A qualitative study of school nurses' moral distress related to COVID-19

OBJECTIVE

To understand school nurses' perceptions and experiences of moral distress related to COVID-19 case management in the school systems.

DESIGN

A descriptive qualitative study guided by Braun and Clarke's reflexive thematic analysis.

SAMPLE

Twelve school nurses practicing in Colorado from December 2021 to January 2022.

MEASUREMENTS

Semi-structured interviews about school nurses' experiences of COVID-19. Investigators utilized an iterative reflexive thematic analysis process engaging the participants' and researchers' subjective experiences.

RESULTS

Four themes were created: (1) keeping kids and the community safe, (2) caught in the middle of the "tug of war" between health and politics, (3) distress amid an ocean of COVID-19 uncertainty, and (4) visibility as a bright spot shining through the COVID-19 cloud.

CONCLUSIONS

Two research questions examined school nurses' experiences of moral distress and their role and scope of practice that affected their relationships in the educational and public health systems. The results of this study confirm the important role of school nurses and interprofessional case management in school environments in the fight against infectious diseases and pandemics. Building stronger relationships between school nurses and public health is imperative for future collaborative and cohesive public health responses to pandemics.

Systems of communication in school-nurse led care coordination: A concept analysis

AIM

To analyze the concept of systems of communication in school nurse-led care coordination to develop an operational definition that will inform intervention development.

BACKGROUND

Communication has been identified as an essential attribute in care coordination. However, previous concept analyses of care coordination did not clearly define systems of communication or consider the context of school-based care coordination. Defining and conceptualizing systems of communication has important implications for improving school nurse-led care coordination.

METHODS

Concept analysis was conducted using Walker and Avant's eight-step concept analysis method. The literature was searched to identify supporting literature that was analyzed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.

RESULTS

Systems of communication in school nurse-led care coordination can be defined as systems wherein care team members, led by the school nurse, collaborate by communicating information and knowledge through an individualized healthcare plan that is student/family-centered and shared through information systems. Attributes require developing an individual health plan that incorporates care coordination needs, information sharing with student/family consent, and a clear delineation of team member roles. Consequences include student/family outcomes, team member knowledge, and efficiency and accuracy of information.

CONCLUSIONS

Concept clarification and a synthesized definition allow for more effective measurement development for effective communication in school nurse-led care coordination. Students with healthcare needs in the school environment require systems of communication that efficiently work toward school nurse-led care coordination that addresses the student's health and academic outcomes.

Program implementation and outcomes from three cohorts of the nurse-family partnership nurse residency program

BACKGROUND

The purpose of this paper is to describe a Nurse-Family Partnership (NFP) Nurse Residency Program (NRP) and program outcomes.

METHODS

Dual methods were used to evaluate the first three cohorts of the NFP NRP. Participants were new NFP nurses, most working in Colorado. Pre-(n = 42) and post-program (n = 26) surveys were completed using the Individual Workplace Perception Scale (IWPS) and endorsement of program objectives; key informant interviews were done with the initial cohort. Descriptive statistics and unpaired t-tests (for the IWPS) were used to explain program effectiveness and efficacy.

RESULTS

Forty-two NFP nurses participated in the program at the onset. There was consistent attendance (92% or more) among those who finished and modest individual attrition during the length of the program. Participants reported high levels of satisfaction with the content and meeting program objectives; there were no significant differences on pre- and post-program IWPS scores.

CONCLUSIONS

The program was well-received by program participants and has the potential to contribute to the professional development of new NFP nurses.

Perspectives of parents of working adolescents in Ontario, Canada

Background

More than half of adolescents have jobs in summer or sometime during the year. While employers are ultimately responsible for their safety, parents are often important in helping their children navigate the work environment. Our study examines the attitudes, beliefs and types of involvement parents have in their children’s work.

Methods

We modeled a telephone survey of 507 English-speaking parents of working adolescents in Ontario, Canada on a US study and examined their perspectives, comparing to earlier findings from the U.S. parents.

Results

Most Ontario parents helped their teens consider questions to ask about work, for example, work hours (90.7%) and job tasks (78.2%) and fewer about workplace safety (57.9%). Parents overall were concerned about their teens, especially younger teens, getting behind on schoolwork (69.3%), being rushed on the job (60.1%) and doing hazardous tasks (58.3%) or working alone (51.9%), or being at work during a robbery (74.5%). Parents of 14–17-year-old daughters were more concerned about their child being assaulted than were parents of sons (62.4% vs. 51.4%), particularly if the teen was in the 18–19 age group (74.3% vs. 52.5%). Half the parents indicated 10–19 h per week was the right amount of work time for their teen, and most agreed that laws should limit the number of hours of youth work.

