Staci Young

Blood center practice and education for blood donors with anemia.

BACKGROUND: Anemia is an early indicator of many diseases, yet blood donors with low hematocrit (Hct) often receive inadequate information about its medical importance. We sought to understand the types of information that are and should be provided to these donors.

Leadership in a Public Housing Community

Community Health Advocate (CHA) programs train community members to assist and advocate for other members of the community regarding health and other community issues. These programs have been successful in improving the health and quality of life of communities. We developed a CHA program in a single public housing development. This program faced unique challenges since the advocates both worked and lived in the same setting. However, confronting and resolving these issues ultimately enhanced the quality of the program.

Development of a Church-Based Cancer Education Curriculum Using CBPR

ancer is the second leading cause of death (following heart disease) in the United States. An estimated 1.4 million cases of invasive cancer were diagnosed in the U.S. in 2005. 1 Racial and ethnic minorities constitute a disproportionate number of these cases. African Americans have both higher cancer incidence and higher rates of cancer mortality than Whites. For instance, African American men are 20% more likely than White males to be diagnosed with cancer and are 40% more likely to die, considering all cancers combined. The five year survival rate for African American women diagnosed with breast cancer is 75%, compared with 89% for White females. Differences in survival rates are due to various factors, including poverty, disparities in treatment, reduced access to medical care, and diagnosis at a later stage. 2 In general, African Americans have a decreased likelihood of surviving five years after diagnosis for all cancer types in comparison with Whites. Wisconsin cancer incidence and mortality rates mirror national patterns. From 1996 through 2000, Wisconsins average cancer mortality rate was 195.7 per 100,000 for the whole population and 271.6 per 100,000 for African Americans. The state average for cancer incidence was 454.3 per 100,000 compared with 523.5 per 100,000 for African Americans. Milwaukee County, located in southeastern Wisconsin, has the highest concentration of African Americans in the state (24.6%) and, not surprisingly, signifi - cantly higher cancer mortality and incidence rates than the state as a whole (488.7 per 100,000 compared with 218.9 per 100,000, respectively). 3

Community blood donors' knowledge of anemia and design of a literacy-appropriate educational intervention

BACKGROUND: The purpose of this project is to improve the health of blood donors by educating and motivating them to seek medical attention for anemia. The National Anemia Action Council, BloodCenter of Wisconsin, and the Medical College of Wisconsin formed a partnership to engage volunteer blood donors and develop an educational intervention to motivate donors with anemia to seek appropriate medical care.

Characteristics of patient encounters that challenge medical students' provision of patient-centered care.

Background Medical educators need to effectively engage and teach medical students to provide patient-centered care (PCC). There is limited appreciation for the issues that clinical students identify as challenges in providing PCC. Method As part of a required half-day PCC workshop in 2007, medical students authored critical incident scenarios on patient encounters where PCC was difficult. The authors analyzed 131 scenarios using qualitative memo technique to identify features associated with these encounters. Categories and themes were identified using constant comparative methodology. Results Commonly cited PCC challenges were student’s/patient’s emotional responses (63%/44%), patient’s/family’s perception of the care plan (54%), conflicting expectations (35%), communication barriers (30%) and patient’s social circumstances (29%). Sixty-three percent of incidents identified PCC-appropriate responses to these challenges. Conclusions Student-authored critical incidents regarding difficult patient encounters can be analyzed to identify key features that students perceive as challenges to providing PCC and can inform curriculum development.

The Influence of Pastors’ Ideologies of Homosexuality on HIV Prevention in the Black Church

Young, Black men who have sex with men (YBMSM) are disproportionately affected by HIV, and Black Churches may be a source of stigma which can exacerbate HIV risk and contribute to negative health and psychosocial outcomes. Findings from this study are based on 21 semi-structured interviews with pastors and ethnographic observation in six Black Churches. Interview transcripts and field notes were analyzed in MAXQDA using thematic content analysis. Although pastors espoused messages of love and acceptance, they overwhelmingly believed homosexuality was a sin and had difficulty accepting YBMSM into their churches. The tension around homosexuality limited pastors’ involvement in HIV prevention efforts, although there still may be opportunities for some churches.

