Judy Honig

Sleepless in America: Inadequate Sleep and Relationships to Health and Well-being of Our Nation's Children

OBJECTIVE. Our goal was to identify characteristics associated with inadequate sleep for a national random sample of elementary school–aged children (6–11 years) and adolescents (12–17 years). METHODS. Data from 68418 participants in the 2003 National Survey of Childrens Health were analyzed by using weighted bivariate and multivariate regression models. The dependent variable was report of not getting enough sleep for a child of his or her age ≥1 night of the past week. Independent variables included demographic characteristics, child health, school and other activities, and family life. RESULTS. Parents of elementary school–aged children with inadequate sleep were more likely to report that their child was having problems at school or had a father with fair or poor health. Parents of adolescents with inadequate sleep were more likely to report that their child had an atopic condition, frequent or severe headaches, a parent with less-than-excellent emotional health, or experienced frequent parental anger. Inadequate sleep in both age groups was associated with parental report that their child usually or always displayed depressive symptomatology, family disagreements involved heated arguing, or parental concern that the child was not always safe at home, at school, or in their neighborhood. CONCLUSIONS. Approximately 15 million American children are affected by inadequate sleep. Primary care providers should routinely identify and address inadequate sleep and its associated health, school, and family factors.

Delayed and Forgone Care for Children with Special Health Care Needs in New York State

Objective: To identify characteristics associated with delayed/forgone care for children with special health care needs (CSHCN) in New York State (NYS) as reported by their parents. Methods: Data come from NYS participants in the 2000–2002 National Survey of Children with Special Health Care Needs. Data were analyzed using weighted bivariate and multivariate regression models. The dependent variable was report of delayed/forgone routine health care. Independent variables included illness characteristics, potential and actual access to care, and provider care characteristics. Results: In NYS, 8.4% reported delayed/forgone health care for their child. Parents of children with delayed/forgone care were more likely to report that their child was uninsured (adjusted odds ratio [aOR] 3.8, 95% confidence interval [CI] 1.3–11.8), had experienced interrupted health insurance (aOR 3.9, 95% CI 1.5–9.7), or their child’s insurance was not adequate for CSHCN (aOR 3.6, 95% CI 1.4–9.1). Further, these parents were more likely to report that providers never spend adequate time (aOR 6.3, 95% CI 1.2–34.4), provide sufficient information (aOR 8.0, 95% CI 2.5–25.0), act as partners in care (aOR 6.7, 95% CI 2.3–19.7), or display cultural sensitivity (aOR 5.4, 95% CI 1.2–24.3). Conclusions: An estimated 40,771 NYS CSHCN experience delayed/forgone routine health care. Their families report two noteworthy barriers: inadequate or discontinuous insurance coverage and poor communication with health-care providers. Access to care for CSHCN can be improved by increasing consistent comprehensive insurance coverage and increasing sensitivity in relationships between health care providers and families of CSHCN.

Does assessing sleep inadequacy across its continuum inform associations with child and family health

INTRODUCTION The purpose of this study was to examine the prevalence and characteristics of children experiencing a continuum of inadequate sleep and its associations with child, family, and environmental variables. METHOD A secondary analysis of weighted responses of 68,418 parents or caregivers of children aged 6 to 17 years participating in the 2003 National Survey of Childrens Health was conducted. Inadequate sleep was categorized as mild, moderate, or severe. RESULTS Approximately one third of parents reported their childs sleep inadequacy as mild (18.6%), moderate (6.8%), or severe (5.8%). Age (P < .001), fair/poor health status (P < .001), frequent depressive symptoms (P < .001), and high parental stress (P < .001) demonstrated a progressive relationship from adequate to severe inadequate sleep. Controlling for child, family, and environment variables, parents of children with inadequate sleep were more likely to report frequent child depressive symptoms, high parental stress, and violent family conflict style. DISCUSSION Sleep inadequacy affects 15 million American children, 6 million at a moderate or severe level. Identification of inadequate sleep should prompt further assessment of its associated factors-depressive symptoms, parental stress, and family conflict-for targeted clinical intervention.

Using social network analysis to examine collaborative relationships among PhD and DNP students and faculty in a research-intensive university school of nursing.

The nursing profession has seen a dramatic rise in the number of schools offering both DNP and PhD nursing programs. Information is limited on the impact of this parallel approach in doctoral education on the quality and scope of scholarly interactions or institutional culture.The authors studied collaboration characteristics across the DNP and PhD programs of a research-intensive university school of nursing, before and after programmatic enhancements. An IRB-approved online survey was delivered to faculty and students of both programs at baseline and one year after curricular changes. Response rates were 70% and 74%, respectively. The responses were analyzed by using social network analysis and descriptive statistics to characterize the number and strength of connections between and within student groups, and between students and faculty. At baseline, the flow of communication was centralized primarily through faculty. At Time 2, density of links between students increased and network centralization decreased, suggesting more distributed communication. This nonlinear quantitative approach may be a useful addition to the evaluation strategies for doctoral education initiatives.

