Asthma in Head Start children: prevalence,risk factors,and health care utilization

PURPOSES: 1. To identify the prevalence and severity of asthma in a Massachusetts Head Start program; 2. To identify associated risk factors for children with asthma; 3. To assess factors associated with health care utilization for asthma management. METHOD: Parents of 316 Head Start children were interviewed using a close-ended survey questionnaire. Survey A was used for demographics and general health screening. Survey B documented more specific asthma information. FINDINGS: There was a 35% prevalence rate of asthma in this preschool Head Start population. Most children had mild to moderate degrees of severity. Atopy, environmental triggers, and tobacco smoke exposure were common risk factors. Seventy-four percent of these children with asthma had used the emergency department at least once in their lifetime for asthma management. Forty-one percent had been hospitalized at least one time for asthma. CONCLUSIONS: These findings are consistent with previous studies that support the need for asthma outreach and interventions in at-risk Head Start preschool populations.     

Communities for healthy living (CHL) – A family-centered childhood obesity prevention program integrated into Head Start services: Study protocol for a pragmatic cluster randomized trial

BackgroundChildhood obesity is highly prevalent and carries substantial health consequences. Childhood obesity interventions have had mixed results, which may be partially explained by the absence of theory that incorporates broader family context and methods that address implementation challenges in low-resource settings. Communities for Healthy Living (CHL) is an obesity prevention program for Head Start preschools designed with careful focus on theory and implementation. This protocol paper outlines the design, content, implementation, and evaluation of CHL.Methods/designCHL integrates a parenting program co-led by Head Start staff and parents, enhanced nutrition support, and a media campaign. CHL content and implementation are informed by the Family Ecological Model, Psychological Empowerment Theory, and Organizational Empowerment Theory. The intervention is directed by community-based participatory research and implementation science principles, such as co‑leadership with parents and staff, and implementation in a real world context. CHL is evaluated in a three-year pragmatic cluster-randomized trial with a stepped wedge design. The primary outcome is change in child Body Mass Index z-score. Secondary outcomes include children's weight-related behaviors (i.e., diet, physical activity, screen use, and sleep), parenting practices targeted at these behaviors (e.g., food parenting), and parent empowerment. The evaluation capitalizes on routine health data collected by Head Start (e.g., child height and weight, diet) coupled with parent surveys completed by subsamples of families.DiscussionCHL is an innovative childhood obesity prevention program grounded in theory and implementation science principles. If successful, CHL is positioned for sustained implementation and nationwide Head Start scale-up.     

Using focus groups to explore the views of parents whose children are in hospital

Parents of children in hospital were invited to attend focus group discussions to give their views on: the experience of attending hospital with their children; information provision; facilities; and relationships with staff. The aim of the study was to inform an action plan to identify good practice and improve aspects of service delivery identified as of concern to parents. Themes identified from recorded discussions of 15 parents in four sessions were categorised as: They should be listening to parents; Stress of staying with their child; Feeling safe; Waiting; Parents as partners in care. Actions were planned to address physical aspects of care, such as provision of parent information, and staff to care for parents waiting with their child. Cultural aspects of care were addressed, as well as the invisible aspects of caring for children and their parents including attitudes and communication. The research indicates that parents appreciate the opportunity to tell their story and supports the idea of holding focus groups in the future.     

Developing team leadership to facilitate guideline utilization: planning and evaluating a 3-month intervention strategy

gifford w., davies b., tourangeau a. & lefebre n . (2011) Journal of Nursing Management 19, 121–132
Developing team leadership to facilitate guideline utilization: planning and evaluating a 3-month intervention strategy Background Research describes leadership as important to guideline use. Yet interventions to develop current and future leaders for this purpose are not well understood. Aim To describe the planning and evaluation of a leadership intervention to facilitate nurses’ use of guideline recommendations for diabetic foot ulcers in home health care. Method Planning the intervention involved a synthesis of theory and research (qualitative interviews and chart audits). One workshop and three follow-up teleconferences were delivered at two sites to nurse managers and clinical leaders (n = 15) responsible for 180 staff nurses. Evaluation involved workshop surveys and interviews. Results Highest rated intervention components (four-point scale) were: identification of target indicators (mean 3.7), and development of a team leadership action plan (mean 3.5). Pre-workshop barriers assessment rated lowest (mean 2.9). Three months later participants indicated their leadership performance had changed as a result of the intervention, being more engaged with staff and clear about implementation goals. Conclusions and implications for nursing management Creating a team leadership action plan to operationalize leadership behaviours can help in delivery of evidence-informed care. Access to clinical data and understanding team leadership knowledge and skills prior to formal training will assist nursing management in tailoring intervention strategies to identify needs and gaps.     

