Addressing immunizations in nursing education: Immunization resources for undergraduate nursing.

Nursing faculty are challenged to integrate immunization content in prelicensure nursing curricula. Historically, most immunization content has been delivered in pediatrics courses, with less emphasis on other populations across the lifespan. Skills related to vaccine administration may be prioritized over the most current immunization science, such as pathophysiology, immunology, and epidemiology. As the most trusted profession rated by the public (Saad, 2020), nurses are ideally suited to address vaccine hesitancy and promote vaccination in the communities they serve. Nurses apply active listening, problem solving, and communication skills with patients and their families, contributing to a person's confidence in their decision to be vaccinated. The Centers for Disease Control and Prevention and the Association for Prevention Teaching and Research collaborated to develop a framework for immunization content and teaching resources, Immunization Resources for Undergraduate Nursing (IRUN), for faculty to use in designing the nursing curricula. Content includes a curriculum framework, curriculum mapping tool, multiple teaching resources, and a dedicated website (IRUNursing.org). The framework provides guidance for faculty on integrating immunization content into a curriculum. Teaching resources include case studies, simulation scenarios, and PowerPoint slide decks. Although primarily focused on prelicensure nursing education, resources are also relevant to advanced professional nursing education.

A Quality Improvement Initiative Addressing Safe Opioid Prescribing and Disposal Postcesarean Delivery.

BACKGROUND: Misuse of prescription opioids is a public health crisis in the United States. In 2016, it was estimated that 3.3 million Americans were misusing prescription opioids (SAMHSA, 2017) and nearly 63,632 deaths were due to prescription opioid misuse. From 1999 to 2010, the number of prescription opioid drugs sold to health care facilities from pharmaceutical companies, nearly quadrupled. Cesarean delivery is the most common surgical procedure performed in the United States and opioids are most often chosen to manage post-operative pain. Research has shown that women, who deliver via cesarean section, are prescribed an excess of opioid tablets upon discharge and often store them in unsecure locations. Furthermore, the vast majority, are not disposed of properly. AIMS: The purpose of this quality improvement project was to assess whether a shared decision-making tool between a discharging obstetric provider and post-cesarean section patient can reduce the pool of unused opioids in the community. DESIGN: A one-group pre/post survey design was used to conduct this study. SETTING: 537-bed teaching hospital composed of 12 labor, delivery and recovery suites, 3 operating suites, and 33 postpartum suites. PARTICIPANTS: Engish speaking women, 18 years or older who delivered by cesarean section. METHODS: A shared decision-making session was implemented on a computer-based tablet, led by the discharge provider and woman following cesarean section on day of discharge. The tool focused on pain expectations, multi-modal methods (both pharmacologic and non-pharmacologic) to manage pain, safe storage, and disposal of excess medication. Women chose the number of 5-mg oxycodone tablets they would be prescribed, up to the institutional standard of 30. Women were provided a home opioid deactivation system to dispose of any excess tablets. A follow-up phone call was completed two weeks following discharge. RESULTS: Sixty women participated in the initiative. The mean number of 5-mg oxycodone tablets prescribed was 18. Women consumed a mean of 13 tablets, with 6 remaining. Eighty-eight percent (n = 33) of women disposed of their excess tablets, with 52% utilizing the opioid deactivation system provided. The initiative resulted in 92% (n = 47) of patients utilizing all of their prescribed tablets or properly disposing of them. CONCLUSION: Engaging post-operative patients in decisions regarding pain management, educating women on multi-modal methods to manage pain, and providing women with a means to properly dispose of excess tablets, can reduce opioid tablets available for misuse and diversion in the community.

Nurse-Family Partnership nurses' attitudes and confidence in identifying and responding to intimate partner violence: An explanatory sequential mixed methods evaluation.