Conclusions

Overall, Ontario parents appear to be more concerned about the safety and also more involved in the work of their adolescent children than U.S. parents previously surveyed. Parents are engaged with their children about their work and may serve as valuable assets to helping to advocate for safe work policies and environments.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10377-9.

Creating COVID-19 alternate care site trainings for interprofessional teams

Purpose

To describe the planning and development of alternate care site (ACS) trainings for community COVID care delivery.

Methods

A timeline of activities by the core training team is presented from the lens of the State of Colorado Emergency Operations, leading to the pilot test of a templated training that was completed during the first week of June 2020. Lessons learned and training topics are described.

Conclusion

This case study of the Colorado experience developing training for community‐based COVID care delivery sites can inform other public health planners creating the same in their locales. And, public access materials from this project may supplement training for both public health and community health nurse educators.

How hospital practitioners can support sofa surfing adolescents to access community mental health services: An English perspective

Informal homelessness or, as Centrepoint describe, 'the hidden homeless' includes young people who may sleep on their friends' or extended family's couches or floor. They estimate that 103,000 people aged 16-24 in the United Kingdom presented to their Local Authority in 2017-2018 as being or at risk of being homeless. A proportion of young people who experience homelessness rely on their own resources rather than approaching their Local Authority for support. There are a number of barriers that make it harder for any homeless person to access services to enhance their emotional well-being. If a young homeless person presents at a hospital, there is an opportunity for them to be directed to the appropriate support required. This is even more critical when young people have an identified mental health need. The authors will outline ways in which hospital practitioners can support adolescents who are sofa surfing and who have an identified mental health need, to receive community-based support when planning for discharge from hospital.

Predictors of Physical Activity in a Predominantly Hispanic Sample of Adolescents

In the United States, the vast majority of Hispanic high school students do not meet physical activity recommendations. This prospective, observational study tested the Theory of Planned Behavior (TPB) to predict physical activity in a convenience sample of 232 high school students from a predominantly Hispanic, rural-fringe, lower-income community in Southwestern United States. Mindfulness was tested as a moderator of the intention-physical activity relationship. Data were collected via self-report questionnaires. Statistical analysis included structural equation modeling (SEM) and moderation analysis. The model explained 60% and 43% of the variance in intention and physical activity, respectively. Attitude (β = 0.49, p < 0.001) and subjective norm (β = 0.44, p < 0.001) predicted intention. Intention (β = 0.58, p < 0.001) and perceived behavioral control (β = 0.13, p < 0.027) predicted physical activity. Mindfulness did not moderate the intention-physical activity relationship. The results support using the TPB to predict physical activity in this population and may inspire ideas for targeted interventions.

Adolescent Marijuana Use and Perceived Ease of Access Before and After Recreational Marijuana Implementation in Colorado

BACKGROUND

As of January 1, 2017, eight states have approved laws for recreational marijuana use. While the social impacts of these changes remain under debate, the influence on adolescent marijuana use is a key policy and health issue across the U.S.

OBJECTIVE

To examine changes in adolescent marijuana-use behaviors in the first year after recreational marijuana implementation in Colorado, and to analyze the effect of retail marijuana store proximity on youth use and perceptions.

METHOD

Secondary analysis of Healthy Kids Colorado Survey data from 40 schools surveyed before and after recreational marijuana sales were implemented (2013 student n = 12,240; 2014 student n = 11,931). Self-reported marijuana use, ease of access, and perceived harms were compared between years and by proximity of recreational marijuana stores to surveyed schools.

RESULTS

Adolescent marijuana use behaviors, wrongness of use, and perceptions of risk of harm were unchanged from baseline to one-year follow-up. Perceived ease of access to marijuana increased (from 46% to 52%). Proximity of recreational marijuana stores was not significantly associated with perceived ease of access to marijuana. Conclusions/Importance: In the first study of adolescent marijuana use and perceptions after state retail implementation of recreational marijuana, there was little change in adolescent marijuana use but a significant change in perception of ease of access. Public health workers and policymakers should continue to monitor these changes as essential for evaluating the impact of liberalization of marijuana policies.