Enhancing low-income parents' capacities to promote their children's health: education is not enough

In 1996 the Capital Heath Region in Edmonton, Alberta integrated a primary health care component into Head Start programs. One aspect of the primary health care component (PHC-HS) was a series of education sessions aimed at strengthening parents' capacities to enhance their children's health. To make the education sessions relevant, 10 focus groups with 65 parents of children who attended Head Start were conducted prior to the sessions. Findings indicated that participants' ability to enhance their children's health and manage their children's illnesses was limited as much by low incomes, inadequate health care coverage, and lack of transportation as it was by a lack of knowledge. Results provide evidence that health education sessions alone are not adequate to significantly enhance low-income parents' capacities to promote their children's health. Efforts to strengthen the abilities of low-income individuals and families to promote their health will be most effective if health education is accompanied by policy advocacy and social action strategies that challenge the socioeconomic and political conditions that negatively affect health. Public health nursing's commitment to social justice, as well as findings about the limitations that low incomes, inadequate health care benefits, and lack of transportation placed on participants' ability to enhance their children's health, underscore the need for public health nurses (PHNs) to address structural conditions contributing to health inequities. As such, an overview of literature that details strategies and theoretical models for challenging socioeconomic and political conditions which restrict the ability of low-income individuals and families to enhance their health is provided.     

Nurse managers' challenges in project management

suhonen m. & paasivaara l . (2011) Journal of Nursing Management 19, 1028–1036
Nurse managers’ challenges in project management Aim To analyse the challenges that nurse managers meet in project management. Background Project management done by nurse managers has a significant role in the success of projects conducted in work units. Methods The data were collected by open interviews (n = 14). The participants were nurse managers, nurses and public health nurses. Data analysis was carried out using qualitative content analysis. Results The three main challenges nurse managers faced in project management in health-care work units were: (1) apathetic organization and management, (2) paralysed work community and (3) cooperation between individuals being discouraged. Conclusions Nurse managers’ challenges in project management can be viewed from the perspective of the following paradoxes: (1) keeping up projects–ensuring patient care, (2) enthusiastic management–effective management of daily work and (3) supporting the work of a multiprofessional team–leadership of individual employees. Implications for nursing management It is important for nurse managers to learn to relate these paradoxes to one another in a positive way. Further research is needed, focusing on nurse managers’ ability to promote workplace spirituality, nurse managers’ emotional intelligence and their enthusiasm in small projects.     

School-based asthma: a study in an African American elementary school.

ISSUES AND PURPOSE: Chronic illnesses, such as asthma experienced by children, are difficult for families and school professionals to manage. This study explored beliefs about asthma and asthma management among schoolchildren, parents, and teachers in an African American school. DESIGN AND METHODS: Focus groups were conducted with schoolchildren, parents, and teachers. Data were analyzed by content analysis; segments of information were categorized into groups that were later abstracted into themes illustrating beliefs and behaviors about asthma. RESULTS: The children reported fear of not being able to breathe and the limitations of living with asthma. The teachers were concerned that they did not have a sufficient understanding of asthma to manage children's asthma during the school day. Parents described complex lifestyles and the challenges of asthma management.     

Service learning: head start and a baccalaureate nursing curriculum working together

Service learning experiences for pediatric nursing students in Head Start programs allow students to achieve the objectives of the pediatric nursing curriculum, model the values of the profession, meet the goals of a community agency, and contribute to the good of society. Students conduct screening tests, present health promotion or safety education projects, develop pediatric-related handouts for the parents and staff, perform assessments of growth and development, identify and research pediatric health issues, and learn the fine art of communicating with preschool children. Head Start schools as clinical sites provide students with ample opportunities to blend nursing theory with application while introducing them to another area of the population. Students, faculty, and Head Start staff agree that this collaboration accomplishes the goals of both organizations.     

