School Health

School Health provides a forum to discuss policy, practice, research, issues and trends, and pearls of wisdom to enhance the day-to-day care of children in the school setting, from daycare to high school.     

Access to Health Care

Purpose: To describe and analyze conceptual and operational definitions of health care access for future nursing theory, practice, and policy. Access to health care is a major health policy concern. However, the elements of access to care are not well understood. As a result, how access is addressed is often inconsistent and unclear.
Organizing construct: Walker and Avant's framework for concept analysis.
Sources: Published literature in nursing and health services from the 1960s to the 1990s. The analysis was done in 1997 for this integrative review of nursing and nonnursing literature.
Methods: Integrative literature review in 1997.
Findings: Access is a complex idea defined in many ways. One of the most comprehensive definitions of access is by the World Health Organization (WHO). Multidementional barriers and facilitators to access vary by community and country.
Conclusions: Societies may define access differently at different stages of development. Scales to measure some dimensions of access are available; however, newer and better measures are needed and are being developed and tested. Data on each of the dimensions are needed for comprehensive assessment of access to health care in all countries at all stages of development.     

The Impact of Health Information Exchange on Health Outcomes

Background and Objective

Healthcare professionals, industry and policy makers have identified Health Information Exchange (HIE) as a solution to improve patient safety and overall quality of care. The potential benefits of HIE on healthcare have fostered its implementation and adoption in the United States. However,there is a dearth of publications that demonstrate HIE effectiveness. The purpose of this review was to identify and describe evidence of HIE impact on healthcare outcomes.

Methods

A database search was conducted. The inclusion criteria included original investigations in English that focused on a HIE outcome evaluation. Two independent investigators reviewed the articles. A qualitative coding approach was used to analyze the data.

Results

Out of 207 abstracts retrieved, five articles met the inclusion criteria. Of these, 3 were randomized controlled trials, 1 involved retrospective review of data, and 1 was a prospective study. We found that HIE benefits on healthcare outcomes are still sparsely evaluated, and that among the measurements used to evaluate HIE healthcare utilization is the most widely used.

Conclusions

Outcomes evaluation is required to give healthcare providers and policy-makers evidence to incorporate in decision-making processes. This review showed a dearth of HIE outcomes data in the published peer reviewed literature so more research in this area is needed. Future HIE evaluations with different levels of interoperability should incorporate a framework that allows a detailed examination of HIE outcomes that are likely to positively affect care.     

Implementing Telemental Health to Improve Access to Mental Health Care in Rural Vermont

Mental health care shortages in the United States are most pronounced in rural areas. This practice-change project aimed to increase access to quality mental health care in rural areas for the treatment of depression and anxiety via telemental health delivery of care. The project yielded improvements across project aims, including an increased percent of enrolled patients from Healthcare Provider Shortage Areas; a decrease in quality measures for depression, anxiety, and disability; and increased patient satisfaction with care. The project can serve as a template for other practices wishing to increase access to mental health care in rural areas.     

Workplace Health Promotion Activities of Finnish Occupational Health Nurses

ABSTRACT Objective: This study describes workplace centered activities performed by occupational health professionals, as well as difficulties linked to workplace centered activities, cooperation with client workplaces, and participation both in risk assessment and in the development of working environment.
Design: The design is a cross-sectional prevalence study.
Sample: The questionnaires were sent to 250 occupational health professionals, of whom 176 (70%) returned the completed forms and of whom 99% were nurses.
Measurements: Their activities, difficulties, cooperation, and participation in risk assessment and development of safe and healthy working conditions.
Analytic strategy: The data were analyzed by using frequencies, means, 1-way ANOVA, and the Kruskal-Wallis test.
Results: Workplace focused activity hours were mainly spent on risk assessment and counseling. One workplace visit took approximately 4 hr. The greatest difficulties were encountered with participation in development projects and in monitoring the effectiveness of improvement activities, especially in health care centers. Occupational health nurses cooperated with client enterprises and participated in risk assessment more often than the other occupational health professionals. Also workplace representatives participated actively in risk assessment. The most difficult modules were considered to be the risk assessment of chemicals, biological factors, and perceived stress, this being especially so in health care centers.
Conclusions: It is essential that occupational health professionals visit more often in their client enterprises and improve their skills in preventing harms caused by chemical and biological factors, and perceived stress.     

