Effects of the COVID 19 Pandemic on School Nurses' Resiliency and Ability to Cope: A Mixed Methods Study in the State of Hawaii.

This mixed-method study examined school nurses' experiences during the Coronavirus Disease 2019 pandemic related to role change, psychological feelings, and coping/resiliency in the State of Hawaii. A total of 30 school nurses completed a Brief Resilience Coping Scale plus a series of open-ended questions in January 2022. On the coping scale, over 40% of participants scored high, 52% scored medium, and 7% scored a low resilient/coping level. We did not identify any association between coping level and participant characteristics. Three qualitative themes emerged: 1) school nurses experience chronic negative emotions related to the pandemic, 2) school nurses demonstrate attributes of resilience, and 3) school nurses utilize positive coping techniques. The pandemic created significant stresses and negative emotions among school nurses. Yet, school nurses reported effective coping strategies and demonstrated strength/resilience. Support and open communication between school nurses, their employers, and other school-based stakeholders is needed to provide continued support for school nurses.

Undergraduate nursing students' perceptions on nursing education during the 2020 COVID-19 pandemic: A national sample.

BACKGROUND: In 2020, nursing educational programs were abruptly interrupted and largely moved online due to the COVID-19 pandemic. PURPOSE: To explore nursing students' perspectives about the effects of the pandemic on their education and intention to join the nursing workforce. METHODS: Undergraduate nursing students from 5 universities across 5 United States regions were invited to participate in an online survey to elicit both quantitative and qualitative data. FINDINGS: The final sample included quantitative data on 772 students and qualitative data on 540 students. Largely (65.1%), students reported that the pandemic strengthened their desire to become a nurse; only 11% had considered withdrawing from school. Qualitatively, students described the effect of the pandemic on their psychosocial wellbeing, adjustment to online learning, and challenges to clinical experiences. CONCLUSION: Findings highlighted the need to develop emergency education preparedness plans that address student wellbeing and novel collaborative partnerships between schools and clinical partners.

Disparities of Delayed Dental Visits and Severe Tooth Loss Among Older Native Hawaiians and Other Pacific Islanders in Hawai'i: A Cross-Sectional Study of Behavioral Risk Factor Surveillance System Data from 2012 to 2020.

Oral health is a major health concern in the US and globally, particularly among communities of color and low-income/low-education groups. General health disparities have been reported among Native Hawaiians (NHs) and Other Pacific Islanders (OPIs), although less is known about the specific racial/ethnic and socioeconomic trends that are relevant to oral health disparities for NHOPIs. We examined delayed dental visits and severe tooth loss among older NHOPI adults in relation to sociodemographic factors and community level disparities using five waves of data from the Hawai'i Behavioral Risk Factor Surveillance System collected between 2012 and 2020. Weighted Poisson regression was used to estimate the unadjusted and adjusted prevalence ratio of delayed dental service utilization and severe tooth loss. Relative to other racial/ethnic groups, older NHs had higher rates of delayed dental service utilization and severe tooth loss after adjusting for sociodemographic factors, and disparities were also found in rural communities.Awareness of the unique challenges and inequities faced by older Indigenous and racially/ethnically marginalized populations is critical for policymakers to develop strategies to achieve health equity.

The Development and Implementation of a School-Based Dental Sealant Program for Hawaii Public Schools.