‘Posture for Learning’: meeting the postural care needs of children with physical disabilities in mainstream primary schools in England – a research into practice exploratory study

Purpose.?To explore teachers and teaching assistants' (TAs) views of how to manage the postural care needs of children with physical disabilities (PD) in mainstream primary schools, with the aim of developing strategies to support teachers and assistants in this role.

Method.?Qualitative data were gathered from a purposive sample of four primary schools in one county in the UK. Individual and focus group interviews with 36 teachers and TAs were carried out and used to generate an explanatory framework around their experiences of managing the postural care needs of children with PD.

Findings.?Teachers and TAs in schools were found to have limited understanding of postural management. Very few had personal experience of the benefits of postural care – instead, most appeared to think in terms of ‘doing’ rather than ‘knowing’ about postural care. When implementing therapy programmes, teaching staff followed therapists' instructions carefully, but did not understand the purpose of their actions. Participants described the emotional impact of caring for a child with PD and expressed anxieties about causing discomfort when using equipment such as specialist seating and standing frames. Equipment was viewed as bulky, uncomfortable and restrictive and not suited to the school environment. When asked which kinds of support would be valuable, participants identified practical solutions such as additional space or resources. Based on these findings, therapists, specialist teachers and parents developed an ‘A–Z of postural care’. This information resource aimed to address the gaps in knowledge and understanding highlighted by teachers and TAs in the interviews and to acknowledge their anxieties when teaching and caring for children with PD. Stakeholder involvement in all aspects of the project from setting the research question to the development of the A–Z resource has assisted in the dissemination of the resource and its integration into the mainstream school system within the county.     

NAP SACC: Implementation of an Obesity Prevention Intervention in an American Indian Head Start Program

Low-income American Indian preschoolers are at greatest risk for overweight and obesity among children aged 2–5 years. The Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) program is an evidence-based intervention that promotes healthy weight development for children enrolled in child care centers. The goal of this continuous quality improvement program is for the child care staff to establish environmental policies and practices that positively influence nutrition and physical activity-related behaviors. A community needs assessment of a Head Start program on an American Indian reservation identified obesity as a priority issue. This project implemented NAP SACC at 15 Head Start sites on the reservation.     

Integrated family delivered care: Development of a staff education programme

Neonatal staff education is critical to the successful implementation of Family Integrated Care (FIC) to support the shift in the focus of care giving for the baby to working with parents as part of the unit of care, treating them as equal and active members of the team in the care of the baby. Education should include an understanding of the parent experience to enable sensitive and effective communication required for partnership working. Effective staff education supports an understanding of the differences of FIC, what is required of staff, provides an opportunity to address hopes and fears and makes sure staff are up to date and confident in their clinical knowledge and skills to up-skill parents. Opportunities to educate staff can be hard to find with the challenges of staffing and acuity on a neonatal intensive care unit, this requires adaptability and innovative ideas to be successful.     

Developing a nursing management degree programme to meet the needs of Irish nurse managers

BACKGROUND: The study is placed within the context of the Irish health care system, which has undergone tremendous change, at the dawn of the new millennium, in particular from the nursing management and leadership viewpoint. AIM OF THE STUDY: The aim of this study is to explore nurses' expectations of the content and delivery of a nursing management degree programme. METHODS: This is an on-going action research study. Data has been collected using a focus group interview, questionnaire, document analysis and a reflective diary. Data was analysed using thematic analysis and SPSS as appropriate to qualitative and quantitative data respectively. To date two action research cycles are near completion and a total sample of 117 students have taken part in the study. FINDINGS: Nurses commencing the programme were unsure of their education and training needs, as they had not yet taken on board the recommendations of the Irish Commission on Nursing (Government of Ireland 1998). The findings suggest that nurse managers may not know what they need to know in light of the many current changes taking place in the Irish health system. The introduction of personal development planning (PDP) is among new strategies taking place as part of the second action research cycle. PDP can help nurse managers to reflect on their current responsibilities and plan for their future career pathways. CONCLUSIONS: The findings are presented in the context of one institution. Action research, which nests comfortably with certain management styles, has proved suitable as a tool for developing and changing this programme. The need for university teachers to focus on management development skills as well as the transmission of management theory is supported.     

