Can the Institute of Medicine trump the dominant logic of nursing? Leading change in advanced practice education.

The Institute of Medicine (IOM; 2010) has called for a transformation of the nursing profession to lead the redesign of health care in the United States. It acknowledges the need for profound change in nursing education, particularly advanced practice education, to produce the next generation of leaders in sufficient quantity to expand access, improve quality, and reduce cost. Although the IOM provides welcome validation of nursing's significant role, most of the recommendations are not new and have been advocated by nurse educators for decades. What has prevented us from creating the nimble and responsive educational programs that would ensure a sufficient corpus of advanced practice nurses with the relevant knowledge and skill to transform our ailing health system? Conceptualizing nursing as a complex, adaptive system (J.W. Begun and K. White, 1997), this article explores three examples of the dominant logic, grounded in a historical legacy that has kept the nursing profession from realizing its promise as a potent force: (a) the continuing preference for experience over education, (b) the belief that only nurses can teach nurses, and (c) the hegemony of the research doctorate.

Advanced practice nursing students in the patient-centered medical home: preparing for a new reality.

Driven by reimbursement incentives for increased access, improved quality and reduced cost, the patient-centered medical home model of health care delivery is being adopted in primary care practices across the nation. The transition from traditional primary care models to patient-centered medical homes presents many challenges, including the assembly of a well-prepared, interprofessional provider team to achieve effective, well-coordinated care. In turn, advanced practice nursing education programs are challenged to prepare graduates who are qualified for practice in the new reality of health care reform. This article reviews the patient-centered medical home model and describes how one college of nursing joined 7 primary care physician practices to prepare advanced practice nursing students for the new realities of health care reform while supporting each practice in its transition to the patient-centered medical home.

Prenatal marijuana exposure and neonatal outcomes in Jamaica: an ethnographic study

OBJECTIVE. To identify neurobehavioral effects of prenatal marijuana exposure on neonates in rural Jamaica. DESIGN. Ethnographic field studies and standardized neuro-behavior assessments during the neonatal period. SETTING. Rural Jamaica in heavy-marijuana-using population. PARTICIPANTS. Twenty-four Jamaican neonates exposed to marijuana prenatally and 20 nonexposed mnonnates were compare at 3 days and 1 month old, using the Brazelton Neonatal Assessment Scale, including supplementary items to capture possible subtle effects. There were no significant differences between exposed and nonexposed neonates on day 3. At 1 month, the exposed neonates showed better physiological stability and required less examiner facilitation to reach organized states. The neonates of heavy-marijuana-using mothers had better scores on autonomic stability, quality of alertness, irritability, and self-refulation and were judged to be more rewarding for caregivers. CONCLUSIONS. The absence of any differences between the exposed on nonexposed groups in the early neonatal period suggest that the better scores of exposed neonates at 1 month are traceable to the cultural positioning and social and economic characteristics of mothers using marijuana that select for the use of marijuana but also promote neonatal development (AU)

Conjugal behaviour and child development in Rural Jamaica - abstract

The effects of maternal conjugal behaviour on child development were studied in rural Jamaica using ethnographic methods and standardized measurments of development and the environment. Fifty-nine children and their caregivers were recruited pre-natally and followed for five years. The children's cognitive and physical development was assessed at age five using the McCarthy Scales of Child Assessment and weight/height ratio. School attendance and the Home Observation for Measurment of the Environment were used as indicators of the environment. The findings suggested that multiple mating, father absence and out of wedlock status did not result in poorer development outcomes and, in many fact may have provided some development advantages for these children. A large number of siblings, however, appeared to be developmentally disadvantaged regardless of mother's conjugal behaviour. (au)

The Rastafarian community and the "gateway" theory: lessons to be learned

The findings presented in this paper are drawn from a national ethnographic study conducted in six Jamaican populations, one of which was composed of members of the Rastafarian religion recruited from Kingston and south coast villages. Ninety-one members of the Rastafarian sect were formally interviewed and observed. The ethnographic study purposely over-sampled the Rastafarian community (1) because it was not sufficiently represented in the 1987 survey and (2) in order to examine the relationship between use of ganja and crack/cocaine. If ganja is, in fact, a "gateway" drug to cocaine, we would anticipate a high prevalence of crack/cocaine in this population. The data revealed that, as a group, members of the Rastafarian community were the most vigorous in shaping the definition of the term "drug". Cocaine is considered a drug but ganja, despite its illegal status, is considered a "natural" substance with health rendering properties and ritual functions. Not surprisingly, 0.4 percent of the Rastafarians surveyed believed that ganja should be legalized. Of all the populations investigated, Rastafarians were most likely to report that crack/cocaine was easy to obtain and to rank crack and cocaine as the most commonly used drugs. As a group, they are, in many ways, the most at risk for crack/cocaine use and addiction; compared with the rest of the sample, they have more urban, tourist and overseas experience as well as high potential for exposure to crack/cocaine. Yet the Rastafarian doctrine and design for living frequently were cited as the justification for preventing and/or for relinquishing the use of crack/cocaine. In its exception to the gateway theory, the Rastafarians community suggests protective mechanisms that inhibit the shift toward crack/cocaine use in high risk populations. (AU)

Five-year follow-up of rural Jamaican children whose mothers used marijuana during pregnancy

This research provides data on the development of 59 Jamaican children, from birth to age 5 years, whose mothers used marijuana during pregnancy. Approximately one-half of the sample used marijuana during pregnancy and were matched with non-users according to age, parity, and socioeconomic status. Testing of the children was done at 1, 3, and 30 days of age with the Brazelton Neonatal Behavioral Assessment Scales and at ages 3 and 5 years with the McCarthy Scales of Children's Abilities. Data about the child's home environment and temperament were collected from direct observations as well as from standardized questionnaires. The results show no significant differences in developmental testing outcomes between children of marijuana-using and non-using mothers except at 30 days of age when the babies of users had more favourable scores on two clusters of the Brazelton Scales: autonomic stability and reflexes. The developmental scores at ages 4 and 5 were significantly correlated to certain aspects of the home environment and to regularity of basic school (preschool) attendance. (AU)

Poor and pregnant: perinatal ganja use in rural Jamaica

This paper reports the ethnographic findings from a study of cannabis use by pregnant women in rural Jamaica. The perceived functions of ganja in reducing the physiological symptoms of pregnancy and associated psychological stress are described in relation to the sociocultural context of pregnancy in low-income rural communities. The data suggest that distinguishing life-style characteristics of cannabis-smoking women may actually mitigate the potentially harmful effects of marijuana. (AU)

Newborn outcomes with maternal marihuana use in Jamaican women

Cluster scores on Brazelton Neonatal Behavior Assessment Scales (BNBAS) are analyzed for babies whose mother used marihuana during pregnancy and compared to a control group. Environmental variables explained significant differences in BNBAS scores. (AU)

Marijuana use among women: an anthropological view

This paper suggests that the concept of intra cultural diversity is a more useful framework for understanding non-conforming behavior among Jamaican rural women than social psychological explanations of deviance from culturally approved sex roles. A comparison of female cannabis smoking in two rural communities, permits us to identify some of the social processes which underly variation in the nature and extent of marijuana use by women in the two settings (AU)