Perception of access to health care by homeless individuals seeking services at a day shelter.

Homeless individuals experience significant physical, mental health and substance abuse issues. This study describes the prevalence of health issues and perceptions of access to care among 300 homeless individuals who use a day shelter. Approximately 43% described a serious/chronic physical health problem, 53% a serious mental health problem, and 49% a substance use disorder. Those reporting a serious problem were more likely to have insurance and to report greater perceived access to care but perceived access to care was less than expected. Having insurance was also related to longer duration of homelessness. Targeting interventions to better match services to homeless individuals is the next challenge for advanced practice psychiatric and other nursing groups. Implications for doctoral level nurses in ways of evaluating models of care for this marginalized group are discussed.

Health information technology and physicians' perceptions of healthcare quality.

OBJECTIVES: To investigate the relationship between the use of health information technology (HIT) and physician perceptions of providing high-quality care and to determine whether this relationship has changed over time. STUDY DESIGN: We used 2 waves of longitudinal data from the Community Tracking Study Physician Surveys, 2000-2001 and 2004-2005. METHODS: Three measures of HIT were examined: a binary variable measuring the use of at least 1 type of HIT, a continuous variable measuring the total number of HIT types, and a binary variable measuring use of all 5 HIT types related to "meaningful use" of HIT as defined by Centers for Medicare and Medicaid Services. Three multivariate models were estimated to study the effect of each HIT measure on physicians' perception of providing high-quality care. Individual fixed-effects estimation also was used to control for individual time-invariant factors. RESULTS: Using at least 1 type of HIT significantly enhanced physicians' perception of providing high-quality care in 2000-2001, but not in 2004-2005. The marginal effect of adding 1 extra HIT type was positive and statistically significant in both periods. The association between using all 5 HIT types related to meaningful use and perceived quality was statistically significant in 2000-2001, but not in 2004-2005. CONCLUSIONS: Health information technology has become a multifunctional system and appears to have enhanced physicians' perception of providing high-quality care. Physicians' perceptions of medical care quality improved as the number of HIT types used increased. This study supports more extensive use of HIT in physician practices.

Effectiveness of a coordinated community effort to promote early literacy behaviors.

The purpose of this study is to report on the effectiveness of a coordinated, community-wide intervention to promote early literacy behaviors with low-income parents, especially parents with limited English language proficiency. The interventions include book distribution programs that were based in clinical settings, childcare centers and home visitation programs. The intent of these interventions was to communicate a message that reading to infants and young children and accessing services at the public library are beneficial. The methodology involved in the administration of a Community Based Parental Survey (CBPS) included questions related to early literacy behaviors in order to evaluate the effectiveness of these efforts. Two independent samples collected in 2001 and 2003 were compared. The data comparison between the two time periods showed a 77% increase in parents reporting that they showed books to their infants on a daily basis. There was also a 71% increase in parents reading books aloud to their children on a daily basis. Other indicators also improved. Establishing an early reading ritual encourages infants to have an association to books, helps in language acquisition and supports the social and emotional connection between a parent and his or her young child. The act of holding an infant and reading to him/her on a consistent basis can improve health literacy and hopefully improve student reading achievements. Early interventions like these are relatively low cost and can yield considerable long term results. We conclude that multi-level community based interventions show positive trends in promoting early literacy behaviors.

Assessment of patient simulation use in selected baccalaureate nursing programs in the United States.

INTRODUCTION: Newly graduated nurses are expected to possess clinical skills and the ability to critically judge quality in patient care. There are an increasing number of baccalaureate nursing (BSN) schools that are integrating the use of patient simulation (PS) in the educational experience of their students. This descriptive study examines the use of PS technology in selected BSN programs in the United States. METHODS: This study targeted National League for Nursing-accredited BSN schools with an online survey related to the current use of PS in course curriculum and how it is being used. Two hundred nine BSN schools were identified and 78 schools responded (37.3% response rate). RESULTS: Sixty (78.9%) BSN schools responded to the survey reported using patient simulators in core clinical nursing courses: health assessment, nursing fundamentals, medical/surgical nursing I and II, pediatrics, and obstetrics courses. Approximately 31% of schools reported using high-fidelity scenarios in more than 51% of their clinical courses. The responding schools indicate that they are using PS in the usual undergraduate nursing courses that coincide with clinical settings. The replacement of actual clinical hours with PS remains controversial and unresolved. Responses to an open-ended question indicated interest in using PS but that many schools are limited by not having a dedicated faculty to champion the way and resources to purchase the technology. CONCLUSIONS: Although there were limitations to this study, it is one of the first to describe the patterns of using PS in nursing schools for clinical education. As the use of this technology grows in BSN programs, addressing the issues resulting from this study are essential to understanding the use of this technology in nursing education.