BACKGROUND: School-based dental sealant programs are noted to increase sealant uptake among children, especially those from low-income families and those living in rural and underserved areas. However, nationally school-based dental sealant programs are substantially underutilized. This paper describes a partnership approach to a school-based dental sealant program for Title 1 public schools in Hawaii. METHODS: The Hawaii Keiki: Healthy and Ready to Learn program partnered with the Hawaii Dental Service to develop and implement an interprofessional, school-based sealant program (SBSP). This article describes the development of key factors, such as partnerships, an interprofessional team, team roles, policies, and marketing tools to optimize program success. RESULTS: The SBSP has completed over 3 academic years of implementation in Hawaii public schools. In its initial year (school year [SY] 2019-2020), which presented challenges due to the COVID-19 pandemic, it served 6 schools (106 students screened) on 1 island. It expanded to 14 schools on 1 island (193 students screened) in its second year (SY 2020-2021), 28 schools on 3 islands (653 students screened) in its third year (SY 2021-2022), and during the Fall of the fourth year, the program reached 50 schools on 3 islands (1821 students screened) and is projected to reach over 70 schools by the end of SY 2022-2023. CONCLUSION: Taking advantage of strategic partnerships and key interprofessional team members, a school-based dental sealant program can help to improve the oral health of children in public schools by helping to decrease barriers to care.

Development of Youth-Centered Health Messaging Posters for High School-Based Health Clinics in Hawaii.

BACKGROUND: Youth may be reluctant to seek health care from school health providers due to feeling embarrassed or stigmatized in the health office environment or worried about their confidentiality. The purpose of this project was to create a set of youth-centered health posters that promote youth engagement with nursing staff and to standardize health messaging across high schools in Hawaii school-based clinics. METHODS: Two community advisory boards, 1 composed of 10 youth stakeholders (mean age 17 years) and the other of 7 adult stakeholders, informed poster development utilizing web-based discussion groups. The discussions were transcribed, and additional data was collected using field notes and anonymous digital messages. Adult advisory board members also provided feedback on suggested poster text through an online survey. RESULTS: Youth and adult advisory board participants identified 4 key health concerns facing youth: confidentiality, sexual health, relationships, and mental health. Based on input from the 2 advisory boards, 4 posters were developed, each centered on 1 key health issue. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: School-based posters can convey important messages to help youth understand their health care rights and responsibilities, as well as identify important issues open for discussion with nurses. CONCLUSION: Posters are an underutilized tool for school health providers to create welcoming, inclusive health care environments and facilitate health-related conversations with youth. This paper describes participant feedback about the characteristics of a memorable poster and briefly outlines current knowledge and recommendations for school health providers regarding each of the 4 health issues.

Increasing the Self-Confidence of School Nurses to Respond to Emergency Situations.

BACKGROUND: School nurses have various degrees of experience responding to respiratory or cardiac emergencies, and most only receive Basic Life Support training every 2 years as required. The goal of the study was to assess school nurses' confidence and competence in emergency situations before and after engaging in emergency preparedness high-fidelity simulations. METHOD: This mixed methods study used a pre-/postsimulation survey design for a group of school nurses (N = 40) in the State of Hawaii. The pre- and postsimulation survey assessed professional demographics and measured confidence. After the presimulation survey, nurses participated in a 1-day training that included two separate emergency simulations using high-fidelity equipment. In addition, education was provided on the program's standardized emergency supply bags with equipment and their use during an emergency. The postsimulation survey was distributed 5 days after the educational intervention. RESULTS: All confidence items significantly improved after the simulation session. Nurses noted the value of the training and hands-on simulation experience. CONCLUSION: Simulation is a useful tool for increasing school nurses' confidence in responding to emergencies occurring on school campuses. [J Contin Educ Nurs. 2023;54(2):71-77.].

Addressing Health Disparities in LGBTQ Youth Through Professional Development of Middle School Staff.

BACKGROUND: Significant health disparities exist for sexual minority youth (SMY). While supportive adults in schools have been shown to improve mental wellbeing and academic outcomes for students, most teachers do not receive training specific to lesbian, gay, bisexual, transgender and queer or questioning (LGBTQ) students. METHODS: The project aimed at providing staff from a Hawaii middle school with "Safe Space" professional training to increase knowledge and comfort in supporting SMY. Pre- and post-training surveys were used to measure knowledge of LGBTQ issues and comfort in supporting LGBTQ students and a 2-week and 3-month survey assessed staff's application of newly learned material. RESULTS: Sixty-four staff participated in the first of 2 training sessions with 59 completing both sessions. Results from the pre- and post-survey showed a 34.9% increase in knowledge of LGBTQ issues (effect size = 1.22) and a 5.5% increase in self-rated comfort level in supporting LGBTQ students (effect size = 0.22). A 3-month follow-up indicated that 52.9% of the respondents were actively applying knowledge learned within their school setting. CONCLUSIONS: The project results demonstrate the value of the training not only in the short term but also staff's ability to apply the knowledge they learned. Given the success of implementation, expansion to other schools could facilitate ally-building attitudes and behaviors as a protective factor for SMY throughout the state.