AIMS: To evaluate the effect of an intimate partner violence intervention education component on nurses' attitudes in addressing intimate partner violence; complementary aims included understanding nurses' perceptions of the education and how it influenced their attitudes and confidence to address intimate partner violence in practice. DESIGN: An explanatory sequential mixed methods design embedded within a 15-site cluster randomized clinical trial that evaluated an intimate partner violence intervention within the Nurse-Family Partnership programme. METHODS: Data were collected between February 2011 and September 2016. Quantitative assessment of nurses' attitudes about addressing intimate partner violence was completed by nurses in the intervention (n = 77) and control groups (n = 101) at baseline, 12 months and at study closure using the Public Health Nurses' Responses to Women Who Are Abused Scale. Qualitative data were collected from nurses in the intervention group at two timepoints (n = 14 focus groups) and focused on their perceptions of the education component. Data were analysed using content analysis. RESULTS: Nurses in the intervention group reported large improvements in their thoughts, feelings and perceived behaviours related to addressing intimate partner violence; a strong effect of the education was found from baseline to 12 months and baseline to study closure timepoints. Nurses reported that the education component was acceptable and increased their confidence to address intimate partner violence. CONCLUSION: Nurses reported improved attitudes about and confidence in addressing intimate partner violence after receiving the education component. However, these findings need to be considered together with trial results showing no main effects for clients, and a low level of intervention fidelity. IMPACT: These evaluation findings underscore that improvement in nurses' self-reported educational outcomes about addressing intimate partner violence cannot be assumed to result in adherence to intervention implementation or improvement in client outcomes. These are important considerations for developing nurse education on intimate partner violence.

Teen pregnancy in Chicago: Who is at risk?

BACKGROUND: Teenage pregnancy, with its associated health and social consequences for young people and society as a whole, is one of the nation's most important public health issues. The purpose of this study was to use Youth Risk Behavior Survey (YRBS) data describe self-reported, pregnancy experiences in 9-12th grade Chicago Public Schools (CPS) students and identify teens at highest risk based on gender, grade-level, race, ethnicity, and sexual orientation. METHODS: Secondary data analysis of the 2017 CPS high school Youth Risk Behavior Survey was conducted. RESULTS: The survey response rate was 73% (n = 1,883). 4.9% (n = 91) of CPS students in grades 9 - 12 reported a pregnancy experience, and 1.9% (n = 34) reported being "unsure" of a pregnancy experience. Statistically significant differences in the likelihood of self-reporting a pregnancy experience were found based on grade level (p = .000), race (p = .023), and sexual orientation (p = .000). CONCLUSION: While risk for a teen pregnancy experience varies across all groups, public health nurses can use YRBS data to better understand pregnancy risk in the populations they serve and can leverage core competencies, and robust community relationships to adapt, implement and evaluate evidence-based teen pregnancy prevention programs for maximum impact on teens at greatest risk.

Effect of Addition of an Intimate Partner Violence Intervention to a Nurse Home Visitation Program on Maternal Quality of Life: A Randomized Clinical Trial.

Importance: Intimate partner violence (IPV) is a public health problem with significant adverse consequences for women and children. Past evaluations of a nurse home visitation program for pregnant women and first-time mothers experiencing social and economic disadvantage have not consistently shown reductions in IPV. Objective: To determine the effect on maternal quality of life of a nurse home visitation program augmented by an IPV intervention, compared with the nurse home visitation program alone. Design, Setting, and Participants: Cluster-based, single-blind, randomized clinical trial at 15 sites in 8 US states (May 2011-May 2015) enrolling 492 socially disadvantaged pregnant women (≥16 years) participating in a 2.5-year nurse home visitation program. Interventions: In augmented program sites (n = 229 participants across 7 sites), nurses received intensive IPV education and delivered an IPV intervention that included a clinical pathway to guide assessment and tailor care focused on safety planning, violence awareness, self-efficacy, and referral to social supports. The standard program (n = 263 participants across 8 sites) included limited questions about violence exposure and information for abused women but no standardized IPV training for nurses. Main Outcomes and Measures: The primary outcome was quality of life (WHOQOL-BREF; range, 0-400; higher score indicates better quality of life) obtained through interviews at baseline and every 6 months until 24 months after delivery. From 17 prespecified secondary outcomes, 7 secondary end points are reported, including scores on the Composite Abuse Scale, SPAN (Startle, Physiological Arousal, Anger, and Numbness), Prime-MD Patient Health Questionnaire, TWEAK (Tolerance/Worry About Drinking/Eye-Opener/Amnesia/C[K]ut Down on Drinking), Drug Abuse Severity Test, and the 12-Item Short-Form Health Survey (physical and mental health), version 2. Results: Among 492 participants enrolled (mean age, 20.4 years), 421 (86%) completed the trial. Quality of life improved from baseline to 24 months in both groups (change in WHOQOL-BREF scores from 299.5 [SD, 54.4] to 308.2 [SD, 52.6] in the augmented program group vs from 293.6 [SD, 56.4] to 316.4 [SD, 57.5] in the standard program group). Based on multilevel growth curve analysis, there was no statistically significant difference between groups (modeled score difference, -4.9 [95% CI, -16.5 to 6.7]). There were no statistically significant differences between study groups in any of the secondary participant end points. There were no adverse events recorded in either group. Conclusions and Relevance: Among pregnant women experiencing social and economic disadvantage and preparing to parent for the first time, augmentation of a nurse home visitation program with a comprehensive IPV intervention, compared with the home visitation program alone, did not significantly improve quality of life at 24 months after delivery. These findings do not support the use of this intervention. Trial Registration: ClinicalTrials.gov Identifier: NCT01372098.

