Introduction Sickle cell disease (SCD) is an inherited hemoglobinopathy that predominantly affects African Americans in the United States. The disease is associated with complications leading to high healthcare utilization rates, including emergency department (ED) visits and hospitalizations. Optimal SCD care requires a multidisciplinary approach involving SCD specialists to ensure preventive care, minimize complications and prevent unnecessary ED visits and hospitalizations. However, most individuals with SCD receive sub-optimal care or are unaffiliated with care (have not seen an SCD specialist). We aimed to identify barriers to care from the perspective of individuals with SCD in a multi-state sample. Methods We performed a multiple methods study consisting of surveys and interviews in three comprehensive SCD centers from March to June 2018. Interviews were transcribed and coded, exploring themes around barriers to care. Survey questions on the specific themes identified in the interviews were analyzed using summary statistics. Results We administered surveys to 208 individuals and conducted 44 in-depth interviews. Barriers to care were identified and classified according to ecological level (i.e., individual, family/interpersonal, provider, and socio-environmental/organizational level). Individual-level barriers included lack of knowledge in self-management and disease severity. Family/interpersonal level barriers were inadequate caregiver support and competing life demands. Provider level barriers were limited provider knowledge, provider inexperience, poor provider-patient relationship, being treated differently, and the provider’s lack of appreciation of the patient’s SCD knowledge. Socio-environmental/organizational level barriers included limited transportation, lack of insurance, administrative barriers, poor care coordination, and reduced access to care due to limited clinic availability, services provided or clinic refusal to provide SCD care. Conclusion Participants reported several multilevel barriers to SCD care. Strategies tailored towards reducing these barriers are warranted. Our findings may also inform interventions aiming to locate and link unaffiliated individuals to care.
Alternative schools are popular interventions for marginalized students, including students with disabilities, but little research has focused on professionals in these settings. Today, close to 11,000 public alternative schools or programs are believed to exist in the United States education system (Foley & Pang, 2006) and as many as one million students are currently attending alternative learning programs in the United States (Lehr, Tan, & Ysseldyke, 2009). While public alternative schools can vary from one another in many ways, they exist to serve youth marginalized in traditional public settings. In this study, we explore the ways teachers, administrators, and nurses in alternative settings collaborate to support mentally healthy school environments for marginalized student populations. Drawing on the process of rationale development ( Hawley & Crowe, 2016 ; Hawley & Jordan, 2014 ; Shaver, 1977 ; Shaver & Strong, 1982) as rooted in social studies education, we explore the perceived purposes of these professionals as they work with some of the nation's most marginalized children. Through focus groups and one-on-one interviews, the data bridge social studies themes rooted in democracy and equity with special education themes of inclusiveness. This work offers insight into the rationales of teachers and professionals engaged in critical work, and provides a platform for helping professionals undergo the rationale development process.
Background: School nurses serve a critical role in academic settings, but evidence indicates that nurses may need help transitioning their generalist nursing training to the school environment (Camp). Continuing education (CE) can be an effective way for school nurses to develop the specialty skills needed for this practice environment (Gormley; Quinn & Smolinski), but a better understanding of how nurses engage in CE is needed to guide course development. The goal of this study is to describe how South Carolina school nurses engage with CE to guide future CE development efforts. Method: A qualitative descriptive design was used to describe engagement in CE for 24 participating South Carolina school nurses. Results: School nurses experienced CE as a process that included deciding to attend, experiencing the course, and implementing practice change. Subthemes relevant to these steps also emerged. Conclusion: For school nurses, CE is a process and is not perceived as a one-time event. Design recommendations and strategies are presented. [ J Contin Educ Nurs. 2022;53(1):35–41.]
Advances in community and public health are needed to address contemporary health needs, particularly poor health outcomes related to the social determinants of health and inequity. Nurses are ideally placed to promote meaningful advances in community and public health, collectively referred to as population health. Nurse educators can promote a deeper understanding of core population health concepts by threading these concepts throughout the academic nursing curricula in addition to standalone population or public health courses. Strategies for incorporating population health concepts in a variety of courses can be conceptualized through the themes emphasizing context, honoring community voices, cultivating community connection, and fostering leadership in social responsibility. Nurse educators with expertise in population health can serve as a resource for faculty as these strategies are implemented. Teaching population health provides exciting opportunities for innovative approaches to facilitate students to link their practice to wider social contexts. Further steps to strengthen the public and community health workforce will still be needed to meet population health needs.
Continuing education (CE) can help school nurses achieve the unique competencies required for the challenges of an academic health setting. A comprehensive understanding of school nurse learning needs is necessary to guide CE development. The purpose of this study was to describe school nurse perceptions of their learning needs according to the Framework for 21st Century School Nursing Practice ™. The researchers analyzed data from 24 interviews with practicing school nurses using descriptive coding to identify perceived learning needs. Learning needs relevant to all areas of the framework were identified, with clinical judgment and team development emerging as priority areas for CE. These results illuminate school nurse perceptions of their own learning needs and can help guide the development of meaningful CE opportunities.
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