How can we evaluate developmental care practices prior to their implementation in a neonatal intensive care unit?

Developmental care is designed to allow optimal neurobehavioral development of the preterm infant. The Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) associates various strategies and focuses on individualized, family-oriented care. Scientific evaluation of developmental care is needed. Randomized controlled trials are the basis for medical evaluation, but present some limitations for developmental care studies. Qualitative research and benchmarking could be of interest in this field of neonatal medicine.

Self-recognition of and provider response to maternal depressive symptoms in low-income Hispanic women.

BACKGROUND: One quarter of mothers of young children experience high levels of depressive symptoms, and only half are identified by themselves or their providers. Little is known about what factors influence maternal and provider recognition of depression. We use data from the San Mateo County, California, Prenatal to Three project to explore self-recognition, provider response, and referral among low-income Hispanic mothers of infants and toddlers. The goals are (1) to describe the patterns of self-recognition of maternal depression, maternal reporting of health professional response, and referrals for mental health services as related to depression severity and (2) to identify determinants of self-recognition, provider response, and mental health referrals. METHODS: Our sample consists of 218 nonpregnant Hispanic mothers in San Mateo County. Self-recognition was defined as an affirmative answer to the question, "Have you thought that you needed help with sadness or depression since your child was born?" High depressive symptoms were defined as a score of > or =10 on the Edinburgh Postnatal Depression Scale (EPDS). We performed chi-square and logistic regression analyses. RESULTS: Twenty-eight percent responded that they needed help with depression since the birth of their baby. Less than half discussed depressive feelings with their provider. Depression recognition factors differed between mothers and health professionals. CONCLUSIONS: Maternal depression is prevalent among Hispanic women on Medicaid but is not readily detected by women or providers. Women and providers use different cues to identify depression, possibly leading to communication discrepancies. Further research on the factors that influence self-recognition and provider recognition of maternal depression is needed.

Prevalence of maternal depressive symptoms in low-income Hispanic women.

BACKGROUND: Maternal depression can have significant repercussions for the health and well-being of mothers and children. In primarily white middle-income populations, approximately 15% of mothers experience depression. Among ethnically and socioeconomically diverse populations, the prevalence of maternal depression has not been as well established. However, the highest rates have been observed among low-income women. Because information about minority, underserved women is particularly sparse, we utilize data from the San Mateo County, California, Prenatal to Three project to describe the prevalence and self-recognition of depressive symptoms among low-income Hispanic mothers of infants and toddlers. METHOD: Telephone interviews of a random sample of women who received Medicaid and gave birth in San Mateo County provided our sample of 218 nonpregnant Hispanic mothers. High levels of depressive symptoms were defined as a score of > or =10 on the Edinburgh Postnatal Depression Scale (EPDS). We performed descriptive analyses and analyses of variance. RESULTS: Twenty-three percent of mothers reported high levels of depressive symptoms. Half of them recognized a need for help with depression. CONCLUSIONS: High levels of maternal depressive symptoms were prevalent among the Hispanic women on Medicaid, but only half of the women experiencing these symptoms identified themselves as needing help with depression.

A strength-based and early relationship approach to infant mental health assessment.

This paper presents a strength-based assessment process that focuses on infant emotional development within the family context. The assessment model, developed over the past five years within a preventive mental health program, represents a shift from deficit to strength-based principles that are consistent with appropriate developmental practice. The strength-based assessment process presented achieves an understanding of the infant's competencies and areas of need, and considers the negative impact that maternal mental illness has on the infant's emotional development.