Maeve Howett

A Conceptual Model of Intentional Comfort Touch

This article discusses the application and integration of intentional comfort touch as a holistic nursing practice. A review of the literature on touch and its related concepts is included. Although nurses use touch frequently in patient encounters, it is not always used intentionally or deliberately to enhance care. The article compares and contrasts intentional comfort touch with nonintentional or procedural touch. The use of intentional comfort touch in innovative clinical settings with diverse and at-risk populations is described. Based on clinical experiences and the current literature, a conceptual model of intentional comfort touch is proposed. The application of touch is discussed as is the meaning and importance of intentional touch for students, faculty, and patients.

Designing a University-Based Lactation Course

A university-based lactation course was developed to provide lactation education to health care providers, with the goal of improving their knowledge, attitude, and skills in assisting American women to breastfeed. This is a key strategy for achieving the Healthy People 2010 objectives, and it addresses the identified need for education among health care professionals. The university as well as an enthusiastic lactation community provided multidisciplinary clinical experiences and classroom lectures to prepare public health students, nurses, midwives, and nurse practitioners to encourage and assist women in breastfeeding. It is hoped that the success of this class and the experiences of the instructors will motivate other lactation consultants to develop similar educational strategies.

An Innovative Approach to Enhance Dermatology Competencies for Advanced Practice Nurses: Service–Learning With a Migrant Farm Worker Health Clinic

The purpose of this article is to describe a novel service–learning opportunity for graduate nursing students that promotes competency in dermatology. A hybrid service–learning course with online didactic content is described, along with tools for evaluation of dermatology competencies. Student evaluation of the course is discussed, and selected research articles are reviewed. Advanced practice nursing and medical education frequently does not adequately prepare primary care providers to be competent in the assessment and management of dermatologic conditions. Embedding dermatology content in a service–learning program can optimize the provision of care, strengthen competencies in dermatology and inter-professional care, and allow students to gain a deeper understanding of the population with which they work. The innovative service–learning program presented is a model for advanced practice nursing education. Tools for evaluating clinical competency and courses often need validation.

Nightingale theory and intentional comfort touch in management of tinea pedis in vulnerable populations.

Vulnerable populations, specifically migrant farm workers and persons experiencing homelessness, are often at an increased risk for foot infections. This risk is related to their working and living conditions, socioeconomic status, limited access to health care, frequent exposure to wet environments, limited access to clean and dry socks and shoes, bathing or laundry facilities, and daily routines that requires them to be on their feet for long periods of time. After years of caring for these populations and hundreds of clinical encounters, an evidence-based, effective method of foot care that incorporates intentional comfort touch has been developed. This article describes methods for mitigating the severity of fungal growth, decreasing the risk of secondary infections, and improving skin integrity by manipulating the micro-environment of the patients’ feet. This includes fundamental aspects of hygiene as described by Florence Nightingale’s Environmental Theory that suggests that direct sunlight, fresh air, and cleanliness improves health.

Break the cycle of environmental health disparities in vulnerable children.

No abstract available.

Grandparents as Caregivers for Grandchildren with Intellectual and Developmental Disabilities

Although there are more grandparents raising grandchildren than at any other time in American history, the experiences of those caring for children with intellectual and developmental disabilities (IDD) has received scant attention. Even less is known about the health challenges and solutions characterizing these families. This chapter uses data collected from 45 grandparents raising grandchildren with IDD in the greater Atlanta metropolitan area to examine their caregiving experiences, with particular attention given to the health of both caregivers and children, and the obstacles and strategies associated with meeting their health needs. Community based organizations such as Innovative Solutions for Disadvantage and Disability and related programs (e.g., Project GRANDD or Grandparents Raising and Nurturing Dependents with Disabilities) play a critical role to this vulnerable population of caregivers charged with strategizing to ensure the well-being of their families.

The use of home-based caregiver assessment to improve children’s health: a pilot project