Clinical clerkship students' perceptions of (un)safe transitions for every patient.

Purpose As calls for training and accreditation standards around improved patient care transitions have recently increased, more publications describing medical student education programs on care transitions have appeared. However, descriptions of students’ experience with care transitions and the sender/receiver communication that supports or inhibits them are limited. To fill this gap, the authors developed this project to understand students’ experiences with and perceptions of care transitions. Method At the start of a patient safety intersession at the Medical College of Wisconsin (2010), 193 third-year medical students anonymously wrote descriptions of critical incidents related to care transitions they had witnessed that evoked a strong emotional reaction. Descriptions included the emotion evoked, clinical context, and types of information exchanged. The authors analyzed the incident descriptions using a constant comparative qualitative methodology. Results Analysis revealed that 111 of the 121 medical students (92%) who disclosed emotional responses had strong negative reactions to unsuccessful transitions, experiencing frustration, irritation, fear, and anger. All of these negative emotions were associated with lack of or poor communication between the sender and receiver: ambiguous roles and responsibilities, insufficient detailing of the patient’s medical course, inadequate identification of the people involved in the transition, incomplete delineation of what the patient needed, and unclear reasons for the transition. Conclusions Third-year medical students’ descriptions of care-transition incidents reveal high rates of strong negative emotions and of communication gaps that may adversely affect patient care. Results support curricular innovations that align students’ needs and experiences with safe patient care transitions.

Community advocates in public housing.

Tenant safety patrolDeveloped in response to safety concerns in the building.Patrol members received 10 hours of training.Advocates work in teams of 2 for regularly scheduled shifts.Program has had a significant impact on security in the building.General equivalency diploma preparation programProgram meets weekly and provides material and informal tutoring.Volunteer teacher from the community assists the advocates with the program.Health committeeAddresses residents’ health concerns as well as misconceptions and myths about disease.Organizes and sponsors an annual health fair.Conducted a health assessment survey.Organizes presentations on diabetes, cancer, smoking, healthy lifestyle habits, etc.Spirituality meetingsProgram meets 3 times a week for prayer, readings, and singing.Local minister participates in the program.Social activitiesStrengthen community cohesiveness and social networks.Activities include a monthly potluck dinner, morning coffee club, weekly discussion group, weekly movie time, special events such as Black history celebrations.

Empowerment, Leadership, and Sustainability in a Faith-Based Partnership to Improve Health

Community-based participatory research is a noted approach for improving community health and reducing health disparities. Community partnerships can serve as a catalyst for change in public health efforts. This article will apply empowerment theory and sustainability principles to an existing faith-based partnership. BRANCH Out is a partnership among 13 African American churches, the City of Milwaukee Health Department—Community Nutrition, and the Medical College of Wisconsin. The partnership goal was to change inaccurate perceptions, knowledge and negative attitudes, and behaviors about chronic disease and promote healthy youth leadership. Faith-based empowerment can occur at the individual, organizational, and community level. BRANCH Out demonstrates how partnerships can be sustained in multiple ways. The partnership also highlights the unique contributions of churches to community health outcomes.

Addressing the community/public health nursing shortage through a multifaceted regional approach.

Despite increasing needs resulting from emerging societal and health care issues, the number of trained community/public health (C/PH) nurses in the United States is facing a precipitous decline. Numerous factors contribute to this shortage including an aging workforce, a poorly funded public health system, inconsistencies in C/PH nursing educational approaches and opportunities, and a shortage of sites for clinical training. Determined to address the C/PH nursing shortage in their region, a consortium of public health professionals, university deans and faculty, and state nursing leaders in southeastern Wisconsin came together to address these issues from three perspectives: (a) curricular analysis and redesign, (b) expansion of clinical placement opportunities, and (c) paid community/public health nursing internships for seniors in baccalaureate nursing programs. This article outlines briefly the activities undertaken related to curricular review and clinical placements, and then describes in detail the approach, challenges and results of the senior internship program. Together, these programs produced long-lasting results including an unprecedented level of collaboration between academic institutions and public health nursing professionals, the expansion of both traditional and nontraditional clinical sites in the region, and a transformative learning experience for seventeen senior nursing students from five participating universities.