Victoria P. Niederhauser

Assessment, management, and prevention of early childhood caries

PurposeTo discuss the role of primary care health providers in identifying infants and young children at risk for dental caries during well-child visits, in providing anticipatory guidance to parents and primary care givers of at-risk children, and in providing appropriate referrals for the timely establishment of a dental home. Data sourcesThe search included the following: Ovid MEDLINE, PubMed, American Academy of Pediatrics Web site, American Academy of Pediatric Dentistry Web site, and the American Dental Association Web site. The following search terms were used: dental caries prevention, caries process, caries balance, dental home, early childhood caries, oral health disparities, dental caries risk assessment, fluoride varnish, oral health anticipatory guidance. Search was limited to English language sources from 1990 through 2007. ConclusionsDental caries is a preventable and reversible infectious disease process, yet it continues to be the single most common chronic disease of childhood. Despite a decrease in caries prevalence and a decrease in untreated tooth decay in 6–19-year-olds in the United States, a 15.2% increase in disease was noted among the nations youngest children aged 2–5 years. Primary care health providers are uniquely positioned to play a significant role in the prevention of dental caries and are encouraged to complete certification courses in caries risk assessment, intervention, education, and referral. Implications for practiceClinicians need to understand the dental caries process, including the process of enamel demineralization and remineralization, and the factors contributing to caries balance. The importance of early identification and intervention for infants and toddlers at high risk for dental caries and primary care health provider-delivered anticipatory guidance during well-child care visits cannot be overestimated.

Barriers to immunizations: Multiethnic parents of under‐ and unimmunized children speak

Purpose: Childhood immunizations are one of the greatest pubic health success stories. Despite the fact that many children receive immunizations according to the recommended schedule, there are many that lag behind. The purpose of this study was to explore the barriers to immunizations in parents whose children are not fully immunized by age 2. Data source: Thirteen focus groups, on four different islands (Oahu, Kauai, Maui, Hawaii) were held with a total of 64 parents. Verbatim transcripts were utilized for content analysis. Conclusion: Five core themes emerged as barriers to childhood immunizations, parental, transportation, financial, child, and organization. The majority of responses were in the parental core theme, which included the sub‐themes of issues, beliefs, knowledge, and fears. Implications for practice: Recommendations included identification of specific barriers to target immunization interventions strategies, public policy changes, identification and case management of high risk families, and minimization of organizational barriers.

Fruit and vegetable intake: issues with definition and measurement.

Accurate determination of fruit and vegetable consumption is essential for research that seeks to determine current fruit and vegetable intake patterns, what type and amount of fruit and vegetable consumption is optimal for human health and for evaluating interventions developed to increase such consumption. However, there are many issues that make accurate determination of fruit and vegetable consumption quite difficult. There are many methods used to measure fruit and vegetable intake, but all have limitations. Also, what foods individuals consider to be or to not be fruits or vegetables appear to be quite variable, with such variability often associated with the individuals racial/ethnic background. Researchers and governmental agencies vary with respect to what foods they include and do not include when calculating fruit and vegetable intake. These differences make it difficult to conduct, evaluate and compare studies in this area. The current paper reviews some of the major issues with measuring and determining fruit and vegetable intake.

Creating innovative models of clinical nursing education.

Although nursing care has changed significantly over the past 30 years, methods to clinically train nursing students have not. The traditional model of clinical nursing education, where a faculty member oversees a group of six to eight students on an acute care unit for a 4- to 8-hour shift, provides a haphazard approach to learning. A need exists to find innovative ways to effectively train more nursing students to better prepare them for todays health care environment. Using a change framework, seven approaches to clinical nursing education were created through academic-practice partnerships. These approaches may increase the effectiveness and efficiency of the clinical nursing education system.

Preceptor expectations and issues with nurse practitioner clinical rotations

Purpose: The purpose of this study was (a) to identify nurse practitioner (NP) preceptor expectations of university faculty members and students, (b) to understand the best methods of communication between university faculty members and the preceptors, and (c) to elicit issues for improvement for the precepting experience. Data sources: This study was a cross‐sectional descriptive design. A survey was sent to all clinicians who precepted NP students from the University of Hawaii from 2003 to 2004 (n= 108). Conclusions: The response rate was 67% (28% males and 72% females) with a mean age of 46.3 years. Sixty‐eight percent of the respondents were NPs, 28% were doctors, and 4% were nurse midwives. The majority of preceptors expected two site visits per semester (51%), that faculty members should observe two patient visits with students (57%), and 65% said the first site visit should occur in the first 4 weeks of the semester. Implications for practice: Conducting an assessment of preceptors issues and expectations of faculty site visits can improve relationships with preceptors and secure and maintain clinical placements for NP students. Recommendations include improving communication, establishing guidelines for site visits, and periodic assessment of progress in preceptor‐student relationships.Purpose: The purpose of this study was (a) to identify nurse practitioner (NP) preceptor expectations of university faculty members and students, (b) to understand the best methods of communication between university faculty members and the preceptors, and (c) to elicit issues for improvement for the precepting experience. Data sources: This study was a cross-sectional descriptive design. A survey was sent to all clinicians who precepted NP students from the University of Hawaii from 2003 to 2004 (n= 108). Conclusions: The response rate was 67% (28% males and 72% females) with a mean age of 46.3 years. Sixty-eight percent of the respondents were NPs, 28% were doctors, and 4% were nurse midwives. The majority of preceptors expected two site visits per semester (51%), that faculty members should observe two patient visits with students (57%), and 65% said the first site visit should occur in the first 4 weeks of the semester. Implications for practice: Conducting an assessment of preceptors issues and expectations of faculty site visits can improve relationships with preceptors and secure and maintain clinical placements for NP students. Recommendations include improving communication, establishing guidelines for site visits, and periodic assessment of progress in preceptor–student relationships.

