Improving access and provision of preventive oral health care for very young, poor, and low-income children through a new interdisciplinary partnership.

OBJECTIVES: We provided oral health care services at 2 sites using a nurse practitioner-dietitian team to increase dental workforce capacity and improve access to care for low-income preschool children. METHODS: Our team provided oral health assessments and education, fluoride varnish application, and dentist referrals. The primary endpoint was participants' access to oral health care. Secondary endpoints included increasing the practice scope of registered dietitians through training programs for oral health assessment and the application of fluoride varnishes for children. The oral health and hygiene and dietary habits of the participants were also determined. RESULTS: From 2010 to 2013, 4360 children received fluoride varnishes in 7195 total visits. Although the proportion of children with dental caries at the first visit was greater at the urban site, both sites were similar by visits 2 and 3. The number of caries declined with increased program visits, which coincided with an increase in the proportion of participants visiting a dentist. CONCLUSIONS: Progress toward eliminating dental health disparities requires addressing barriers to dental care access. We showed that expanding access to oral health services through nurse practitioner-dietitian cooperation improved access to preventive fluoride varnishing use in low-income children.

Expanding oral health preventative services for young children: a successful interprofessional model.

Progressive solutions are needed to solve the oral health chronic disease problem in the U.S. The importance of oral health coupled with urgent community oral health needs, shortage of primary providers, and emphasis on interprofessional collaboration make the timing ripe for allied health training and practice in oral health preventative services. A successful model is described that addressed the unmet oral health care needs of low-income and at-risk children. The model is a guide for integrating an oral health screen, fluoride varnish, anticipatory guidance, and dental referrals into allied health practice. An alternative oral health provider approach was used to address the low rate of early caries detection, preventative oral care, and access for underserved children. A comprehensive system for the administrative and clinical components of the project, including implementation plan, clinical protocols, prescriptive authority, a dental home referral system, clinical training and competency testing, was developed. The interprofessional project increased oral health services capacity and practice acceptance of oral health screening and fluoride varnishing among dietitians. Oral health care services provide allied health practitioners with unique opportunities to impact the poor access and unmet needs of at risk children and adults and to improve overall health.

The relevance of standards of professional school nursing practice.

This descriptive correlational study assessed school nurses' knowledge of and perceived relevance of the Standards of Professional School Nursing Practice. Of the 1,162 Ohio school nurses sent questionnaires, 345 returned usable questionnaires (30%). The typical respondent was a 50-year-old Caucasian woman with 24 years of nursing experience, 12 years of school nursing experience, and a caseload of 3 public schools serving 1,500 students. Factors that positively related to the school nurses' knowledge and perceptions of the relevance of the standards were age, advanced degree preparation, school nursing experience, and practicing in a metropolitan area. Factors that negatively related to knowledge and perceived relevance were practicing in a rural area and caseload of special needs students. Standards of practice provide a mechanism for defining and supporting practice roles for nurses. Thus, it is important to increase awareness and use of the standards, especially among school nurses practicing in rural areas.

Negotiating dyadic identity between caregivers and care receivers.

PURPOSE: To describe the ways in which caregivers (CGs) and their care receivers (CRs) negotiate the dyadic rules that influence how the care experience "fits into" their lives and to suggest theory based on the data. DESIGN: This qualitative study was part of a larger, NIH-funded study of 60 care dyads and their use of respite care in the Midwestern United States. The sample for this analysis included 60 informal CGs and CRs in their home settings. Data collection for the larger study began in 1994 and continued through 1998. METHODS: CGs and CRs were interviewed in their homes with one researcher interviewing the CG regarding the care experience while another researcher interviewed the CR. Qualitative content analysis was used to analyze the data. FINDINGS: The theory of CG and CR dyadic identity development, formulated in this study, indicates that a mutually agreed-upon care dyadic identity is developed when both parties negotiate a set of rules about their conduct together in the caregiving and care receiving relationship. Failure to agree on these dyadic rules may result in strain in the care process. Three archetypes of dyadic relationships were identified, based on the degree of immersion into a dyadic identity: (a) complete and mutually accepted immersion of an identity into the care process by both parties, (b) retention of personal identities while also accepting the caregiving or care-receiving roles, and (c) rejection of the roles by one or both parties. CONCLUSIONS: Negotiation was important in these dyadic care relationships, and thus attention to assisting CGs and CRs to develop negotiation skills is needed. More research is needed to substantiate and expand this theory of CG and CR dyadic identity development, and to examine linkages between negotiated processes and outcomes.

Spirituality in caregiving and care receiving.

Spirituality is a part of holistic care for clients and families. This qualitative, descriptive study examined spirituality in 60 caregivers and 60 care receivers, equally divided between Caucasians and African Americans. Themes were coping (subthemes of formal religion and social support) and meaning (subthemes of positive attitude, retribution or reward, and all encompassing). Needs of caregivers and care receivers include opportunities for formal religion (communion, prayer), social support (visiting, respite), and interactions to assist them find meaning in their caregiving and care receiving. Implications for nurses include collaborating with clergy to support the spiritual needs of caregivers and care receivers.

Teenage pregnancy among African-Americans: a qualitative examination of maternal education, teenage pregnancy, family dynamics, and conflict resolution.

This qualitative study is derived from interviews conducted during a larger quantitative study that examined facilitators and barrier to communication and negotiations in African American families whose teen daughters had one or more unwed teen pregnancies. Based on the larger study's findings that the education of the teens mother was a statistically significant factor in teen pregnancy, 17 robust interviews were analyzed in this study and sorted on variables of maternal education and teen pregnancies. From the analysis of the data, seven themes emerged. Findings indicated that almost all girls reported a lack of contact with a father and girls of higher educated mothers tended to have more supportive family structures than did girls of lower educated mothers. Most of the families rejected the teen pregnancy, although later some accepted the infant. In comparison to mothers with a higher level of education, mothers with a lower level of education leaned toward more absolutist and negative solutions without full discussions about ideas of sex with their teens. Discussion indicated the need for interventions based on negotiation principles and tactics.