Child Temperament, Maternal Feeding Practices, and Parenting Styles and Their Influence on Obesogenic Behaviors in Hispanic Preschool Children.

Although obesogenic behaviors (physical activity and/or sedentary behavior and dietary intake) are known predictors of childhood weight status, little is known about mother and child behaviors contributing to obesogenic behaviors and obesity in Hispanic preschool children, whose obesity rate is higher than in non-Hispanic Whites and non-Hispanic Blacks. The purpose of this cross-sectional, descriptive study was to examine relationships among child temperament, maternal behaviors (feeding practices and parenting style), child obesogenic behaviors, and child weight status in 100 Hispanic preschool children. Results showed that higher scores on the negative affectivity dimension of child temperament were associated with higher scores on the dimension of permissive parenting, and permissive parenting was associated with less time spent in sedentary behaviors (B = -3.53, confidence interval [-7.52, -0.90]). Findings can guide school nurses in developing interventions that consider child temperament and parenting style to promote nonobesogenic behavior in Hispanic preschoolers.

Understanding tailored PHN interventions and outcomes of Latina mothers.

OBJECTIVE: To examine associations of data-driven intervention approaches (IAs) with the outcomes of adolescent or adult Latina mothers with or without the Mental health problem. DESIGN AND SAMPLE: Retrospective observational study using public health nurse (PHN)-generated data for 676 Latina mothers aged 14-52. MEASURES: Mothers' age, having the Mental health problem, number of problems and interventions, and Knowledge, Behavior, and Status scores using the Omaha System. Mother-specific percentages of interventions to the total number received were calculated. Visualizations and statistical tests were used to analyze the association of IAs relating mothers' characteristics, problems, interventions, and outcomes. RESULTS: Four IAs were discovered. Sample characteristics differed significantly among IAs by age and having the Mental health problems. There was a small effect of age on outcomes (<0.10). PHNs differentially addressed problems in IA1-IA4 compared with IA2-IA3 (p < 0.001). Mothers who received IA3 had the most improvement and highest scores in Knowledge and Behavior (all p < 0.001). Mothers who received IA2 had the most improvement and highest scores in Status (both p < 0.001). CONCLUSIONS: The IAs were associated with outcomes differentially among Latina mothers, depending on multiple complex factors. These methods may be useful in understanding intervention tailoring and should be replicated with other populations and datasets.

An academic practice partnership: Building capacity to meet sexual health education policy requirements of a public school system.

The purpose of this clinical concepts paper is to describe the development, implementation, and evaluation of a formal academic-practice partnership between a large, urban, public school system and a college of nursing, based on the American Association of Colleges of Nursing's Guiding Principles to Academic-Practice Partnerships. The overarching goal of the partnership was to increase the school district's capacity to meet sexual health education policy requirements while providing graduate nursing students with an opportunity to work with a diverse population of youth during a public health nursing practicum course. As a result of the partnership, over 2,000 public school students (grades 5-12) have received comprehensive sexual health education and increased their knowledge by an average of 19.7-32.7%. In addition, 79 prelicensure, graduate nursing students have been placed at the public school system for public health nursing practicum and 100% have met all clinical objectives. As with any partnership, successes and lessons learned were identified. Discussion of both is included in this paper and may benefit other organizations considering entering into similar partnerships. Ultimately, academic-practice partnerships are an important mechanism to simultaneously meet the growing needs of community practice partners and nursing education programs, while strengthening public health nursing practice.

