Diane B. McNaughton

Development of a nurse home visitation intervention for intimate partner violence

BackgroundDespite an increase in knowledge about the epidemiology of intimate partner violence (IPV), much less is known about interventions to reduce IPV and its associated impairment. One program that holds promise in preventing IPV and improving outcomes for women exposed to violence is the Nurse-Family Partnership (NFP), an evidence-based nurse home visitation program for socially disadvantaged first-time mothers. The present study developed an intervention model and modification process to address IPV within the context of the NFP. This included determining the extent to which the NFP curriculum addressed the needs of women at risk for IPV or its recurrence, along with client, nurse and broader stakeholder perspectives on how best to help NFP clients cope with abusive relationships.MethodsFollowing a preliminary needs assessment, an exploratory multiple case study was conducted to identify the core components of the proposed IPV intervention. This included qualitative interviews with purposeful samples of NFP clients and community stakeholders, and focus groups with nurse home visitors recruited from four NFP sites. Conventional content analysis and constant comparison guided data coding and synthesis. A process for developing complex interventions was then implemented.ResultsBased on data from 69 respondents, an IPV intervention was developed that focused on identifying and responding to IPV; assessing a clients level of safety risk associated with IPV; understanding the process of leaving and resolving an abusive relationship and system navigation. A need was identified for the intervention to include both universal elements of healthy relationships and those tailored to a womans specific level of readiness to promote change within her life. A clinical pathway guides nurses through the intervention, with a set of facilitators and corresponding instructions for each component.ConclusionsNFP clients, nurses and stakeholders identified the need for modifications to the existing NFP program; this led to the development of an intervention that includes universal and targeted components to assist NFP nurses in addressing IPV with their clients. Plans for feasibility testing and evaluation of the effectiveness of the IPV intervention embedded within the NFP, and compared to NFP-only, are discussed.

Depression and Suicidal Ideation Among Mexican American School-Aged Children.

The purpose of this study was to describe depression and suicidal ideation rates in a community sample of 182 urban fourth and fifth grade Mexican American children using the Children’s Depression Inventory (CDI). We used a descriptive secondary data analysis design. The mean CDI score was 9.55 (SD = 5.8). Thirty-one percent fell in the depressed range using a clinical cut point of 12 and 7% fell into the depressed range using the non-clinical cut point of 19. Thirty-eight percent (n = 69) reported suicidal ideation. The depression rate was consistent with national rates. A non-clinical cut point of 19 showed that 87% of children reporting suicidal ideation were not identified as depressed. Many of these children do not report the most typical symptoms of depression. The results of this study provide school nurses with vital information to support efforts addressing the mental health needs of Mexican American children.

Regional Variations in Cancer Screening Rates Found in Women With Diabetes

Background: A review of the literature gives conflicting findings regarding gender-specific cancer screening rates found in women with chronic illness. Objectives: The purpose of this study was to determine if women with diabetes have different patterns of cancer screening than women of the general population, and if so, to identify the determinants of these screening patterns guided by the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model. Methods: The 12 states using the optional womens health module for the 2003 Behavioral Risk Factor Surveillance System were downloaded into the STATA software. Contingency tables were used to identify the prevalence of cancer screening in women who self-report that they have diabetes in comparison with women who report being nondiabetic. Logistic regression was used to examine the association between the PRECEDE model determinants and the screening behaviors. Results: No significant association was found between having a diagnosis of diabetes and having mammography screening rates (F = 1.5, p =.22). However, cervical cancer screening rates were statistically significantly different between the two groups of women (F = 39.01, p <.01). A gap in cervical cancer screening rates was identified among women with diabetes as compared with women without diabetes (78% versus 86%, respectively). Regional exceptions were noted between the 12 states. Ten of the 11 PRECEDE variables demonstrated a significant association with Papanicolaou test screening rates. The states demonstrating inadequate screening rates were the states with the most negative PRECEDE factors. Discussion: Research has shown that the primary reason women seek cancer screening is when they are encouraged by a healthcare provider. If other care providers are focused on disease management, nurses who provide holistic care can build on the advocacy role inherent in nursing and encourage screening in underserved areas of the country.

Clinical Trail Outcomes of the Mexican American Problem Solving Program (MAPS)

Depression among Mexican immigrant women and children exceeds national prevalence rates. Given the influence of maternal depression on children, a clinical trial testing the effects of the Mexican American Problem Solving (MAPS) program was designed to address depression symptoms of Mexican immigrant women and their fourth and fifth grade children (302 dyads) through a linked home visiting and after school program compared to peers in a control group. Schools were randomized to intervention and control groups. There were statistically significant improvements in the childrens health conceptions and family problem solving communication, factors predictive of mental health. Improvements in childrens depression symptoms in the intervention group approached statistical significance. These promising results suggest that refined school based nursing interventions be included in community strategies to address the serious mental health problems that Mexican immigrants face.

Problem Stabilization: A Metric for Problem Improvement in Home Visiting Clients.