Barriers and Facilitators to the Incorporation of Environmental Health into Public Health Nursing Practice

ABSTRACT Objectives: To describe the environmental health (EH) demands placed on public health nurses (PHNs) as well as the barriers and facilitators to incorporating EH into PHN practice. Design and Sample: A cross‐sectional multimode (Web and pencil/paper) survey was used to collect data from PHNs in 1 rural western state. Research participants included 141 PHNs from a total of 228 survey invitations (61% response). Measures: A 39‐item questionnaire was developed to measure the frequency of EH demands experienced by PHNs as well as the barriers and facilitators to the incorporation of EH into PHN practice and standard demographics. Results: Significant numbers of PHNs reported less than baccalaureate preparation (29%), suggesting that EH competencies cannot be assumed. PHNs are often asked for basic EH information and cite lack of time and lack of interest on the part of the populations being cared for as barriers to incorporating EH into their practice. Facilitators included free or inexpensive continuing education programs offered via the Internet and additional Internet resources or staff resource people. Conclusion: PHNs represent a significant portion of the public health workforce and have implied and explicit mandates to address EH issues in their practice. Resources should be directed toward helping PHNs become better prepared to address the current and future EH needs of populations.     

Population Health Surveillance Practice of Public Health Nurses

ABSTRACT Objective: To report the population health surveillance functions of public health nurses and to describe factors that impede these functions.
Design and Sample: An interpretive qualitative study was conducted in Public Health Service areas in Eastern Canada. Participants were public health nurses ( n =55) with an average of 14.5 years of pertinent work experience.
Measures: Semistructured face-to-face, telephone interviews, and focus groups were conducted, transcribed, coded, and analyzed.
Results: The nurses in this study used ecosocial population health surveillance functions that included multilevel societal influences on health. Extensive interprofessional and intersectoral networks were foundational to their surveillance work, allowing them to monitor what was occurring in the community and transfer this knowledge into various systems to contribute toward improved health outcomes. However, the nurses did not acknowledge the significance of their population health surveillance work, and documentation structures did not support these surveillance functions.
Conclusion: New surveillance methods and documentation structures that reflect an ecosocial surveillance approach are needed that are more consistent with public health nurses' population-focused practice.     

Documentation of Health Risks and Health Promotion Counseling by Emergency Department Nurse Practitioners and Physicians

Purpose: The purpose of this study was to examine medical record documentation of health risk factors and health promotion discharge counseling by nurse practitioners and physicians practicing in an emergency department in the U.S. midwest.
Methods: In this two-group comparative study researchers examined random-stratified medical records 305 nonacute ambulatory patients for selected health risk factors, including smoking, alcohol use, elevated blood pressure, obesity, and dental caries.
Results: Fifty-nine percent of this sample of relatively young adults (mean age = 33) had one or more health-risk factors. According to medical record documentation, only 22% of these adults, with nonacute problems, received health promotion counseling. Multivariate analyses indicated that nurse practitioners were slightly more likely to provide smoking cessation counseling than were physicians.
Conclusions: Many opportunities for identification of health risks and follow-up counseling, as recommended in Healthy People 2000 and by the U.S. Preventive Services Task Force, were not documented. To meet the new goals of Healthy People 2010, health care providers in all settings should identify health risk factors and document health promotion counseling during every patient encounter.     

