Social justice: added metaparadigm concept for urban health nursing

Historically, the nursing metaparadigm has been used to describe 4 concepts of nursing knowledge (person, environment, health, and nursing) that reflect beliefs held by the profession about nursing's context and content. The authors offer an assessment of the metaparadigm as it applies to community and public health nursing in urban settings and offer an amendment of the metaparadigm to include the central concept of social justice. Each of the metaparadigm concepts and the central concept of social justice is discussed as it applies to a model of urban health nursing teaching, research, and practice.     

Nursing students' knowledge and beliefs about care of older adults in a shifting context of nursing education

baumbusch j., dahlke s. & phinney a. (2012)?Nursing students' knowledge and beliefs about care of older adults in a shifting context of nursing education. Journal of Advanced Nursing68(11), 2550-2558. ABSTRACT: Aim. To a report a study of improvements in students' knowledge and beliefs about nursing care of older adults following completion of an introductory course with integrated adult/older adult content. Background. Nursing schools are under pressure to provide accelerated programmes to meet growing workforce demands and provide students with the knowledge they require to care for an ageing population. Thus, stand-alone courses in gerontological nursing are being eliminated and integrated with general adult content. The effect of this approach remains poorly understood. Design. A one-group pretest-post-test design was used. Methods. Data were collected between September-December 2010. Students completed the Palmore Facts on Aging Quiz, the Perceptions of Caring for Older People Scale, and open-ended questions about their experiences before and after completing a course with integrated adult/older content. Results. Students' knowledge and beliefs about nursing care of older adults demonstrated an important improvement following completion of the course. Qualitative findings reflected three themes: relating to older people; neglect by the system; having time to learn. Conclusions. Findings from this study suggest that even when integrated with general adult content, students' knowledge and beliefs about older adult care can be positively influenced. Furthermore research is needed to examine long-term integration of students' learning about older adult care. Nursing faculty with expertise in nursing care of older adults must develop resources and supports for their colleagues to build capacity among nurse educators and integrate older adult content throughout nursing programmes to enhance nursing practice with an ageing population.     

Health literacy and functional health status in Korean older adults

Aims and objectives. The aim of the study was to investigate the relationships of health literacy to chronic medical conditions and the functional health status among community‐dwelling Korean older adults. Background. In the literature, limited health literacy has been reported to have adverse effect on health outcomes. However, the link between health literacy to health status among Korean older adults needs to be clarified. Design. A cross‐sectional survey. Methods. A cross‐sectional survey of 103 community‐dwelling Korean older adults was conducted from June 2007–September 2007. Health literacy was measured using the Korean Functional Health Literacy test and functional health status was measured using the subscales of the Medical Outcomes Study 12‐item Short‐Form Health Survey. Results. Individuals with a low health literacy had significantly higher rates of arthritis and hypertension. After adjusting for age, education and income, older individuals with low health literacy had higher limitations in activity and lower subjective health. In a model adjusting for age and income only, older individuals with low health literacy were more likely to report lower levels of physical function and subjective health and higher levels of limitations in activity and pain. Conclusions. Among community‐dwelling Korean older adults, limited health literacy is associated independently with higher rates of chronic medical conditions and lower subjective health status. Relevance to clinical practice. Nurses are key to providing health education to older adults. The understanding of the relationship of health literacy to health status is essential to develop communication and health education efforts for older adults in nursing practice.     

Challenges and successes of infusing environmental health content in a nursing program

Environmental health has received minimal attention in nursing curricula over the past decade, despite efforts by the Institute of Medicine (1995) and others to advance the environmental health agenda in nursing education, practice, and research. This paper describes an initiative that was first funded as a part of the Environmental Health Scholars Program in 2000 to incorporate environmental health into master's and undergraduate nursing programs at one university. Evaluation of this initiative highlights the challenges and successes experienced in this academic setting. A number of recommendations based on this experience and the literature are offered. There is a perceived need to define the critical body of knowledge and skills in environmental health and to develop tools to enable educators and practitioners to apply this knowledge in public health nursing and other specialty practices. In tandem, opportunities and incentives are needed to encourage faculty development and the infusion of environmental health into existing curricula. Changes are also needed across practice settings to proactively address environmental health issues so that environmental health becomes and remains an integral part of nursing.     

