Nancy H. Busen

Community-based participatory research to prevent substance abuse and HIV/AIDS in African-American adolescents

Adolescence is a time for exploration and risk-taking; in todays urban environment, with the twin threats of substance abuse and HIV/AIDS, the stakes are particularly high. This paper describes a community-based participatory research project to design, implement, and evaluate a faith-based substance abuse and HIV/AIDS prevention program for African-American adolescents. A coalition of university-based investigators and African-American church member stakeholders collaborated on all aspects of Project BRIDGE, the 3-year intervention to reduce substance abuse and HIV/AIDS in African-American adolescents. Our results support the use of community-based participatory research to create desirable change in this setting. Adolescents who participated in Project BRIDGE reported significantly less marijuana and other drug use and more fear of AIDS than a comparison group. Project BRIDGE has been designated an official ministry of the church and the program has been extended to others in the larger metropolitan community. The church now has a well-trained volunteer staff. University faculty developed skills in negotiating with community-based settings. The coalition remains strong with plans for continued collaborative activities.

Bone Mineral Density in a Cohort of Adolescent Women Using Depot Medroxyprogesterone Acetate for One to Two Years

The purpose of this study was to examine estradiol and bone mineral density (BMD) in a cohort of adolescents using depot medroxyprogesterone acetate (DMPA) for one to two years. BMD was significantly decreased in the femoral neck and lumbar spine at year one. Estradiol levels suggested hypoestrogenization among subjects

Facilitating risk reduction among homeless and street-involved youth

PurposeThe purposes of this evaluation project were to describe a group of homeless adolescents and street-involved youth who utilized a mobile unit that provided medical and mental healthcare services and to assess the efficacy of the services provided in reducing their health risk behaviors. Data sourcesThe records of 95 youth aged 15–25 years who used the medical mobile unit for an average of 14 months were examined and evaluated according to the national health indicators related to risk reduction. Current literature related to health risk behavior among homeless youth was reviewed, synthesized, and provided the background for this article. ConclusionsData were obtained from the records of mostly heterosexual youth with a mean age of 20.5 years. Approximately one third of the participants were high school graduates and most were without health insurance. Living situations were transient including friends, shelters, crash pads, or the streets. Abuse accounted for the majority leaving home. Psychiatric conditions and substance abuse were common. Medical conditions were related to transient living situations, substance abuse, and sexual activity. Success of the program was associated with sustained counseling, stabilizing youth on psychotropic medications, decreasing substance use, providing birth control and immunizations, and treating medical conditions. Implications for practiceHomeless youth are one of the most underserved vulnerable populations in the United States with limited access and utilization of appropriate healthcare services. Nurse practitioners often serve as care providers but are also in a position to effectively lobby to improve health care for homeless youth through professional organizations and community activism. Furthermore, when designing and evaluating healthcare services, multidisciplinary teams need to consider risk reduction for homeless youth in the context of their environment.

A collaborative model for community-based health care screening of homeless adolescents*

Because of their survival life-style, homeless youth are at extremely high risk for contracting life-threatening and debilitating diseases, such as acquired immunodeficiency syndrome and hepatitis B, and for engaging in chronic substance abuse; yet health services are often limited and not easily accessed. This article describes an innovative health-screening project for 150 homeless youth between the ages of 11 and 23 years in an urban metroplex. The Homeless Youth Services Project was the initial phase of a multiphase project to investigate the social and health services available to homeless youth. The study project was a collaborative effort between several community agencies that shared the multiple goals of identifying the homeless adolescent population, documenting the rate of human immunodeficiency virus (HIV) seroprevalence and level of risk, and identifying community services and resources. Results of the screening project included the psychosocial and physical risks associated with homeless adolescents as well as the laboratory results of blood and urine screens. Consistent with the literature, the study population had a history of runaway behavior; physical, sexual, and substance abuse; and high rates of HIV seroprevalence and hepatitis B. Implications for advanced practice nurses working with homeless youth are also addressed.

