1
|
Kett PM, Shahrir S, Bekemeier B. Public Health Nurses' Proficiencies and Training Needs in an Emergency Response: A Cross-Sectional Observational Study. J Public Health Manag Pract 2024; 30:354-366. [PMID: 38489524 DOI: 10.1097/phh.0000000000001888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To address gaps in understanding the public health nursing workforce regarding competencies recognized as critical during an emergency response. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional observational study using data with information on local health department staff- and organizational-level characteristics collected from across the United States in 2021. We used logistic regression to estimate the association between 2 binary nurse-specific predictors-(1) whether the staff person was a nurse and (2) whether the staff worked in a local health department that was "nurse-led" (directed by a nurse)-and reported proficiencies important to the COVID-19 response. Models controlled for relevant local health department and community characteristics. RESULTS In the sample, 19% were nurses and 37% were at nurse-led health departments. Nurse versus nonnurse staff had higher odds of reporting proficiencies in skills related to Justice, Equity, Diversity, and Inclusion and in the skill "identifying/applying evidence-based approaches to address public health issues." However, nurses, compared with their nonnurse peers, had higher odds of reporting training needs in domains related to community engagement, policy engagement, and cross-sectoral collaboration. Conversely, staff at nurse-led health departments, compared with non-nurse-led staff, had higher odds of reporting proficiencies in many of these same areas, including "collaborating across the public health system" and "influencing policies external to the organization that affect community health." There were no areas in which nurse-led staff had lower odds of reporting proficiencies or higher odds of identifying training needs. CONCLUSIONS Findings from this study highlight areas of strength for public health nurses, particularly strengths related to diversity, equity, and inclusion, as well as areas where more training is needed. Such findings can help guide future public health nurse workforce development as well as underscore the value of public health nursing leadership and staff at local health departments for supporting community health.
Collapse
Affiliation(s)
- Paula M Kett
- Author Affiliations: Center for Health Workforce Studies, Department of Family Medicine, School of Medicine (Drs Kett and Shahrir); and Department of Child, Family, and Population Health, School of Nursing (Dr Bekemeier), University of Washington, Seattle, Washington
| | | | | |
Collapse
|
2
|
Kett PM, Bekemeier B, Patterson DG, Schaffer K. Competencies, Training Needs, and Turnover Among Rural Compared With Urban Local Public Health Practitioners: 2021 Public Health Workforce Interests and Needs Survey. Am J Public Health 2023; 113:689-699. [PMID: 37196230 DOI: 10.2105/ajph.2023.307273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Objectives. To compare rural versus urban local public health workforce competencies and training needs, COVID-19 impact, and turnover risk. Methods. Using the 2021 Public Health Workforce Interest and Needs Survey, we examined the association between local public health agency rural versus urban location in the United States (n = 29 751) and individual local public health staff reports of skill proficiencies, training needs, turnover risk, experiences of bullying due to work as a public health professional, and posttraumatic stress disorder symptoms attributable to COVID-19. Results. Rural staff had higher odds than urban staff of reporting proficiencies in community engagement, cross-sectoral partnerships, and systems and strategic thinking as well as training needs in data-based decision-making and in diversity, equity, and inclusion. Rural staff were also more likely than urban staff to report leaving because of stress, experiences of bullying, and avoiding situations that made them think about COVID-19. Conclusions. Our findings demonstrate that rural staff have unique competencies and training needs but also experience significant stress. Public Health Implications. Our findings provide the opportunity to accurately target rural workforce development trainings and illustrate the need to address reported stress and experiences of bullying. (Am J Public Health. 2023;113(6):689-699. https://doi.org/10.2105/AJPH.2023.307273).
