A scoping review of the role of policy in mitigating childhood obesity in underserved populations using the RE-AIM framework.

BACKGROUND: Childhood obesity is an escalating crisis in the United States. Health policy may impact this epidemic which disproportionally affects underserved populations. AIM: The aim was to use the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to assess health policy impact on preventing or treating school-aged children (5 > 18 years) with obesity in underserved populations. METHODS: A scoping review of 842 articles was conducted. Twenty-four articles met the inclusion criteria and underwent data extraction. RESULTS: Twelve studies included subgroup analysis, with four suggesting an impact of policy on at-risk groups. None of the 24 studies fully applied the RE-AIM framework. Policies positively impacted childhood obesity in 12 studies across the sample. LINKING EVIDENCE TO ACTION: Our review revealed inconsistent evidence for the effectiveness of policy on childhood obesity, perhaps due to the lack of focus on the social determinants of health. In addition, many studies did not evaluate the outcomes for underserved populations. Therefore, we propose more attention to social determinants in future legislation and evaluation of policy effectiveness on underserved populations. Findings identify an urgent need for the design, implementation, and evaluation of policies specifically directed to address the inequities of racism, social injustices, and social determinants of health that impact childhood obesity in the United States. Future work needs to identify who was reached by the policy, who benefitted from the policy, and how policies were implemented to address obesity-related health disparities. Nurses should advocate for the evaluation of childhood obesity policies, particularly in underserved populations, to determine effectiveness. Nurses, particularly those trained in population and community health and research, should advocate for policy research that considers inequities rather than controls for these variables. Multi-layered interventions can then be tailored to sub-populations and evaluated more effectively.

Affected family members social support experiences when assisting an individual with substance use disorder.

INTRODUCTION: Social support is a factor in the health and well-being of all populations (WHO, 2018). Having a loved one with substance use disorder (SUD) negatively affects family members. Affected Family Members (AFM) providing support for individual with substance use disorder (ISUD) are at risk of losing their social support network. Losing social support negatively influences AFMs health and well-being. DESIGN: As part of a larger mixed methods study, the researchers used qualitative inquiry to explore the experiences and perceptions of social support of the AFM of an ISUD. METHODS: The thematic framework of social support was applied to this qualitative study to identify the conceptual determinants of the perceptions and experiences of the AFM and the development of emergent themes. Participants completed an anonymous electronic survey that included Open-ended questions. A total of 101 participants completed the open-ended questions with 1088 narrative responses received. The utilization of an audit trail, reflexive journal, and in-depth thematic analysis conducted by the researchers has ensured the rigor of the study. RESULTS: Three themes emerged from the AFMs perspective: (1) We are all alone, and we have to fend for ourselves, (2) No one understands what we are going through and (3) People cannot relate and recoil from us. CONCLUSION: Identification of the specific needs of the AFM was crucial, and the first step in designing programs in future research to provide social support for ensuring the health and well-being of the AFM. CLINICAL RELEVANCE: Nurses need to provide family-centred care to ISUD, including their AFMs, in order for the ISUD to continue to receive support to facilitate their recovery. This research highlights ways in which the nurse caring for the ISUD can provide supportive interventions for the AFMs.

American Academy of Nursing expert panel consensus statement on inequities in the juvenile justice system rooted in systemic and structural racism.

The overrepresentation of youth of color has long been acknowledged and accepted in juvenile justice and legal systems. Many risk factors contribute to the detention and incarceration of youth; however, there is little evidence to explain how structural inequities and systemic racism add to that vulnerability. Historically, laws were passed to benefit the White society and resulted in outcomes that caused grave aftereffects for people of color and in some cases, ethnic minorities. Within the context of juvenile justice and the lens of critical race theory, the authors of this paper seek to illuminate selected historical educational, environmental, legal, and health care policies, practices, and decisions that led to their detrimental consequences. Recommendations for mitigating both intended (through law, funding, policies) and the unintended barriers as experienced by youth of color are presented.

International consensus-based policy recommendations to advance universal palliative care access from the American Academy of Nursing Expert Panels.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

Effective Weight Loss for Children: A Meta-analysis of Intervention Studies 2002-2015.

