Health Care Delivery to Farmworkers in the Southwest: An Innovative Nursing Clinic

The migrant and seasonal farmworkers of the United States constitute a medically underserved population with many health care needs. Barriers to health care among farmworker families include financial constraints, cultural factors, restrictive labor practices, and absence of accessible clinics in rural areas. The Migrant Health Outreach Program is a federally funded mobile nursing clinic created to deliver health care to farmworkers where they live and work. The Migrant Health Outreach Team, composed of family nurse practitioners, registered nurses, and health care workers, offers primary care including health care maintenance and treatment of acute and chronic illness. The mobile nursing clinic serves the target population of farmworkers as a successful alternative to a traditional medical clinic.     

American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Sedation and Respiratory Depression

As the complexity of analgesic therapies increases, priorities of care must be established to balance aggressive pain management with measures to prevent or minimize adverse events and to ensure high quality and safe care. Opioid analgesia remains the primary pharmacologic intervention for managing pain in hospitalized patients. Unintended advancing sedation and respiratory depression are two of the most serious opioid-related adverse events. Multiple factors, including opioid dosage, route of administration, duration of therapy, patient-specific factors, and desired goals of therapy, can influence the occurrence of these adverse events. Furthermore, there is an urgent need to educate all members of the health care team about the dangers and potential attributes of administration of sedating medications concomitant with opioid analgesia and the importance of initiating rational multimodal analgesic plans to help avoid adverse events. Nurses play an important role in: 1) identifying patients at risk for unintended advancing sedation and respiratory depression from opioid therapy; 2) implementing plans of care to assess and monitor patients; and 3) intervening to prevent the worsening of adverse events. Despite the frequency of opioid-induced sedation, there are no universally accepted guidelines to direct effective and safe assessment and monitoring practices for patients receiving opioid analgesia. Moreover, there is a paucity of information and no consensus about the benefits of technology-supported monitoring, such as pulse oximetry (measuring oxygen saturation) and capnography (measuring end-tidal carbon dioxide), in hospitalized patients receiving opioids for pain therapy. To date, there have not been any randomized clinical trials to establish the value of technologic monitoring in preventing adverse respiratory events. Additionally, the use of technology-supported monitoring is costly, with far-reaching implications for hospital and nursing practices. As a result, there are considerable variations in screening for risk and monitoring practices. All of these factors prompted the American Society for Pain Management Nursing to approve the formation of an expert consensus panel to examine the scientific basis and state of practice for assessment and monitoring practices for adult hospitalized patients receiving opioid analgesics for pain control and to propose recommendations for patient care, education, and systems-level changes that promote quality care and patient safety.     

Sources of Stress for Nurse Practitioners

The purpose of this study was to identify perceived stressors and manifestations of stress in nurse practitioners practicing in Missouri and California. The greatest sources of stress reported by the entire sample (N=80) were in the categories of time demands and role restrictions. Missouri nurse practitioners found role restriction problems significantly more stressful than California nurse practitioners did. Manifestations of stress fell within the norms of non-psychiatric adults on the Symptom Check List 90-R.     

Culture BoundAnxiety Disorder in Adolescence: A Case Study

TOPIC:  There are a number of culture-bound syndromes in the literature that may directly impact on clients' systems of meaning and, thus, the clinician's ability to effectively intervene. This applies to Hispanic/Latino children, particularly those who present with anxiety and somatic symptoms.
PURPOSE:  This case study deals with a 14-year-old Hispanic girl who presented at a behavioral health clinic with anxiety behaviors.
SOURCES:  Review of the literature and case example from practice.
CONCLUSION:  Since culture can have a profound influence on a child's thoughts, emotions, and behaviors, nurses' cultural understanding is critical in psychiatric diagnostic evaluation and treatment.     

Camina por Salud: Walking in Mexican-American women

Forty-six percent of older Mexican-American women report that they do not engage in leisure time physical activity (PA); 38.1% of them are obese. This study (1) evaluated a PA intervention for coronary heart disease risk reduction and (2) determined which variables affect adherence to PA. For 36 weeks, Group I members walked for 3 days a week and Group II members walked for 5 days a week. We measured the participants' total body fat, regional fat, blood lipids, and adherence to PA The walking interventions favorably affected body fat, with significant differences in body mass index reduction, F(2, 16) = 12.86, p = .001. No statistical difference was noted in the anthropometric and blood lipid results between the baseline and 36-week measures.     

Mentoring students and junior faculty in faculty research: A win-win scenario

The concept of mentoring in nursing has focused primarily on moving novice nurses to a more advanced level of expertise in the clinical setting. With the growing emphasis on expanding evidence-based practice in nursing, however, mentoring within the context of research is becoming increasingly important. This article describes the many reciprocal benefits of research mentoring for students, junior faculty, and senior faculty researchers as well as for colleges of nursing and nursing science. Suggestions for implementing processes that facilitate successful mentoring within a research setting also are offered.