Collapse
Affiliation(s)
- Paula M Kett
- Paula M. Kett and Davis G. Patterson are with the Center for Health Workforce Studies, Department of Family Medicine, and Betty Bekemeier is with the School of Nursing, University of Washington, Seattle. Kay Schaffer is with the de Beaumont Foundation, Bethesda, MD
| | - Betty Bekemeier
- Paula M. Kett and Davis G. Patterson are with the Center for Health Workforce Studies, Department of Family Medicine, and Betty Bekemeier is with the School of Nursing, University of Washington, Seattle. Kay Schaffer is with the de Beaumont Foundation, Bethesda, MD
| | - Davis G Patterson
- Paula M. Kett and Davis G. Patterson are with the Center for Health Workforce Studies, Department of Family Medicine, and Betty Bekemeier is with the School of Nursing, University of Washington, Seattle. Kay Schaffer is with the de Beaumont Foundation, Bethesda, MD
| | - Kay Schaffer
- Paula M. Kett and Davis G. Patterson are with the Center for Health Workforce Studies, Department of Family Medicine, and Betty Bekemeier is with the School of Nursing, University of Washington, Seattle. Kay Schaffer is with the de Beaumont Foundation, Bethesda, MD
| |
Collapse
|
3
|
Lee D, Kett PM, Mohammed SA, Frogner BK, Sabin J. Inequitable care delivery toward COVID-19 positive people of color and people with disabilities. PLOS Glob Public Health 2023; 3:e0001499. [PMID: 37074996 PMCID: PMC10115306 DOI: 10.1371/journal.pgph.0001499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/10/2023] [Indexed: 04/20/2023]
Abstract
This study aimed to explore provider observations of inequitable care delivery towards COVID-19 positive patients who are Black, Indigenous, and Other People of Color (BIPOC) and/or have disabilities and to identify ways the health workforce may be contributing to and compounding inequitable care. We conducted semi-structured interviews between April and November 2021 with frontline healthcare providers from Washington, Florida, Illinois, and New York. Using thematic analysis, major themes related to discriminatory treatment included decreased care, delayed care, and fewer options for care. Healthcare providers' bias and stigma, organizational bias, lack of resources, fear of transmission, and burnout were mentioned as drivers for discriminatory treatment. COVID-19 related health system policies such as visitor restrictions and telehealth follow-ups inadvertently resulted in discriminatory practices towards BIPOC patients and patients with disabilities. As patients experience lower quality healthcare during the pandemic, COVID-19-related restrictions and policies compounded existing inequitable care for these populations.
Collapse
Affiliation(s)
- Danbi Lee
- Department of Rehabilitation Medicine and Disability Studies Program, University of Washington, Seattle, WA, Untied States of America
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, WA, Untied States of America
| | - Paula M Kett
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, WA, Untied States of America
| | - Selina A Mohammed
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, WA, Untied States of America
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, Untied States of America
| | - Bianca K Frogner
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, WA, Untied States of America
| | - Janice Sabin
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, WA, Untied States of America
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, Untied States of America
| |
Collapse
|
4
|
Woodward KF, Kett PM, Willgerodt M, Summerside N, Hart J, Buchanan DT, Cunitz TC, Birkey C, Zierler BK. Using an academic-practice partnership to enhance ambulatory care nursing skills. Nurse Educ Today 2022; 119:105585. [PMID: 36215853 DOI: 10.1016/j.nedt.2022.105585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/13/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Ambulatory nursing services are essential to healthcare in communities, but nursing curricula often omit ambulatory care training. The purpose of this project was to enhance ambulatory care competencies among nursing students and provide ongoing education for practicing nurses through an academic-practice partnership. METHODS A four-year externally funded project targeted enhancements to undergraduate nursing curricula and development activities. Students received didactic content and clinical experiences and were evaluated to assess critical ambulatory care nursing skills. Existing continuing education offerings were enhanced with team-based practice content. RESULTS Despite pandemic-related clinical training changes, data from multiple quarters showed improvement in students' perceptions of self-efficacy (1.7-4.28-point increases) and actual performance (3.46-4.05-point increases) of core competencies on the 20-point evaluation scales. In addition, students rated simulations favorably, with scores ranging from 1.4 to 1.9 on the 2-point subscales. CONCLUSION An academic-practice partnership provides mutually beneficial opportunities for enhancing the ambulatory care nursing workforce through undergraduate education and training and professional development for practicing nurses.
Collapse
Affiliation(s)
- Kyla F Woodward
- Department of Child, Family, and Population Health Nursing, University of Washington, United States of America.