健康教育与健康宣教在社区儿童保健中的应用效果

目的：探索健康教育与健康宣教在社区儿童保健中的作用。方法在深圳市某居民区随机抽取10个住宅小区200名儿童及其家长,随机分为对照组（n=200）和健康教育宣教组（n=200）。健康宣教组定期将家长组织起来开展专题讲座,在小区内发放健康教育的宣传手册,长期张贴内容丰富的养育海报,尽可能对家长进行一对一的指导培训,并提供联系方式以保证家长方便及时咨询。对照组仅发放养育宣传册。采用调查问卷的方式统计2组家长在接受健康教育后对儿童保健知识的掌握程度与儿童定期体检情况。结果在健康教育之前,2组家长对儿童保健知识有一定的了解,且差异无统计学意义（x^2=0.038,P〉0.05）;健康宣教组家长接受定期健康教育之后,儿童保健知识知晓率显著高于对照组（x^2=95.75,P〈0.001）。将调查儿童按年龄分为4个组后,发现健康宣教组儿童定期体检率均显著高于对照组儿童（P〈0.05）。结论通过对家长实施多种形式的健康教育,能够不断提高家长对儿童保健知识的掌握程度,提高儿童定期体检率,有助于社区儿童健康成长。     

量化健康教育与随机健康教育的效果比较

为考察量化健康教育的效果 ,我们将 2 0 0例住院患者随机分为量化健康教育组 (实验组 )和随机健康教育组(对照组 ) ,分别按两种模式对患者实施教育。结果表明 :实验组对宣教内容的掌握、主动参与性明显高于对照组 ,对健康教育的满意度亦明显高于对照组。患者的自身条件如年龄和文化程度也影响健康教育的效果 ,文化程度越高 ,理解掌握的知识越多 ,获取的信息量也越多 ,效果越好 ;年龄越大 ,掌握的知识越少。调查结果对促进建立完善的临床健康教育制度有重要的指导意义     

The Psychopathology of Self-Assessed Health:A Cognitive Approach to Health Anxiety and Hypochondriasis

This paper reviews the relevant cognitive research on health anxiety and hypochondriasis, as well as research examining temperament/personality and social developmental factors relevant to health and illness cognition and associated negative emotional states. A cognitive developmental model is proposed which integrates individual difference variables, selective attention/cognitive factors, and social learning processes that may serve as vulnerability and maintenance factors in the etiology of health anxiety and hypochondriasis. Future directions for the study of cognition and hypochondriasis are suggested.     

Health Intelligence Atlas: A Core Tool for Public Health Intelligence

Background  The dramatic increase in complexity and volume of health data has challenged traditional health systems to deliver useful information to their users. The novel coronavirus disease 2019 (COVID-19) pandemic has further exacerbated this problem and demonstrated the critical need for the 21st century approach. This approach needs to ingest relevant, diverse data sources, analyze them, and generate appropriate health intelligence products that enable users to take more effective and efficient actions for their specific challenges. Objectives  This article characterizes the Health Intelligence Atlas (HI-Atlas) development and implementation to produce Public Health Intelligence (PHI) that supports identifying and prioritizing high-risk communities by public health authorities. The HI-Atlas moves from post hoc observations to a proactive model-based approach for preplanning COVID-19 vaccine preparedness, distribution, and assessing the effectiveness of those plans. Results  Details are presented on how the HI-Atlas merged traditional surveillance data with social intelligence multidimensional data streams to produce the next level of health intelligence. Two-model use cases in a large county demonstrate how the HI-Atlas produced relevant PHI to inform public health decision makers to (1) support identification and prioritization of vulnerable communities at risk for COVID-19 spread and vaccine hesitancy, and (2) support the implementation of a generic model for planning equitable COVID-19 vaccine preparedness and distribution. Conclusion  The scalable models of data sources, analyses, and smart hybrid data layer visualizations implemented in the HI-Atlas are the Health Intelligence tools designed to support real-time proactive planning and monitoring for COVID-19 vaccine preparedness and distribution in counties and states.     

Moving Toward Health Equity by Addressing Social Determinants of Health

Social determinants of health—the conditions in which people are born, grow, work, live, and age that affect health and quality of life—are strongly associated with disparities in health status and life expectancy. Nurses require a comprehensive understanding of social determinants and their associations with health outcomes to provide patient-centered care. Nurses can be leaders and change agents in advancing health equity by screening for social determinants that affect women and by engaging in cross-sector collaboration to build partnerships outside the health care system to address complex social needs. Nurses can also use their experience and knowledge to advocate for system-level change, which is required to address the upstream factors influencing the health of women.     

