Addressing health inequities through simulation training and education in rural and tribal communities.

Background: The nursing shortage is serious and getting worse in medically underserved areas. Nursing education needs to include faculty education in simulation-based education that focuses on public health and cultural education. New nurse graduates are inadequately prepared and need additional training to provide culturally appropriate care to varied and rural populations. Method: This project used simulation-based education and rural clinical placements to enhance the training and education needs of faculty, students and community partners to better address the health care needs of people living in rural and medically underserved areas of the Navajo Nation and northern Arizona. Results: The project increased knowledge and interest among faculty and community partners on simulation-based education as well as positive student learning experiences. Conclusion: Public health and culture can be integrated into simulation-based education. Partnerships with tribal communities can play a valuable role in nursing education.

School Nutrition Policies and Practices on an American Indian Reservation: Research and Policy Considerations.

Navajo (Diné) and other American Indian children are more affected by overweight and obesity than their U.S. counterparts. In this descriptive study, the authors combined a socioecological and Navajo cultural framework to analyze the various factors that influence food choices available to children in schools. The Healthy Hunger-Free Kids Act of 2010 updated nutrition standards for school meals and all other foods and beverages sold in schools. Some studies have shown that improved nutrition standards were not favorably received by students and school food programs. To better understand these broader trends in a Navajo context, the researcher administered in-person surveys to 6 principals and 14 food service workers from a sample of 6 schools and performed on-site observations of two schools. Data were analyzed using a combination of descriptive statistics, matrix analysis, and thematic analysis techniques. Results showed that schools were offering more healthy food options in school lunches and that some schools were still serving unhealthy foods, such as pizza, tater tots, and French fries. Classroom and fundraising events provided other sources for low-nutrient foods and beverages. Participants had mixed responses about the updated nutrition standards, and food waste of healthy foods was a major concern. This study proposes opportunities for nurses to engage in research and advance stronger policies that increase healthy food options and limit access to less healthy foods.