| | - Paula M Kett
- Department of Child, Family, and Population Health Nursing, University of Washington, United States of America; Center for Health Workforce Studies, Department of Family Medicine, Univ. of Washington, United States of America
| | - Mayumi Willgerodt
- Department of Child, Family, and Population Health Nursing, University of Washington, United States of America; Center for Sciences Interprofessional Education, Research, and Practice, Univ. of Washington, United States of America
| | - Nicole Summerside
- Center for Sciences Interprofessional Education, Research, and Practice, Univ. of Washington, United States of America; Department of Biobehavioral Nursing and Health Informatics, University of Washington, United States of America
| | - Jennie Hart
- Center for Sciences Interprofessional Education, Research, and Practice, Univ. of Washington, United States of America; Department of Biobehavioral Nursing and Health Informatics, University of Washington, United States of America
| | - Diana Taibi Buchanan
- Center for Sciences Interprofessional Education, Research, and Practice, Univ. of Washington, United States of America; Department of Biobehavioral Nursing and Health Informatics, University of Washington, United States of America
| | - Tamara C Cunitz
- Department of Child, Family, and Population Health Nursing, University of Washington, United States of America; Center for Sciences Interprofessional Education, Research, and Practice, Univ. of Washington, United States of America
| | - Carly Birkey
- Kaiser Permanente of Washington, United States of America
| | - Brenda K Zierler
- Center for Sciences Interprofessional Education, Research, and Practice, Univ. of Washington, United States of America; Department of Biobehavioral Nursing and Health Informatics, University of Washington, United States of America
| |
Collapse
|
5
|
Kett PM, Bekemeier B, Herting JR, Altman MR. Advancing health equity: Organizational characteristics emphasized by health department nurse lead executives. Public Health Nurs 2022; 39:1308-1317. [PMID: 35714667 DOI: 10.1111/phn.13109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare nurse and non-nurse lead executives' relationship with organizational characteristics supporting performance and health equity in local health departments (LHD). DESIGN This was a cross-sectional quantitative study. SAMPLE The final national sample consisted of 1447 LHDs using the 2019 Profile of Local Health Departments survey. MEASUREMENTS We used multivariable logistic and negative binomial regression analyses to explore the relationship between nurse versus non-nurse LHD lead executives and involvement in ten organizational characteristics including community health assessment (CHA) and community health improvement plan (CHIP) completion and policy activities related to the social determinants of health (SDOH). RESULTS Multivariable logistic regression models showed that, for nurse lead executives, the odds of having completed a CHA is 1.49 times, and the odds of having completed a CHIP is 1.56 times, that of non-nurse lead executives. Negative binomial regression models predicted nurse lead executives, compared to non-nurses, to perform 1.18 times more SDOH-related policy activities. CONCLUSION Results suggest that nurse lead executives are more likely than non-nurses to emphasize assessment in their work and engage in upstream-focused policy activities. As such, they are important partners in work to facilitate health equity.
Collapse
Affiliation(s)
- Paula M Kett
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Betty Bekemeier
- Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Jerald R Herting
- Department of Sociology, College of Arts and Sciences, University of Washington, Seattle, Washington, USA
| | - Molly R Altman
- Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| |
Collapse
|
6
|
Kett PM, van Eijk MS, Guenther GA, Skillman SM. "This work that we're doing is bigger than ourselves": A qualitative study with community-based birth doulas in the United States. Perspect Sex Reprod Health 2022; 54:99-108. [PMID: 35797066 DOI: 10.1363/psrh.12203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CONTEXT Community-based birth doulas support pregnant women, transgender men, and gender non-binary individuals during the perinatal period and provide essential services and expertise that address health inequities, often taking on additional roles to fill systemic gaps in perinatal care in the United States (US). Despite the benefits that community-based birth doulas provide, there is little research exploring the work-related conditions and stressors community-based doulas experience. To address this gap, we examined the work experiences, related stressors, and stress management strategies of individual community-based birth doulas. METHODS In this qualitative, descriptive study we conducted 18 interviews in March through June 2021 with individuals who self-identified as community-based doulas working in underserved communities in the US. We analyzed the interviews for themes, which we defined and finalized through team consensus. RESULTS The doulas reported engaging in specific strategies in their work to address perinatal inequities. They also described facing several work-related stressors, including witnessing discrimination against clients, experiencing discrimination in medical environments, and struggling with financial instability. To mitigate these stressors and job-related challenges, interviewees reported they relied on doula peer support and reconnected with their motivations for the work. CONCLUSIONS Community-based doulas provide essential services and expertise which address inequities and systemic gaps in perinatal care. However, as they work to improve perinatal health, doulas themselves are providing equity work amidst an inequitable system and with insufficient political or financial support. Increased compensation and systemic support which acknowledges the breadth of services provided is needed to strengthen and sustain this critical part of the perinatal workforce.