Preferred intervention strategies to improve dietary and physical activity behaviors among African-American mothers and daughters.

OBJECTIVE: The objective of this study was to identify cultural- and age-appropriate intervention strategies to improve dietary and physical activity (PA) behaviors in African-American adolescent daughters and their mothers. DESIGN AND SAMPLE: A convergent parallel mixed methods design with interactive quantitative and qualitative measures was used. Twenty-four 9th- and 10th-grade African-American daughters from a large urban high school and their mothers participated. MEASURES: Measures included the 2013 Youth Risk Behavior Surveillance System dietary and PA questions, 2013 Behavioral Risk Factor Surveillance System dietary and PA questions, and BMI. Focus group questions covered preferred intervention formats and strategies for delivering a dietary and PA intervention. RESULTS: Fifty-five percent of daughters and 92% of mothers were overweight/obese. Mothers tended to prefer the group format (mothers/daughters together or mothers together) for delivering a dietary and PA intervention, while the daughters' delivery preferences were mixed. Top mother/daughter dyad strategy preferences for both dietary and PA were goal setting and use of rewards/prizes. CONCLUSIONS: These findings suggest several dietary and PA obesity intervention strategies that can guide obesity prevention efforts for African-American daughters and their mothers.

A Systematic Review of Literature on Culturally Adapted Obesity Prevention Interventions for African American Youth.

Obesity and overweight prevalence in African American (AA) youth continues to be one of the highest of all major ethnic groups, which has led researchers to pursue culturally based approaches as a means to improve obesity prevention interventions. The purpose of this systematic review was to evaluate culturally adapted obesity prevention interventions targeting AA youth. A search of electronic databases, limited to multicomponent culturally adapted obesity prevention controlled trials from 2003 to 2013, was conducted for key terms. Eleven studies met inclusion criteria. We used the PEN-3 model to evaluate the strengths and weaknesses of interventions as well as to identify cultural adaptation strategies. The PEN-3 model highlighted the value of designing joint parent-youth interventions, building a relationship between AA mentors and youth, and emphasizing healthful activities that the youth preferred. The PEN-3 model shows promise as an overarching framework to develop culturally adapted obesity interventions.

Determinants of Obesity in the Hispanic Preschool Population: An Integrative Review.

OBJECTIVE(S): The purpose of this integrative review was to identify factors associated with obesity in Hispanic preschool children. DESIGN AND SAMPLE: Integrative research review based on strategies described by Whittemore and Knafl. Thirty-five research reports using qualitative and/or quantitative methods and including a majority of participants (parents or preschool-aged children) of Hispanic ethnicity. MEASURES: Data were analyzed using the Matrix Method. RESULTS: Decreased physical activity of the child and increased maternal body mass index were found as contributors to obesity in the preschool, Hispanic population. The relationship between maternal feeding practices and beliefs, food choices and childhood obesity are widely studied with little consistency in findings across studies. CONCLUSIONS: Public health nurses can work with communities to promote physical activity and safe outdoor places for exercise. In addition, they can advocate for the availability of healthy food choices in neighborhood schools. Maternal feeding practices, acculturation, and the child's environment require further research.

Factors explaining variability in health literacy outcomes of public health nursing clients.

OBJECTIVES: To evaluate variability in health literacy outcomes due to home visiting (HV) program components including PHN, Intervention, and Client. DESIGN AND SAMPLE: A comparative, correlational study evaluated PHN home visiting program data that included PHNs (N = 16); Interventions (N = 21,634); and Clients (N = 141). Client age ranged from 14 to 46 (median = 21, mean = 22.8, SD = 6.65). Clients were predominately White (75.9%), not married (84.4%), and female (99.3%). PHNS documented care using electronic health records (EHR) and the Omaha System. MEASURES: The outcome of interest was health literacy benchmark attainment (adequate knowledge) operationalized by Omaha System Problem Rating Scale for Outcomes Knowledge scores averaged across problems. INTERVENTION: Program of individually tailored, evidence-based HV interventions provided by PHNs. RESULTS: There were 233 different interventions for 22 problems. Knowledge benchmark was attained by 16.3% of clients. Four factors explained variance in reaching the knowledge benchmark: Client (51%), Problem (17%), Intervention (16%), and PHN (16%). CONCLUSIONS: The PHN and intervention tailoring are actionable components of HV programs that explain variability in health literacy outcomes. Further research should examine effects of training on PHN relationship skills and intervention tailoring to optimize outcomes of evidence-based PHN HV programs, and to evaluate whether improving health literacy may subsequently improve client problems.

