Bridging Cultures for Latino Children: School Nurse and Advanced Practice Nurse Partnerships

TOPIC:  Barriers to use of mental health services by Latino families include stigma, service costs, and disparity of services with cultural values and traditions. School nurses are in key positions to recognize mental health needs of Latino children and form relationships that facilitate family connections with mental health services. Advanced practice psychiatric nurses may be contracted by school districts to provide consultation to school nurses or may be available to school nurses through connections with school-based health centers. Case examples are provided to illustrate the value of school nurse consultation with an advanced practice psychiatric nurse in promoting awareness of cultural influences on children's symptoms and behaviors and developing culturally sensitive approaches to engage Latino children and families in school and health services.
PURPOSE:  This paper aims to review literature on Latino mental health and present rationale for school nurse and advanced practice nurse partnerships to promote culturally sensitive approaches that facilitate Latino family access and utilization of health services.
SOURCES:  Published literature and case scenarios.
CONCLUSIONS:  With advanced practice nurse consultation, school nurses identify mental health needs of Latino children and develop culturally sensitive approaches that bridge Latino families' access to and utilization of health services.     

Assessing the need for child-care health consultants

This study surveyed health and safety needs of child-care programs; examined the perceptions of directors, the person identified as being responsible for a program, concerning health consultation; and determined how directors would secure funds to pay for consultative services. The survey was conducted in a state without mandates for child-care health consultation and minimal access to consultants. The researchers designed and pilot-tested a Child Care Health and Safety Survey. Working with a task group of statewide child health experts, the researchers revised the survey and mailed it to a random sample of child-care programs. Twenty-two Head Start Programs, 122 licensed child-care centers, and 116 family child-care homes participated, representing a return rate of 73, 36, and 30%, respectively. The majority of programs expressed interest in child-care health consultation offered for free or fee-based. Directors identified reasonable means of obtaining funds to support consultation. All programs had needs related to supporting health practices in their settings, provision of health services for staff, and health screening for children. Public health nurses, specially trained to advise child care, are well positioned to offer consultation. Systems of health consultation may be accepted as fee-for-service arrangements, supporting sustainability.     

The role of the child primary mental health worker

The purpose of the study was to explore how the child primary mental health worker role, as defined in the Health Advisory Service document, has been interpreted in each of the mental health trusts in England. Studies have indicated there is a deficit in recognition and treatment skills, by primary care workers, of psychological difficulties presented by children and young people, which could be supported by specialist mental health workers. A postal questionnaire was sent to 169 English mental health trusts. There were 98 returns (59%) indicating that 22 child mental health services had established this new role and a further 42 were planning to develop it in the near future. The child primary mental health workers were spending on average 35% of their time in primary care offering consultation and training to health professionals, rather than direct work with children and families. This development was found to be a growing area of advanced practice for nurses. Given the stated intention of the majority of services to develop or retain this role, further evaluation studies will be needed.     

An Introduction to Pediatric Home Health Care

purpose . To provide an overview of the delivery of home health care services to pediatric patients
population . All pediatric patients
conclusions . Institution-based nurses are integral in making referrals for home health care services and assuring home health care agencies have the needed information for providing seamless services.
practice implications . Institution-based nurses are the first line in the transition to home and are key members in making the transition happen without unnecessary difficulty for the child and family. This article presents pragmatic information about home health care agencies and how they operate so that institution-based nurses can maximize the benefit their pediatric patients receive from home health care.     

Retinoblastoma: An overview for advanced practice nurses

Purpose: To provide an overview of the current literature surrounding the detection and management of retinoblastoma as well as care for the long-term survivor to serve as a guide for advanced practice nurses.
Data sources: Comprehensive review of the literature on retinoblastoma including case studies, journal reviews, retrospective studies, and briefs.
Conclusions: Retinoblastoma is a pediatric intraocular malignancy usually detected in the primary care setting. Typically asymptomatic, primary care providers will often identify the presence of retinoblastoma upon routine eye exam. Prompt diagnosis and commencement of treatment are paramount as delay in diagnosis leads to higher morbidity and mortality. Treatment options vary depending on the extent of disease.
Implications for practice: Although current survival rates for retinoblastoma exceed 90%, individual visual outcome and survival are dependent upon early detection and prompt referral. In addition to research and education of survivors and families, advanced practice nurses play a key role in early detection and maintaining the current survival rate.     

