Introduction: Homeless individuals experience increased rates of chronic physical and mental heal... more Introduction: Homeless individuals experience increased rates of chronic physical and mental health conditions. They also experience difficulty accessing care and poor health outcomes compounded by social and economic factors, such as housing insecurity, unemployment, and limited social support. The purpose of this study was to describe the perceptions of homeless individuals related to their health and experiences accessing care. Method: Qualitative descriptive methods and content analysis were used to gather, analyze, and interpret the data and identify themes. Results: Three themes were identified: men who are homeless experience bias throughout their health care and interpersonal relationships, the best care is person-centered and considers patients’ priorities, and care coordination resources are inadequate. Discussion: The housing needs of homeless individuals are best contextualized by their health and social needs. In addition, their priorities must be taken into consideration to develop culturally congruent services that are appropriate and effective care for this population.
Dramatic changes in the delivery of healthcare have placed an increased emphasis on developing cr... more Dramatic changes in the delivery of healthcare have placed an increased emphasis on developing critical thinking skills and clinical decision making abilities of nurses on both the undergraduate and graduate levels. The authors discuss teaching-learning strategies that promote clinical decision making skills of advanced practice nurses. Particular attention is paid to advanced practice nurses who are being prepared to work within specialty practice settings. An algorithm to guide educators to teach clinical decision making is presented.
While the curricula of clinical nurse specialist (CNS) programs have proved to be successful in m... more While the curricula of clinical nurse specialist (CNS) programs have proved to be successful in meeting past and current health care needs of specialty populations, the needs of children requiring care by the CNS have changed greatly over the past few years. Because of advanced technology, more children are surviving, although they may have serious physical, developmental, and psychosocial disabilities. At the same time, the educational, health, and social services for these children have become harder to access. A conceptual model, Family-Focused Pediatric Transitional Care (FFPTC), was used to interpret a survey of graduates of a pediatric clinical specialist program and their employers. Recommendations regarding possible changes in pediatric clinical nurse specialist curricula are offered to guide future educational agendas. Advanced skills in clinical decision making and coordinating care across the continuum from the hospital to the community and to the home have become essential role competencies for the clinical nurse specialist.
Working as specialists in a changing environment, advanced practice nurses in pediatric oncology ... more Working as specialists in a changing environment, advanced practice nurses in pediatric oncology (APN-POs) benefit from specific pediatric oncology education. The graduates of a pediatric nurse practitioner program in pediatric oncology completed a survey about their educational experience and its impact on their current practice. This practitioner program included a subspecialty education in pediatric oncology and an early form of distance learning. The respondents' answers parallel a number of emerging themes in APN-PO practice and education. Employing distance learning methods in providing subspecialty education holds important implications for future APN-PO education and practice and for the health care of communities throughout the country.
Abstract Purpose To explore perceptions of community dwelling caregivers of preschool-aged childr... more Abstract Purpose To explore perceptions of community dwelling caregivers of preschool-aged children regarding the influence of social determinants of health (SDOH) on children's school readiness. Parents' perspectives regarding solutions to enhance school readiness in preschool-aged children are also explored. Methods This study employed a qualitative, descriptive design and a community based participatory research (CBPR) approach. An academic institution collaborated with parents, teachers, and administrators at a community-based preschool learning center. Ten young-adult to middle-aged mothers and caregivers attended two separate focus groups and completed open-ended questionnaires. Inductive and deductive thematic analysis of text were employed. Findings Three themes emerged 1) Families described the vast lack of appropriate community resources and inability to access those resources that are available to prepare their children for school 2). Family members need help processing information about social resources 3) Community, individual and systemic level solutions to enhance school readiness. Conclusions Academic-Community partnerships provide an opportunity to (1) identify solutions to remove systemic barriers that impede children's readiness for school, and (2) design interventions to support families through that process. Interventions to enhance school readiness should be family-focused and can be informed by understanding the influence of SDOH during the planning stages. SDOH create barriers and prevent parents from prioritizing their children's school, health-care, and developmental needs. Practice implications Interventions to enhance school readiness should be family-based and can be informed by understanding the influence of SDOH during the planning stages. Social advocacy is also needed to enhance the ability of parents to enhance their children's school readiness.
Additional file 2. BMI z-score trajectory, with 95% confidence interval, after moving to higher v... more Additional file 2. BMI z-score trajectory, with 95% confidence interval, after moving to higher versus lower poverty neighborhood for youth attending New York City schools from 2006/2007 through 2016/2017.