Collapse
Affiliation(s)
- Paula M Kett
- Department of Family Medicine, Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
| | - Marieke S van Eijk
- Department of Anthropology, Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
| | - Grace A Guenther
- Department of Family Medicine, Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
| | - Susan M Skillman
- Department of Family Medicine, Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
| |
Collapse
|
7
|
van Eijk MS, Prueher L, Kett PM, Frogner BK, Guenther GA. Financial Instability of Federal Navigator Program Challenges Organizations to Help Uninsured Enroll in Health Insurance Coverage. J Health Care Poor Underserved 2022; 33:1555-1568. [DOI: 10.1353/hpu.2022.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
8
|
van Eijk MS, Kett PM, Prueher L, Frogner BK, Guenther GA. Lack of Consistent Investment in Federal Insurance Navigator Program Undermines Navigators' Equity Work in Vulnerable Communities. J Public Health Manag Pract 2022; 28:399-405. [PMID: 35121713 DOI: 10.1097/phh.0000000000001503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CONTEXT Navigators in the federal Insurance Navigator Program ("Navigator Program"), who are employed by organizations in states with Federally Facilitated Marketplaces, provide enrollment assistance, outreach, and education to individuals who are eligible for health insurance coverage. Such work is central to public health efforts to address inequities but continues to be poorly understood and undervalued. More information is needed to understand the components of navigators' equity work and how decreases in program funding have affected their service provision. OBJECTIVE To examine navigators' labor at a granular level to better understand and highlight the equity work they do, the training and skills required for this work, and the Navigator Program-based challenges they face. DESIGN This was a descriptive qualitative study using data collected from interviews conducted in February-May 2021. We used a thematic analysis approach to develop major themes and subthemes. SETTING This was a national study. PARTICIPANTS We conducted 18 semistructured interviews with 24 directors, navigators, and other professionals at organizations funded as federally certified Navigator Programs. MAIN OUTCOME MEASURES Components of navigators' work; required training and skills; and challenges faced in accomplishing the work. RESULTS We identified 3 major themes: (1) navigators' health equity work goes beyond required responsibilities; (2) equity skills are built on the job; and (3) financial instabilities challenge navigators' health equity work. CONCLUSION Navigators bring specialized and essential skills and services to underserved communities. They are trusted sources of information, advocates, resource connectors, and, most significantly, health equity workers. However, the Navigator Program fails to support navigators' work and the communities they serve in the long term. To facilitate organizations' capacities to train, keep, and support navigators in this health equity work and to guarantee long-term enrollment assistance for underserved communities, efforts to stabilize funding are needed.
Collapse
Affiliation(s)
- Marieke S van Eijk
- Departments of Anthropology (Drs Van Eijk and Prueher) and Family Medicine (Drs Kett and Frogner and Ms Guenther), Center for Health Workforce Studies, University of Washington, Seattle, Washington
| | | | | | | | | |
Collapse
|
9
|
Kett PM, Bekemeier B, Altman MR, Herting JR. "Not everybody approaches it that way": Nurse-trained health department directors' leadership strategies and skills in public health. Nurs Inq 2022; 29:e12487. [PMID: 35266247 DOI: 10.1111/nin.12487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
Evidence points to nurses as possessing particular skills which are important for public health leadership; in particular, investigators have found that a nurse public health director is strongly associated with positive health department performance. To better understand this association and to guide the effective deployment of nurse leaders, researchers sought to explore the specific leadership strategies used by nurse public health directors, using a critical thematic analysis approach to examine these leadership strategies in the context of certain ideologies, power differentials, and social hierarchies. Data were collected via semistructured interviews conducted from July to September 2020 with 13 nurse public health directors from across the United States. Major themes illustrate a distinct picture of the nursing approach to public health leadership: (a) approaching their work with an other-focused lens, (b) applying theoretical knowledge, (c) navigating the political side of their role, and (d) leveraging their nursing identity. Findings articulate the nurse public health director's distinctive combination of skills which reflect the interprofessional nature of public health nursing practice. Such skills demonstrate a specialized approach that may set nurse leaders apart from other types of leaders in carrying out significant public health work.
Collapse
Affiliation(s)
- Paula M Kett
- Department of Family Medicine, Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
| | - Betty Bekemeier
- Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Molly R Altman
- Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Jerald R Herting
- Department of Sociology, University of Washington, Seattle, Washington, USA
| |
Collapse
|
10
|
Kett PM, Bekemeier B, Herting JR, Altman MR. Addressing Health Disparities: The Health Department Nurse Lead Executive's Relationship to Improved Community Health. J Public Health Manag Pract 2022; 28:E566-E576. [PMID: 34475368 DOI: 10.1097/phh.0000000000001425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
CONTEXT The nurse-trained local health department (LHD) lead executive has been shown to be positively associated with LHD performance; however, no other research has explored whether this association translates to improved community health. OBJECTIVE To investigate the relationship between the type of LHD leadership-whether or not the lead executive is a nurse-and changes in health outcomes. DESIGN This study used a multivariate panel time series design. Each model was estimated as a pooled time series and using time and unit fixed effects, with a 1-year lag used for all covariates and the main predictor. SETTING A national, county-level data set was compiled containing variables pertaining to the LHD, community demographics, and health outcomes for the years 2010-2018. PARTICIPANTS The unit of analysis was the LHD. The data set was restricted to those counties with measurable mortality rates during at least 8 of the 9 time periods of the study, resulting in a total of 626 LHDs. MAIN OUTCOME MEASURES The outcomes of interest were changes in 15- to 44-year-old all-cause mortality, infant mortality, and entry into prenatal care. RESULTS In models with combined time and unit fixed effects, a significant relationship exists between a nurse-led LHD and reduced mortality in the 15- to 44-year-old Black population (-5.2%, P < .05) and a reduction in the Black-White mortality ratio (-6%, P < .05). In addition, there is a relationship between the nurse-led LHD and a reduction in the percentage of the population with late or no entry to prenatal care. CONCLUSIONS The evidence presented here helps connect the known positive association between nurse lead executives and LHD performance to improvements in community health. It suggests that nurse leaders are associated with health improvements in line with addressing health inequities.
