Kate Shade

Choosing Fatherhood: How Teens in the Justice System Embrace or Reject a Father Identity

The purpose of this qualitative study was to further the understanding of father identity and role development among adolescents involved in the justice system. Youth who were expecting a child or parenting an infant and who were incarcerated, arrested, or had admitted to criminal behavior participated in interviews and observations in a juvenile detention center and in the community. Data analysis revealed 4 patterns of fathering intentions: (a) embracing fatherhood, (b) being barred from fatherhood, (c) being ambivalent about fatherhood, or (d) rejecting fatherhood. Community health nurses can use this information to assess father identity status and address factors that interfere with father engagement.

Evaluation of nursing dysphagia screening tools among patients with stroke: a systematic review protocol

Review question/ Objective The objective of this systematic review is to evaluate the effectiveness of two bedside screening tools used by nurses to assess for dysphagia among hospitalized adult patients with stroke. The two screening tools discussed are the Toronto Bedside Swallowing Screening Test and the 90‐cc Water Swallow Test. In adult patients with acute stroke, how effective is the Toronto Bedside Swallow Screening Test compared to the 90‐cc Water Swallow Screening Test in detecting dysphagia and predicting the risk of acquiring nosocomial aspiration pneumonia. Sensitivity, specificity, positive predictive value and negative predictive value will be utilized to evaluate the validity of these two dysphagia‐screening tools. Reliability of the two tools will be established. Video‐Fluoroscopy (VF) and Fibreoptic Endoscopic Evaluation of Swallowing (FEES) will be the gold standard to which the tools will be compared against. Background Stroke occurs when blood flow to the brain is stopped and the brain cells do not receive enough oxygen and begin to die.1 Once brain cells are damaged, signs and symptoms such as weakness, numbness, aphasia, dysphagia and other symptoms become apparent.1 Risk factors for stroke include hypertension, cardiac disease, diabetes, smoking and a history of stroke.1 There are three types of stroke: Transient Ischemic Attack (TIA), ischemic stroke and hemorrhagic stroke.1 TIA occurs when the blood flow to the brain is blocked for a short period of time, whereas ischemic stroke happens when blood clots or fatty deposits obstruct the blood flow to the brain and hemorrhagic stroke occurs when a blood vessel ruptures in the brain causing blood to exert pressure on the surrounding tissues.1 Stroke is considered to be the primary cause of dysphagia.2 Dysphagia is defined as difficulty with swallowing food or fluid.2 There are two types of dysphagia: oropharyngeal and esophageal.2 Oropharyngeal dysphagia is defined as the inability to pass food or fluid from the mouth to the esophagus.3 Esophageal dysphagia is defined as difficulty moving food or fluid through from the esophagus to the stomach.2 Oropharyngeal dysphagia is the most common type of dysphagia among patients with stroke.2 An estimated 42% to 67% of patients with stroke develop dysphagia within three days post‐event.3 Annually, the number of persons in the U.S. with stroke who experience dysphagia ranges between 160,000 and 573,000.4 Stroke can affect normal swallowing physiology by damaging areas of the motor cortex that controls the muscles involved in swallowing.5 An individual with a normal swallow can move the food or fluid from the mouth to the stomach in four phases, as described below: Oral preparatory phase: Food is masticated, mixed with saliva and is formed into a ball or bolus.6 Oral propulsive phase: The tongue helps the food to move into the oropharynx.6 Pharyngeal phase: The soft palate rises, larynx and hyoid bones move upward, while the vocal cords fold to the midline and the epiglottis covers the trachea. The tongue then pushes the bolus through the pharynx.6 Esophageal phase: The bolus passes through the esophagus. The squeezing motion of the throat muscles helps the bolus to move to the stomach.6 Of the four phases of the normal swallow process, only the oral and pharyngeal phases are affected when a patient experiences a stroke.6 Stroke patients have difficulty controlling the tongue and are unable to chew and swallow food particles as both the oral and pharyngeal phases of swallowing are impaired.6 When stroke patients are given fluids, they have difficulty holding the liquid in the oral cavity and therefore, the liquid may enter the pharynx hastily and cause aspiration. When there is impairment in the esophageal phase of swallowing, transport of food to the esophagus is affected.6 The food remains in the pharynx when the patient attempts to swallow, or swallows ineffectively.6 An estimated 40% to 50% of stroke patients with dysphagia aspirate.7 Aspiration is referred to as breathing in an object.8 Aspiration is caused by food particles or fluid droplets entering the airways and lungs.9 Silent aspiration occurs when a patient aspirates particles without exhibiting any signs or symptoms.10 It has been estimated that 40% to 70% of stroke patients suffer from silent aspiration.11 One third of stroke patients exhibiting signs and symptoms of aspiration will suffer from pneumonia that requires pharmacological treatment.12 Pneumonia that occurs during an inpatient episode and was not present on admission is considered to be “hospital‐acquired pneumonia” or nosocomial pneumonia.13(p.88) “Hospital‐acquired pneumonia” commonly results in increased hospital length of stay, with associated costs ranging from USD

Adolescent Fathers in the Justice System Hoping for a Boy and Making Him a Man

13,000 to

A conceptual model of incarcerated adolescent fatherhood: adolescent identity development and the concept of intersectionality.

