Enhancing Healthier Birth Outcomes by Creating Supportive Spaces for Pregnant African American Women Living in Milwaukee.

Objectives Nationwide, African American women report higher stress levels and less access to pre- and postnatal resources. Wisconsin mirrors national infant mortality trends that show a persistent four-decade gap in infant survival between African American and White populations. The objective of the Milwaukee Birthing Project (MBP) was to implement a community-based health promotion intervention to improve birth outcomes for pregnant, low-income African American women, evaluate its effectiveness, and document its usefulness to inform development of future interventions. The project involved a mentoring and supportive relationship between 28 volunteer mentors (Sister Friends) and 20 pregnant women (Little Sisters). Methods The project implementation and evaluation were informed by the lifecourse perspective and a postcolonial feminist framework. Thematic analysis was used to analyze ethnographic data from monthly meetings and interviews with pregnant Little Sisters and Sister Friends. Results Our findings showed patterns both in community spaces and spaces created during the MBP. Program spaces contrasted with everyday life spaces and allowed women to experience community support. Based on our analysis, we classify these spaces as: (1) community spaces lacking support, (2) safe spaces of belonging and understanding, (3) spaces that foster meaningful interaction, and (4) safe, supportive spaces for other women in the future. Conclusions for Practice Future interventions should consider intentionally developing safe spaces to attain health goals. From a postcolonial feminist perspective, the voices of women who are at greatest risk for experiencing poor birth outcomes are crucial to the development of effective policies.

Using Omaha System Documentation to Understand Physical Activity among Rural Women.

OBJECTIVE(S): Examine factors related to physical activity among rural women using Omaha System data. DESIGN AND SAMPLE: Mixed methods: quantitative analysis of de-identified clinical data and thematic analysis of public health nurse (PHN) focus group data. Rural women who received PHN services (N = 852) and purposively selected PHNs (N = 12). MEASURES: Omaha System problems; signs/symptoms; knowledge, behavior, and status ratings; demographics. RESULTS: Physical activity behavior among rural women was inconsistently appropriate (M = 3.27). Age, body mass index, physiological, psychosocial, and environmental domain problems, and physical activity knowledge explained 33.2% of physical activity behavior variance. Almost all women for whom specific problems were documented had insufficient physical activity. This included physiological problems of cognition and pregnancy; psychosocial problems of abuse, caretaking/parenting, mental health, and interpersonal relationship; and environmental problems of neighborhood/workplace safety and income. Having problems in two or more domains was significantly associated with insufficient physical activity behavior (p < .001). PHNs validated findings and expressed concerns that client complexity, priorities, and time constraints may affect client assessment and documentation. CONCLUSIONS: PHNs should assess rural women who are not physically active for potentially serious physiological, psychosocial, and environmental problems. Departmental policies requiring assessment of Omaha System data across programs enabled population health measurement and research.

Evidence-based characteristics of nurse-managed health centers for quality and outcomes.

There are approximately 250 nurse-managed health centers (NMHC) in the United States, but there are few consistent descriptions of their functions and even fewer reports of their outcomes. Because NMHCs have been identified as a unique and effectual health care delivery care model (Patient Protection and Affordable Care Act), a description of their characteristics and a framework for outcome evaluation are required for their continued evolution and expansion. This study identifies the principal characteristics of U.S. NMHCs described in the professional literature through an integrative review and classifies these characteristics through a multistage qualitative analysis in relation to Donabedian's structure-process-outcomes model, a well-established model for evaluating quality in health care. This study yielded an evidence-based definition of NMHCs that is more reflective of current NMHC practice across settings and recognizes the full scope of nursing practice that is considered one solution to the health care crisis in the country. Using the results from this study, NMHCs will be able to structure self-evaluations of quality care and compare their quality related to structure, processes, and outcomes with other primary health care delivery systems.

Providing and funding breast health services in urban nurse-managed health centers.