Collapse
Affiliation(s)
- Paula M Kett
- Department of Child, Family, and Population Health, School of Nursing (Drs Kett, Bekemeier, and Altman), and Department of Sociology, College of Arts and Sciences (Dr. Herting), University of Washington, Seattle, Washington
| | | | | | | |
Collapse
|
11
|
Van Eijk MS, Guenther GA, Kett PM, Jopson AD, Frogner BK, Skillman SM. Addressing Systemic Racism in Birth Doula Services to Reduce Health Inequities in the United States. Health Equity 2022; 6:98-105. [PMID: 35261936 PMCID: PMC8896213 DOI: 10.1089/heq.2021.0033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose: Birth doulas support pregnant people during the perinatal period. Evidence of doulas' positive impacts on pregnancy and birth outcomes, particularly among underserved populations, supports expanding access. However, health workforce-related barriers challenge the development of robust doula services in the United States. This study examined the various approaches organizations have taken to train, recruit, and employ doulas as well as their perspectives on what system-level changes are needed to redress health inequities in underserved communities and expand access to birth doula services. Methods: In addition to literature and policy reviews, we conducted 16 semistructured interviews from March to August 2020 with key informants from organizations involved in training, certifying, advocating for, and employing doulas, and informants involved in state policy making. We analyzed data using qualitative analysis software to identify cross-cutting themes. Results: The landscape of organizations involved in doula training and certification is diverse. In discussing their training and curriculum, interviewees from large organizations and community-based organizations (CBOs) stressed the importance of incorporating a focus on structural racism in maternal health into training curricula. CBOs specifically offered three areas of systems-level change that can help equitably grow doula services: the importance of addressing structural racism, changing the balance of power in decision making and policy making, and a cautious approach to Medicaid reimbursement. Conclusion: This study provides evidence of how doula organizations move the field toward better serving the specific needs of underserved populations. It recognizes the expertise of CBOs in developing policy to expand doula services to communities in need. The information from this study highlights the complexities of facilitating consistency across doula training and certification requirements and implementing a sustainable funding mechanism while also meeting communities' unique needs.
Collapse
Affiliation(s)
- Marieke S. Van Eijk
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Grace A. Guenther
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Paula M. Kett
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Andrew D. Jopson
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Bianca K. Frogner
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Susan M. Skillman
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
12
|
Kett PM. The individual focus of nursing research in breastfeeding: Perpetuating a neoliberal perspective. Public Health Nurs 2020; 37:281-286. [PMID: 31965619 DOI: 10.1111/phn.12710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 01/14/2023]
Abstract
In this paper, I argue for the need to shift the focus of nursing research regarding breastfeeding from that of individual responsibility to include a more system-focused, population health approach. In the 2011, "Call to Action to Support Breastfeeding," the U.S. Surgeon General called attention to the pervasive disparities in breastfeeding outcomes in the United States. A plethora of nursing research exists aimed at addressing these disparities; however, this research leans toward a neoliberal perspective, mainly focusing on individual factors and failing to address the systemic inequities contributing to these disparities. A shift in nursing science that focuses research at a population level would more effectively support addressing disparities in breastfeeding outcomes and embrace a commitment to social justice. In focusing at a population level, specific inequities that must be addressed include the negative history of breastfeeding in the Black population, systemic racism, and gender inequality. Critical research methodologies are proposed as useful approaches to address these inequities. By engaging in this level of research and using a critical lens, nurse scientists broaden their scope of care to include the entire population, motivate needed social and policy change, facilitate the choice to breastfeed, and ultimately eliminate breastfeeding disparities.
Collapse
Affiliation(s)
- Paula M Kett
- School of Nursing, University of Washington, Seattle, WA, USA
| |
Collapse
|