Evaluation of two academic practice partnerships for chronic disease management in nursing education.

More clinical sites are essential to meeting the learning needs of nursing students who will care for patients with chronic disease after graduation. Partnerships between schools of nursing and academic practices can increase clinical training capacity, allow future nurse practitioners (NPs) to apply knowledge and skills in the context of care delivery, and potentially improve patient outcomes with little associated risk. This article describes the experiences of primary care NP students (n = 37), NP faculty (n = 2), and clinic providers (n = 2) in an academic practice partnership performing home visits with complex pediatric asthma and adult heart failure (HF) patients. A 14-item postexperience survey was used to obtain student feedback. Over 75% (n = 28) of student participants responded. Most respondents, 80% assigned to pediatric asthma patients and 90% assigned to adult HF patients, reported the home visit experience prepared them to care for patients with chronic diseases. Clinic providers indicated the extra attention to both patient groups reduced barriers to care and improved care continuity. This partnership offers a model for developing clinical skills in advanced practice nursing students and enhancing scarce clinical placement resources. Findings were used to refine the program and expand to include all 150 students in the subsequent academic year.

Maximizing the Role of the Nurse: Strategies to Address Gaps in Asthma Care in Schools.

PURPOSE: The purpose of this project was to describe differences in the numbers of children with a diagnosis of asthma identified through two methods, determine barriers to receiving asthma interventions in elementary school settings, and make recommendations for action and advocacy for school nurses to increase the number of children with access to asthma medications at school. DESIGN AND METHODS: The authors conducted a review of the asthma diagnosis process from the initial identification of a diagnosis to the delivery of interventions with 349 enrolled students in one large, urban public school in Tennessee. RESULTS: Sixty children were identified using the school's existing parent identification process and 91 children who participated in a concurrent asthma education program self-identified or were referred by a teacher, staff, or administrator. Only seven students identified through the combined methods had access to asthma medication (albuterol) at school. CONCLUSION: Missing asthma action plans, medication forms and inhalers emerged as major barriers to intervention even when a child's diagnosis is documented. PRACTICE IMPLICATIONS: The Asthma School Readiness Process (ASRP) was developed, which describes recommendations for nurses in school and community settings to promote safety and access to asthma medication in schools.

Improving Asthma Management in the Elementary School Setting: An Education and Self-management Pilot Project.

PURPOSE: To increase daily asthma symptom self-assessments of elementary school students using Green Means Go, an asthma education and self-assessment program, via a partnership between an elementary school and a school of nursing. METHODS: Over four months, accelerated MSN nursing students provided small group education sessions to teach students and teachers to identify asthma symptoms by Asthma Action Plan (AAP) zones and actions for each zone. To promote continuity of care between school and home, a teacher-parent communication log during yellow zone days was encouraged. RESULTS: Students with asthma (n = 90), teachers (n = 12) and parents (n = 1) participated. Previously no students performed daily self-assessments and at program end, all students accurately identified symptoms, AAP zones, and action steps. A total of 789 symptom self-assessments were recorded. Teachers reported increased asthma knowledge. One parent attended an education session and one home visit was completed. No communication logs were returned. CONCLUSIONS: Partnerships between elementary and nursing schools may be an effective strategy for delivery of health programs to high-risk children with chronic diseases. Self-assessment of symptoms and taking appropriate actions at school are critical components of early asthma intervention, particularly when a school nurse is not always available. Training teachers to follow a child's AAP within school policies is a critical second step. Home visits showed potential as a strategy for engaging parents. PRACTICE IMPLICATIONS: In the current climate of school nurse shortages, management of asthma-related episodes in school can be improved with similar partnerships and programs that promote health education and self-management.

Enhancing Pediatric Asthma Care and Nursing Education Through an Academic Practice Partnership.

BACKGROUND: Home environmental assessments and interventions delivered via academic practice partnerships (APP) between clinics and schools of nursing may be a low or no cost delivery model of pediatric asthma care and professional education. Patients receive enhanced clinical resources that can improve self-management and healthcare utilization. Additionally, students can practice chronic disease management skills in actual patient encounters. OBJECTIVE: To describe outcomes of the implementation of an APP between a school of nursing and a pediatric asthma specialty clinic (PASC) to deliver a home visit program (HVP). The HVP was designed to reduce emergency department visits and asthma related hospitalizations in PASC patients and provide clinical experiences for nursing students. METHODS: PASC referred patients to the HVP based on their level of asthma control. Students provided an individualized number of home visits to 17 participants over a nine month period. A 12-month pre- and post-HVP comparison of emergency department visits and asthma related hospitalizations was conducted. Additional information was gathered from stakeholders via an online survey, and interviews with APP partners and HVP families. OUTCOMES: Children had fewer asthma related hospitalizations post HVP. Findings suggest a reduction in exposure to environmental triggers, improved patient and family management of asthma, and increased PASC knowledge of asthma triggers in the home and increased student knowledge and skills related to asthma management. CONCLUSIONS: Multiple clinical and educational benefits may be realized through the development of APPs as an infrastructure supporting targeted interventions in home visits to pediatric asthma patients and their families.

