Implementation of nursing services in community corrections: A community-academic partnership.

Persons who are incarcerated (PWAI) suffer from a disproportionately higher number of physical and mental health conditions. While most jails and prisons provide onsite healthcare, community correctional centers often do not and accessing community healthcare is challenging due to insurance issues, inadequate health literacy, mistrust, and long waits for appointments. A registered nurse-led wellness clinic provides a viable solution to addressing the healthcare needs of PWAI in a community correctional setting. Through a community-academic partnership between a college of nursing and two community correctional transitional centers for men, a registered nurse (RN) faculty member and nursing students provide onsite healthcare. Services include, but are not limited to, acute and chronic disease management, case management, healthcare navigation, and health education. In the first 2 years of operation, there have been 587 new resident health assessments, 882 RN visits, and 152 group education sessions. RN visits have been primarily for: connection to resources (42.6%), medication management (15.6%), and acute conditions (12%). A RN-led wellness clinic is an innovative way to address health needs for PWAI. While this model of care focuses on an academic RN faculty practice at community correctional centers it could be replicated across community settings.

Collaborative Care: Integrating Behavioral Health Into the Primary Care Setting.

INTRODUCTION: Integrated behavioral health is a model of health care that aims to meet the complex health care needs of patients in primary care settings. Collaborative Care (CC) is an evidence-based model incorporating an interdisciplinary team to improve outcomes for behavioral health disorders commonly seen by primary care providers. AIM: CC was implemented in a nurse-managed health center in a medically underserved community of Chicago with a team of family nurse practitioners, psychiatric mental health nurse practitioners, and a licensed clinical social worker. METHODS: Integration of the CC model required restructuring of the patient visit, the care team, and financial operations. Weekly team meetings were held for interdisciplinary case consultation and training for the primary care team by the psychiatric nurse practitioner. The model includes suggested goals of reducing patient scores of validated depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) screening tools to a score less than 5 points or to less than 50% of original score. RESULTS: During the initial year of implementation, 166 patients received care under the CC model, with 64 patients currently receiving active care. In this cohort, 22% reached suggested goals for depression and 47% for anxiety. CONCLUSIONS: CC has benefits for both patients and providers. Patients receive holistic treatment of both mental and physical health needs and access to psychiatric services for medication initiation and behavioral health modalities when necessary. We observed that the CC model improved collaboration with behavioral health specialists and the competence and confidence of family nurse practitioners.

A Correctional Facility Academic-Practice Partnership: Implementation of a Nurse-Led COVID-19 Initiative.

In 2020, the COVID-19 pandemic resulted in one in five individuals incarcerated in U.S. correctional institutions contracting COVID-19 and 1,700 deaths. Correctional adult transition centers house incarcerated individuals who typically do not have on-site health care access. A COVID-19 outbreak could devastate this population, who live in high-density conditions and have been documented as high risk for poor health outcomes. Owing to a robust practice partnership between a college of nursing and two adult transition centers, a nurse-led COVID-19 initiative was implemented to minimize transmission in the facilities and ensure appropriate health care referral for residents who tested positive for COVID-19. The initiative identified six residents with positive results, who were transferred to a state prison infirmary for management and to minimize risk for other residents.

Leveraging an Academic Practice Partnership to Support a COVID-19 Mass Vaccination Clinic.

BACKGROUND: When the first coronavirus disease 2019 (COVID-19) vaccines received emergency use authorization by the U.S. Food and Drug Administration in December 2020, distribution of the vaccine began within 24 hours. METHOD: Nursing faculty leveraged a long-standing practice partnership with the academic health center (AHC) to lead an innovative effort mobilizing nursing and interprofessional student volunteers to support the COVID-19 mass vaccination program for AHC frontline health care staff, patients, and community members. RESULTS: Student vaccinators administered 98,000 vaccinations and contributed a significant service to the university health system by supporting the swift rollout of the vaccine program. The total number of volunteer vaccinator hours (11,820) resulted in an approximate cost savings of $768,300 to the AHC. CONCLUSION: During a global health crisis, nursing students and faculty demonstrated a strong commitment to the academic-practice partnership and improved access to COVID-19 vaccinations for residents of the health system's underserved communities. [J Nurs Educ. 2022;61(6):308-313.].

Lessons Learned From the Implementation of an Integrated Prenatal Opioid Use Disorder Program.

