Perspectives of individuals with sickle cell disease on barriers to care.

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.

School Nurse Perceptions of Continuing Education: Identifying the Process of Engagement.

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.].

Care Matters: Student Perspectives of Mental Health Determinants in an Alternative High School.

Public alternative schools in the United States are multifaceted educational entities that often serve students marginalized from traditional spaces, yet little research exists highlighting the perceptions of alternative school students regarding mental health-promoting school practices. In this qualitative study, the voices of seven alternative high school students (four female and three male) are presented through the use of a targeted focus group. The following two research questions guided this study: What aspects of the public alternative school environment do students perceive to facilitate their mental health? What aspects of public alternative school environments do students perceive as barriers to mental health? Using qualitative descriptive methods, findings suggested that for these students the alternative school is a unique institution, designed for them, in which they can thrive due to the caring nature of the professionals they encounter. Implications for practitioners dedicated to producing mental health-promoting, inclusive school spaces for marginalized youth are presented.

A Qualitative Exploration of School Nurse Continuing Education 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.

Strategies for embedding population health concepts into nursing education.

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.

Innovative Work Behavior of Middle School Faculty and Staff Related to Student Mental Health.

School nurses may find increased capacity to respond to student mental health needs by understanding and capitalizing on the innovative work behavior (IWB) of faculty and staff. The purpose of this study was to describe IWB related to student mental health among middle school faculty and staff as well as to determine the influence of selected individual characteristics, school characteristics, and behavioral health indicators on IWB related to student mental health. Multimethods of data collection were used including surveys, interviews, and publicly available school data. Data were described and relationships examined via correlational and multiple linear regression analysis and hierarchical linear modeling. The median IWB score was 41 (range 0-84) for faculty and staff participants. An increase in number of years worked in the K-12 environment was associated with less IWB related to student mental health. School nurses who explore IWB by faculty and staff may find opportunities to collaborate and improve student health outcomes.

Building a Community of Scholars: One Cohort's Experience in an Online and Distance Education Doctor of Philosophy Program.

BACKGROUND: Online and distance education is becoming increasingly common in higher education. As students explore graduate programs, they are often overwhelmed with the variety of program delivery options available. For graduate students pursuing a Doctor of Philosophy (PhD), a particular concern relates to building a community of scholars and how to do so through an online and distance learning program. METHOD: Through a review of literature and personal stories, this article will highlight innovative strategies utilized by a cohort of PhD students related to online and distance learning and developing a community of scholars. RESULTS: PhD students developed a community of scholars using innovative strategies to communicate and collaborate. CONCLUSION: Building a community of scholars is possible through online and distance education using simple forms of technology to connect and collaborate.