ABSTRACT
We examined the benefits of a collaboration between the Indian Health Service and an academic medical center to address the high rates of unintentional drug overdose in American Indians/Alaska Natives. In January 2015, the Indian Health Service became the first federal agency to mandate training in pain and opioid substance use disorder for all prescribing clinicians. More than 1300 Indian Health Service clinicians were trained in 7 possible 5-hour courses specific to pain and addiction. We noted positive changes in pre- and postcourse knowledge, self-efficacy, and attitudes as well as thematic responses showing the trainings to be comprehensive, interactive, and convenient.
Subject(s)
Analgesics, Opioid/therapeutic use , Education, Medical, Continuing/organization & administration , Opioid-Related Disorders/ethnology , Pain Management/methods , United States Indian Health Service/organization & administration , Academic Medical Centers/organization & administration , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Attitude of Health Personnel , Computer-Assisted Instruction/methods , Cooperative Behavior , Health Knowledge, Attitudes, Practice , Humans , Indians, North American , Inuit , Opioid-Related Disorders/diagnosis , Opioid-Related Disorders/prevention & control , Practice Patterns, Physicians' , Self Efficacy , United StatesABSTRACT
The Baby-Friendly Hospital Initiative (BFHI) increases exclusive breastfeeding. Breastfeeding protects against obesity and diabetes, conditions to which American Indians and Alaska Natives are particularly prone. As part of the First Lady'sLet's Move! in Indian Countryinitiative, the US Department of Health and Human Services' Indian Health Service (IHS) began implementing the BFHI in 2011. The IHS administers 13 US birthing hospitals. There are 5 tribally administered hospitals in the lower 48 states that receive IHS funding, and the IHS encouraged them to seek Baby-Friendly designation also. In the 13 federally administered hospitals, the IHS implemented a Baby-Friendly infant feeding policy, extensive clinician training, and Baby-Friendly compatible medical records. All hospitals also became compliant with the World Health Organization's International Code of Marketing of Breast-Milk Substitutes. Strategies and solutions were shared systemwide via webinars and conference calls. Quality improvement methods, technical assistance, and site visits assisted with the implementation process. Between 2011 and December 2014, 100% (13 of 13) of IHS federally administered hospitals gained Baby-Friendly designation. The first Baby-Friendly hospitals in Arizona, New Mexico, North Dakota, Oklahoma, and South Dakota were all IHS sites; 6% of all US Baby-Friendly hospitals are currently IHS hospitals. One tribal site has also been Baby-Friendly designated and 3 of the 5 remaining tribally administered hospitals in the lower 48 states are pursuing Baby-Friendly status. Baby-Friendly Hospital Initiative implementation systemwide is possible in a US government agency serving a high-risk, underprivileged population. Other systems looking to implement the BFHI can learn from the IHS model.
Subject(s)
Breast Feeding/ethnology , Health Policy , Health Promotion/organization & administration , Health Services, Indigenous/organization & administration , Indians, North American , Postnatal Care/organization & administration , United States Indian Health Service/organization & administration , Female , Health Promotion/methods , Hospitals, Maternity/organization & administration , Humans , Infant , Infant, Newborn , Postnatal Care/methods , United StatesSubject(s)
Health Promotion , Healthcare Disparities , Indians, North American/psychology , Infant Care/organization & administration , Maternal Health Services/organization & administration , Mothers/psychology , Postnatal Care/organization & administration , Alaska/ethnology , Breast Feeding/psychology , Female , Health Promotion/organization & administration , Healthcare Disparities/ethnology , Hospitals , Humans , Indians, North American/ethnology , Infant , Infant, Newborn , Maternal Health Services/standards , Organizational Policy , PregnancyABSTRACT
The purpose of this paper is to describe the results of a survey of advanced practice nurses (APNs) to determine the activities they perform related to caring for patients with addictions and or co-occurring mental health disorders, the amount of addictions education in their graduate programs, and their perceptions of the value of addictions education for their role. Data were obtained from 233 APNs in New York State using a tool adapted from a previous job analysis survey. APNs reported the greatest amount of experience in history taking for various types of addictions and co-occurring mental health disorders and least amount of experience in performing objective exams, using standardized screening tools, ordering related diagnostic tests, prescribing pharmacological treatments, and making referrals for addiction treatment. Respondents reported a mean of less than three hours addictions education in their graduate programs in contrast to their high perceived importance of this clinical area.