Impact of the COVID-19 Pandemic on the Hawai'i Nursing Workforce: A Cross-sectional Survey.

The coronavirus disease (COVID-19) pandemic has placed extraordinary strain on health care systems. This has led to increased stress among health care workers, and nurses in particular, which has had a negative impact on their physical and psychosocial wellbeing. This is likely to negatively impact the nursing workforce at the state and national levels as the pandemic continues. The purpose of this study was to assess whether nurses licensed in Hawai'i have considered leaving the workforce. A cross-sectional online survey was conducted among Hawai'i nurses at all levels of licensure, with 421 responding. Of these nurses, 97 (23.0%) reported considering leaving the workforce, with safety (39.2%) and family/caregiver strain (32.0%) being the most common reasons. Reconsidering whether they should stay employed in their current roles (Odds ratio [OR] 2.05; 95% CI 1.56 - 2.69) and fear to continue providing direct patient care (OR 1.97; 95% CI 1.54 - 2.54) were associated with increased odds of having considered leaving the workforce. Based on these results, the State of Hawai'i and local health care organizations need to adjust their nursing workforce estimates and address how to alleviate nurses' stressors and safety concerns to mitigate a potential workforce shortage. Research is needed to develop interventions to support and empower nurses in their current roles but also address future emergency preparedness.

Assessing licensed nurses COVID-19 vaccine attitudes and intentions: a cross-sectional survey in the state of Hawaii.

Nurses are the largest single occupation of health care providers and at greatest risk for exposure to and acquisition of Coronavirus Disease 2019 (COVID-19). In December 2020, nurses in Hawaii were recruited for an online survey that measured perceived risk/threat of COVID-19, vaccine attitudes, and perceived safety of COVID-19 vaccines, as well as level of intention: primary, secondary (i.e., delayed), or no intention to vaccinate. The final sample consisted of 423 nurses. Participants were primarily Asian (27.9%) and White (45.2%). The majority were 18-50 years (65.5%) and female (87.0%), held an RN license (91.7%), and identified as a staff nurse (57.7%) in the hospital setting (56.7%). Among participants, 52.3% indicated primary intention, 27.9% secondary intention, and 19.9% no intention to vaccinate. The strongest predictors of any level of intention were greater positive attitudes toward COVID-19 vaccination and lower concerns related to COVID-19 vaccine safety. Findings can guide interventions to support vaccine acceptance for those who initially decline vaccination.

Undergraduate nursing students' COVID-19 vaccine intentions: A national survey.