What is needed for Trauma Informed Mental Health Services in Australia? Perspectives of clinicians and managers

Trauma Informed Care is an approach to the delivery of mental health care that requires sensitivity to the prevalence and effects of trauma in the lives of people accessing services. While TIC is increasingly emphasized in mental health policy and frameworks in Australia, people working in mental health settings have reportedly struggled to translate the values and principles into their everyday practice. This qualitative study used an experience‐based co‐design methodology to explore the potential for implementation of Trauma Informed Care into mental health services in Australia. The experiences of consumers, carers, clinicians, and managers were gathered. This paper presents the perspectives of clinicians (n = 64) and senior managers (n = 9) from across three Local Health Districts in New South Wales in Australia. All data were analysed thematically to address the research question: What is needed for Trauma Informed Mental Health Services in Australia? To be trauma‐informed, managers required: leadership at all levels, access to resource, relevant and accessible training, support for staff, resolution of wider systems issues, and clarification of the concept and actions of TIC. Clinicians identified that to be trauma‐informed they required services to: be aware of staff well‐being, support different ways of working, address workplace cultures and provide increased resources. The findings have implications for any service, team or individual seeking to implement TIC within mental health settings.     

Investigating and implementing change within the primary health care nursing team

Primary care is developing rapidly with significant impacts on the nursing team. Such changes have brought inter-professional team-working into sharper focus, particularly community care and collaborative working. This paper: examines the nursing roles within a general practice; describes the perspectives of service users; identifies areas of change; clarifies core and specialist skills; defines new roles among the primary health care nursing team; proposes a new model of working; and identifies appropriate education. The project was set in a general practice in south-west England and used an action research methodology. The objectives were to create a change in practice and to develop and refine existing theory to underpin nursing roles. Throughout the research regular team meetings allowed reflection and discussion about research findings and progress. Data were collected from multiple sources, including team workshops, patient focus group interviews, and individual interviews with GPs, practice managers and area managers. Reflective diaries and a patient survey were also used. The analysis of the quantitative and qualitative data collected from patients formed a basis for practice development and facilitated the team's reflection on the areas of change. Overall high satisfaction with services and care was expressed in the patient interviews and the questionnaire. The themes from the data highlighted areas important for patients and helped in shaping the new roles and responsibilities for team members. Regarding the team perspective, the data indicated many areas that could be considered for development. The community nursing team decided to concentrate on three key areas: child health, leg ulcer management, and cardiovascular health. The research concludes that action research presents some problems and challenges but is a useful approach to developing team-working in primary health care.     

Exploring the role of the nurse unit manager in forensic mental health inpatient units: A qualitative study

Forensic mental health (FMH) inpatient settings are complex working environments at times due to a number of factors including the presence of challenging behaviours that may include violence and aggression, restrictions related to legislation, extended length of stay and the impact of trauma. Nurse unit managers (NUMs) play an important role in managing the unit environment and clinical standards of care to achieve better outcomes for consumers and staff. However, the role of NUMs in an FMH setting is poorly understood. The overall aim of this study was to explore the role of NUMs working within an FMH setting in Victoria, Australia. To our knowledge, this is the first study that has examined the subject. Data were collected via focus groups from n = 32 participants which included NUMs, their managers, staff who work alongside the NUMs and the staff the NUMs manage. Data were analysed using thematic analysis and four themes were interpreted from the data, (i) lack of role clarity, (ii) the importance of clinical Leadership and forensic mental health knowledge, (iii) step up in responsibility and step down in pay and (iv) seeing the difference you make. The role of the NUM within a forensic mental health setting comes with a number of challenges, but also opportunities to enact change. An ongoing effort to better support those employed within the NUM role and make the role desirable for aspiring staff is critical to the sustainability of a skilled clinical workforce and quality of care in this complex setting.     

