and transgender patients. BACKGROUND: Until the landmark ruling in Obergefell vs. Hodges, lesbian, gay, bisexual and transgender individuals and same-sex couples have had limited relationship rights as only a few states recognised marriages and provided legal protections for same-sex couples. Health care providers' knowledge of and attitudes towards advance care planning plays a significant role in determining whether or not individuals successfully complete advance directives, yet advance care planning for lesbian, gay, bisexual and transgender individuals is poorly understood among both health care providers and same-sex couples. DESIGN: These data were part of a larger research study that explored the current state of lesbian, gay, bisexual and transgender-sensitive nursing practice. METHOD: Undergraduate nursing students recruited and interviewed nurse key informants (n = 268) about medical advance directives, medical power of attorney and other legal documents for lesbian, gay, bisexual and transgender patients. RESULTS: Nearly 50% of key informants indicated a lack of knowledge of advance directives, over 26% reported the difficulties nurses face regarding advance directives are the same for both lesbian, gay, bisexual and transgender and heterosexual patients, and nearly 25% indicated difficulties including having to decide who has the legal right to make decisions for the patient. CONCLUSION: The study demonstrated the need for education and training for practising nurses in advance care planning for lesbian, gay, bisexual and transgender patients and same-sex couples. RELEVANCE TO CLINICAL PRACTICE: Nurses are in a position to act as educators, advocates and decision makers for their patients. Nurse's lack of understanding of advance care planning may negatively impact the type and quality of care lesbian, gay, bisexual and transgender patients receive.

Does your organization use gender inclusive forms? Nurses' confusion about trans* terminology.

AIMS AND OBJECTIVES: To describe nurses confusion around trans* terminology and to provide a lesson in Trans* 101 for readers. BACKGROUND: Of the estimated 9 million persons in the United States of America who are identified as lesbian, gay, bisexual and transgender, about 950,000 (0.2-0.5% of adult population) are identified as trans* (a term that encompasses the spectrum, including transgender, transsexual, trans man, trans woman and other terms). The Institute of Medicine (2011, The health of lesbian, gay, bisexual and transgender people: Building a foundation for better understanding. The National Academies Press, Washington, DC) identified transgender persons as an understudied population with significant need for health research, yet the nursing literature contains little guidance for educating nurses on trans* issues. DESIGN: This is a mixed methods structured interview design with nurse key informants. The scripted interview was based on the Health Care Equality Index, which evaluates patient-centred care to lesbian, gay, bisexual and transgender patients and families. These data were part of a larger research study that explored the current state of lesbian, gay, bisexual and transgender-sensitive nursing practice. METHOD: Undergraduate nursing students recruited and interviewed 268 nurse key informants about gender inclusive forms (capable of identifying trans* patients) at their agencies. RESULTS: Only 5% reported use of gender inclusive forms, 44% did not know about inclusive forms, 37% did not understand what a gender inclusive form was and 14% confused gender with sexual orientation. CONCLUSION: The study demonstrated a critical need for education in gender identity and sexual orientation terminology. RELEVANCE TO CLINICAL PRACTICE: The lack of understanding of concepts and terminology may affect basic care of lesbian, gay, bisexual and transgender patients especially those who identify as transgender.

Knowledge and fears among Asian Americans chronically infected with hepatitis B.

Asian Americans are disproportionately affected by hepatitis B (HBV) infection. In the USA, one in ten Asian Americans is infected with HBV. The purpose of the study was to explore knowledge, fears and follow-up care among Asian Americans chronically infected with hepatitis B. A sample of 154 completed an online survey which included demographic information, follow-up treatment information, and HBV knowledge and fears/concerns. Our findings indicate that there are differences by ethnicity and birthplace among Asian Americans in terms of follow-up care and treatment. In addition, our study indicates that there were substantial knowledge gaps regarding contracting HBV, transmission, and prevention. We found that HBV-infected respondents had many fears about their infection. Three primary concerns were identified: (a) concerns related to liver cancer and overall health, (b) transmission to loved ones, and (c) stigma. Our findings indicate that Asian Americans chronically infected with HBV need more education to manage HBV including information on the importance of follow-up treatment and care and education on preventing transmission, risk for liver cancer, and HBV impact on overall health.

Nurses' Knowledge About Transgender Patient Care: A Qualitative Study.

This study explored practicing nurses' knowledge of the needs of transgender patients. Structured interviews were conducted with 268 nurses in the San Francisco Bay Area. This study focused on the responses to 1 item in the 16-item interview, "Describe health care issues that are particular to transgender patients." Three themes emerged from the data: discomfort, transition, and harsh consequences of being transgender. These findings revealed nurses' discomfort and lack of knowledge about transgender people and their health care needs. Nursing curricula must challenge the gender binary to better prepare nurses to provide quality care for patients of all genders.

Disability Among Sexual Minority Women: Descriptive Data from an Invisible Population.

PURPOSE: To assess the health and well-being of sexual minority women (SMW) with disabilities. METHODS: A survey assessing physical and mental health and quality of life was administered to a convenience sample of 52 women with disabilities and 74 without disabilities. All had been recruited for an SMW's health intervention targeting women over 40 with potential for weight-related health problems. RESULTS: Women with disabilities experienced more discrimination, had more posttraumatic stress disorder and anxiety disorders, were less connected to SMW's communities, had more physical health limitations, and reported poorer quality of life, mostly related to physical factors such as energy level and pain. CONCLUSION: SMW with disabilities have rarely been studied, and may have significant challenges with health, including greater need for community support. Studies are needed to further explore the influences on the health and well-being of SMW with disabilities.

"Never in All My Years... ": Nurses' Education About LGBT Health.

In spite of recent calls for patient-centered care and greater attention to the needs of lesbian, gay, bisexual, and transgender (LGBT) patients, nurses still lack basic education about LGBT patient care and, as a result, may have negative attitudes, endorse stereotypes, and/or feel uncomfortable providing care. This study reports on education/training of practicing nurses and explores some of the reasons for nurses reporting feelings of discomfort with LGBT patient care. Transcripts from structured interviews with 268 nurses in the San Francisco Bay Area revealed that 80% had no education or training on LGBT issues. Although most said they were comfortable with LGBT patient care, some of their comments indicated that they might not be providing culturally sensitive care. Implications for nursing education and for policies and procedures of health care institutions are addressed.

Nursing students' perceptions of their knowledge of lesbian, gay, bisexual, and transgender issues: effectiveness of a multi-purpose assignment in a public health nursing class.

Nurses work with diverse populations, but the nursing literature lacks research, theoretical frameworks, or practice guidelines regarding lesbian, gay, bisexual, and transgender (LGBT) health. Through diverse teaching strategies, students explored issues related to LGBT patients, families, and nurses using a cultural humility lens. Diverse teaching strategies included readings, a 2-hour presentation on LGBT health issues, and an assignment to conduct a scripted interview with two nurse key informants, based on the Health Care Equality Index (HEI). Students completed an online LGBT awareness preinterview survey, completed interviews, and completed a postinterview survey. Students showed a significant increase in knowledge about sexual orientation and gender identity and research and interview methods from pretest to posttest. The diverse teaching strategies involved in this assignment can enhance student knowledge, attitudes, and skills related to LGBT health care needs and increase appreciation of nursing research.