Implementation of the Navajo fruit and vegetable prescription programme to improve access to healthy foods in a rural food desert.

OBJECTIVE: To utilise a community-based participatory approach in the design and implementation of an intervention targeting diet-related health problems on Navajo Nation. DESIGN: A dual strategy approach of community needs/assets assessment and engagement of cross-sectorial partners in programme design with systematic cyclical feedback for programme modifications. SETTING: Navajo Nation, USA. PARTICIPANTS: Navajo families with individuals meeting criteria for programme enrolment. Participant enrolment increased with iterative cycles. RESULTS: The Navajo Fruit and Vegetable Prescription (FVRx) Programme. CONCLUSIONS: A broad, community-driven and culturally relevant programme design has resulted in a programme able to maintain core programmatic principles, while also allowing for flexible adaptation to changing needs.

Microaggressions: Black students' experiences - A qualitative study.

BACKGROUND: Studies in other disciplines have shown that Black college students experience microaggressions on campus. This affects campus learning climates, posing a risk to students' success. PURPOSE: The purpose of this secondary analysis is to describe Black nursing students' experiences with microaggression at a predominantly white institution. METHODS: In this secondary analysis of a descriptive qualitative study, principles of thematic analysis were used to code, categorize, and synthesize interview data from 16 nursing alumni participants specifically to examine microaggression. RESULTS: The thematic analysis of the data revealed microaggressive behaviors experienced by Black nursing students. Three salient themes emerged: microaggressions among peers, from faculty members to students, and in the clinical setting. CONCLUSION: This study offers critical insights into the microaggressions that Black students experience. These microaggressions interfere with students' learning and highlight the need for academic institutions to take measures to dismantle these behaviors. These findings can illuminate to faculty and students the roles they play in perpetuating racism and subjecting students of color to detrimental psychological distress.

Impact of a Fruit and Vegetable Prescription Program on Health Outcomes and Behaviors in Young Navajo Children.

BACKGROUND: Rates of childhood obesity are higher in American Indian and Alaska Native populations, and food insecurity plays a major role in diet-related disparities. To address this need, local healthcare providers and a local nonprofit launched the Navajo Fruit and Vegetable Prescription (FVRx) Program in 2015. Children up to 6 y of age and their caregivers are enrolled in the 6-mo program by healthcare providers. Families attend monthly health coaching sessions where they receive vouchers redeemable for fruits, vegetables, and healthy traditional foods at retailers participating in the FVRx program. OBJECTIVES: We assessed the impact of a fruit and vegetable prescription program on the health outcomes and behaviors of participating children. METHODS: Caregivers completed voluntary surveys to assess food security, fruit and vegetable consumption, hours of sleep, and minutes of physical activity; healthcare providers also measured children's body mass index [BMI (kg/m2)] z score at initiation and completion of the program. We calculated changes in health behaviors, BMI, and food security at the end of the program, compared with baseline values. RESULTS: A total of 243 Navajo children enrolled in Navajo FVRx between May 2015 and September 2018. Fruit and vegetable consumption significantly increased from 5.2 to 6.8 servings per day between initiation and program completion (P < 0.001). The proportion of participant households reporting food insecurity significantly decreased from 82% to 65% (P < 0.001). Among children classified as overweight or obese at baseline, 38% achieved a healthy BMI z score at program completion (P < 0.001). Sixty-five percent of children were retained in the program. CONCLUSIONS: The Navajo FVRx program improves fruit and vegetable consumption among young children. Children who are obese or overweight may benefit most from the program.

The Experiences of Black Nursing Alumni at a Predominantly White Institution.

BACKGROUND: Despite increasing minority enrollment in nursing programs, student attrition remains a persistent problem. PURPOSE: The purpose of this study was to describe the experiences of a diverse group of black alumni at a predominantly white institution in the United States. METHOD: In this qualitative descriptive study, researchers conducted focus group interviews with 16 recent graduates of accelerated baccalaureate and direct-entry nurse practitioner programs. RESULTS: Four themes emerged as barriers to success: burden of exclusion and isolation, lack of diversity among students and faculty, struggling to find mentors, and cultural assumptions. Five themes captured the strategies alumni adopted to succeed: strength in numbers, helpful mentors, resilience, faith, and self-silencing. CONCLUSION: Participants experienced challenges but successfully navigated the program until they graduated. The study findings lay the groundwork for the development of programs that foster success for all students.