An Interprofessional Education Project to Address the Health Care Needs of Women Transitioning From Prison to Community Reentry

With the implementation of the Patient Protection and Affordable Care Act, the need for health care providers to work collaboratively in teams to provide cost-effective, quality health care has become even more apparent because an estimated additional 22 million Americans gain health care coverage by 2014. The need for evidenced-based care that combines the expertise of various disciplines has been acknowledged by policy makers and health educators. With support from national Association for Prevention, Teaching and Research, an interprofessional education course was designed and implemented by health professionals in nursing, nutrition, and dentistry, in collaboration with a local community agency, to address the health care needs of women transitioning from prison to the community. Health care needs of women in prison are often overlooked, and access to care is limited. When released from prison, utilization of even basic health services is rare. Four interactive teaching-learning sessions were offered at a residential facility for women in transition over a 12-week period. Topics were selected based on feedback from the participants and included stress reduction, self-beast examination, hypertension, and common dental conditions. Teaching methods and materials were interactive and designed for sustainability. The model for this interprofessional education project, which employed a service-learning approach, can be adapted for other communities. Working with our communities requires innovative thinking to be effective but provides an enriching life experience to those involved. A community-based reciprocal learning environment benefits all partners in the real-world environment.

Bone Mineral Density in Adolescent Women Using Depot Medroxyprogesterone Acetate

Purpose To present current data on bone mineral density (BMD) in adolescent women using the long‐acting contraceptive depot medroxyprogesterone acetate (DMPA) and also to discuss the importance of developing maximal bone mass during adolescence to offset bone demineralization later in life. Data Sources Research‐based articles in the medical literature, review articles, and recommendations from the American Academy of Pediatrics and the National Osteoporosis Foundation. Conclusions Osteoporosis is a preventable disease that affects millions of Americans, particularly older women. Factors influencing the attainment and maintenance of peak bone mass during childhood and adolescence affect the future risk of fractures. Although longitudinal studies conducted on adolescent women using DMPA are very limited, findings suggest that adolescents are losing bone density during a time of expected bone accretion. Implications for Practice Clinicians must consider all the risks and benefits when prescribing contraceptives to adolescents. By themselves, the findings related to BMD and DMPA use by adolescents are not sufficient to limit the use of DMPA as a contraceptive method. However, clinicians must take into account the addition of other modifying factors associated with BMD that may contribute to overall bone loss in adolescent females. More prospective data on the long‐term use of DMPA by adolescents are needed to determine DMPAs effect on bone loss and to determine if bone loss is transient in adolescents.

Exploring the skin-to-skin contact experience during cesarean section.

Purpose:To explore and describe the mothers experience of holding her neonate in skin‐to‐skin contact (SSC) immediately after cesarean delivery during surgical closure and recovery. Data sources:Eleven women between the ages of 23 and 38 years, who had achieved 39.1–40.2 weeks gestational age, participated in an ethnographic study using observations and interviews with the mothers conducted at 24–48 h postdelivery. Interviews were transcribed verbatim and content analysis of both observational notes and transcripts were used to analyze the data. Conclusions:Findings from this study describe the mothers experience of SSC during cesarean section. The primary theme that emerged was mutual caregiving: the mother–neonatal interaction and their shared and reciprocal relationship and benefits during SSC. Two contextual issues also were illuminated (a) the fathers influence on the SSC experience and (b) the cesarean environment. Implications for practice:With cesarean section the most common surgical procedure among American women, advanced practice nurses are in a unique position to encourage and educate women on the use of SSC for their benefit and that of their newborn. Advanced practice nurses are also empowered to influence institutional policy on SSC during cesarean deliveries at the local and national level.