BACKGROUND: Investigators have implemented a variety of strategies for managing and treating childhood overweight and obesity over the past decade, yet the high prevalence of childhood overweight or obesity remains. The aim of this meta-analysis was to examine the effectiveness of childhood overweight or obesity interventions addressing weight loss from 2002-September 2015. METHODS: The population focused on in this review were children who were overweight. The treatment group interventions focused on weight loss for overweight children, and included dietary, physical activity, life style changes, or a combination of treatments. Control groups received no treatment other than what they would usually receive in their normal daily lives including standard healthcare assessments. Outcomes for the studies were focused on whether the overweight children in the treatment groups lost weight. RESULTS: The criteria for the meta-analysis were met by 16 intervention studies, with a total of 19 outcomes reported within those studies. Two thousand, three hundred and seventeen participants ranged from 6 to 15 years of age with a mean age of 12 years or less. The majority of the 16 studies were conducted outside the United States (n = 13), with half reporting data on the cost of running the programming (n = 8) and were overwhelmingly conducted by interdisciplinary teams without nurses as members of the team (n = 13). The M effect was g = .732, p < .001 with a 95% confidence interval of 0.351 to 1.113, with quality scores ranging from 20 to 29 out of a possible 41. The heterogeneity analyses overall Q score was 378, an I-squared of 95, with a fail-safe N of 415. LINKING EVIDENCE TO ACTION: Diverse interventions included in this meta-analysis had a significant positive effect on weight loss in overweight children. Future research needs to focus on the role of the nurse in ensuring development and translation of the effective interventions in real world settings, at a scale that would move beyond small segments of the affected populations of overweight children.

College instructors' experiences with undergraduate students who have mental health symptoms: systematic review.

OBJECTIVE: to synthesize peer-reviewed research exploring postsecondary instructors' experiences with undergraduate students with mental health (MH) symptoms. METHODS: English-language, peer-reviewed primary research articles published between 2010 and 2021 were included. Themes and subthemes were analyzed. RESULTS: Ten articles met criteria. Three themes emerged: Instructor Actions in the Moment, with subthemes Talking with Students, Making Referrals, and Doing Nothing; Processing the Complex Emotional Impact, with subthemes Caring and Confidence, Powerlessness and Apprehension, Struggle with Boundaries, and Worry about Safety; and Needs Unmet by the Institution, with subthemes Wanted Disclosure, Wanted MH Training, Wanted Clear Policies, Wanted Institutional Support, and Wanted Robust Campus Counseling Services. Lack of resources was the major reported impediment. CONCLUSIONS: Several implications for institutions emerge. MH education should be provided for instructors. Institutions should ensure MH policies are clear and easily accessible. Institutions should acknowledge instructors' efforts with students. Finally, training on applicable laws surrounding student MH should be available.

Caring for nontraditional families: Kinship, foster, and adoptive.

PURPOSE: Information about nontraditional (kinship, foster, and adoptive) families is typically scattered or overlooked both in nursing education and nursing practice settings. Using a nursing-centric, population-focused lens, the current state of nontraditional families in the United States is briefly described. An overview of the challenges and psychological dynamics involved when a nonbiological parent assumes the role of caregiver is provided. CONCLUSION: Based on the 2010 Census findings and other indicators, we now understand that nontraditional families and their children make up a considerable portion of the population. Nurses, regardless of level of practice, have the potential to positively impact health outcomes of nontraditional parents and their children. Knowledge of the formation and needs of nontraditional families can inform, and improve, culturally safe, trauma-informed nursing care. PRACTICE IMPLICATIONS: This discussion is a first step in appreciating the formation of nontraditional families and the importance of trauma-informed, unbiased, nonstereotypic discourse in nursing care. By describing the heterogeneity of how families are built through kinship care, foster placements, and adoptive homes, nurses' assessments and interventions will be informed and through a lens of the high potential for past traumas. With this foundational knowledge, nurses interfacing with nontraditional families are better prepared to provide much needed support and relevant care for this unique population.

Pediatric End of Life Care: Impact of Islamic Faith.

Studies investigating children and families' experiences at end of life in Saudi Arabia are limited. However, one factor found to have an impact on patient and primary caregiver end of life care is Islam. Since women are the primary caregivers for children in Saudi Arabia, the purpose of this study was to explore the perceptions of Muslim women caring for a child at end of life. Using a qualitative approach, interviews were conducted with 24 female primary caregivers caring for a child at end of life. Thematic analysis was used to analyze the data. The researchers found that Islamic beliefs and practices had a positive influence on primary caregivers' experiences. Islamic beliefs and practices helped support participants through their child's end of life experience. Results have implications for health care education, practice, policy, and future research on end of life in Saudi Arabia other Muslim countries.