INTRODUCTION: In December 2020, the first two COVID-19 vaccines were approved in the United States (U.S.) and recommended for distribution to front-line personnel, including nurses. Nursing students are being prepared to fill critical gaps in the health care workforce and have played important supportive roles during the current pandemic. Research has focused on vaccine intentions of current health care providers and less is known about students' intentions to vaccinate for COVID-19. METHODS: A national sample of undergraduate nursing students were recruited across five nursing schools in five U.S. regions in December 2020. The survey measured perceived risk/threat of COVID-19, COVID-19 vaccine attitudes, perceived safety and efficacy of COVID-19 vaccines, sources for vaccine information and level of intention to become vaccinated [primary, secondary (i.e., delayed), or no intention to vaccinate]. RESULTS: The final sample consisted of 772 students. The majority (83.6%) had intentions to be vaccinated, however of those 31.1% indicated secondary intention, a delay in intention or increased hesitancy). The strongest predictors of primary intention were positive attitudes (OR = 6.86; CI = 4.39-10.72), having lower safety concerns (OR = 0.26; CI = 0.18-0.36), and consulting social media as a source of information (OR = 1.56; CI = 1.23-1.97). Asian (OR = 0.47; CI = 0.23-0.97) and Black (OR 0.26; CI = 0.08-0.80) students were more likely to indicate secondary intention as compared to primary intention. Students in the Midwest were most likely to indicate no intention as compared to secondary intention (OR = 4.6; CI = 1.32-16.11). CONCLUSIONS: As the first two COVID-19 vaccines were approved/recommended in the U.S. nursing students had overall high intentions to vaccinate. Findings can guide development of educational interventions that reduce concerns of vaccine safety that are delivered in a way that is supportive and affirming to minoritized populations while being respectful of geo-political differences.

Vulnerability related to oral health in early childhood: a concept analysis.

AIM: This article is a report of the analysis of the concept of vulnerability and its relationship to oral health in early childhood. BACKGROUND: Poor oral health is a continued problem for children worldwide. Vulnerability increases the probability of poor oral health outcomes. The lack of clarity of the concept of vulnerability creates difficulty in understanding this multi-factoral condition. DATA SOURCES: Data source included 34 articles covering the period 2000-2009 from a variety of disciplines, including nursing, dentistry, medicine and public health. METHODS: The concept analysis was conducted using Rodgers' evolutionary method. The literature was analysed and a social ecology model was used to frame the discussion, recognizing family and community influences on children's oral health. RESULTS: The context of oral health in early childhood contributes to the changes in the concept vulnerability. The attributes are closely related to family and community factors and identified as limited parental income, parental education, community-based services and fluoride; and exposure to poor parental habits, parental neglect and harmful toxins. The primary antecedent is identified as a form of limited protection from exposure to various circumstances. CONCLUSION: Children with limited protection have increased vulnerability and greater probability of poor health outcomes. Nurses who understand the concept of vulnerability related to oral health and can identify factors that create protection and are capable of decreasing vulnerability through parent education, community awareness and policy changes that support children and families.

Benefits of Oral Health Education at Women, Infant, and Children (WIC) Clinic Visits: Assessments of Parent's Oral Health Beliefs, Behaviors and Dental Access in O'ahu, Hawai'i.

Improving oral health outcomes in Hawai'i for children and families remains a high priority. Children in the state are leading the nation with the highest caries rates, while women before, during, and after pregnancy are failing to receive regular and necessary dental care resulting in poor health outcomes. To answer for this need, an educational intervention was conducted among families enrolled in the Kapi'olani Medical Center for Women and Children's Women, Infant, and Children program (WIC) in O'ahu. The project included the following activities: (1) identification the oral health beliefs and behaviors of families, (2) providing oral health education to families, and (3) reassessing beliefs and behaviors in 3-6 months to document the impact of theeducation session. Participants consisted of 81 families resulting in the data on 176 children and 4 pregnant women. Of the 81 families, 40 representing84 children completed the follow-up oral health questionnaire. Results of the assessment and education demonstrated a positive impact on the family's oral health behaviors. Parents were 6.61 times as likely to report using fluoride toothpaste in the follow-up visit compared to their initial visit (95% confidence interval [CI] = 3.12-14.00). Additionally, statistically significant changes were noted in the frequency of children's daily tooth brushing (odds ratio [OR] = 2.15, 95% CI = 1.33-3.46), as well as in the incidence of children receiving fluoride varnish application over time (OR = 2.66, 95% CI = 1.50-4.73). These results provide further evidence that initiating a simple educational intervention can have a positive impact on oral health behaviors in groups that are at highest risk for developing dental disease in Hawai'i.