基层部队新兵集训期间健康状况及短期干预的效果

目的 了解新兵集训期间的健康状况,并探讨短期综合健康干预对提高集训期间新兵健商指数的效果.方法 将113名参加集训的新兵随机分为研究组(N=58)和对照组(N=55),对照组采取常规训练,研究组在此基础上进行为期1个月的综合健康干预,比较两组研究对象干预前后的健商指数.结果 两组新兵干预前及对照组干预前后,健商指数各维...     

Pupils' Experiences of the Annual Health Dialogue with the School Health Nurse

This study describes and analyses the health dialogue on the basis of the pupils' experience and the association with background factors such as age, sex, geographical areas, family and social class. The theoretical framework is based on empowerment and health promotion, and on Kolb's theory of experiential learning. The study, conducted in 1991, is the Danish contribution to the WHO collaborative study ‘Health Behaviour in School Children’. A nationwide random sample of pupils aged 11, 13 and 15 (n = 1860) answered a standardized questionnaire about perceived health, health behaviour, social situation and the health dialogue with the school health nurse. Among the pupils, 68% had participated in the annual health dialogue at the time of the survey (three quarters of the way through the school year). The youngest pupils, and the girls, often participated in groups and reported the greatest number of topics discussed. The health dialogue most frequently comprised 11–20 topics. Most topics discussed were related to health promotion, 31%–60% were related to prevention of illness and symptoms and the rest were related to psychosocial issues. Girls more often reported discussing personal relationships and boys more often discussed action-related topics. Pupils from lower social classes more frequently reported topics related to prevention of illness and symptoms and psychosocial issues. The discussions are the first step in a learning process as a Concrete Experience (CE).     

冠心病患者健康信念与健康行为的相关性研究

目的探讨冠心病患者的健康信念与健康行为的关系。方法用方便抽样的方法，调查了广州市3所三甲医院的103名冠心病患者，并以105名正常人作为对照。采用问卷调查法，用健康促进生活方式量表和冠心病健康信念问卷分别调查了研究对象的健康行为和健康信念，并使用SPSS11．0软件包进行统计分析。结果冠心病患者的健康信念总分与健康行为中健康责任和营养两个维度呈正相关（P〈0．05）；健康信念中维护健康动机与健康行为总分及其各维度均呈正相关（P〈0．05）；知觉到严重度与健康行为中运动和锻炼、自我实现两个维度呈负相关（P〈0．05）；知觉到益处与健康行为总分及其自我实现、压力应对和营养三个维度呈正相关（P〈0．05）。结论冠心病患者的健康信念可影响其健康行为，对维护其健康的愿望越强烈，就越有利于其健康行为的建立；越能意识到冠心病的严重性，就越能采取运动和锻炼、自我实现等健康行为；越能意识到采取健康行为所能带来的益处，就越能采取自我实现、正确积极地应对压力及合理的饮食等健康行为。     

Quality Health Outcomes Model

Purpose: Donabedian's 1966 framework of structure, process, and outcome has guided three decades of study in the United States of the elements needed to evaluate and compare medical care quality. Donabedian's perspective was essentially linear, assuming that structures affect processes, which in turn affect outcomes. Patient characteristics are sometimes considered as mediating outcomes and clinical interventions are considered to be processes. A model is presented in the following article that relates multiple factors affecting quality of care to desired outcomes. It extends previous models by positing dynamic relationships with indicators that not only act upon, but reciprocally affect the various components.
Scope and Sources: The proposed model was derived from a synthesis of the authors' experience in quality of care practice and research, as well as selected previous theories.
Conclusions: The quality health outcomes model is sufficiently broad (a) to guide development of databases for quality improvement and outcomes management, (b) to suggest key variables in clinical intervention research, and (c) to provide a framework for outcomes research and outcomes management that compares not only treatment options, but organizational or system level interventions. The model also has several policy implications.