Primary Caregivers Caring for a Child at End of Life in Saudi Arabia.

Background: Caring for children at end of life (EOL) can be devastating for primary caregivers who are responsible for the physical, social, and emotional needs of their dying child. Limited information was found on resources in Saudi Arabia to manage the impact on primary caregivers from caring for a child receiving end of life care (EOLC). Purpose: The purpose of this study was to explore the experiences of primary caregivers caring for a child receiving EOLC within the Saudi Arabian health care system. Methods: A descriptive phenomenological study was conducted, and 24 female primary caregivers were interviewed individually. Participants were recruited from three hospitals and the surrounding community in Jeddah, Saudi Arabia. The data were collected over a period of seven weeks between August and September of 2019. Individual in-depth interviews were conducted using an 11-item investigator-developed interview guide derived from the literature on EOL. Thematic analysis was completed using transcripts from all interviews. Results: The findings suggest that primary caregivers caring for a child receiving EOLC were impacted psychologically, physically, socially, and financially. Primary caregivers expressed their heartbreak, lack of sleep, isolation, and financial challenges while caring for their child at EOL. Conclusions: Similar to what has been reported in the literature, primary caregivers caring for a child at EOL experience biopsychosocial and financial challenges. In addition, this study has implications for nursing education, practice, policy, and research regarding EOLC. Also, the findings can guide future research on EOL in Saudi Arabia and worldwide.

Childhood obesity within the lens of racism.

Despite decades of research and a multitude of prevention and treatment efforts, childhood obesity in the United States continues to affect nearly 1 in 5 (19.3%) children, with significantly higher rates among Black, Indigenous, and People of Colour communities. This narrative review presents social foundations of structural racism that exacerbate inequity and disparity in the context of childhood obesity. The National Institute of Minority Health and Health Disparities' Research Framework guides the explication of structurally racist mechanisms that influence health disparities and contribute to childhood obesity: biologic and genetic, health behaviours, chronic toxic stress, the built environment, race and cultural identity, and the health care system. Strategies and interventions to combat structural racism and its effects on children and their families are reviewed along with strategies for research and implications for policy change. From our critical review and reflection, the subtle and overt effects of societal structures sustained from years of racism and the impact on the development and resistant nature of childhood obesity compel concerted action.

A Schema of Toxic Stress Informed by Racism, Transgenerational Stress, and Disadvantage.

INTRODUCTION: The Toxic Stress Schema (TSS) is an ecological framework with a social justice lens for identifying and alleviating stress and strengthening social determinants of health for children and families of color impacted by the COVID-19 pandemic and the cumulative effects of racism and generational, systemic inequities. METHOD: Relevant literature is reviewed, and examples were provided to illustrate the differential impacts of the "stress superstorm" of 2020 had on children of color based on their family's position on the advantage-disadvantage continuum. RESULTS: The utility of the TSS framework as a model for advanced nursing practice is demonstrated, and recommendations are formulated for the pediatric nurse practitioner's role in health policy. DISCUSSION: The COVID-19 pandemic elucidated the historical inequities experienced by children and families of color. The TSS framework provides a model for recognizing, organizing, and implementing.

Youth and Parent Health-Related Quality of Life and Association With Glycemic Outcomes in Preadolescents and Adolescents With Type 1 Diabetes.

INTRODUCTION: We explored differences in Health-Related Quality of Life (HRQOL) and the youth's glycosylated hemoglobin (A1c) of preadolescent and adolescent youths with type 1 diabetes (T1D) by individual (age, sex, race) and family (socioeconomic status) factors, and associations between youths' HRQOL, their parents' HRQOL, and youth's A1c. METHOD: Correlational secondary analysis of baseline data from a randomized controlled trial testing a developmental intervention for youths with T1D and their parents from two diabetes clinics. RESULTS: Better adolescent HRQOL was associated with better glycemic control. Better preadolescent HRQOL was associated with better parent HRQOL. Non-White adolescents had worse HRQOL than White adolescents; whereas Non-White preadolescents had worse glycemic control than White preadolescents. DISCUSSION: Addressing HRQOL may promote better glycemic control in adolescents with T1D. For preadolescents with T1D, parent HRQOL support may impact preadolescent HRQOL and improve glycemic control moving into adolescence. Further study is warranted for non-White youths with T1D HRQOL and A1c outcomes.