Evaluation of school-based health center programs and services: the whys and hows of demonstrating program effectiveness.

Evaluation and dissemination of the outcomes of school-based health center (SBHC) services is essential for the continual growth and funding of SBHCs in the United States. Since their inception, SBHCs have been practice sites for nurse practitioners and have used interdisciplinary teams to provide care for underserved school-aged children. Early research and evaluation focused on describing the types of services and the quality of care provided. Supporters of SBHCs were anxious to demonstrate that the care provided was "as good as" care delivered in traditional primary care practices. Documentation of program impacts, such as changes in population health indicators or improved academic achievement, has been more elusive. Current evaluation priorities outlined by the National Assembly on School-Based Health Care include evaluation of mental health services using a new online tool; assessing productivity of SBHC staff; measuring quality; and attempts to link SBHC care with improved academic outcomes.

Comprehensive risk assessment for adolescents in school-based health centers.

Providing comprehensive clinical services in school-based health centers affords the advanced practice nurse the opportunities for professional growth and fulfillment. Nurse practitioners are the primary clinician in the majority of SBHCs [1]. A substantial body of knowledge exists supporting the needs of adolescents, as well as methods by which nurse practitioners may assess, document, and intervene in order to improve health outcomes in this age group. To help move the field of school-based health care from innovation to mainstream, nurse practitioners need to continue to be part of the development of conceptual frameworks, appropriate methods, and evaluation of the process and outcomes. Educational achievement, access to care and reimbursement, and reduction of adolescent morbidity are indicators that have great significance in policy development. The extent to which nurse practitioners in SBHCs can provide evidence of making a difference will determine the success of this important health care venue for adolescents and demonstrate their own professional excellence.

Case manager satisfaction in public health.

PURPOSE OF THE STUDY: The purpose of this study was to examine correlates of case managers' satisfaction with their work, services, and service network and to identify connections to service performance and service costs. PRIMARY PRACTICE SETTING: A decentralized public health program that exemplifies the trend toward more diverse clients and networked services. METHODOLOGY AND SAMPLE: A mixed method design with 34 case managers. RESULTS: As hypothesized, the case managers' experiences with clients and the service network, and their service effectiveness, were associated with their satisfaction with their jobs and the services they provide. Satisfaction was also positively associated with more timely service delivery. These associations were explained in part by case managers' education and training. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Case managers can achieve high levels of job and service satisfaction in outreach programs serving a diverse client population in a decentralized service network. Case managers' job and service satisfaction improves with reduced service problems and service delays and when case managers can devise work-arounds for persistent service problems. Using advanced practice nurses (APN) and providing more on-the-job training may increase case manager satisfaction with their jobs and the services they provide. Special efforts may be needed to prevent a decline in job satisfaction with years of experience.

The work of nurse case managers in a cancer and cardiovascular disease risk screening program.

PURPOSE OF THE STUDY: The purpose of this conceptual model of nursing and health policy-based study was to identify the frequency and correlates of activities performed by nurse case managers. PRIMARY PRACTICE SETTINGS: Massachusetts Women's Health Network (WHN) contracting organization sites for breast and cervical cancer and cardiovascular disease risk screening. METHODOLOGY AND SAMPLE: Twenty nurse case managers were interviewed. RESULTS: More time was spent performing client service activities than bureaucratic activities. Frequently performed client service activities were tracking test results, finding/connecting with clients, assessing client needs, and educating clients. The most frequently performed activity was documenting services; the least, discharging clients. Client service activity frequency was correlated with client caseload size, social barriers, overall workload, satisfaction with the way activities are carried out in the WHN, special training in WHN policies and procedures, and contracting organization service delivery arrangements. Bureaucratic activity frequency was correlated with caseload size, workload, months as a WHN case manager, system barriers, satisfaction with the way activities were carried out in the WHN, and special training. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Documentation requires a great deal of WHN nurse case managers' time, which perhaps could be more productively spent with clients. Thus, more efficient ways to document services need to be identified. Additional research is needed to determine similarities and differences in activities performed by WHN nurse case managers and other case managers working in cancer and cardiovascular disease screening programs. Strategies need to be identified to remove all barriers that interfere with performance of case manager practice activities. Strategies are needed to reduce client fear of bills, overcome scheduling constraints, and improve translation services to lessen language barriers to effective communication.