Diane C. Martins

Assessment of Food Intake, Obesity, and Health Risk among the Homeless in Rhode Island.

OBJECTIVE The objective of this study was to examine the relationship between the nutritional status, incidence of food insecurity, and health risk among the homeless population in Rhode Island. DESIGN AND SAMPLE This correlational study utilized a convenience sample of 319 homeless adults from Rhode Islands largest service agency for the homeless. Information on use of services such as access to emergency foods, shelters, and the Supplemental Nutrition Assistance Program (SNAP) was requested. MEASURES Food security was measured by the six-item subset of the USDA Food Security Core Module. Anthropometric measures included height, weight, and waist circumference. A 24-hr dietary recall was collected to determine the food intake for a subset of participants who agreed to supply this information (n = 197). CONCLUSION Average dietary recall data indicated insufficient intake of vegetables, fruit, dairy, and meats/beans. It also indicated excessive intake of fats. Of the 313 participants, 29.4% were overweight and 39% were obese. Over 94% of the participants were food insecure, with 64% of this subset experiencing hunger. Fifty-five percent of the participants were currently receiving SNAP benefits. The majority of the sample was found to be food insecure with hunger.

Application of Critical Reflective Inquiry in Nursing Education

Critical reflective inquiry (CRI) is a method of inquiry developed by Kim (1999) to be applied in clinical practice to improve one’s practice as well as discover knowledge embedded in practitioner’s practice. The method is based on the philosophies and tenets of action science and critical philosophy, and encompasses three phases: descriptive, reflective, and critical. This chapter describes the application of CRI in a nursing education program with aims of instilling in students the mode of reflective practice and to learn not only through practicing in clinical situations but also from reflecting on and critiquing their clinical experiences. A qualitative analysis of a set of CRI reports revealed five themes in clinical practice that represented specific concerns and problems for the students. These five thematic areas are (a) client–nurse interaction and communication, (b) knowing the patient or patient identity, (c) nursing care, (d) ethics, and (e) interpersonal relationships with other health-care professionals. While these CRIs revealed the students’ insights into their own practice, students needed inputs from the faculty members to enrich their reflections and critiques. The findings of this analysis suggest that faculty members should consider these five areas as the basis for varying students’ clinical experiences so that students would gain experiences in a variety of problematic situations.

Critical interactionism: an upstream-downstream approach to health care reform.

Currently, per capita health care expenditures in the United States are more than 20% higher than any other country in the world and more than twice the average expenditure for European countries, yet the United States ranks 37th in life expectancy. Clearly, the health care system is not succeeding in improving the health of the US population with its focus on illness care for individuals. A new theoretical approach, critical interactionism, combines symbolic interactionism and critical social theory to provide a guide for addressing health care problems from both an upstream and downstream approach. Concepts of meaning from symbolic interactionism and emancipation from critical perspective move across system levels to inform and reform health care for individuals, organizations, and societies. This provides a powerful approach for health care reform, moving back and forth between the micro and macro levels. Areas of application to nursing practice with several examples (patients with obesity; patients who are lesbian, gay, bisexual, and transgender; workplace bullying and errors), nursing education, and research are also discussed.