16,000 per episode.3(p.3155) The mortality rate associated with pneumonia is three times higher in patients with dysphagia than in those without this condition.3 Dysphagia screening is important in early recognition of patients with dysphagia, who are at risk of developing aspiration pneumonia.14 Dysphagia screening should be performed on patients with acute stroke prior to giving food, fluids or medications.12 The dysphagia screening is a simple “clinical bedside exam” that determines: a) the presence of dysphagia; b) the need for a dysphagia evaluation by a speech language pathologist; c) whether the patient can receive food, fluids or medications; and d) whether a nutritional consult or intravenous fluid hydration is needed.15(para3)The American Speech Language‐Hearing Association recommends dysphagia screening as an initial assessment with a pass or fail outcome, to identify patients requiring further assessment and evaluation by a speech pathologist. If a patient fails the dysphagia screening, the patient cannot receive food or fluid by mouth until a speech language pathologist evaluates the patient.15 Video‐Fluoroscopy and FEES are considered to be the gold standard for identifying dysphagia and the risk of aspiration.16 Video‐Fluoroscopy provides dynamic images of the bolus during the swallowing process.16 The bolus can be tracked going through the alimentary tract when contrast materials such as barium sulfate are added.16 However, expensive equipment is required and the patient is exposed to radiation during this diagnostic test.14 The FEES test requires “trans‐nasal passage of flexible laryngoscope into the hypo‐pharynx” during the swallowing process so that the passage of food or liquids can be video‐taped.”16(p.478) The individual performing this test must be capable of executing the test safely.17 Although VF and FEES allow for accurate diagnosis of dysphagia and aspiration pneumonia, both tests are invasive and require trained staff.17 Bedside dysphagia screening tests are inexpensive, quick and may be equally useful in screening for dysphagia among stroke patients.16 Nurses have an important role in dysphagia screening; however, nurses must receive training to perform this task successfully.16 A speech language pathologist performs the dysphagia evaluation process that includes interview with patients/families, “observation, formulation and communication of the results and recommendations” to the physician responsible for the patient.15(para 4) There are a number of bedside dysphagia screening tools currently in use.12 The effectiveness of a screening tool is determined by its reliability, validity and clinical utility.12 Reliability is defined as the ability of the tool to provide consistent and stable results and is measured through a test‐retest method.17 Validity is measured by a tools sensitivity and specificity.17 Sensitivity refers to how successful a tool is in detecting patients with dysphagia, whereas specificity assesses how successful a tool is in detecting patients without dysphagia.18 Positive predictive value is defined as the percentage of stroke patients with positive screening tests that have dysphagia.18 Negative predictive value refers to the percentage of stroke patients with negative screening tests that do not have dysphagia.18 “The sensitivity and specificity are inversely proportional.”18(p.47)That is, the higher the value of sensitivity, the lower is the value of specificity.19 Leder and colleagues assess that while there is no consensus for a specified/defined parameter or value for sensitivity, an effective dysphagia screening tool should have a sensitivity value of 95% or greater.19 In the late 1990s and early 2000s, there was a movement to evaluate swallow screening tests.12 There was also an effort to identify the significant factors associated with dysphagia and risk of aspiration (e.g. abnormal gag reflex, dysphonia, dysarthria and cough after swallow).12 There was a mounting body of research demonstrating the need for a dysphagia screening tool with sufficient sensitivity, specificity and predictive strength, that could be administered by a frontline healthcare professional.12 By 2007, the American Heart Association/American Stroke Association guidelines recommended stroke patients be assessed for dysphagia prior to administering food, fluid or medication orally.12 In 2010, the Joint Commission (TJC) removed the dysphagia screening performance standard because the National Quality Forum (NQF) did not support this measure.12 The lack of support from the NQF was because no single dysphagia screening tool was identified as being “superior”.12(p.e.25) Therefore, studies published from 2007‐2014 will be considered for inclusion in this review. The data chosen indicate the period in which studies were being conducted to assess the validity, sensitivity and specificity of various dysphagia screening tools and identify an evidence‐based dysphagia screening tool. The two dysphagia‐screening tools recommended in the guidelines were the Toronto Bedside Swallowing Screening Test and the 90cc Water Swallow Screening Test.20 The Toronto Bedside Swallowing screeni

Mental Health Needs of Youth in Juvenile Justice: An Executive Summary

Using a constructivist grounded theory approach, we explored the development of father identity among boys involved in the juvenile justice system. Youth were recruited from a juvenile detention center and school district in a northern California county with a high teen birth rate. The participants were expecting a child or parenting an infant and had been arrested, incarcerated, or had committed a crime. We collected data through observations and individual interviews. Using constant comparative and dimensional analysis, we found that expectant adolescent fathers hoped for a boy and envisioned their central role as father to be making their son a man. This article contributes to greater understanding of father identity development for youth involved in the justice system. We suggest that teen parenting policies and programs include interventions sensitized by gender, accounting for the influence masculine ideals of manhood have on the development of father identity and the father–child relationship.