Review article: Environmental heatstroke and long-term clinical neurological outcomes: A literature review of case reports and case series 2000–2016

Global temperatures are rising; extreme environmental heat can result in adverse health effects including heatstroke. Acute effects of heat are well recognised, but there is less understanding of potential long-term adverse outcomes. Our aim was to review recent medical literature for clinical cases of environmental heatstroke with a focus on neurological outcome. Structured search strategies were designed to retrieve publications of heatstroke case reports using Ovid Medline and Embase (2000–2016). One thousand and forty-nine abstracts were identified, and after application of exclusion criteria 71 articles deemed relevant. Ninety cases were identified from 71 articles. 100% presented with acute neurological symptoms; 87.8% presented with non-neurological symptoms. 44.4% patients recovered fully, 23.3% died, 23.3% suffered convalescent or long-term neurological sequelae, and in 8.9% no long-term follow up was available. 57.1% of the patients who died or had a neurological deficit had no documented co-morbidity. Patterns of neurological deficits included 66.7% patients with motor dysfunction, 9.5% cognitive impairment, 19% both motor and cognitive impairment and 4.7% other. In total 71.4% of the impaired patients had long-term cerebellar dysfunction. Adverse long-term neurological outcomes were common in surviving patients presenting with environmental heatstroke. Permanent neurological deficits were present in 34.4% of survivors where outcome was known; many were young, healthy individuals. Cerebellar injury was common suggesting cerebellar structures are vulnerable to heat. These findings highlight that people of all ages and pre-morbid states are at risk of severe heat-related illness. In the face of climate change, effective interventions for heat-related illness, including both treatment and prevention are necessary.     

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.     

Older adults' knowledge of pressure ulcer prevention: a prospective quasi-experimental study

hartigan i. , murphy s. & hickey m . (2011) Older adults’ knowledge of pressure ulcer prevention: a prospective quasi‐experimental study. International Journal of Older People Nursing 7 , 208–218
doi: 10.1111/j.1748‐3743.2011.00274.x Aim. To test an evidence base patient education leaflet to evaluate older adults’ knowledge of pressure ulcers and prevention strategies. Background. The increasing population of older adults living in the community managing chronic health conditions are at risk of pressure ulcer development. Education leaflets are a useful adjunct to reinforce healthcare professional’s verbal information to promote healthy lifestyles choices. However, little is known of the effectives of pressure ulcer prevention educational leaflets for older adults. Methods. A quasi‐experimental uncontrolled pre‐test, post‐test study of participants’ knowledge of pressure ulcer and preventative strategies was conducted. Community dwelling older adults (n = 75) were recruited to this study. Older adult’s knowledge was measured pre‐ and postdistribution of an education intervention. A risk assessment scale was recorded to identify whether this cohort of older adults were actually at risk of developing pressure ulcers. Conclusion. The results indicate that an education leaflet enhanced patients’ knowledge relating to pressure ulceration. Printed education materials increase knowledge and understanding which may lend to older adults adopting healthy behaviours. Implications for practice. An education leaflet can help older adults and their carers to be more empowered as active participants in reducing the incidence of pressure ulceration.     

Open the door whenever opportunity knocks

The Community Environmental Health Program/Community Outreach and Education Program (CEHP/COEP) New Mexico Center for Environmental Health Sciences has learned that listening and responding to opportunities that arise in local communities can be a more effective means of reaching health care providers, lay health workers, and community members than structured plans of action. While specific opportunities that have occurred in New Mexico may be unique, they are presented here with the hope that they might suggest new strategies to the reader and help to identify parallel opportunities in other communities. The paper is organized around three major opportunities to which CEHP/COEP has responded: (1) the need for more informed health care in communities with unique and complex environmental and occupational exposures due to their proximity to National Laboratories; (2) the need for resources on environmental health within local provider networks and issue-specific groups; and (3) the need for community environmental health projects within the College of Nursing. CEHP/COEP's responses, observations, and lessons learned through these experiences are discussed. In the end, the major lesson is that the ability to respond to opportunities requires flexibility and creativity; by sticking doggedly to plans, valuable-and sometimes more profitable and productive-opportunities may be missed.