Translation of health surveys using mixed methods.

PURPOSE The purpose of this study was to determine the effectiveness of a process-based translation method for a health survey instrument, Searching for Hardships and Obstacles to Shots (SHOTS), using a community-based participatory approach with the Hmong community. DESIGN The study was based on a cross-sectional survey to assess the reliability and validity of the SHOTS immunization survey, an instrument used in the Hmong community, who are refugees originally from Laos living in the United States. METHOD Process-based universalistic health survey translation methods were used in a six-step procedure to translate the instrument. Mixed methods were used to analyze results, including cognitive interviewing, content validity indexing, Cronbachs α, t tests, and the Kolmogorov-Smirnov test. FINDINGS Participants were able to accurately complete the SHOTS survey in either Hmong or English, depending on participant preference. CONCLUSIONS Universalistic, process-based, mixed methods used to analyze language translation, in combination with the principles of community-based participatory research, provide effective methods to translate health surveys. Involvement of the community strengthens the quality of translation and improves reliability and validity of survey results. CLINICAL RELEVANCE Healthcare providers require accurate and reliable information from evidence-based health surveys to plan for culturally responsive care. Cross-cultural research often relies on language translation. Translation of a health survey instrument may be improved with universalistic, process-based methodology.

Health risk factors associated with presenteeism in the workplace.

Objective: An emerging concern in the workplace is the productivity of employees who come to work instead of staying home when they are ill, also referred to as presenteeism. This study examined the health risks associated with presenteeism. Methods: Using a cross-sectional correlational design, we used data from a 2010 self-reported wellness surveys. A negative binomial regression model was used to explore the association between employee health risks and presenteeism. Results: The findings revealed that workplace stress (&bgr; = 0.76; P < 0.001), stress at home (&bgr; = 0.87; P < 0.001), and financial stress (&bgr; = 0.59; P < 0.001) were related to presenteeism. Other health risks were not associated with presenteeism. Conclusions: We found that only stress was related to presenteeism, and other health risks were unrelated to presenteeism.

Building Strong and Ready Army Families: A Multirisk Reduction Health Promotion Pilot Study

A quasi-experimental prospective study was conducted to assess the stage of change progression and elimination of unhealthy behaviors among active duty Army soldiers and their spouses (N = 245) before and after attending a community-based wellness program. Significant differences in stage progression between the intervention group and a comparison group was seen in the fitness (p = 0.05) and communication risk categories (p = 0.03) immediately after the intervention; significant differences in stage progression in fitness (p = 0.05) and spirituality (p = 0.005) risk categories 6 months after baseline. There was a significant increase in seat belt use (p = 0.008), a decrease in reported tobacco use (p < 0.05), and a reduction in family stress (p = 0.06) and personal stress (p < 0.02) in the intervention group. Targeting multiple behavior changes and risk reduction in a single intervention program presents several challenges. In this pilot study, there were many positive nonsignificant trends in risk reduction that might translate into significant changes with a larger sample.

Prescribing for children: issues in pediatric pharmacology.

Children and adults respond to drugs differently. There are important differences in the absorption, distribution, metabolism, and excretion of medications during infancy and childhood. Childrens body systems are less developed; their gastrointestinal transit time varies; and their body composition changes with development. This article will explore pediatric pharmacokinetics, the effect the body has on a drug, and the implications for practice. The controversial off-label use of medications must be considered when prescribing medications because specific dosage guidelines for the pediatric population still are not available for the majority of marketed drugs. Prescription writing must be appropriate, legible, and meticulous. Family education about medications and administration techniques is an essential part of the clinicians role. The limited scope of current research in pharmacokinetics and the effects on the developing child creates the need for more studies on drug therapy and the pediatric client. Furthermore, clinicians need to expand research on the effects of parental education on accurate medication administration and drug therapy compliance.

USING PARTNERSHIPS TO ADVANCE NURSING PRACTICE AND EDUCATION: THE PRECIOUS PRINTS PROJECT

With the release of the Institute of Medicines (2011) Future of Nursing report, nursing leaders recognized that strong academic-practice partnerships are critical to advancing the reports recommendations. Using established principles for academic-practice partnerships, a manufacturer, childrens hospital, student nurses organization, and college of nursing created the Precious Prints Project (P(3)) to give families who have experienced the death of a child a sterling silver pendant of the childs fingerprint. This article outlines the background, implementation, and benefits of the P(3) partnership with the aim of encouraging readers to consider how similar programs might be implemented in their organizations. To date, the program has given pendants to more than 90 families. In addition, nurses and nursing students have been introduced to the provision of a tangible keepsake for families experiencing the loss of a child and participation in philanthropy and an academic practice partnership.