Efficacy of a Latino mother-child communication intervention in elementary schools.

Children of Latino immigrants in the United States encounter ecological stressors that heighten their risk for depressive symptoms, externalizing behavior, and problems in school. Studies have shown that affirming parent-child communication is protective of child depressive symptoms and accompanying problems. The purpose of this study was to assess the efficacy of an adapted mother-child communication intervention for Latino immigrant mothers and their fourth- to sixth-grade children delivered after school. The intervention, Family Communication ("Comunicación Familiar"), was delivered at children's elementary schools in six sessions lasting 2 hr each. Significant improvements were found in children's reports of problem-solving communication, with their mother and mothers' reports of reduced family conflict. Strengths of the intervention are improved mother-child communication, acquisition of communication skills that can transfer to relationships within the classroom, and a design that allows delivery by nurses or other professional members of the school support team.

Adaptation and feasibility of a communication intervention for Mexican immigrant mothers and children in a school setting.

Children of Mexican immigrants are exposed to multiple ecological risks that heighten their likelihood of experiencing depressive symptoms. In previous studies, affirming parent-child communication has been found to be protective against depressive symptoms in Hispanic youth. Interventions focused on enhancing communication between parents and youth have the possibility of strengthening protective factors for children. The aims of this study were to (1) adapt an evidence-based parent-child communication intervention (Mission Possible) for cultural relevance for low-income, low-literacy Mexican immigrant mothers and their children and (2) assess feasibility of delivering the adapted intervention in a school setting. Adaptation took place in a series of focus groups of mother-child dyads. The revised intervention was delivered to 27 mother-child dyads in two elementary schools. Feasibility was supported by high participant satisfaction, 80% attendance rate, and 75% retention rate. This preliminary work suggests strategies for school nurses to partner with immigrant families and outlines a potential intervention that expands the school nursing role.

Family home visiting outcomes for Latina mothers with and without mental health problems.

OBJECTIVE: To evaluate outcomes of a public health nursing family home visiting (FHV) intervention for Latina mothers with and without mental health problems. DESIGN AND SAMPLE: Retrospective cohort analysis of de-identified FHV data. Latina clients served by public health nurses (PHNS) in an urban Midwest public health agency (2007-2010). Of the 680 clients there were 158 with mental health problems (n = 30, 14-17 year olds; n = 128, 18-52 year olds) and 522 without mental health problems (n = 100, 14-17 year olds; n = 422, 18-52 year olds). MEASURES: Client age, number of problems, number of visits, length of service, presence of mental health problem, and Omaha System knowledge, behavior, and status scores for all client problems. Analysis included general linear mixed models adjusted for co-variables (i.e., age, comorbidities). RESULTS: All groups improved knowledge, behavior, and status. Knowledge improvement was not significantly different across groups. Behavior improved more among adults with mental health problems (p = .013). Status improved more among adolescents with mental health problems (p = .012). CONCLUSIONS: Latina mothers, particularly those with mental health problems, improve after PHN FHV services. Further study should examine intervention patterns associated with these outcomes, and seek explanations for differences in outcomes.

Development of a nurse home visitation intervention for intimate partner violence.