Nurse Practitioners and Parent Education: A Partnership for Health

Purpose To present the findings from a pilot‐test of an innovative curriculum for parent education classes that included information about well child care and the care of sick children presented to substance abusing women at a residential drug treatment facility. Data Sources Selected literature and the results of a comparison of pre‐ and post‐tests from the 37 women who received the classes over a 6 week period. Conclusions The Healthy Children, Happy Children parent education program was successful overall in increasing the knowledge of the mothers about common skin disorders, care of infants, toddlers, and preschoolers, and basic first aid. Implications for Practice Nurse practitioners (NPs) are well suited to teach parent education classes that contain information on growth and development, well child care and diagnosis and management of acute minor conditions. The Healthy Children, Happy Children curriculum can be adapted to a variety of settings and populations.

Leadership development: educating nurse practitioners for the future.

&NA; The development of leadership potential is recognized to be an essential component of nurse practitioner education to prepare graduates for a dynamic health care system, Leadership potential refers to those skills that enable a nurse practitioner to function as a change agent and to effectively resolve conflict. The purpose of the study was to examine personal variables (personality type, self‐esteem, and learning style) with respect to the leadership potential of pediatric nurse practitioner graduates over a 3‐year period. The research study was descriptive, and data were analyzed using descriptive statistics. The subjects consisted of 21 female students who completed five instruments used to measure the relationships between variables and leadership potential Significant results were found between those students who learned abstractly and the ability to function effectively as a change agent post‐program.

Conspicuous Omission Versus Voice and Visibility: Reconstructing Cultural Messages about Nursing and the Future of Healthcare

On March 31, 2004, USA Today published a nearly fullpage article, “Doctors Heal the System,” that described a new model of healthcare proposed by the American Academy of Family Physicians (AAFM) in their report, “The Future of Family Medicine” (Martin et al., 2004). A schematic rendition of the proposed model for healthcare situated the patient and physician in the center, working together to make informed decisions. The central figures were encircled by other health professionals and services that support the healthcare system and delivery of care. These included physician specialists, nutritionists, exercise physiologists and health coaches, health educators, psychologists, group meetings, and medical-evidence data bases. Nurses were conspicuously absent from the model, and the text of the article refers to nurses only three times as (a) a nurse educator available for group visits, (b) someone a patient might e-mail, and (c) someone who enters billing information onto a laptop. Media play a pivotal role in shaping and perpetuating cultural images. USA Today has a circulation of 2.238 million and is available through hotels, airlines, businesses, and newsstands worldwide. Their audience represents more than 5.4 million people; the majority are well-educated, middleaged males (see http://www.usatoday.com). The AAFM report and subsequent news article compel us to ask what cultural notions of the nursing profession are reflected in both the reporter’s rendering and the original AAFM model that conspicuously omits nurses while including other health professionals and nonprofessionals. Additionally, what constructions of nurses and the nursing profession underlie the perception of physicians in family medicine that they would largely omit references to the care provided by nurses, the largest health care profession? The incongruence of such an omission is particularly striking when one notes findings from the Institute of Medicine (that were quoted in the AAFM report itself) that nurse practitioners are key primary care providers who deliver culturally competent, cost-effective, highquality health care services to a wide variety of clients in the United States (Donaldson, Yordy, Lohr, & Vanselow, 1996). If the system is to be healed, it will be done as an interdisciplinary effort. Buresh and Gordon (2000) have suggested that when the cultural images of nursing are negative, or in this case, omitted, nurses need to be prepared to respond. “Envision how things would be if the voice and visibility of nursing were commensurate with the size and importance of nursing in health care” (Buresh & Gordon, 2000, p. 11). The publication of the article coincided with the annual meeting of the Society for Applied Anthropology in Dallas, at which the Council on Nursing and Anthropology (CONAA) organized and contributed to multiple sessions. Discussions among CONAA members and other professional colleagues about this media report have contributed to our decision to respond to the USA Today story. What message are we sending or reinforcing if we remain silent in light of this very public omission? We invite your reflections.