Community immersion is an effective way of bringing concepts to life while nursing students are e... more Community immersion is an effective way of bringing concepts to life while nursing students are engaged with community members in the real world. Opportunities to apply, observe, and clarify abstract health promotion ideas, including social determinants of health, abound when seen in everyday interactions with individuals outside of an acute care setting. This article details the experiences of a community immersion class as it responded to the COVID-19 pandemic and had to transition mid-semester from an in-person course to a virtual format. Lessons learned from this unique experience provide a case for how to minimize disruptions to a health promotion class, maintain existing commitments with different community organizations, and adapt meaningful engagement to community needs during the pandemic.
Hypertension is associated with almost 25% of US deaths. Philadelphia has the highest prevalence ... more Hypertension is associated with almost 25% of US deaths. Philadelphia has the highest prevalence of hypertension of the 6 largest cities in the US, predominantly in non-Hispanic Black communities. Social determinants of health (SDOH) contribute to the development of hypertension and limit access to preventative resources and treatment. This case study describes an interprofessional collaboration between the University of Pennsylvania Schools of Nursing and Veterinary Medicine to offer blood pressure screenings at the annual MLK Day of Service Wellness and Vaccination Clinic. Clients were approached for blood pressure screenings and health education. Sixty-seven clients (48.2%), largely from zip codes with high levels of hypertension, agreed to blood pressure screening; 45 (67.2%) clients were hypertensive. Our One Health clinic could be a model to reach residents in marginalized communities.
Nursing students could benefit professionally by participating in community engagement, but barri... more Nursing students could benefit professionally by participating in community engagement, but barriers to student involvement in community engagement exist. Community Champions, a nursing student-led, faculty-mentored service-learning group, promotes local outreach and engagement with a variety of community initiatives for nursing students. The purpose of this study was to examine former and current Community Champions perceptions of the barriers and facilitators to participating in community engagement initiatives, as well as their satisfaction with the community engagement initiatives. The study used a 14-item survey, consisting of both Likert-scale items and open-ended questions. Of the 130 Community Champions invited to complete the survey, 40 Community Champions responded (30.8% response rate). Quantitative responses were analyzed using descriptive statistics, and qualitative responses were reviewed for themes to generate future recommendations for program improvement. Respondent...
Little is known about fostering sustainable, collaborative community-academic partnerships that e... more Little is known about fostering sustainable, collaborative community-academic partnerships that effectively improve physical activity and health in residents of under resourced communities using Participatory Action Research (PAR) driven models. The purpose of this PAR study was to evaluate the impact of an urban, intergenerational, and physical activity dance program by identifying community preferred measurable outcomes that promote program participation and sustainability. A descriptive, qualitative design was employed using semi-structured interview guides to facilitate discussions for two adult focus groups and one youth focus group. Exactly 19 community-residing adults and six youth who lived in urban neighborhoods in West Philadelphia participated in the discussions. The audiotapes were transcribed and analyzed using directed content analysis. Five outcome themes emerged and included: (1). Enhancing the psychological and emotional well-being of the individual, (2). Enhancemen...
ABSTRACT Evidence-based practice is a shift in the health care culture from basing decisions on c... more ABSTRACT Evidence-based practice is a shift in the health care culture from basing decisions on consensus opinion, past practice, and precedent toward the use of rigorous analysis of scientific evidence using outcomes research and clinical evidence to guide clinical decision making. The development of evidence-based clinical practice guidelines (CPG) is critical to guide the assessment and management of children with diabetes. This article provides an overview of the infrastructure and processes that are crucial to providing evidence-based care in a large urban pediatric diabetes center. Development of a CPG to identify microalbuminuria in children with type 1 diabetes is discussed.
Introduction: Parents (PP) of children in primary care clinics previously reported factors influe... more Introduction: Parents (PP) of children in primary care clinics previously reported factors influencing their height-related medical decision making. However, patients seeking height-related care in endocrine subspecialty clinics and their parents (EP) differ demographically from the general population. Objective: To determine EP height-related medical concerns and expectations, and to compare between EP and PP. Methods: EP completed a survey assessing their concerns in seeking medical care for their child’s height with identical questions previously asked of PP and two additional questions about growth hormone (GH) treatment. Results: A greater proportion of the 166 EP (80% response rate) than the 1,820 PP (83% response rate) previously surveyed was Caucasian (75% EP, 41% PP) and privately insured (80% EP, 58% PP). Both groups rated treatment efficacy and risks most as having a bigor extreme impact on decision making (65% EP, 58% PP). The second most rated concern for EP was compari...