Assessing exploitation experiences of girls and boys seen at a Child Advocacy Center

The primary aim of this study was to describe the abuse experiences of sexually exploited runaway adolescents seen at a Child Advocacy Center (N=62). We also sought to identify risk behaviors, attributes of resiliency, laboratory results for sexually transmitted infection (STI) screens, and genital injuries from colposcopic exams. We used retrospective mixed-methods with in-depth forensic interviews, together with self-report survey responses, physical exams and chart data. Forensic interviews were analyzed using interpretive description analytical methods along domains of experience and meaning of sexual exploitation events. Univariate descriptive statistics characterized trauma responses and health risks. The first sexual exploitation events for many victims occurred as part of seemingly random encounters with procurers. Older adolescent or adult women recruited some youth working for a pimp. However, half the youth did not report a trafficker involved in setting up their exchange of sex for money, substances, or other types of consideration. 78% scored positive on the UCLA PTSD tool; 57% reported DSM IV criteria for problem substance use; 71% reported cutting behaviors, 75% suicidal ideation, and 50% had attempted suicide. Contrary to common depictions, youth may be solicited relatively quickly as runaways, yet exploitation is not always linked to having a pimp. Avoidant coping does not appear effective, as most patients exhibited significant symptoms of trauma. Awareness of variations in youth's sexual exploitation experiences may help researchers and clinicians understand potential differences in sequelae, design effective treatment plans, and develop community prevention programs.

Increasing documentation and referral for youth at risk for violence through the primary health care setting

OBJECTIVE

Evaluate the use of a previsit violence risk screen to determine whether screening during routine care increases health care practitioner's (HCP's) documentation of violence risk.

METHODS

Once consented, adolescents filled out the Violence Injury, Protection and Risk Screen Tool (VIPRS). For usual care screen results were not viewed by the HCP. For the intervention screen results were imbedded in the electronic medical record and viewed by the HCP. The primary outcome-documented reference to violence risk-was determined by chart review.

RESULTS

Three hundred and fifty-six youth participated. Age was 14.5 years (SD 0.3); 65% female, 45% Hispanic, 38% black. Odds of violence related documentation was 47.4 (P < .001) in the intervention compared with usual care. Those who were positive on the VIPRS had a 10 times greater odds of receiving a violence intervention compared with controls.

CONCLUSIONS

Previsit screening for violence risk significantly increases HCP's documentation of violent behavior and referral for intervention.

Multiple perpetrator rape among girls evaluated at a hospital-based child advocacy center: seven years of reviewed cases

The aim of this study was to describe contextual events, abuse experiences, and disclosure processes of adolescents who presented to a hospital-based Child Advocacy Center for medical evaluation and evidentiary collection as indicated after experiencing multiple perpetrator rape during a single event (n=32) and to compare these findings to a group of single perpetrator sexual assaults (n=534). This study used a retrospective mixed-methods design with in-depth, forensic interviews and complete physical examinations of gang-raped adolescents. Patients ranged from 12 to 17 years (M=14 years). Girls who experienced multiple perpetrator rape during a single event were more likely to have run away, to have drunk alcohol in the past month, and to have participated in binge drinking in the past 2 weeks. Acute presentation of these victims were rare but 30% had hymenal transections and 38% had sexually transmitted infections (STIs). Forensic interviews revealed alcohol was a common weapon used by offenders, and its use resulted in victims experiencing difficulty in remembering and reporting details for police investigation or physical and mental health care. Most victims were raped at parties they attended with people they thought they could trust, and they felt let down by witnesses who could have helped but did not intervene. Although relatively rare, multiple perpetrator rape during a single event is a type of severe sexual assault experience and has significant risks for deleterious health outcomes. These victims require health care by trained providers to diagnose physical findings, treat STIs, screen for trauma, and support victims.

Adverse outcomes among homeless adolescents and young adults who report a history of traumatic brain injury

OBJECTIVES

We examined the prevalence of self-reported traumatic brain injury (TBI) among homeless young people and explored whether sociodemographic characteristics, mental health diagnoses, substance use, exposure to violence, or difficulties with activities of daily living (ADLs) were associated with TBI.

METHODS

We analyzed data from the Wilder Homelessness Study, in which participants were recruited in 2006 and 2009 from streets, shelters, and locations in Minnesota that provide services to homeless individuals. Participants completed 30-minute interviews to collect information about history of TBI, homelessness, health status, exposure to violence (e.g., childhood abuse, assault), and other aspects of functioning.