Nurse-managed health centers (NMHCs) are an innovative health care delivery model that serves as an important point of health care access for populations at risk for disparities in health outcomes. This article describes the process and outcomes of clinical breast health services in two NMHCs located in a large Midwestern city. Findings indicate that client's knowledge about breast health was increased after they received breast health services from NMHC nurses. Significant positive changes in behavior related to the early detection of breast cancer were found in the study. NMHCs, identified for expansion in the Patient Protection and Affordable Care Act, offer a unique health care services delivery model that promotes access to care and early identification of breast cancer in very low-income and uninsured women.

An integrative review of information systems and terminologies used in local health departments.

OBJECTIVE: The purpose of this integrative review based on the published literature was to identify information systems currently being used by local health departments and to determine the extent to which standard terminology was used to communicate data, interventions, and outcomes to improve public health informatics at the local health department (LHD) level and better inform research, policy, and programs. MATERIALS AND METHODS: Whittemore and Knafl's integrative review methodology was used. Data were obtained through key word searches of three publication databases and reference lists of retrieved articles and consulting with experts to identify landmark works. The final sample included 45 articles analyzed and synthesized using the matrix method. RESULTS: The results indicated a wide array of information systems were used by LHDs and supported diverse functions aligned with five categories: administration; surveillance; health records; registries; and consumer resources. Detail regarding specific programs being used, location or extent of use, or effectiveness was lacking. The synthesis indicated evidence of growing interest in health information exchange groups, yet few studies described use of data standards or standard terminology in LHDs. DISCUSSION: Research to address these gaps is needed to provide current, meaningful data that inform public health informatics research, policy, and initiatives at and across the LHD level. CONCLUSIONS: Coordination at a state or national level is recommended to collect information efficiently about LHD information systems that will inform improvements while minimizing duplication of efforts and financial burden. Until this happens, efforts to strengthen LHD information systems and policies may be significantly challenged.

A systematic method to document population-level nursing interventions in an electronic health system.

Many public health electronic health systems lack the specificity to distinguish between individual- and population-based levels of care provided by public health nurses. Data that describe the broad scope of the everyday practice of public health nurses are critical to providing evidence of their effectiveness in promoting community health, which may not be fully appreciated in an arena of scarce resources. This article describes a method to document population-based nursing practice by adding population-based interventions to the nursing taxonomy underlying an electronic health information system. These interventions, derived from the Intervention Wheel, were incorporated into the Omaha System taxonomy, the conceptual framework for the Automated Community Health Information System (ACHIS), which is a longstanding data system used to capture nursing practice in community nursing centers. This article includes a description of the development and testing of the system's ability to capture the practice of the district public health nurse model. This method of adapting an existing data system to capture population-based interventions could be replicated by public health administrators interested in better evaluating the processes and outcomes of public health nursing and other public health professionals.

Inequitable access: provider characteristics and reimbursement policies of primary care office sites in Milwaukee.

INTRODUCTION: Availability of primary physician care is a key determinant of health care access. While inequities in access can be related to individual and health care system characteristics, this study focused on the organizational characteristics of the health care system and examined the availability and accessibility of primary care physician offices in Milwaukee, Wisconsin. METHODS: The study design was a secondary analysis of data extracted from a database of information about physician offices established for case management purposes. Analyzed data related to provider characteristics--geographic distribution, types of practice, hours of practice, and acceptance of new patients--and reimbursement policies. RESULTS: Results indicated there were barriers to primary care access in Milwaukee. Although the majority of physicians accepted new patients, most providers were available only during standard business hours, were located outside the center city, and limited acceptance of patients who were on Medicaid or had no health insurance. IMPLICATIONS: Access improves when there is a medical home and a single clinician coordinating patient health care. This is the role of primary care, and this study supports the need for expanded availability of primary care practitioners.

Community health: an evolutionary concept analysis.

