Medication interventions for African-American adults: Practice-based evidence from two nurse-led clinics.

OBJECTIVE: This study was conducted to describe and examine the impact of medication intervention practices among African-American clients in two nurse-led community nursing centers (CNCs). METHODS: This study used a retrospective-descriptive design. Omaha System data from visits of 196 African-American adults living with chronic disease and having two or more CNC visits in which medication regimen was an identified problem and the main reason for the visit was analyzed. RESULTS: The sample had a mean age of 53.1 (6.67) and was primarily women (82%), uninsured, and with high school or less education. A total of 9,259 Medication regimen interventions were documented and implemented during 1,146 client CNC visits. A paired samples t test revealed statistically significant improvements in Knowledge (t = 2.434, p < .01). Behavior (t = 0.077, p = .94) and Status (t = 1.489, p = .14) remained unchanged, although the ratings trended toward improvement for each. CONCLUSION: This study provides evidence that the nursing center model of care does improve the knowledge of medications among African-American clients. The study also demonstrated the Omaha System's utility to evaluate the impact of nursing interventions in community settings.

Lessons learned for recruitment and retention of low-income African Americans.

Recruitment and retention of low-income African Americans in clinical trials is challenging. This paper reports recruitment and retention strategies that yielded high rates for both in a clinical trial pilot to improve hypertension self-management among low-income African Americans. The study successfully recruited 96.7% (59 of 61 participants) within a seven month period. Retention rates for the 1, 3, and 6-month post-baseline assessment visits were 91.5%, 88.1%, and 83.1%, respectively. Recruitment and retention strategies include two grounded in previous literature: a culturally sensitive and diverse research team and use of incentives. Four additional strategies were developed for this study to meet the needs of the study site and participants, which included: study site collaboration; ongoing communications; responding to the clinical environment; and addressing participants' health literacy levels. A discussion of key recruitment and retention strategies and suggestions for future studies focused on low-income African American participants ensues.

Using the Omaha System to Evaluate the Integration of Behavioral Health Services into Nurse-Led Primary Health Care.

Integrating behavioral health services into nurse-led primary care at one location ensures that individuals receive a comprehensive array of preventive and restorative services, based on their varying needs. A formative program evaluation of a federally funded behavioral health integration (BHI) project in a small nurse-led clinic used the Omaha System taxonomy to explore the changes in the documented practice of providers due to the BHI implementation. The evaluation provided evidence of the benefits of a collaborative care model to urban low-income, underserved, adults who were predominantly African American/Blacks.

Client experiences in a prenatal home visiting program: A prenatal care coordination program evaluation.

OBJECTIVE(S): Prenatal home visiting programs are a strategy to promote positive birth outcomes. Ongoing evaluations of these programs are important to promote fidelity and quality. The goal of this program evaluation was to gain clients' perspectives of their experiences in one Wisconsin Health Department's Prenatal Care Coordination program including: (a) why clients entered the program, (b) whether client expectations were met, and (c) how expectations impacted client retention. DESIGN: A Health Department in Wisconsin undertook a three-part program evaluation of their Prenatal Care Coordination program in 2014-2015. Highlighted here is the final phase of this evaluation. The evaluation was guided by the CDC's (1999) Framework for Program Evaluation in Public Health. SAMPLE: Clients meeting eligibility criteria were divided into representative clusters using k-means clustering model. Twenty semi-structured interviews with former clients of the Wisconsin Health Department's Prenatal Care Coordination program were conducted. RESULTS: Most clients had no expectations coming into the program and were satisfied with the services they received. Participants named the nurse-client relationship and support from this relationship as a key benefit of the program, while a secondary benefit was the information and resources received. The Health Department used these findings for program improvement and strategic planning.

Engaging African American Women in Community-Based Health Promotion Programs: Key-Informant Recommendations.

This explorative qualitative study describes the lived experiences of urban-dwelling African American (AA) women who participated in a nurse-led community-based health-promotion program for up to 20 years. Data were collected using semistructured interviews and analyzed using a phenomenological approach. Two central themes arose, the program facilitated behavior change and supported retention and recruitment. The findings suggest that AA women will attend classes and invite other participants when facilitators embed relevant community-engaged principles in the program. The participants recommended essential elements that supported the longevity of the program. Future studies may determine if these suggestions resonate with other AA women.

The Effect of a Teaching Model for Improving Undergraduate Nursing Students' Cultural Competency / 한국간호교육학회지

PURPOSE: This study evaluated the effect of a teaching model to improve cultural competency (TMCC) for Korean undergraduate nursing students. METHODS: A nonequivalent control group pretest/posttest quasi-experimental study was conducted with a convenience sample of 168 undergraduate nursing students in South Korea. The experimental group of 121 seniors was taught a 13-week teaching model in order to improve cultural competence. A control group with 47 junior students underwent nursing major courses, but did not take this teaching model. Before and after the program, students' level of cultural competency was measured using the Questionnaire for Cultural Competence (QCC) consisting of three sub-scales: “awareness and desire,” “encounter,” and “nursing skill and knowledge.” RESULTS: After the experiment, the experimental group showed significantly higher improvement in the Questionnaire for Cultural Competence in the three sub-scales of “awareness and desire,” “encounter,” and “nursing skill and knowledge” than the control group (p= < .050). CONCLUSION: A teaching model to improve cultural competence was effective in improving Korean undergraduate nursing students' cultural competency. Further studies need to be repeated in order to identify the effectiveness of the teaching model to improve cultural competency with graduate or clinical nurses.

Evidence-based characteristics of nurse-managed health centers for quality and outcomes.

There are approximately 250 nurse-managed health centers (NMHC) in the United States, but there are few consistent descriptions of their functions and even fewer reports of their outcomes. Because NMHCs have been identified as a unique and effectual health care delivery care model (Patient Protection and Affordable Care Act), a description of their characteristics and a framework for outcome evaluation are required for their continued evolution and expansion. This study identifies the principal characteristics of U.S. NMHCs described in the professional literature through an integrative review and classifies these characteristics through a multistage qualitative analysis in relation to Donabedian's structure-process-outcomes model, a well-established model for evaluating quality in health care. This study yielded an evidence-based definition of NMHCs that is more reflective of current NMHC practice across settings and recognizes the full scope of nursing practice that is considered one solution to the health care crisis in the country. Using the results from this study, NMHCs will be able to structure self-evaluations of quality care and compare their quality related to structure, processes, and outcomes with other primary health care delivery systems.