Nurse Practitioner Transition to Practice: Recommendations and Strategies for Designing and Implementing Fellowships.

Fellowships prepare new graduate nurse practitioners (NPs) to become skilled providers with advanced knowledge and clinical competency to practice nursing in a specialized area. The literature lacks guidance about comprehensive approaches for the development, implementation, evaluation, and accreditation of NP fellowships. The purpose of this article was to describe recommendations and useful strategies for professional development nurse educators to deliver optimal learning and training for NPs transitioning into practice.

Exploration of Vaccination Attitudes Among Parents and Caregivers in a Rural Appalachian Health Clinic.

At a rural Appalachian health clinic in Kentucky, 20% of patients under 18 years were not up to date with the CDC-recommended immunization schedule. Reasons parents or caregivers chose to delay or refuse their child's immunizations were explored using the Caregiver Vaccination Attitude Scale. High levels of trust in the healthcare provider and self-reported vaccine knowledge highlight opportunities for rural healthcare providers to apply evidence-based communication strategies to address vaccine hesitancy and promote the safety and health of the entire community.

Utilizing Academic-Community Partnerships With Nursing Students to Improve Hand Hygiene in Elementary Students to Reduce Transmission of COVID-19.

Coronavirus disease 2019 (COVID-19) has raised awareness about the vital role school nurses have in improving the overall health of children. School nurses provide health promotion within schools, yet over 60% of schools have only a part-time nurse or no nurse. Nursing students may be valuable partners for health promotion and academic-community partnerships may be mutually beneficial to schools of nursing and local schools. Using a nursing student team to teach hand hygiene while school health staff were present provided an opportunity for hands-on training to help the staff master curriculum content and ensure competency. This article describes a collaborative partnership initiative that expanded access to health promotion education in schools to increase knowledge about reducing the spread of infectious disease, such as COVID-19, while providing valuable clinical experiences for nursing students.

Leveraging School Nurse Expertise to Meet Children's Health and Nutrition Needs in Afterschool Programs.

The National Association of School Nurses' position statement clarifies the role of school nurses in afterschool activities is to assess, plan, and evaluate the health needs of students in programs that extend beyond the regular school day. School nurses leverage their expertise as trusted and caring providers to deliver health promotion education in the school setting. They can partner with afterschool programs to assess students' healthy eating and physical activity. The purpose of this article is to describe an exemplar assessment of Healthy Eating and Physical Activity in one afterschool program and discuss approaches to address preventable factors associated with childhood obesity.

Child Abuse Response Simulation for Advanced Practice Nursing Students.

PURPOSE: The purpose of this project was for advanced practice nursing students to gain experience taking a history from a parent or caregiver and communicating the treatment plan for an infant in which child abuse is suspected. PROJECT: Fifty-three students participated in a 1:1 simulated encounter with a standardized patient acting as the mother of an infant with a leg injury that reportedly resulted from a fall from the couch. Students received feedback from the standardized patient via an assessment tool and debriefed with faculty immediately after the simulation. OUTCOME: All students demonstrated empathy, acknowledged the mother's emotions, and communicated the concern for abuse. Additionally, all students explained the x-ray findings, need for hospital admission, and referral to investigative agency for further evaluation. CONCLUSION: Simulations designed to provide advanced practice nursing students with experience interviewing a parent and responding in the case of suspected child abuse are an important method of preparing them for initial clinical encounters.

Leveraging Resources to Improve Clinical Outcomes and Teach Transitional Care Through Development of Academic-Clinical Partnerships.

Nurse educators need to provide students with clinical experiences that prepare them for our rapidly changing health care environments. This article describes how nurse educators used academic and clinical resources to develop a partnership between a school of nursing and clinical entity to facilitate successful transitions from hospital to home for adult heart failure and pediatric asthma patients.

Adult rat forelimb dysfunction after dorsal cervical spinal cord injury.

Repairing upper extremity function would significantly enhance the quality of life for persons with cervical spinal cord injury (SCI). Repair strategy development requires investigations of the deficits and the spontaneous recovery that occurs when cervical spinal cord axonal pathways are damaged. The present study revealed that both anatomically and electrophysiologically complete myelotomies of the C4 spinal cord dorsal columns significantly increased the adult rat's averaged times to first attend to adhesive stickers placed on the palms of their forepaws at 1 week. Complete bilateral myelotomies of the dorsal funiculi and dorsal hemisection, but not bilateral dorsolateral funiculi injuries, also similarly increased these times at 1 week. These data extend a previous finding by showing that a forepaw tactile sensory deficit that occurred in the adult rat after bilateral C4 spinal cord dorsal funiculi injury is due to damage of the dorsal columns. Averaged times to first attend to the stickers also decreased to those of sham-operated rats at 3 and 4 weeks post-dorsal hemisection with weekly testing. In contrast, a separate group of rats with dorsal hemisections had significantly increased times when tested only at 4 weeks. These data indicate that frequent assessment of this particular behavior in rats with dorsal hemisections extinguishes it and/or engenders a learned response in the absence of sensory axons in the dorsal columns and dorsolateral funiculi. This finding contrasted with weekly testing of grid walking where increased forelimb footfall numbers persisted for 4 weeks post-dorsal hemisection.