Use of a search model to enhance patient education in a clinical setting.

Many paths lead toward the goal of safe, high-quality health care. One component of this goal is to obtain current and relevant information for client care. Patients, as well as health care providers, use the World Wide Web to find information. With the growing number of documents on the Web, an organized approach to searching fosters locating desired material, evaluating authenticity and accuracy, and applying the material to the patient, student, or practitioner population, as appropriate. This article explores the use of a search model in a nurse-managed clinic for homeless and lower income patients. Nurses in a wide variety of settings use the search process described to locate useful health care information.

Meeting the health needs of homeless or low-income persons: role of the nurse practitioner.

Providing health care for homeless or low-income families presents many challenges and rewards. Nurse practitioners are in a unique position to make a positive impact on the health needs of this population. However, they need to think about the ramifications of their approach, assessment techniques, and intervention strategies to optimize the health care offered. We share our experience in working with this population and lessons we have learned from review of the literature.

Antiretroviral therapy for pediatric and adolescent HIV.

As the number of children infected in the HIV epidemic increases, the school nurse can play an important role in ensuring that these children receive comprehensive health care. Compliance with following an immunization program for HIV-infected children is a potential problem for various reasons. Many of these children come from homes where the mother also has HIV/AIDS. She is likely to be involved in keeping her family together, caring for her own health needs, and meeting financial and social needs of her family. Access to health care may be limited. The majority of vaccines administered within the first few months of life are parenteral and consist of inactivated antigens. Children or infants who are immunosuppressed may be unable to respond to the immunogen, thus rendering them susceptible to many infectious diseases. Heterosexual transmission and pregnancy compound the problems of HIV/AIDS (Flynn, 1994). Compliance following an immunization schedule becomes a greater challenge when working with the adolescent population. Parents may not understand that the risk of receiving vaccine, MMR for example, is less than the risk of severe complications associated with the diseases themselves. Coordination of care between the child, parent, and school district personnel is imperative to minimize the risk of further health-related problems of the HIV-infected child. Encouraging regular immunizations can decrease the child's susceptibility to infection, and administering medications properly can enhance the benefits of the drug therapy. An excellent resource for answering questions of school nurses related to HIV/AIDS is the National Pediatric and Family HIV Resource Center; contact Elaine Gross, R.N., M.S. at 1-800-362-0071.

Medications for early onset bipolar illness: new drug update.

The diagnosis and treatment of children and adolescents with Early Onset Bipolar Disorder (EOBD) constitutes one of the more controversial areas of child psychiatry today. Diagnosis is problematic because of overlapping symptom profiles with other childhood psychiatric disorders, some of which may be occurring co-morbidly. Attempts to deal with problematic behavioral patterns often lead to students receiving multiple psychotropic medications in addition to the mainstays of bipolar treatment, namely, mood stabilizers or thymolytics. The school nurse plays an important role in helping to identify and record behaviors which can assist in clarifying diagnoses and in monitoring responses to medications. The nurse's participation in educating and assisting these students to understand and optimize their drug therapy is critical to positive therapeutic outcomes.

A cardiovascular risk reduction program for the classroom.

A quasi-experimental, longitudinal study was conducted to test the effectiveness over a 1-year period of a cardiovascular risk reduction program for school-age children. The effectiveness of the program was measured with the children's knowledge of physiology of the heart and cardiovascular risk factors, their health habits, and their physical measurements. Ninety-eight children between the ages of 9 and 12 years participated in the study. The experimental group received a series of five 40-minute sessions on physiology of the heart, smoking, hypertension, diet, and physical activity. Short-term effectiveness of the program was found for the children's knowledge of physiology of the heart and smoking. Long-term effectiveness was found for running activity.

Continuous quality improvement and school nurses' problem solving methods.

The concept of continuous quality improvement is already well known in industry. It is, however, potentially applicable to any organization that provides products or services (health care and education) to customers (students and their families, teachers, etc.). In the present situation of increasingly complex health care needs of many students, continuous quality improvement--which involves problem solving and management techniques to effect services--is a relevant concept in the school setting.

Student experiential learning: a collaborative community practice project.

Theoretical and experiential learning in community assessment are essential components of the preparation of first-level community health nurses. This article describes a collaborative community practice project in which faculty incorporated senior baccalaureate community health nursing students as participants. Students assessed availability and utilization patterns of health care services in Spokane, Washington. Data derived from the survey were used by community planners in addressing issues of access to health care by low-income persons. Learning outcomes of this experiential process are described within the context of Burnard's Experiential Learning Model and community health nursing course objectives. Recommendations for design of similar experiential learning opportunities are made.

Community analysis: a collaborative community practice project.

Lack of access to health care is a concern in many communities. A group of representatives from health, social service, other community agencies and nursing education meet regularly to address issues in providing care to homeless, low-income, and uninsured persons in Spokane, Washington. This group's efforts has been hampered by lack of clearly identified factors that adversely affect access to care. One aspect of community analysis performed by this group used a collaborative community practice model. Community diagnoses were determined from information collected from service providers. Community health nursing faculty, as clinical specialists, can play a role in such a collaborative process.

Problem solving styles of school nurses.

School nurses are challenged on a daily basis to solve complex problems and generate creative solutions to meet the health needs of children. This study focused on how school nurses go about solving problems in the delivery of school health services. The results showed that school nurses' problem-solving style allows them to act as "bridgers" within the educational environment and to promote collaboration among many types of school personnel.

Cardiovascular risk factors in children: a Bloomsday research report.

Cardiovascular risk factors identified in major studies of children include a family history of heart disease, smoking, blood pressure, dietary factors, exercise or fitness level, and stress. The purpose of this descriptive study was to identify differences in children's physical measurements with regard to six cardiovascular risk factors. A descriptive design using three questionnaires and physical measurements was used. The questionnaires included the Bloomsday Cardiovascular Fitness Questionnaire, the Coronary Risk Profile, and the Diet Habit Survey. Physical measurements included blood pressure readings, weight, total serum cholesterol, and high-density lipoprotein levels. A convenience sample of 78, predominantly Caucasian children between the ages of 7 and 18 years (M = 13.13, SD = 2.79) participated. Results indicated that differences in physical measurements were significantly for children with respect to the cardiovascular risk factors, including dietary factors, blood pressure, exercise, and stress. Nursing implications for thorough assessment and intervention through education are discussed.

A program to prepare prospective school nurses.

In using case presentation as a means to integrate the three roles, a case example might be as follows: A child fell on the playground and cut his chin, which obviously needed stitches. The parents, because of their religious beliefs, were unwilling to accept medical assistance. To help prospective school nurses find a solution to this problem, they are first asked to use the nursing process to assess the child and the situation. Then, they are asked to discuss school policies and procedures related to this type of situation. Following these steps, students are asked to evaluate their value systems and how their values may affect their decision-making ability. Decisions they must make include determining the extent of the injury, conversing with the parents, deciding which school personnel need to be notified, and forming a final plan of care for the child. To complete requirements for initial certification, students submit names of school personnel, parents, students and their supervising nurse who, with the instructor, evaluate their final performance. Competencies are graded on a pass-fail basis with an opportunity to rewrite if necessary. A letter grade for the course is based upon completion of course objectives and assignments. School nurses who have an appropriate educational background are in a unique position to make significant contributions to the school-age child, family, educational staff, and community. School Nursing I is designed to give prospective school nurses the background they need to carry out their responsibilities.