Nonsuicidal self‐injury among lesbian, gay, bisexual and transgender populations: an integrative review

AIMS AND OBJECTIVES To conduct an integrative review of nonsuicidal self-injury among lesbian, gay, bisexual and transgender populations to better understand the prevalence; to identify the lesbian, gay, bisexual and transgender subgroups at increased risk for nonsuicidal self-injury; and to examine the risk factors associated with nonsuicidal self-injury among lesbian, gay, bisexual and transgender populations. BACKGROUND Nonsuicidal self-injury, defined as intentional injury to the bodys surface without intent to die, is a significant mental health concern among adolescents and adults. Mental health disparities in lesbian, gay, bisexual and transgender populations, including anxiety, depression and suicidality, have been documented in the scientific literature with little focus on findings about nonsuicidal self-injury. DESIGN Integrative literature review of published quantitative and qualitative empirical research. METHODS A literature search of 11 on-line databases was conducted of articles published through April 2015. Keywords were used to identify articles about lesbian, gay, bisexual and transgender populations and nonsuicidal self-injury. RESULTS After screening by title, abstract and full text, 26 articles were included in this review. The literature synthesised demonstrates a consistent pattern of increased prevalence of nonsuicidal self-injury among sexual and gender minority populations compared with heterosexual peers. This body of literature indicates which subgroups of the lesbian, gay, bisexual and transgender populations appear to be at increased risk for nonsuicidal self-injury and which specific factors contributing to vulnerability to nonsuicidal self-injury among these populations. CONCLUSIONS Lesbian, gay, bisexual and transgender populations are at higher risk for nonsuicidal self-injury compared with the general population. Lesbian, gay, bisexual and transgender-specific and general risk factors appear to contribute to this heightened vulnerability. RELEVANCE TO CLINICAL PRACTICE Clinical nurses should screen for nonsuicidal self-injury and for sexual and gender minority identity in all of their patients. Comprehensive assessment of lesbian, gay, bisexual and transgender patients presenting with nonsuicidal self-injury may lead to identification of risk factors that can be addressed through nursing interventions. Nurse researchers and clinicians should take an active role in developing and implementing evidenced-based tailored interventions to reduce the higher vulnerability to nonsuicidal self-injury among lesbian, gay, bisexual and transgender populations.

Building Framework for Nursing Scholarship: Guidelines for Appointment and Promotion

As nursing academia responds to shifts in nursing education--the emergence of clinically focused doctoral degrees and an emphasis on evidence-based practice, comparative effectiveness, and translational research, nursing scholarship is undergoing transformation. This article outlines guidelines for appointment and promotion that incorporate the academic tripartite and are relevant for all faculty. A clear and equitable pathway for professorial advancement for the both the clinician and research faculty is delineated. Without such clarity and equity, the unique contributions of clinical and research scholars and the synergy that results from these distinctions will not be garnered. Although there is significant overlap in the criteria, there are also distinguishing scholarly activities and outcomes. For each standard at each rank, unique sample criteria of clinical and research scholarship are outlined and the shared scholarly activities that demonstrate the standard. Using an adaptation of Boyers model, the guidelines incorporate a broadened view of nursing scholarship and offer a framework for nursing academia that recognizes new ways of knowledge. Although recognizing the coexistence of science and practice, these guidelines offer a clear trajectory for advancement in the professorial role that applies an expanded perspective of and provide a framework for nursing scholarship.

DNP Portfolio: The Scholarly Project for the Doctor of Nursing Practice

The terminal scholarly project is an intrinsic component of doctoral education that affords the student the opportunity to integrate knowledge amassed during the course of study and provides a foundation for future erudition. We describe how Columbia University School of Nursing uses the portfolio as a comprehensive, competency-based assessment for Doctor of Nursing Practice students and propose that the portfolio is a preferred format for the terminal scholarly project for Doctor of Nursing Practice programs that focus on provision of direct care to a patient population.

Building the Next Generation of Advanced Practice Nurses Through Clinical Education and Faculty Practice: Three International Perspectives

Aims and Objectives: This article aims to provide an overview of the history of advanced practice nursing, including regulation, education, and faculty practice of nurse practitioners/advanced practice nurses from Australia, the United Kingdom, and the United States. Background: Clinical nursing education has evolved from the apprenticeship model to the multiple learning methods that are employed today. The faculty practice model has the most promise and maybe the new frontier to achieve excellence in clinical education. Design: Discursive paper. Methods: Advanced practice nursing clinical education will be discussed, current trends presented, and future educational directions considered. The essential characteristics of an effective clinical educator and the ideal context for clinical education will be highlighted with the goal of educating for clinical excellence. Contemporary practices of a nurse practitioner regulation and education will be examined. Conclusions: Faculty practice in advanced practice nursing requires critical elements, which include role modeling, financial sustainability, teaching credibility, translation of research to practice, and clinical expertise. Challenges to a functional context include conflicting regulatory issues, limited scope of practice, external agency restrictions, and lack of institutional support. Relevance to clinical practice: It is essential to understand the ideal characteristics and context for effective advanced practice clinical education and identify specific challenges within each country’s functional contexts that prevent effective advanced practice clinical education. Strategies to address these current challenges and to enhance clinical excellence to maximize the effectiveness of advanced practice nursing education.

Establishing a program of global initiatives for nursing education.

In the global nursing community, schools of nursing are increasingly developing initiatives and networks across national boundaries. This article describes the process undertaken at a school of nursing to determine its global health priorities and develop a program of global initiatives for nursing education. A series of meetings were held to determine faculty global activities and gauge interest in designing a 5-year strategic plan for the program. A volunteer Strategic Planning Work-group was convened to formalize a mission, vision, and strategic plan for the program, which were presented to, refined by, and vetted by an advisory board and the faculty at large. We recommend this process to schools committed to developing or expanding a program dedicated to global initiatives and a global perspective in educational planning. Involving stakeholders, building on current strengths, and aligning with mission and vision are essential elements for developing a meaningful program of global initiatives for nursing education.

A school-based clinic in a preschool

Primary health care in a school-based clinic (SBC) for preschoolers is examined. Based on personal experience, a PNP describes an actual preschool SBC. The benefits of an on-site service for this age group include periodic and accurate developmental assessments and screening procedures and improved compliance with treatments and referrals. The process of establishing an SBC is presented in terms of management, funding, and resources.