BACKGROUND: Public health nurse (PHN) home visiting programs have been widely employed to improve life course trajectories for high risk mothers. Home visiting programs are often lengthy, during which PHNs simultaneously address multiple problems using diverse interventions over several client encounters. To manage PHN caseloads it is critical to understand the trajectory of client improvement and the optimal duration or services. PHN documentation data enable intervention trajectory research for specific client problems. A new metric called problem stabilization is proposed for evaluating interim improvement during PHN home visiting. Problem stabilization is an intervention pattern for a client problem that is characterized by co-occurring actions (i.e. teaching, guidance, and counseling; treatments and procedures; case management; and/or surveillance) during a client encounter; followed by surveillance actions only for that problem during a subsequent client encounter. The purpose of the study was to investigate problem stabilization during home visiting services for high risk mothers. METHODS: A retrospective cohort was created using family home visiting intervention documentation data from a local Midwest public health agency over a six year period (2000-2005). The data set consisted of Omaha System interventions for 720 high risk mothers. Analysis was conducted using descriptive statistics and Kaplan Meier curves. RESULTS: On average 30.1% of the time, client problems stabilized before discharge. Stabilization patterns differed by problem. Time to stabilization was longest for Caretaking/parenting and Antepartum/postpartum problems, and shortest for Residence and Mental health problems. CONCLUSIONS: Problem stabilization, a proposed intermediate outcome of PHN home visiting care, appears to be meaningful in describing client response to PHN intervention. This metric is an example of meaningful use of structured clinical electronic health record data for program evaluation and clinical decision support.

Determinants of Obesity in the Hispanic Preschool Population: An Integrative Review

OBJECTIVE(S) The purpose of this integrative review was to identify factors associated with obesity in Hispanic preschool children. DESIGN AND SAMPLE Integrative research review based on strategies described by Whittemore and Knafl. Thirty-five research reports using qualitative and/or quantitative methods and including a majority of participants (parents or preschool-aged children) of Hispanic ethnicity. MEASURES Data were analyzed using the Matrix Method. RESULTS Decreased physical activity of the child and increased maternal body mass index were found as contributors to obesity in the preschool, Hispanic population. The relationship between maternal feeding practices and beliefs, food choices and childhood obesity are widely studied with little consistency in findings across studies. CONCLUSIONS Public health nurses can work with communities to promote physical activity and safe outdoor places for exercise. In addition, they can advocate for the availability of healthy food choices in neighborhood schools. Maternal feeding practices, acculturation, and the childs environment require further research.

Efficacy of a Latino Mother–Child Communication Intervention in Elementary Schools

Children of Latino immigrants in the United States encounter ecological stressors that heighten their risk for depressive symptoms, externalizing behavior, and problems in school. Studies have shown that affirming parent–child communication is protective of child depressive symptoms and accompanying problems. The purpose of this study was to assess the efficacy of an adapted mother–child communication intervention for Latino immigrant mothers and their fourth- to sixth-grade children delivered after school. The intervention, Family Communication (“Comunicación Familiar”), was delivered at children’s elementary schools in six sessions lasting 2 hr each. Significant improvements were found in children’s reports of problem-solving communication, with their mother and mothers’ reports of reduced family conflict. Strengths of the intervention are improved mother–child communication, acquisition of communication skills that can transfer to relationships within the classroom, and a design that allows delivery by nurses or other professional members of the school support team.

Adaptation and Feasibility of a Communication Intervention for Mexican Immigrant Mothers and Children in a School Setting.

Children of Mexican immigrants are exposed to multiple ecological risks that heighten their likelihood of experiencing depressive symptoms. In previous studies, affirming parent–child communication has been found to be protective against depressive symptoms in Hispanic youth. Interventions focused on enhancing communication between parents and youth have the possibility of strengthening protective factors for children. The aims of this study were to (1) adapt an evidence-based parent–child communication intervention (Mission Possible) for cultural relevance for low-income, low-literacy Mexican immigrant mothers and their children and (2) assess feasibility of delivering the adapted intervention in a school setting. Adaptation took place in a series of focus groups of mother–child dyads. The revised intervention was delivered to 27 mother–child dyads in two elementary schools. Feasibility was supported by high participant satisfaction, 80% attendance rate, and 75% retention rate. This preliminary work suggests strategies for school nurses to partner with immigrant families and outlines a potential intervention that expands the school nursing role.

A Systematic Review of Literature on Culturally Adapted Obesity Prevention Interventions for African American Youth

Obesity and overweight prevalence in African American (AA) youth continues to be one of the highest of all major ethnic groups, which has led researchers to pursue culturally based approaches as a means to improve obesity prevention interventions. The purpose of this systematic review was to evaluate culturally adapted obesity prevention interventions targeting AA youth. A search of electronic databases, limited to multicomponent culturally adapted obesity prevention controlled trials from 2003 to 2013, was conducted for key terms. Eleven studies met inclusion criteria. We used the PEN-3 model to evaluate the strengths and weaknesses of interventions as well as to identify cultural adaptation strategies. The PEN-3 model highlighted the value of designing joint parent–youth interventions, building a relationship between AA mentors and youth, and emphasizing healthful activities that the youth preferred. The PEN-3 model shows promise as an overarching framework to develop culturally adapted obesity interventions.

Directions for Refining a School Nursing Intervention for Mexican Immigrant Families

Mexican immigrant mothers and their children encounter many stressors as they adapt to life in the United States. This article reports a secondary data analysis from a school-based home visiting program focused on assisting Mexican immigrant mothers and their children develop problem-solving strategies in dealing with stressors. Data were abstracted from home visiting records to determine the types of problems Mexican immigrant mothers chose to discuss with nurses. Nine categories of problems were developed from the data. Problems most frequently identified by mothers were family health concerns and access to health care, parenting and financial concerns. Findings and implications for school nursing practice are discussed.