OBJECTIVE: To evaluate key lessons learned from efforts at increasing engagement in integrated prenatal and opioid use disorder services. DESIGN: An interdisciplinary team consisting of a board-certified obstetrician and registered nurse led the implementation of this multipronged approach driven by several plan-do-study-act cycles to develop an integrated prenatal and opioid use disorder program. SETTING/LOCAL PROBLEM: An urban community health center in Chicago, Illinois, where mental health issues, including substance use, are the leading cause of death for pregnant people. PARTICIPANTS: Connections were made with local harm reduction agencies, substance use treatment facilities, and community outreach programs to develop partnerships with organizations providing existing addiction and maternal-child services in the community. INTERVENTION/MEASURES: Partnership building was achieved through organization needs assessments, dissemination of information about integrated services, and sustained communication. Referral workflow guides and patient education cards were created and distributed to community partners. Incoming referrals were tracked at the clinic site. Use of the referral materials was evaluated via online surveys distributed to community partners. RESULTS: In the 18 weeks of enhanced integration, three patients engaged in services and were initiated on medication for opioid use disorder, two of whom had been referred from agencies targeted in the outreach efforts. Surveys showed that community partners believe the referral guides were easy to use and that the harm reduction information on the patient cards was useful. CONCLUSION: An urban community health center was equipped to provide comprehensive, integrated services to pregnant people with opioid use disorder, but barriers such as community unawareness and stigma impeded engagement. Sustained collaboration with community partners serving pregnant people with opioid use disorder supports program development and linkage to care. Integrated prenatal and opioid use disorder care is feasible, is destigmatizing in nature, and can lead to improved maternal and fetal outcomes.

Closing the gap: Collaborative care addresses social determinants of health.

ABSTRACT: Social determinants of health have a significant impact on individual and community health outcomes. Using an integrated behavioral health model at a primary care clinic-a Federally Qualified Health Center-NPs led an interdisciplinary team to address outcome measures that are influenced by social determinants of health.

School Nurse Job Descriptions in Urban Districts: Alignment With the Framework for 21st-Century School Nursing Practice.

It is recommended that every student has daily access to a school nurse and that school nurses work in alignment with the Framework for 21st-Century School Nursing Practice (Framework). Little is known about Framework alignment with school nursing practice. The purpose of this study is to describe the alignment between the Framework and school nurse job descriptions in large, urban school districts across the United States. Using content analysis, with a directed approach, researchers used the Framework to analyze school nurse job descriptions for 16 school districts, analyzing 375 individual job responsibilities. The majority of job responsibilities reviewed (86%) were related to principles within the care coordination and community/public health nursing component, while job responsibilities within the key principles of leadership and quality improvement components were limited (14%). The Framework can be a useful tool to guide school nurse practice and however needs to be intentionally brought into job descriptions.

Transition of Nurse Practitioner Faculty Practice and Student Clinicals to Telehealth: Response to the COVID-19 Pandemic.

The COVID-19 pandemic forced the US health care system to evaluate alternative care delivery strategies to reduce the risk of coronavirus transmission to patients and health care providers. Telehealth modalities are a safe and effective alternative to face-to-face visits for primary and psychiatric care. Federal policy makers approved changes to telehealth reimbursement coverage and allowed flexibility of location for patients and providers. This article describes the transition of patient visits to telehealth by nurse practitioner faculty at an academic medical center to maintain continuity of care of underserved patient populations. This pivot facilitated resumption of clinical learning experiences for nurse practitioner students.

The interaction of neonatal abstinence syndrome and opioid use disorder treatment availability for women insured by medicaid.

OBJECTIVE: This paper will discuss the process of mapping opioid use disorder (OUD) treatment resources for pregnant women and discuss the intersection between treatment resources and rates of neonatal abstinence syndrome (NAS). DESIGN: A resource manual was developed through a systematic process with stakeholders across Illinois. Resources were mapped by county and overlaid with county rates of NAS, using hospital discharge data. RESULTS: Across Illinois, 89 treatment resources were identified for pregnant women insured by Medicaid. Resources were concentrated in 36% of Illinois' counties. Counties with limited treatment resources generally had high rates of NAS. Sixty-six percent of NAS cases among rural Illinois residents had no OUD treatment resources in their county. Rural counties had less access to medication-assisted treatment (MAT), the standard of care for treatment of OUD, compared with other counties across the state. CONCLUSIONS: Efforts to increase OUD treatment options for pregnant women insured by Medicaid should concentrate on geographic areas with limited access and high need.