The Association Between Risk Behaviors and Race/Ethnicity on Dental Visiting Among High School Students in Hawai'i: Hawai'i Youth Risk Behavior Survey, 2013, 2015.

Risk behaviors are known to adversely affect health outcomes, but the relationship between youth risk behaviors and oral health remains unclear. The objective of this study is to examine the likelihood of dental visiting among Hawai'i public high school students by demographic factors and number of adverse risk behaviors. Aggregated 2013 and 2015 Hawai'i public high school Youth Risk and Behavior Survey (YRBS) data was analyzed from 10,720 students. Results showed that, overall, 77.1% of students reported a dental visit in the past 12 months. Students who were ages 15, 16, 17, and ≥ 18 years old were less likely than students who were ≤ 14 years old to visit a dentist. Those who identified as Hispanic, Native Hawaiian, Filipino, Other Pacific Islander, and students who identified as more than one race/ethnicity were less likely to visit the dentist than their white counterparts. In addition, students having either 4 risk behaviors or ≥ 5 risk behaviors were less likely to report a dental visit than those with no risk behaviors. These findings support the presence of disparities in oral health care utilization among high school students in Hawai'i and reveal a significant association between age, number of risk behaviors, and race/ethnicity with the likelihood of utilizing dental services. Oral health programs should consider screening for risk factors and multiple risk behaviors, integrating with other health programs that share similar risk behaviors, and account for cultural differences in their development, implementation, and evaluation.

Assessment, Education, and Access: Kona Hawai'i WIC Oral Health Pilot Project.

The Kona WIC oral health pilot project was developed to assess the oral health beliefs and behaviors of parents of children and pregnant women at the Kona WIC site and to demonstrate the ease of providing oral health education to families in order to improve oral health behaviors. Data were collected from 50 families about the oral health behaviors and dental care of a total of 73 children, including 5 pregnant women, four of whom had a child enrolled in WIC and one pregnant woman without any previous children. Data revealed that 68% of children with teeth had been seen by a dentist within 6 to 12 months of the study visit. Mothers were seen less often, with 55% stating that they had not been seen for a dental visit for over one year. Parental knowledge about the effects of fluoride on teeth was limited; however, 90% of the parents would allow fluoride varnish applied to their child's teeth, 88% would give daily fluoride drops/tablets to their child, and 78% would support water fluoridation if it would help to improve their children's oral health. Additionally, for children old enough to receive fluoride supplementation, 60% were not given a prescription by their health care providers, and 58% had not received any fluoride varnish applications. By offering oral health education in a WIC clinic and assisting clients to seek out comprehensive care within a dental home, children and caregivers can be provided essential education and resources early in a child's life or women's pregnancies to reduce poor oral health outcomes.

Oral Health Knowledge and Practices of Pediatric and Family Nurse Practitioners.

INTRODUCTION: The purpose of the study was to assess the relationship between oral health educational activities of NPs and their current oral health knowledge and practices. METHOD: An online survey was distributed to practicing NPs and members of the NAPNAP organization. RESULTS: The study results from n = 147 NPs indicated an association between oral health CE attendance and knowledge on the age to initiate fluoride toothpaste, age for an initial dental visit, as well as NPs comfort in educating about oral hygiene, diets to reduce caries, bacterial transmission and caries development, in addition to the NPs comfort in performing a risk assessment, oral exam, and identifying decay and other oral pathology compared to NPs that had not attended a CE course. DISCUSSION: The study findings demonstrate the importance of CE courses for NPs on the latest oral health guidelines and practices beyond their traditional academic education, in order to improve oral health outcomes among children.

The Association Between Socio-demographic Factors, Dental Problems, and Preterm Labor for Pregnant Women Residing in Hawai'i.