Introduction: Homeless individuals experience increased rates of chronic physical and mental heal... more Introduction: Homeless individuals experience increased rates of chronic physical and mental health conditions. They also experience difficulty accessing care and poor health outcomes compounded by social and economic factors, such as housing insecurity, unemployment, and limited social support. The purpose of this study was to describe the perceptions of homeless individuals related to their health and experiences accessing care. Method: Qualitative descriptive methods and content analysis were used to gather, analyze, and interpret the data and identify themes. Results: Three themes were identified: men who are homeless experience bias throughout their health care and interpersonal relationships, the best care is person-centered and considers patients’ priorities, and care coordination resources are inadequate. Discussion: The housing needs of homeless individuals are best contextualized by their health and social needs. In addition, their priorities must be taken into consideration to develop culturally congruent services that are appropriate and effective care for this population.
Dramatic changes in the delivery of healthcare have placed an increased emphasis on developing cr... more Dramatic changes in the delivery of healthcare have placed an increased emphasis on developing critical thinking skills and clinical decision making abilities of nurses on both the undergraduate and graduate levels. The authors discuss teaching-learning strategies that promote clinical decision making skills of advanced practice nurses. Particular attention is paid to advanced practice nurses who are being prepared to work within specialty practice settings. An algorithm to guide educators to teach clinical decision making is presented.
While the curricula of clinical nurse specialist (CNS) programs have proved to be successful in m... more While the curricula of clinical nurse specialist (CNS) programs have proved to be successful in meeting past and current health care needs of specialty populations, the needs of children requiring care by the CNS have changed greatly over the past few years. Because of advanced technology, more children are surviving, although they may have serious physical, developmental, and psychosocial disabilities. At the same time, the educational, health, and social services for these children have become harder to access. A conceptual model, Family-Focused Pediatric Transitional Care (FFPTC), was used to interpret a survey of graduates of a pediatric clinical specialist program and their employers. Recommendations regarding possible changes in pediatric clinical nurse specialist curricula are offered to guide future educational agendas. Advanced skills in clinical decision making and coordinating care across the continuum from the hospital to the community and to the home have become essential role competencies for the clinical nurse specialist.
Working as specialists in a changing environment, advanced practice nurses in pediatric oncology ... more Working as specialists in a changing environment, advanced practice nurses in pediatric oncology (APN-POs) benefit from specific pediatric oncology education. The graduates of a pediatric nurse practitioner program in pediatric oncology completed a survey about their educational experience and its impact on their current practice. This practitioner program included a subspecialty education in pediatric oncology and an early form of distance learning. The respondents' answers parallel a number of emerging themes in APN-PO practice and education. Employing distance learning methods in providing subspecialty education holds important implications for future APN-PO education and practice and for the health care of communities throughout the country.
Abstract Purpose To explore perceptions of community dwelling caregivers of preschool-aged childr... more Abstract Purpose To explore perceptions of community dwelling caregivers of preschool-aged children regarding the influence of social determinants of health (SDOH) on children's school readiness. Parents' perspectives regarding solutions to enhance school readiness in preschool-aged children are also explored. Methods This study employed a qualitative, descriptive design and a community based participatory research (CBPR) approach. An academic institution collaborated with parents, teachers, and administrators at a community-based preschool learning center. Ten young-adult to middle-aged mothers and caregivers attended two separate focus groups and completed open-ended questionnaires. Inductive and deductive thematic analysis of text were employed. Findings Three themes emerged 1) Families described the vast lack of appropriate community resources and inability to access those resources that are available to prepare their children for school 2). Family members need help processing information about social resources 3) Community, individual and systemic level solutions to enhance school readiness. Conclusions Academic-Community partnerships provide an opportunity to (1) identify solutions to remove systemic barriers that impede children's readiness for school, and (2) design interventions to support families through that process. Interventions to enhance school readiness should be family-focused and can be informed by understanding the influence of SDOH during the planning stages. SDOH create barriers and prevent parents from prioritizing their children's school, health-care, and developmental needs. Practice implications Interventions to enhance school readiness should be family-based and can be informed by understanding the influence of SDOH during the planning stages. Social advocacy is also needed to enhance the ability of parents to enhance their children's school readiness.
Additional file 2. BMI z-score trajectory, with 95% confidence interval, after moving to higher v... more Additional file 2. BMI z-score trajectory, with 95% confidence interval, after moving to higher versus lower poverty neighborhood for youth attending New York City schools from 2006/2007 through 2016/2017.