Evaluation of occupational therapy school-based consultation service for students with fine motor difficulties

PURPOSE: This paper describes a 2-year study that addressed the perceived occupational performance changes among students with fine motor difficulties receiving occupational therapy school-based consultation (OTSBC) services. METHOD: The sample included 52 stakeholders of students with fine motor difficulties who received occupational therapy services. Six exploratory focus groups and one participatory and action-based focus group were conducted with parents, teachers, occupational therapists, and Community Care Access Centre case managers. RESULTS: Results supported the benefits of OTSBC. Key concerns identified were the wait for service, confusion about service expectations, inadequate communication among stakeholders, school board issues, and constraints in the health care system. Recommendations identified were to train teachers, provide early intervention, address service delivery issues related to health and education systems, and promote awareness of occupational therapy service and its effectiveness. PRACTICE IMPLICATIONS: Occupational therapists working with students with fine motor difficulties could consider providing formal education programs for teachers, promoting early intervention of fine motor problems, and communicating to stakeholders regarding the expectations and effectiveness of OTSBC.     

Asthma care of children in clinical practice: do parents report receiving appropriate education?

This paper describes asthma education received from the health care provider as reported by parents of children with asthma and evaluates differences in their report based on socio-demographic and disease characteristics. Methods: Parents of 228 children with asthma were recruited from diverse clinical practice sites and asked to report on the level of education received in key content areas the National Asthma Education and Prevention Program identified as critical. Results: The overall proportion of education content fully discussed was 66%. Areas that dealt with acute management (how to manage an asthma attack: 75%) and medication administration (how to use an MDI: 81%) were most likely to be discussed. Content dealing with ongoing chronic management and collaborative care planning (discussing goals of management: 44%; providing written guidelines for acute management: 44%) was significantly less likely to be discussed. Education reported differed significantly based on symptom severity and socio-demographic characteristics. Parents of children with moderate to severe persistent symptoms reported receiving more education than those of children with mild symptoms (p < .05). Minority and poor parents, parents with less education, and parents whose children received health care in a clinic practice setting reported more education received than did their counterparts (p < .05). Summary: Significant gaps exist in education received overall, and specifically in areas associated with developing a collaborative relationship between parent and health care provider. The initial observation of socio-demographic differences in education reported has implications for pediatric nurses involved in asthma education and warrants further investigation.     

Nursing care of a school-age child with asthma: an ecological system theory approach

This research applied the Ecological System Theory of Dr. Bronfenbrenner (1979) to evaluate and analyze the impact of a school-age asthmatic child's ecological environment on the child's development. This project ran from March 16th to April 16th, 2010. A full range of data was collected during clinical care, outpatient follow-up services, telephone interviews, home visits, and school visits and then identified and analyzed. Results indicated that the family, household environment, campus, teachers, classmates, physical education program, and medical staffs comprised the most immediate microsystem and that parents, school nurses, teachers, and classmates formed the child's mesosystem. Researchers found a lack of understanding and appreciation in the mesosystem regarding asthmatic patient care needs. Hidden factors in the environment induced asthma, which eventually caused the child to be unable to obtain necessary medical care assistance. The exosystem reflected adequacy of the family social economy. The father's flexible working hours allowed him to allocate more time to childcare responsibilities. The government Asthma Medical Payment program also facilitated effective care. The macrosystem demonstrated parental cognition related to asthma treatment and caring to be deeply influenced by local customs. Thus, rather than using advanced medical treatments, parents preferred to follow traditional Chinese medicinal practices. Evaluation using the Ecological of Human Development Theory showed the subject's ecology environment relationships as based upon a foundation of family and school. Therefore, active family and school support for an asthma management plan appropriate to the subject's needs was critical. Asthma symptoms were better controlled after the child and his parents invested greater effort in mastering asthma management protocols.     

Managing diversity in the environment of care

In this report, the authors delineate the experience of Lakeland Regional Medical Center Inc. with redeployed services over the last 10 years. They provide a brief history of the restructuring, then focus on their experience with the management of redeployed services. In addition to the perspectives of the authors, they include information gathered through interviews with staff and managers in both the operating and business centers. The article concludes with a summary of the challenges and opportunities of managing a department with redeployed services and cross-trained staff.