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.

Using Youth Risk Behavior Survey Data to Create Change: A Guide for 21st-Century School Nurses.

To meet the diverse and complex needs of school-age children, school nurses must practice student-centered, evidence-based, and quality care. As school nurses look to increase the use of data within their practice, the Youth Risk Behavior Survey (YRBS) is an essential source of information about adolescent behaviors that contribute to leading causes of morbidity and mortality. Results from the YRBS are available at the national, state and, in some cases, school district and county level. In addition to providing an overview of the YRBS survey, this article will guide readers on how to implement the survey, access results, and apply the findings within their student population. The use of these data aids nurses who act as leaders within the school community.

Care and Treatment Recommendations for Pregnant Women with Opioid Use Disorder.

BACKGROUND: Recent data suggest a significant increase in use of opioids among pregnant women. In the United States, reported rates of neonatal abstinence syndrome increased from 1.5 per 1,000 to 6.0 per 1,000 live births from 2000 to 2013. Use of opioids, both pharmacologic and nonpharmacologic, during pregnancy exposes women and babies to increased risks of adverse health outcomes. Professional organizations recommend addressing the complex needs of women who use opioids during pregnancy. OBJECTIVE: The purpose is to review the role of nurses in the prenatal setting caring for pregnant women with opioid use disorder. METHODS: We conducted a literature search using the CINAHL, PubMed, and PsycInfo electronic databases through January 2018 to identify best practices for referring women to treatment from the prenatal care office. Search terms included "substance use disorder," "pregnancy," "prenatal care," "referral," and "referral pathway." RESULTS: From our search, 68 abstracts were identified as relevant for review. Eight articles were selected for the analysis based on our focus. The findings assisted in development of our recommendations for nurses. CLINICAL IMPLICATIONS: During prenatal care, nurses can screen for opioid use disorder, develop positive relationships, and refer to treatment. This care should be based on values-neutral strategies to promote healthy outcomes for pregnant women and their babies.

What Is a Nurse?

Traditional images of the profession don't reflect the myriad roles we now play.

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.

Evidence of Public Health Nursing Effectiveness: A Realist Review.

OBJECTIVES: The purpose of this realist review was to examine PHN interventions and their outcomes during the period preceding the Affordable Care Act (1990-2010), to determine what types of interventions demonstrated effectiveness, and whether these were related to target population or setting. DESIGN AND SAMPLE: The review focused on PHN interventions with data support documented over 20 years. A search of the published literature using CINHAL, PubMed, and ancestry methods resulted in 64 articles meeting the search criteria. The researchers reviewed each article for the relevant variables; achieved consensus for each variable; and summarized results using descriptive statistics. RESULTS: Documented PHN interventions targeted vulnerable populations. Interventions included health education, behavior change, and screening. There was evidence of effectiveness of PHN interventions in a number of studies; however, the study limitations and variety of intervention types make overall conclusions about PHN effectiveness challenging. CONCLUSIONS: Despite the long history of PHN working in communities to promote and maintain the health of vulnerable populations, practice outcomes have not been well documented. Further work is needed to: strengthen the methods for documenting effectiveness of PHN practice; focus on promising PHN interventions via multisite studies; and translate evidence-based PHN interventions to practice settings.

Embracing a competency-based specialty curriculum for community-based nursing roles.

The Quad Council competencies for public health nursing (PHN) provide guidance in developing curricula at both the generalist and specialist level. However, these competencies are based on nursing roles in traditional public health agencies and community/public health is defined more broadly than official agency practice. The question arises as to whether community-based specialties require largely the same knowledge and skill set as PHN. The purpose of the competency cross-mapping project reported here was to (a) assess the intersection of the Quad Council competencies with four community-based specialties and (b) ensure the appropriateness of a Quad Council-based curriculum to prepare graduates across these four specialties (home health, occupational health, environmental health, and school nursing). This article details the multistep cross-mapping process, including validation with practice leaders. Results indicate strong alignment of community-based specialty competencies with Quad Council competencies. Community-based specialty-specific content that did not align well is identified, along with examples of didactic and clinical strategies to address gaps. This work indicates that a Quad Council-based curriculum is appropriate to prepare graduates in community-based specialties when attention to the specialty-specific competencies in the clinical setting is included. This work guides the development of a doctorate of nursing practice curriculum in PHN, encompassing the four additional community-based specialties.