Structural competency: A pilot study.

OBJECTIVE: The objective of this study is the use of structural competency (SC) as a tool to broaden the view of nursing students beyond individual, behavioral, biological, and cultural frameworks to encompass the structural determinants of health. DESIGN: This mixed-methods pilot study consists of a concurrent nested strategy in which close-ended, forced-choice questions are the drivers while open-ended questions are embedded therein. SAMPLE: The sample consists of second-year doctor of nursing practice students. MEASURES: The short-term impact is measured through the use of a survey tool. INTERVENTION: The 3-hr SC educational module focuses on six learning objectives: knowledge of structural terms, identifying SC effects on population and patient health; strategizing responses to these influences, student readiness to create change at the individual, organizational, and systems-level, identifying needed tools, and assessing empowerment and burnout. RESULTS: Students understand structural terms and are willing to create systemic change but lack necessary tools which may result in burnout. CONCLUSIONS: Careful thought about curricula incorporating SC and skills to offset the potential impact of burnout is needed.

Initial development of an attention-deficit/hyperactivity disorder visual analog scale for rapid assessment of medication effects.

Attention-deficit/hyperactivity disorder (ADHD) is a commonly occurring neurodevelopmental disorder in children and young adults. If under or inadequately treated, long-term morbidity, mortality, increased social, and health care costs may follow. Standardized assessment tools aid in accurate diagnosis and ongoing treatment modifications; however, they are underused by providers at follow-up visits. This article discusses the development of an assessment tool, presents initial data on the use of a nonstandardized visual analog scale (VAS), and re-emphasizes the importance of regular inclusion of standardized rating scales during periodic reassessments. A targeted literature search of PubMed, Articles+, ERIC, CINAHL, and Google Scholar was performed and findings were reported. An interview with the developer was conducted along with a chart review comparing those using and not using the VAS. The use of the VAS may improve appointment efficiency and result in more thorough symptom assessment. Introduction of the VAS may remind providers of the importance of using standardized tools to reassess all ADHD symptoms regularly. Furthermore, the need for practice efficiency highlights the value of standardization of this VAS.

A pedagogy of social justice for resilient/vulnerable populations: Structural competency and bio-power.

BACKGROUND: Nursing schools frequently assert the importance of social justice curriculum, but little information is available about specifics for such a class. PURPOSE: The purpose of this article is to describe a class that builds a foundation for the understanding of social justice and the pedagogical frameworks on which it rests. METHODS: The authors develop a class grounded in bio-power and structural competency. DISCUSSION: Described are topics presented to students, the rationale for their selection along with class activities and implementation challenges. Highlighted is the use of praxis as students incorporate the components of structural competency and bio-power. The focus is on the potential for public health and advanced practice registered nurses to recognize and evaluate structural factors in patient and population-based care. CONCLUSION: Faculty meet substantive challenges in teaching social justice, including lack of recognition of societal forces which affect student's ability to provide care. Focused effort incorporating newer structural and philosophical frameworks in a social justice class may improve the provision of health services. The frameworks of structural competency and bio-power provide a critical paradigm salient in social justice pedagogy.

Building a clinical ladder for ambulatory care.

Finding innovative rewards for nursing service will be integral in meeting the challenges of future shortages of nursing staff. A clinical ladder is one tool worth exploring and perfecting to address those challenges. Exploration of a case study demonstrates a method for developing a clinical ladder. Steps and pitfalls in developing a clinical path are illustrated. Future uses, benefits, and opportunities for clinical ladders are suggested.