Emma Mitchell

International Experiences in Nursing Education: A Review of the Literature

Service learning and study abroad opportunities have become increasingly popular in nursing education in the past decade. The purpose of this systematic review was to explore existing literature concerning global health experiences in nursing education. Twenty-three empirical articles from 2003 to 2010 were reviewed, building upon existing reviews of international nursing education literature. Research on two-way exchange experiences and models for best practice were found to be lacking. While an array of countries were represented as the visiting or hosting side of the experience, few co-authors from host countries were found, particularly in literature originating from the U.S. The authors recommend that two-way exchange programs be evaluated to identify successful strategies and barriers to success. Ongoing evaluation of exchanges is necessary to ensure continued sustainable partnership and exchange in immersion experiences for nursing students.

Conceptual Model for Partnership and Sustainability in Global Health

Although nursing has a long history of service to the global community, the profession lacks a theoretical and empirical base for nurses to frame their global practice. A study using grounded theory methodology to investigate partnership and sustainability for global health led to the development of a conceptual model. Interviews were conducted with 13 global health nurse experts. Themes from the interviews were: components for engagement, mutual goal setting, cultural bridging, collaboration, capacity building, leadership, partnership, ownership, and sustainability. Next, the identified themes were reviewed in the literature in order to evaluate their conceptual relationships. Finally, careful comparison of the interview transcripts and the supporting literature led to the Conceptual Framework for Partnership and Sustainability in Global Health Nursing. The model posits that engagement and partnership must precede any planning and intervention in order to create sustainable interventions. This conceptual framework will offer nurses important guidance for global health nursing practice.

Legislative activity related to the human papillomavirus (HPV) vaccine in the United States (2006–2015): a need for evidence-based policy

State-based policies to mandate HPV vaccination are politically challenging and have received broad criticisms. There is a critical need to understand the legislative activities that underpin subsequent policy implementation. The objective of this policy analysis was to analyze state legislation that focused on HPV vaccination from 2006–2015. A content analysis was conducted among primary sources of legislative data from HPV vaccine-related bills, including using the National Conference of State Legislatures as a search-source. Findings reveal that much of the legislative activity occurred early after the HPV vaccination was introduced, and focused on increased information for parents, public financing, awareness campaigns, etc. Far fewer states focused on voluntary or mandatory vaccination. Understanding the barriers to achieving mandatory vaccination policy and implementation of such policies for HPV vaccines remains a public health priority.

Adverse Childhood Experiences and Cervical Cancer Screening

BACKGROUND Adverse childhood experiences (ACEs) have been associated with an increased risk of a variety of diseases, including cancer. However, research has largely ignored how ACEs impact cancer screening, a potential intermediate outcome. As such, the present study examined the association between ACEs and ever and recent use of Papanicolaou (Pap) test, among women aged 21 and older. MATERIALS AND METHODS Analyses used the 2009 Tennessee Behavioral Risk Factor Surveillance System (n = 1527) to model odds of ever and recently (within the last 3 years) engaging in Pap tests screening from nine different adversities. Bivariate and multivariate logistic regression models were run to accomplish this. RESULTS In bivariate and multivariate models, living in a household in which adults treated each other violently increased odds of ever receiving a Pap test. In bivariate models, physical and sexual abuse was associated with decreased odds of receiving a recent Pap test. After accounting for confounders, only the latter association remained significant. CONCLUSIONS Results highlight a potential mechanism by which early childhood experiences can impact the development of cervical cancer. Providers of care should consider modifications to their screening practices, including screening for child abuse, to better serve all women.

Colorectal cancer screening and adverse childhood experiences: Which adversities matter?

Adverse Childhood Experiences (ACEs) have been associated with an increased risk of a variety of diseases, including cancer. However, research has not paid enough attention to the association between ACEs and cancer screening. As such, the present study examined the association between ACEs and ever using colorectal cancer (CRC) screening, among adults age 50 and over. Analyses used the 2011 Behavioral Risk Factor Surveillance System (n=24,938) to model odds of ever engaging in CRC screening from nine different adversities. Bivariate and multivariate models were fit. In bivariate models, physical abuse, having parents that were divorced or separated, and living in a household where adults treated each other violently were associated with lower odds of engaging in CRC. In multivariate models that accounted for potential confounders, emotional and sexual abuse were each associated with higher odds of engaging in CRC. Results suggest potential pathways by which early childhood experiences can impact future health behaviors. Future research should examine this association longitudinally.