Community immersion is an effective way of bringing concepts to life while nursing students are e... more Community immersion is an effective way of bringing concepts to life while nursing students are engaged with community members in the real world. Opportunities to apply, observe, and clarify abstract health promotion ideas, including social determinants of health, abound when seen in everyday interactions with individuals outside of an acute care setting. This article details the experiences of a community immersion class as it responded to the COVID-19 pandemic and had to transition mid-semester from an in-person course to a virtual format. Lessons learned from this unique experience provide a case for how to minimize disruptions to a health promotion class, maintain existing commitments with different community organizations, and adapt meaningful engagement to community needs during the pandemic.
Hypertension is associated with almost 25% of US deaths. Philadelphia has the highest prevalence ... more Hypertension is associated with almost 25% of US deaths. Philadelphia has the highest prevalence of hypertension of the 6 largest cities in the US, predominantly in non-Hispanic Black communities. Social determinants of health (SDOH) contribute to the development of hypertension and limit access to preventative resources and treatment. This case study describes an interprofessional collaboration between the University of Pennsylvania Schools of Nursing and Veterinary Medicine to offer blood pressure screenings at the annual MLK Day of Service Wellness and Vaccination Clinic. Clients were approached for blood pressure screenings and health education. Sixty-seven clients (48.2%), largely from zip codes with high levels of hypertension, agreed to blood pressure screening; 45 (67.2%) clients were hypertensive. Our One Health clinic could be a model to reach residents in marginalized communities.
Nursing students could benefit professionally by participating in community engagement, but barri... more Nursing students could benefit professionally by participating in community engagement, but barriers to student involvement in community engagement exist. Community Champions, a nursing student-led, faculty-mentored service-learning group, promotes local outreach and engagement with a variety of community initiatives for nursing students. The purpose of this study was to examine former and current Community Champions perceptions of the barriers and facilitators to participating in community engagement initiatives, as well as their satisfaction with the community engagement initiatives. The study used a 14-item survey, consisting of both Likert-scale items and open-ended questions. Of the 130 Community Champions invited to complete the survey, 40 Community Champions responded (30.8% response rate). Quantitative responses were analyzed using descriptive statistics, and qualitative responses were reviewed for themes to generate future recommendations for program improvement. Respondent...
Little is known about fostering sustainable, collaborative community-academic partnerships that e... more Little is known about fostering sustainable, collaborative community-academic partnerships that effectively improve physical activity and health in residents of under resourced communities using Participatory Action Research (PAR) driven models. The purpose of this PAR study was to evaluate the impact of an urban, intergenerational, and physical activity dance program by identifying community preferred measurable outcomes that promote program participation and sustainability. A descriptive, qualitative design was employed using semi-structured interview guides to facilitate discussions for two adult focus groups and one youth focus group. Exactly 19 community-residing adults and six youth who lived in urban neighborhoods in West Philadelphia participated in the discussions. The audiotapes were transcribed and analyzed using directed content analysis. Five outcome themes emerged and included: (1). Enhancing the psychological and emotional well-being of the individual, (2). Enhancemen...
ABSTRACT Evidence-based practice is a shift in the health care culture from basing decisions on c... more ABSTRACT Evidence-based practice is a shift in the health care culture from basing decisions on consensus opinion, past practice, and precedent toward the use of rigorous analysis of scientific evidence using outcomes research and clinical evidence to guide clinical decision making. The development of evidence-based clinical practice guidelines (CPG) is critical to guide the assessment and management of children with diabetes. This article provides an overview of the infrastructure and processes that are crucial to providing evidence-based care in a large urban pediatric diabetes center. Development of a CPG to identify microalbuminuria in children with type 1 diabetes is discussed.
Introduction: Parents (PP) of children in primary care clinics previously reported factors influe... more Introduction: Parents (PP) of children in primary care clinics previously reported factors influencing their height-related medical decision making. However, patients seeking height-related care in endocrine subspecialty clinics and their parents (EP) differ demographically from the general population. Objective: To determine EP height-related medical concerns and expectations, and to compare between EP and PP. Methods: EP completed a survey assessing their concerns in seeking medical care for their child’s height with identical questions previously asked of PP and two additional questions about growth hormone (GH) treatment. Results: A greater proportion of the 166 EP (80% response rate) than the 1,820 PP (83% response rate) previously surveyed was Caucasian (75% EP, 41% PP) and privately insured (80% EP, 58% PP). Both groups rated treatment efficacy and risks most as having a bigor extreme impact on decision making (65% EP, 58% PP). The second most rated concern for EP was compari...
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