A Mixed Methods Exploration of Texas School Nurses' Involvement in Addressing Substance Use and Sexual/Reproductive Health Among Students in Alternative High Schools

Students in alternative high schools (AHSs) have higher levels of substance use and risky sexual behaviors than students in traditional high schools. In this mixed methods study, we examine school nurses' efforts in Texas AHSs to address substance use and sexual/reproductive health. The nurses addressed substance use and sexual reproductive health mostly at the individual level, after students initiated risky behaviors. Nurses' efforts were influenced by district, school, and community factors (e.g., understaffing, outdated programs that weren't evidence-based or tailored to AHS students' behaviors, and family involvement). Usually, nurses were not practicing to their full scope as outlined by the National Association of School Nurses Framework. Substance use was a common reason for AHS placement and could contribute to the school-to-prison pipeline, and AHSs did not always have Narcan on campus to address drug overdoses. Our findings suggest implications for providing equitable health services to this underserved, understudied student population.

Nurses' role in health promotion and prevention: A critical interpretive synthesis

BACKGROUND

Role confusion is hampering the development of nurses' capacity for health promotion and prevention. Addressing this requires discussion to reach agreement among nurses, managers, co-workers, professional associations, academics and organisations about the nursing activities in this field. Forming a sound basis for this discussion is essential.

AIMS AND OBJECTIVES

To provide a description of the state of nursing health promotion and prevention practice expressed in terms of activities classifiable under the Ottawa Charter and to reveal the misalignments between this portrayal and the ideal one proposed by the Ottawa Charter.

METHODS

A critical interpretive synthesis was conducted between December 2018 and May 2019. The PubMed, CINAHL, Scopus, PsychINFO, Web of Science and Dialnet databases were searched. Sixty-two papers were identified. The relevant data were extracted using a pro-forma, and the reviewers performed an integrative synthesis. The ENTREQ reporting guidelines were used for this review.

RESULTS

Thirty synthetic constructs were developed into the following synthesising arguments: (a) addressing individuals' lifestyles versus developing their personal skills; (b) focusing on environmental hazards versus creating supportive environments; (c) action on families versus strengthening communities; (d) promoting community partnerships versus strengthening community action; and (e) influencing policies versus building healthy public policy.

CONCLUSIONS

There are notable misalignments between nurses' current practice in health promotion and prevention and the Ottawa Charter's actions and strategies. This may be explained by the nurses' lack of understanding of health promotion and prevention and political will, research methodological flaws, the predominance of a biomedical perspective within organisations and the lack of organisational prioritisation for health promotion and prevention.

Calling the Shots: Primary Care Providers Discuss Addressing Health-Risk Behaviors During Sports Physicals

INTRODUCTION

We sought to describe primary care providers' perceived barriers and facilitators to addressing health-risk behaviors during preparticipation examinations (PPEs; i.e., "sports physicals").

METHODS

From October 2014 to September 2015, we conducted semistructured interviews with a purposive sample of 12 pediatric and family nurse practitioners and seven pediatricians serving diverse patient populations in central Texas. Interviews were transcribed and analyzed using content analysis to identify salient themes.

RESULTS

Providers discussed interrelated barriers to addressing risk behaviors during PPEs at interpersonal, family, clinic, and policy levels. Providers described greater barriers to addressing risk behaviors in group-based settings (e.g., in a school gymnasium) than in private practice. Participants also discussed facilitators and gave examples of strategies for effectively addressing health-risk behaviors during PPEs.

DISCUSSION

Findings suggest changes for systems (e.g., billing policies) and clinics (e.g., providing private spaces) and provider training to support the routine use of PPEs for addressing these key threats to adolescent health.