The Acceptability of Clean Delivery Kits on the Atlantic Coast of Nicaragua: A Focused Ethnography

Anecdotal reports suggest rates of puerperal sepsis/umbilical cord infection in the Southern Atlantic Autonomous Region (RAAS) of Nicaragua are high, as maternal/infant mortality rates are. Clean delivery kits (CDKs; sealed containers, clean razor blades, soap, string to tie umbilical cords, and clean plastic sheeting) have been shown to decrease perinatal infection rates in low-income countries. Participant observation, focus groups, and key informant interviews with parties involved in delivery practices and policies were conducted in this focused ethnography to determine the cultural acceptability of CDKs for midwives in the RAAS. The CDKs were acceptable in their contents, although remain controversial. Although evidence points to deliveries taking place at home without the use of sterile equipment, the Ministry of Health policy is for deliveries to take place in hospitals/health clinics.

Rural health nursing research review: global perspectives.

The CINAHL and MEDLINE databases were used to conduct a review of international rural nursing research published between 2003 and 2007. In total, 41 articles were reviewed and organized based on the United Nations Human development Index, which categorizes countries based on development status. Critical review of international rural nursing research yielded three major organizational themes: clinical issues, aspects of nursing practice, and nursing and health policy research. Despite the variety in international locale of the research, these themes and other common findings emerged. The need for increased access to specialized nursing knowledge, resources, and support is an ongoing issue facing nurses in rural and remote settings.

Using Twitter to Understand Public Perceptions Regarding the #HPV Vaccine: Opportunities for Public Health Nurses to Engage in Social Marketing

Objectives: Given the degree of public mistrust and provider hesitation regarding the human papillomavirus (HPV) vaccine, it is important to explore how information regarding the vaccine is shared online via social media outlets. The purpose of this study was to evaluate the content of messaging regarding the HPV vaccine on the social media and microblogging site Twitter, and describe the sentiment of those messages. Design and Sample: This study utilized a cross‐sectional descriptive approach. Over a 2‐week period, Twitter content was searched hourly using key terms “#HPV and #Gardasil,” which yielded 1,794 Twitter posts for analysis. Each post was then analyzed individually using an a priori coding strategy and directed content analysis. Results: The majority of Twitter posts were written by lay consumers and were sharing commentary about a media source. However, when actual URLs were shared, the most common form of share was linking back to a blog post written by lay users. The vast majority of content was presented as polarizing (either as a positive or negative tweet), with 51% of the Tweets representing a positive viewpoint. Conclusions: Using Twitter to understand public sentiment offers a novel perspective to explore the context of health communication surrounding certain controversial issues.

HPV vaccination series completion and co-vaccination: Pairing vaccines may matter for adolescents

Very little is known about the effect of concurrent co-vaccination on HPV series completion. This study utilized a retrospective review of a Clinical Data Repository to assess whether concurrent vaccination had an impact on HPV vaccination series completion, and whether there were differences based on age. 3371 patients who received the HPV vaccine at a single academic medical center between the years 2009-2013 were included in this analysis. The adjusted odds ratio (aOR) for effect of concurrent vaccination on series completion for the age group 9-18 was 1.32 (95% CI 1.09, 1.60). Although not statistically significant, the aOR for effect of concurrent vaccination on completion changed direction for the 19-25 age group and was 0.44 (95% CI 0.17, 1.12). This study provides preliminary evidence that pairing the HPV vaccine with one or more co-vaccines may yield a higher HPV vaccination completion rate among adolescents age 9-18.

Diabetes prevention and management among minority ethnic groups in Nicaragua: Findings from Phase 2 of a community-based participatory research study

Objectives: To (1) describe barriers to diabetes prevention and self-management, (2) explore how religious beliefs inform diabetes prevention and self-management and (3) describe community action strategies to address the problem of diabetes locally. Design: Qualitative, descriptive design. Setting: Three Moravian Churches located, respectively, in Bluefields, Pearl Lagoon and Tasbapounie on Nicaragua’s Southern Atlantic Coast. Methods: Using convenience sampling procedures, local church pastors or leaders, health professionals and local lay adults with or at-risk for type 2 diabetes were recruited. Structured by an interview guide, focus groups were conducted. Data were analysed using Krippendorff’s content analysis method. Results: Barriers to diabetes prevention and self-management behaviours included financial constraints, inconsistent availability of diabetes medications and testing supplies, and limited diabetes knowledge. Religious faith was identified as central in coping with the daily demands of preventing or self-managing diabetes. Community action strategies to address diabetes included (1) the formation of interdisciplinary diabetes teams, (2) church-based diabetes care and (3) public health announcements. Conclusion: Findings informed culturally sensitive diabetes prevention and self-management education through the identified community action strategies.