Abstract Background: Grandparents Raising and Nurturing Dependents with Disabilities (Project GRANDD) is a support program for grandparents who are the primary caregivers of grandchildren with developmental disabilities, chronic illness, and behavior or learning difficulties. A critical problem contributing to diminished quality of life for the family is the grandparents’ own poor health, as well as the lack of access to available resources. This project pairs nursing students from the local university with grandparents participating in the GRANDD support program to improve the caregiving grandparents’ health. Methods: A total of 12 nurse practitioner (NP) students were paired with six grandparents. Students performed home visits and assessments, health histories, environmental assessments, and windshield surveys over the course of several weeks. Follow-up visits for medication reconciliation, referral to resources, or for patient health education were conducted in person or via phone. Results: The grandparents’ demographic characteristics were as follows: African American females, on fixed incomes on or near poverty level, had multiple co-morbidities, and showed reluctance in seeking help because of their role as primary caretaker. Nursing students demonstrated increased awareness of the cycle of disability and disadvantage, and improved skills that enable them to aid vulnerable individuals in accessing community resources. Conclusions: This pilot program had a positive impact on students and grandparents. Much is needed regarding outcome measurement and standardization of methods, but the initial results demonstrated a beneficial relationship between NP students and Project GRANDD participants, thus contributing to the ongoing effort to break the cycle of disadvantage and disability in this vulnerable population.

Break the cycle of environmental health disparities in vulnerable children

Literature reflects life. The literature on children who grow up in circumstances of social and economic disadvantage is very much a part of the place and time. Charles Dickens (1812–1870) wrote much of children who suffered under the burden of being poor in 19th Century London. In that age of industrialization, technical advances brought rapid progress to society, but also resulted in seismic population shifts. Large numbers of people moved from rural agricultural settings and lifestyles to the cities, where the new engines of industry promised more opportunities. Unfortunately, it also resulted in disenfranchisement and poverty for many, highlighting the contrasts between those who benefitted from industrialization and those who suffered as a result. In fact, there were a large number of orphans in London at the time, which raised concern in some circles about “The great London waif crisis”, the circumstances of which were captured by Dickens in his book “Oliver Twist”, the story of a boy who struggled with his environment and the people who dominated it [1]. Oliver Twist, the literary character, like his author creator, managed to survive and succeed by his own gumption, while so many others of his peer group suffered and succumbed. Katherine Boo, in her recent book, “Behind the beautiful everlastings”, captured the plight of children living in the slums of Mumbai in the end of the first decade of the 21st century [2]. She described the lives of children (as well as the adults) who populate Annawadi, a makeshift settlement in the shadow of luxury hotels near the Mumbai airport. In a 2001 census, it was estimated that about 6.5 million people were living in the slums of Mumbai, representing nearly 55% of Mumbai’s population. It has been estimated that in 2011, there were 8 million people living in the slums [3]. The numbers are staggering, and the sense of despair and fragile hope is captured by Boo in her chronicle. The similarities between late 19th Century London and early 21st Century Mumbai are striking. Although the differences are of an order of magnitude greater, both contrast the affluence of the world outside with the world of the child’s bubble of existence, trapped in a cycle of poverty and vulnerability to predators, environmental hazards, emotional stress, distress, and suffering.

Belly Models as Teaching Tools: What Is Their Utility?:

Marble/ball models are often used to represent newborn stomach capacity; however, their accuracy has not been determined. The objective of this review was to analyze data on newborn stomach capacity and determine whether marble/ball models serve as accurate representations. A literature search yielded limited data, most emanating from the early 1900s. Data suggest that anatomic capacity of the newborn stomach varies with the birth weight of the infant. Physiologic capacity bears no relation to anatomic capacity of the newborn stomach but is a measure of the ability of the mother to produce milk and the newborn to ingest milk. Given the wide range of feeding volumes on days 1 and 3 and the reported 8-fold increase in average feeding volume during the same time period, it is best to acknowledge that feeding volumes like anatomic stomach capacity vary widely and do not lend well to visual representation by marble/ball models. J Hum Lact. 24(2):199-205. Los modelos Bolas/Canicas (Marble/balls) se usan con frecuencia para representar la capacidad estomacal del recién nacido, pero su precisión no se ha determinado. El objetivo de esta revisión fue de analizar datos sobre la capacidad estomacal del recién nacido y determinar si los modelos marble/ball son representaciones precisas. Una revisión de la literatura mostró datos muy limitados, la mayoría de principios de los 1900s. Los datos sugieren que la capacidad anatómica del estomago del recién nacido varia con el peso al nacer del bebe. La capacidad fisiológica no tiene relación con la capacidad anatómica del estomago del recién nacido, pero es la medida de la habilidad de la madre de producir leche y la ingesta del recién nacido. Dado el gran margen de los volúmenes de alimentación en el día 1 y 3 y el aumento de 8 veces reportado en el promedio del volumen de alimentación durante el mismo periodo, es mejor reconocer los volúmenes de alimentación como la capacidad anatómica que varía en un gran margen y no confiarse a la representación visual de los modelos marble/ball.