RESULTS

Of the 2732 participating adolescents and young adults, 43% reported a history of TBI. Participants with TBI became homeless at a younger age and were more likely to report mental health diagnoses, substance use, suicidality, victimization, and difficulties with ADLs. The majority of participants (51%) reported sustaining their first injury prior to becoming homeless or at the same age of their first homeless episode (10%).

CONCLUSIONS

TBI occurs frequently among homeless young people and is a marker of adverse outcomes such as mental health difficulties, suicidal behavior, substance use, and victimization.

Suicidality among preadolescent maltreated children in foster care

This study sought to determine the prevalence of suicidal ideation, plans, and attempts among 515 preadolescent (aged 9-11 years) maltreated children who entered foster care within the prior year. Over a quarter (26.4%) of the children had a history of suicidality according to their own and/or their caregiver's report, 4.1% of whom were imminently suicidal. In bivariate analyses, children at higher risk of suicidality tended to be younger, non-Hispanic, abused, and to have experienced multiple types of maltreatment, more referrals to child welfare, more household transitions, and a longer length of time in foster care. There were no gender differences. Multiple regression analyses found physical abuse and chronicity of maltreatment to be the most robust predictors of suicidality. It is critically important that these high-risk children are screened for suicidality before adolescence and that caregivers and professionals are informed of their risk status so that they may implement mental health treatment, monitoring, and harm reduction measures.

Primary care practitioners' detection of youth violence involvement

BACKGROUND

Youth violence is a widespread public health problem. Despite recommendations to address youth violence by the American Academy of Pediatrics, it is unclear how often primary care practitioners (PCPs) do so.

PURPOSE

To determine PCPs' documentation of violence involvement.

METHODS

Children 11 to 17 years old were enrolled while attending a clinic. They completed questionnaires assessing violence involvement confidentially without the knowledge of the PCP. The primary outcome, documented reference to violence involvement, was determined by chart review.

RESULTS

A total of 165 youth participated: mean age = 14.5 years (standard deviation = 1.7), 43% male, 46% white. In all, 14.5% of charts documented any violence involvement. Of the 20% of youth who reported serious violence involvement, PCPs documented violence issues 19.4% of the time. Factors associated with documentation included nonwhite race (P < .05), having public (or no) insurance (P < .001), visit type (routine checkup (P < .05), and clinic site (P < .001).

CONCLUSION

PCPs infrequently document discussion of violence-related issues, specifically in youth who are demonstrating risk.

Differences in Abuse and Related Risk and Protective Factors by Runaway Status for Adolescents Seen at a U.S. Child Advocacy Centre

OBJECTIVES

This study examined the abuse prevalence and characteristics, and risk and protective factors, among both runaway and non-runaway adolescents evaluated at a Child Advocacy Center (CAC) in Minnesota, which had implemented a referral program to assess runaways for potential sexual assault or sexual exploitation.

METHODS

A cross-sectional analysis of self-report and chart data for the 489 adolescent girls who were evaluated between 2008 and 2010. Chi-square and t-tests by runaway status compared abuse experiences, trauma responses, health issues, and potential protective assets associated with resilience between runaways and non-runaways. Bivariate logistic regressions explored the relationship of these risk and protective factors to self-harm, suicide attempts, and problem substance use, separately for runaways and non-runaways who had experienced sexual abuse.

RESULTS

Runaways were significantly more likely than non-runaways to have experienced severe sexual abuse, to have used alcohol and drugs, and reported problem substance use behavior, higher levels of emotional distress, more sexual partners, and they were more likely to have a sexually transmitted infection (STI). Runaways had lower levels on average of social supports associated with resilience, such as connectedness to school, family or other adults. Yet higher levels of these assets were linked to lower odds of self-harm, suicide attempt and problem substance use for both groups.

CONCLUSIONS AND IMPLICATIONS

CACs should encourage referrals of runaway adolescents for routine assessment of sexual assault, and incorporate screening for protective factors in addition to trauma responses in their assessments of all adolescents evaluated for possible sexual abuse, to guide interventions.

Parental support for the human papillomavirus vaccine

This study examined support for the human papillomavirus (HPV) vaccine among a representative sample of Minnesota parents after approval from the U.S. Food and Drug Administration. Support for the vaccine was high; 87% supported its use. Although individual characteristics predicted support, support was high across subgroups with two-thirds or more of parents supporting the vaccine.