Development of an International School Nurse Asthma Care Coordination Model.

AIM: To identify and compare how school nurses in Reykjavik, Iceland and St. Paul, Minnesota coordinated care for youth with asthma (ages 10-18) and to develop an asthma school nurse care coordination model. BACKGROUND: Little is known about how school nurses coordinate care for youth with asthma in different countries. DESIGN: A qualitative descriptive study design using focus group data. METHODS: Six focus groups with 32 school nurses were conducted in Reykjavik (n = 17) and St. Paul (n = 15) using the same protocol between September 2008 and January 2009. Descriptive content analytic and constant comparison strategies were used to categorize and compare how school nurses coordinated care, which resulted in the development of an International School Nurse Asthma Care Coordination Model. FINDINGS: Participants in both countries spontaneously described a similar asthma care coordination process that involved information gathering, assessing risk for asthma episodes, prioritizing healthcare needs and anticipating and planning for student needs at the individual and school levels. This process informed how they individualized symptom management, case management and/or asthma education. School nurses played a pivotal part in collaborating with families, school and healthcare professionals to ensure quality care for youth with asthma. CONCLUSIONS: Results indicate a high level of complexity in school nurses' approaches to asthma care coordination that were responsive to the diverse and changing needs of students in school settings. The conceptual model derived provides a framework for investigators to use in examining the asthma care coordination process of school nurses in other geographic locations.

Characteristics of violence among high-risk adolescent girls.

INTRODUCTION: Recent evidence demonstrates increasing rates of involvement with violence among adolescent girls. The objective of this study was to describe the types and sources of violence experienced within social contexts of adolescent girls at high risk for pregnancy. METHOD: Qualitative data for this analysis are drawn from intervention summary reports of 116 girls participating in Prime Time, a youth development intervention for adolescent girls. Descriptive content analysis techniques were used to identify types and sources of violence experienced by girls within their daily contexts. RESULTS: Types of violence included physical fighting, witnessing violence, physical abuse, gang-related violence, verbal fighting, verbal abuse, and sexual abuse. Sources of violence included family, peers and friends, romantic partners, community violence, and self-perpetrated violence. Many girls in this study experienced violence in multiple contexts. DISCUSSION: It is imperative that efforts to assess and prevent violence among adolescent girls include paying attention to the social contexts in which these adolescents live.

Prime time: 18-month violence outcomes of a clinic-linked intervention.

Prime Time, a youth development intervention, aims to reduce multiple risk behaviors among adolescent girls seeking clinic services who are at high risk for pregnancy. The purpose of the current study was to examine whether Prime Time involvement produced changes in relational aggression, physical violence, and related psychosocial and behavioral outcomes. Qualitative case exemplars illustrated social contexts of intervention participants with differing longitudinal patterns of relational aggression and physical violence. Data were from a randomized efficacy trial with 13-17 year-old girls (n = 253) meeting specified risk criteria. Intervention participants were involved in Prime Time and usual clinic services for 18 months, control participants received usual clinic services. Participants in the current study completed self-report surveys at baseline and 18 months following enrollment. Outcomes analyses revealed significantly lower levels of relational aggression perpetration in the intervention group versus controls. In contrast, Prime Time involvement did not result in significant reductions in physical violence. Exploratory dose-response analyses indicated that reductions in relational aggression may have been most pronounced among girls actively involved in Prime Time case management and peer leadership activities. Qualitative findings suggested that the intervention's emphasis on modeling and building supportive relationships contributed to reductions in relational aggression. This study contributes to what has been a very limited evidence base regarding effective approaches to preventing violence among high-risk adolescent girls. Findings suggest that offering youth development interventions through clinic settings hold promise in reducing violence risk among vulnerable youth.

The international school nurse asthma project: barriers related to asthma management in schools.

AIM: This article is a report of an international study of barriers to asthma care from the perspectives of school nurses in Reykjavik, Iceland and St. Paul, Minnesota, in the context of their schools, communities and countries. BACKGROUND: Globally, asthma affects the health and school performance of many adolescents. School nurses play a key role by providing care to adolescents with asthma in school settings. Understanding universal barriers to asthma management in schools is important for developing interventions that are effective in multiple societal contexts. DESIGN: Exploratory, descriptive study. METHODS: Parallel studies were conducted from September 2008-January 2009, through six focus groups among school nurses (n = 32, in Reykjavik n = 17 and St. Paul n = 15) who were managing asthma in adolescents. Focus groups were audio-recorded and transcribed verbatim in English or Icelandic. The Icelandic transcripts were translated into English. Descriptive content analytic techniques were used to systematically identify and categorize types of barriers to asthma care. RESULTS: School nurses in both countries identified common barriers, such as time constraints, communication challenges and school staff barriers. The primary difference was that St. Paul school nurses identified more socio-economic and health access barriers than school nurses in Reykjavik. CONCLUSION: Greater cultural and linguistic diversity and socio-economic differences in the student population in St. Paul and lack of universal healthcare coverage in the US contributed to school nurses' need to focus more on asthma management than school nurses in Reykjavik, who were able to focus more on asthma prevention and education.

Developing a family-centered participatory action research project.

The purpose of this article is to illustrate strategies used to design and implement a family-centered, participatory action research (PAR) project to meet the asthma information needs identified by English-, Hmong-, and Spanish-speaking parents of preschool children with asthma enrolled in a multisite, urban Head Start program. PAR is an approach that encourages researchers and those who will benefit from the research (e.g., families and community leaders) to work together in all phases of the project. PAR projects involve two core components: a needs assessment and action plan development. PAR is rooted in the cultural tradition of the participants and builds on strengths and resources in the community. Actively involving family participants and community leaders in community-based PAR projects increases the likelihood of developing interventions and resources that are culturally relevant and address family needs.

Addressing asthma management challenges in a multisite, urban Head Start program.

OBJECTIVE: To develop an action plan based on asthma management challenges identified by Head Start teachers in a multisite program. DESIGN AND SAMPLE: Qualitative, participatory action research project. Three focus groups were conducted with Head Start teachers (n=14), and 1 with Center managers (n=15) in an urban Midwestern program. MEASURES: Brief background questionnaire and semistructured focus group interview guide. Content analytic techniques were used to identify and categorize asthma management issues in transcripts of teacher focus groups. Center managers verified the findings and recommended action plan strategies to address asthma management challenges. RESULTS: Head Start staff identified 4 common challenges: (a) undiagnosed and unreported asthma, (b) coordinating asthma care with parents, (c) medication administration issues, and (d) variability among asthma action plans. The action plan focused on (a) early identification of asthma, (b) improving coordination of asthma care with parents, (c) developing more asthma education and resources for Head Start staff and parents, and (d) developing a standardized, comprehensive Head Start asthma action plan. CONCLUSIONS: Public health nurses can play a major role in ensuring quality care in Head Start programs by periodically identifying staff needs and developing strategies to address asthma management challenges.