Identification of nurses' competencies in primary health care through a Delphi study in southern Brazil

ABSTRACT Objective: This investigation aimed to identify and analyze the general and specific competencies of nurses in the primary health care practice of Brazil.
Design: The Delphi Technique was used as the method of study.
Sample: 2 groups of participants were selected: One contained primary health care nurses ( n =52) and the other specialists ( n =57), including public health nurses and public or community health faculty.
Measurements: 3 questionnaires were developed for the study. The first asked participants to indicate general and specific competencies, which were compiled into a list for each group. A Likert scale of 1–5 was added to these 2 lists in the second and third questionnaires. A consensus criterion of 75% for score 4 or 5 was adopted.
Results: In the nurses' group, 17 general and 8 specific competencies reached the consensus criterion; 19 general and 9 specific competencies reached the criterion in the specialists' group. These competencies were classified into 10 domains: professional values, communication, teamwork, management, community-oriented, health promotion, problem solving, health care, and education and basic public health sciences.
Conclusions: These competencies reflect Brazilian health policy and constitute a reference for health professional practice and education.     

Child protection and public health: nurses' responsibilities

BACKGROUND: Health care workers have been recognized as having a key role in the protection and care of Scotland's children, particularly in respect of identification and detection of child abuse. Nurses, especially health visitors, are often the first professionals to suspect that child abuse has taken place. While previous research has found that health visitors have primarily perceived their role as that of providing support and advice to vulnerable families, there are pressures on them to fulfil a more narrow surveillance role. Concurrent with a lack of clarity about the role of health visitors in child protection, there has been increasing recognition that other nurses can also make an important contribution, including those who do not work directly with children. AIMS: The aim of the study was to explore nurses' understanding of their professional responsibilities in relation to child protection, and the potential for nurses to be involved in the protection of children from abuse. METHODS: A qualitative interview-based design was used, and 99 nurses working in an National Health Service trust in a Scottish city were interviewed, either individually or in groups, about their professional involvements in child protection issues. Interview data were subjected to thematic analysis. FINDINGS: There was lack of consensus among interviewees about the nursing remit in child protection issues, particularly with respect to the extent to which nurses should actively seek to detect cases of child abuse. An emphasis on identification and detection was not easily accepted by many nurses, and was perceived by some to be a change from their more traditional role of supporting families, as well as being potentially in conflict with some public health responsibilities. CONCLUSION: In spite of the perception of some nurses that there is a sharp divide between child protection work and public health interventions, many of the child protection roles identified by nurses, such as supporting families, parenting education and service development, are clearly within the ambit of contemporary notions of public health. Furthermore, it is clear that there is a role in child protection for a much wider group of nurses than health visitors.     

Illuminating the clinical nurse specialist role of advanced practice nursing: a qualitative study

As the advanced practice nursing initiative in Canada gains momentum, effort is being directed towards clarifying and defining advanced practice roles. A qualitative study was undertaken to increase understanding of the clinical nurse specialist role of advanced practice. Sixteen nurses who worked in advanced practice roles, organizing and providing healthcare for children with complex health needs and their families across the continuum of care, participated in in-depth conversations about the nature of their practice, the knowledge that informs it and the factors that influence it. Findings suggest that clinical nurse specialists have a unique role in the organization and delivery of healthcare for specialized populations with complex health needs in their dual focus on the system level of healthcare and on population health needs. Initiatives directed to children and families within the study participants' specialties included program development, consultation and educational outreach and the development of clinical guidelines and policies. Although the nurses described their practice as focusing both on individual children and families and on the population of children and families within their specialty, it is at the population level that they see their greatest potential for contributing to the delivery of high-quality, cost-effective healthcare.     

Patients bringing information to primary care consultations: a cross-sectional (questionnaire) study of doctors' and nurses' views of its impact

Objectives  To explore the perceived frequency and impact of patients bringing health information from the Internet to primary care consultations.
Method  A questionnaire was sent to all general practitioners (GPs) and practice nurses (nurses) in a primary care trust in the North-west of England.
Results  The response was 52.3%, more nurses responding than GPs (61.2% vs 46.8%). A substantial majority (93.9% and 78.0%) had experienced patients bringing such information in the last 6 months, which often lengthened the consultations. Significantly more nurses than GPs felt that the information helped the consultation (87.1% vs 37.7%), but also reported that patients bringing such information was off-putting (21.9% vs 6.3%).
Conclusions  Both GPs and nurses experienced patients bringing health information to consultations and significantly differed in their views about whether it helped or hindered. Primary care staff should anticipate patients' use of the Internet for health information and should actively manage patients introducing it into the consultation.     

Does Advanced Community/Public Health Nursing Practice Have a Future?