TITLE: Community health: an evolutionary concept analysis. AIM: This paper is a report of a concept analysis of community health. BACKGROUND: Community health is a term that has been broadly used in both research and practice. Although local communities are invested in community health improvement, this process often occurs without a clear definition of the concept of community health. DATA SOURCES: Data sources included a sample of 537 papers covering the period 1990 to 2004 and representing the disciplines of nursing, public health, medicine and sociology and landmark works concerning community health, six community health assessment instruments and interviews with seven key community health informants. REVIEW METHODS: Rodgers' Evolutionary Method of Concept Analysis was used to design the study and analyse the data. The professional literature was analysed and compared with the use of the concept of community health in community health assessment instruments and by key informants. RESULTS: Dynamic and contextual, community health is achieved through participatory, community development processes based upon ecological models that address broad determinants of health. The primary focus of this collaborative work is population-based health promotion and disease prevention. CONCLUSION: The definition derived from the concept analysis of community health makes explicit the importance of community-based participatory action in local health improvement processes. Identification of the attributes of community health will enhance communication across disciplines involved in community health practice, research and education.

An Exploration of Hmong Women's Perspectives on Cancer.

PURPOSE: The purpose of this study was to explore the perspectives of Hmong women on cancer, using focus groups as the research method. METHODS: Two focus group interviews were conducted and the narrative data were analyzed using thematic content analysis. RESULTS: Themes that emerged from the focus group discussions included "fatalistic and 'black and white' thinking", "valuing rumors rather than scientific information", "strong adherence to traditional medicine", "male leaders controlling health care decisions", "embarrassment discussing women's bodies", and "preferred strategies in addressing cancer". CONCLUSION: Many Hmong people in the United States believe that both traditional and Western health care practices are effective, but when health professionals do not address differences in language, communication, and beliefs about health, trust between the provider and client may erode. The findings of this study provide new insight into the importance of cultural accommodation to improve early cancer detection in the Hmong community.

Community-based participatory action: impact on a neighborhood levelcommunity health improvement process.

BACKGROUND: The Riverwest Health Initiative (RHI) is a community-based participatory action (CBPA)-driven coalition. The group used several action models to create a community health improvement process (CHIP) uniquely suited for the neighborhood. The issues the coalition addressed and the processes used to inform community health improvement are described at the level of an urban neighborhood, including almost 7,000 households in six census tracts. OBJECTIVES: Describe the influence of conceptual models of CBPA on the development of a neighborhood CHIP. Demonstrate the effect of integrating CBPA and CHIP in acquiring locally relevant health information. METHODS: RHI incorporated resident input in developing a health assessment survey to augment epidemiologic data. The survey allowed neighborhood residents to describe their health status, behaviors, and health care utilization. It included perceptions about neighborhood support and safety, mental and emotional health, and other issues not usually captured in available epidemiologic data. RESULTS: Based on survey results and an iterative process of community input, residents identified health priorities that were more specific to their community than would have otherwise been available from traditional public health data sources. This information was used to inform the strategic planning process. CONCLUSIONS: The CHIP provided local data that helped practitioners to better target scarce resources to the specific health concerns of the community. Linking the processes of CHIP and CBPA allowed the RHI to be informed in an ongoing manner about the neighborhood's strengths and challenges.

Eleven years of primary health care delivery in an academic nursing center.

Academic community nursing centers (CNCs) emphasize partnership with the communities they serve to provide access to services that promote, restore, and maintain health. In this study, selected data from an 11-year clinical data set are presented to show the scope of academic CNC nursing practice, describe client services and expanded nursing roles, show the use of a computerized clinical documentation system in tracking nursing practice, and assess the usefulness of the Lundeen conceptual model. The study design was a retrospective review of computerized client record data. The setting was a CNC located in the neighborhood center of a large federally subsidized housing development. The sample was 25,495 client visits to the CNC. Visit data were coded and entered into a relational data management program to facilitate analysis. Findings show an expansion over time of nursing practice and client services that include strong case management and management of illness care. Findings also suggest that a computerized clinical documentation system that specifically tracks nursing practice is vital if nurses are to identify and eventually be reimbursed for client care specific to nursing practice. Finally, the Lundeen conceptual model was shown to be useful across the continuum of care provided at CNCs.