BACKGROUND: Despite an increase in knowledge about the epidemiology of intimate partner violence (IPV), much less is known about interventions to reduce IPV and its associated impairment. One program that holds promise in preventing IPV and improving outcomes for women exposed to violence is the Nurse-Family Partnership (NFP), an evidence-based nurse home visitation program for socially disadvantaged first-time mothers. The present study developed an intervention model and modification process to address IPV within the context of the NFP. This included determining the extent to which the NFP curriculum addressed the needs of women at risk for IPV or its recurrence, along with client, nurse and broader stakeholder perspectives on how best to help NFP clients cope with abusive relationships. METHODS: Following a preliminary needs assessment, an exploratory multiple case study was conducted to identify the core components of the proposed IPV intervention. This included qualitative interviews with purposeful samples of NFP clients and community stakeholders, and focus groups with nurse home visitors recruited from four NFP sites. Conventional content analysis and constant comparison guided data coding and synthesis. A process for developing complex interventions was then implemented. RESULTS: Based on data from 69 respondents, an IPV intervention was developed that focused on identifying and responding to IPV; assessing a client's level of safety risk associated with IPV; understanding the process of leaving and resolving an abusive relationship and system navigation. A need was identified for the intervention to include both universal elements of healthy relationships and those tailored to a woman's specific level of readiness to promote change within her life. A clinical pathway guides nurses through the intervention, with a set of facilitators and corresponding instructions for each component. CONCLUSIONS: NFP clients, nurses and stakeholders identified the need for modifications to the existing NFP program; this led to the development of an intervention that includes universal and targeted components to assist NFP nurses in addressing IPV with their clients. Plans for feasibility testing and evaluation of the effectiveness of the IPV intervention embedded within the NFP, and compared to NFP-only, are discussed.

Directions for refining a school nursing intervention for Mexican immigrant families.

Mexican immigrant mothers and their children encounter many stressors as they adapt to life in the United States. This article reports a secondary data analysis from a school-based home visiting program focused on assisting Mexican immigrant mothers and their children develop problem-solving strategies in dealing with stressors. Data were abstracted from home visiting records to determine the types of problems Mexican immigrant mothers chose to discuss with nurses. Nine categories of problems were developed from the data. Problems most frequently identified by mothers were family health concerns and access to health care, parenting and financial concerns. Findings and implications for school nursing practice are discussed.

Regional variations in cancer screening rates found in women with diabetes.

BACKGROUND: A review of the literature gives conflicting findings regarding gender-specific cancer screening rates found in women with chronic illness. OBJECTIVES: The purpose of this study was to determine if women with diabetes have different patterns of cancer screening than women of the general population, and if so, to identify the determinants of these screening patterns guided by the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model. METHODS: The 12 states using the optional women's health module for the 2003 Behavioral Risk Factor Surveillance System were downloaded into the STATA software. Contingency tables were used to identify the prevalence of cancer screening in women who self-report that they have diabetes in comparison with women who report being nondiabetic. Logistic regression was used to examine the association between the PRECEDE model determinants and the screening behaviors. RESULTS: No significant association was found between having a diagnosis of diabetes and having mammography screening rates (F = 1.5, p =.22). However, cervical cancer screening rates were statistically significantly different between the two groups of women (F = 39.01, p <.01). A gap in cervical cancer screening rates was identified among women with diabetes as compared with women without diabetes (78% versus 86%, respectively). Regional exceptions were noted between the 12 states. Ten of the 11 PRECEDE variables demonstrated a significant association with Papanicolaou test screening rates. The states demonstrating inadequate screening rates were the states with the most negative PRECEDE factors. DISCUSSION: Research has shown that the primary reason women seek cancer screening is when they are encouraged by a healthcare provider. If other care providers are focused on disease management, nurses who provide holistic care can build on the advocacy role inherent in nursing and encourage screening in underserved areas of the country.

Clinical Trail Outcomes of the Mexican American Problem Solving Program (MAPS).

Depression among Mexican immigrant women and children exceeds national prevalence rates. Given the influence of maternal depression on children, a clinical trial testing the effects of the Mexican American Problem Solving (MAPS) program was designed to address depression symptoms of Mexican immigrant women and their fourth and fifth grade children (302 dyads) through a linked home visiting and after school program compared to peers in a control group. Schools were randomized to intervention and control groups. There were statistically significant improvements in the children's health conceptions and family problem solving communication, factors predictive of mental health. Improvements in children's depression symptoms in the intervention group approached statistical significance. These promising results suggest that refined school based nursing interventions be included in community strategies to address the serious mental health problems that Mexican immigrants face.