Societal trends and predicted needs of the health care system indicate that there will be increasing demands for health care professionals who can effectively manage the health needs of populations and communities. Nurses who have master's degrees in community/public health nursing have the educational background to provide this expertise. Although the Association of Community Health Nursing Educators and many nursing leaders maintain that these nurses are advanced practice nurses, most leading nursing organizations and state nurse practice acts do not include population and community health management skills in their definitions of advanced practice nursing. These exclusions have produced a serious status problem for master's programs in community/public health nursing. This article examines issues affecting the current and future status of master's-level community/public health nursing. Solutions are suggested for ensuring the viability of this specialty area.     

Maternal Predictors of Toddler Health Status

PURPOSE.  The purposes of this study were to examine the relationships among maternal and environmental variables in the first 6 months postpartum and toddler health status, and to identify predictors of toddler health .
DESIGN AND METHODS.  A secondary analysis was conducted on an existing dataset of a longitudinal parent–child survey .
RESULTS.  Maternal stress predicted 8% of the variance in child health status at 18 months of age. Children in nonparental care more than 20 hr per week were perceived as less healthy .
PRACTICE IMPLICATIONS.  Pediatric nurses should assess levels of maternal stress in the early months postpartum and anticipate poorer health status in toddlers who spend more than 20 hr per week in nonparental care .     

Mental health community liaison in aged care: a service of value to all

Aim.  This paper describes an effective community nursing role in which mental health care is brought to long-term care in a way that restores and promotes mental health wellbeing in the older person, builds understanding between clinicians, and develops staff confidence in attending to the whole needs of residents of nursing homes.
Background.  Mental health is a significant issue in the ageing population and there is much that mental health nurses as well as staff in long-term care can do to promote early detection of problems, facilitate effective treatment and build coping in the older person and family so that they recover from grief or depression issues and go on to make this stage of life satisfying and rewarding.
Conclusions.  The mental health nurse liaison role is a useful contribution to comprehensive aged care in the community. The role provides support to clinicians enabling them to develop skills and expand their area of practice, whilst creating an environment in which the needs of the client may also be better understood and thereby met.     

Nursing Children and Adolescents With Bipolar Disorder: Assessment, Diagnosis, Treatment, and Management

TOPIC:  The role of the mental health nurse in the assessment, diagnosis, treatment, and management of children and adolescents with bipolar disorder in community and hospital settings.
PURPOSE:  In many areas of clinical practice, mental health nurses have more contact with service users than any other professional group. They are therefore well placed to support children and adolescents with bipolar disorder during first contact with primary care services, through engagement with specialist mental health services, and in accessing early intervention and crisis services. This paper summarizes the contribution that child and adolescent mental health nurses make to the care of children and adolescents with bipolar disorder.
SOURCES:  This paper is based on evidence from systematic reviews; meta-analyses and best practice evidence from CINAHL; EMBASE; MEDLINE, PsychINFO; Cochrane Collaboration; National Institute for Health and Clinical Excellence; National Collaborating Centre for Mental Health; NHS Centre for Reviews and Dissemination; Oxford Centre for Evidence Based Medicine; United States Agency for Healthcare Research and Quality.
CONCLUSIONS:  Child and adolescent mental health nurses work with children and adolescents who have bipolar disorder in a range of settings. These include community mental health services, hospitals, and schools. Due to the multidisciplinary nature of the treatment and management of bipolar disorder during childhood and adolescence, nurses have a major role to play in providing frontline assessment services, monitoring treatment, and delivering psychosocial interventions.     

The perceived perceptions of head school nurses in developing school nursing roles within schools

Aim  To gain a deeper understanding of how Swedish head school nurses perceive their leadership in developing school health care.
Background  A well-functioning school health care is important for promoting the health of children and young people.
Method  Constructivist-grounded theory was used to analyse 11 individual interviews with nine head school nurses.
Results  Head school nurses strive to find a balance between what they experience as vague formal goals and strong informal goals which leads to creating local goals in order to develop school health care.
Conclusion  The head school nurse's job is experienced as a divided and pioneering job in which there is uncertainty about the leadership role. They provide individual support to school nurses, are the link between school nurses and decision makers and highlight the importance of school nurses' work to organizational leaders.
Implications for nursing management  This study shows that school health care needs to be founded on evidence-based methods. Therefore, a structured plan for education and training in school health care management, based on research and in cooperation with the academic world, would develop the head school nurses' profession, strengthen the position of school health care and advance the school nurses' work.     

Dr. Loretta C. Ford: A pioneer in healthcare

Dr Loretta C. Ford is a true pioneer. Her work in public health launched the nurse practitioner movement. Together with Dr Henry Silver in 1965, Dr Ford co-founded the first expanded or advanced role to educate nurses to: assess, diagnose and treat common pediatric problems in primary care. Since then, there has been an increase in the number of specialty programs and an acknowledged global need for advanced practice nurses. She transformed our understanding of health and illness, the education of nurses, and the practice of humane patient care.