Periodontal disease during pregnancy has the potential to increase the risk of adverse perinatal outcomes including preterm labor (PTL), prematurity, and low birth weight (LBW). Despite professional recommendations on the importance and safety of dental assessments and treatments, the rate of dental care utilization during pregnancy remains low. The purpose of this study was to document the utilization of dental services and explore the relationships among socio-demographic factors, dental problems, and PTL in pregnant women residing in Hawai'i. Hawai'i Pregnancy Risk Assessment Monitoring System (PRAMS) survey results were analyzed from 4,309 women who experienced live births between the years 2009-2011. Results revealed that 2 in 5 women in Hawai'i had their teeth cleaned during pregnancy, while 1 in 5 reported seeing a dentist for a dental problem. Women who reported having a dental problem during pregnancy were more likely to experience PTL (OR=1.46, 95% CI=1.10-1.94, P=.008) compared to women without a dental problem. In addition, Native Hawaiian and Part-Hawaiian women were more likely to experience PTL (OR=1.73, 95% CI=1.22-2.46, P=.002) compared to Caucasian women. These findings document the underutilization of dental services in pregnant women in Hawai'i and reveal an association between poor dental care and PTL. Identification of groups at risk for maternal complications may assist in the development of programs that are sensitive to the diverse cultures and variability of community resources that exist throughout Hawai'i.

Predictors of Dental Cleaning Over a Two-year Time Period Around Pregnancy Among Asian and Native Hawaiian or Other Pacific Islander Race Subgroups in Hawai'i, 2009-2011.

Oral health disease is linked to several chronic diseases including adverse health outcomes around pregnancy. Optimizing a woman's oral health before, during, and after pregnancy can impact her health and the health of her children. Preventive, diagnostic, and restorative dental services can be done safely and effectively including during pregnancy. We examined data from the 2009-2011 Hawai'i Pregnancy Risk Assessment Monitoring System (PRAMS) to assess the prevalence of dental cleanings over an approximately 2 year (Median: 2.0 years, Range:1.6-2.5 years) time period (12 months before pregnancy, during pregnancy, and in the first few months postpartum) among 4,735 mothers who recently had a live birth. Adjusted prevalence ratios (APR) of dental cleanings were calculated for both race and Medicaid/QUEST insurance status adjusting for maternal age and education. During a two-year span before, during, and after pregnancy an estimated 60.8% of women had dental cleanings. Native Hawaiian (APR=0.87; 95% CI=0.80-0.93), Other Pacific Islander (0.70; 0.58-0.83), Filipino (0.90; 0.82-0.97), and Chinese (0.76; 0.63-0.93) mothers were less likely to have had dental cleanings compared to white mothers. Additionally, mothers with Medicaid/QUEST health insurance (0.73; 0.68-0.79) were less likely to have had cleanings. More than one-third of recently pregnant mothers did not have dental cleanings in the approximately two-year time period. Native Hawaiian, Other Pacific Islander, Filipino, and Chinese mothers and those on Medicaid/QUEST health insurance were less likely to receive regular dental care. Identification of the reasons why these populations do not seek regular dental care can inform programmatic efforts to improve oral health outcomes for women and families.

Efficacy of oral health promotion in primary care practice during early childhood: creating positive changes in parent's oral health beliefs and behaviors.

Nurse practitioners frequently provide care to children suffering from poor oral health. Creative approaches to impacting dental disease are needed due to the current lack of traditional dental providers. This study investigated the effects of oral health promotion provided by primary care providers on parental oral health beliefs and behaviors. Participants receiving standard oral care during two well child visits and two additional enhanced oral health visits (n=44) were compared to participants receiving standard oral care during two well child visits alone (n=40). Results revealed changes in parent's perception of the importance of oral care for their children's primary teeth compared to general healthcare needs (p<0.05), response to brushing their children's teeth (p<0.0001), confidence in brushing their teeth (p<0.05) and frequency of brushing (p<0.0001) in both groups. This small but important study shows that oral health programs in primary care can produce changes that can improve oral health outcomes. Parents and children exposed to oral health programs during their frequent well child care visits in the first years of life may help decrease the rate of early childhood caries and improve their quality of life.