Healthy Weight and Cardiovascular Health Promotion Interventions for Adolescent and Young Adult Males of Color: A Systematic Review

Cardiovascular disease is the leading cause of mortality in the United States, accounting for one fourth of deaths. Higher rates of obesity put Hispanic and Black men at increased risk. The American Heart Association cites diet quality, physical activity, and body weight as alterations responsive to health promotion intervention. Prevention strategies need to begin in adolescence and the emerging adulthood years to impact cumulative risk factors. A scoping review identified search terms and this was followed by a systematic review of Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed databases for articles published in English from January 1, 2002, through May 11, 2017. This review explores community-based content, delivery, recruitment, or retention strategies used with young men of color aged 15 to 24 years. Of 17 articles describing 16 individual interventions and 1 describing multiple interventions (with samples ranging from 37 to 4,800), 13 reported significant results in one or more domains. No studies specifically targeted the needs of young men and only three had more than 50% male participants. There was a gap in studies that addressed young men in the ages of interest with most interventions reaching participants aged 11 to 19 years. Cultural tailoring was addressed through recruitment setting, interventionist characteristics, community involvement, and theoretical frameworks such as motivational interviewing that allow individual goal setting. Because young men seek access to preventive health services less than young women, it is suggested that interventions that are community based or use push technology (send information directly to the user) be increased.

District health manager and mid-level provider perceptions of practice environments in acute obstetric settings in Tanzania: a mixed-method study

BACKGROUND

In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs).

METHODS

This study was guided by the basic strategic human resources management (SHRM) component model. A convergent mixed-method design was utilized to assess qualitative and quantitative data from the Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers project. Survey data was obtained from 837 mid-level providers, 83 of whom participated in a critical incident interview whose aim was to elicit negative events in the practice environment that induced intention to leave their job. HRH management practices were assessed quantitatively in 48 districts with 37 members of CHMTs participating in semi-structured interviews.

RESULTS

The eight human resources management practices enumerated in the basic SHRM component model were implemented unevenly. On the one hand, members of CHMTs and mid-level providers agreed that there were severe shortages of health workers, deficient salaries, and an overwhelming workload. On the other hand, members of CHMTs and mid-level providers differed in their perspectives on rewards and allocation of opportunities for in-service training. Although written standards of performance and supervision requirements were available in most districts, they did not reflect actual duties. Members of CHMTs reported high levels of autonomy in key HRH management practices, but mid-level providers disputed the degree to which the real situation on the ground was factored into job-related decision-making by CHMTs.

CONCLUSIONS

The incongruence in perspectives offered by members of CHMTs and mid-level providers points to deficient HRH management practices, which contribute to poor practice environments in acute obstetric settings in Tanzania. Our findings indicate that members of CHMTs require additional support to adequately fulfill their HRH management role. Further research conducted in low-income countries is necessary to determine the appropriate package of interventions required to strengthen the capacity of members of CHMTs.

Professional practice models for nurses in low-income countries: an integrative review

BACKGROUND

Attention is turning to nurses, who form the greatest proportion of health personnel worldwide, to play a greater role in delivering health services amidst a severe human resources for health crisis and overwhelming disease burden in low-income countries. Nurse leaders in low-income countries must consider essential context for nurses to fulfill their professional obligation to deliver safe and reliable health services. Professional practice models (PPMs) have been proposed as a framework for strategically positioning nurses to impact health outcomes. PPMs comprise 5 elements: professional values, patient care delivery systems, professional relationships, management approach and remuneration. In this paper, we synthesize the existing literature on PPMs for nurses in low-income countries.

METHODS

An integrative review of CINAHL-EBSCO, PubMed and Scopus databases for English language journal articles published after 1990. Search terms included nurses, professionalism, professional practice models, low-income countries, developing countries and relevant Medical Subject Heading Terms (MeSH).

RESULTS

Sixty nine articles published between 1993 and 2014 were included in the review. Twenty seven articles examined patient care delivery models, 17 professional relationships, 12 professional values, 11 remuneration and 1 management approach. One article looked at comprehensive PPMs.

CONCLUSIONS

Adopting comprehensive PPMs or their components can be a strategy to exploit the capacity of nurses and provide a framework for determining the full expression of the nursing role.

In their own words: The experience of professional nurses in a Northern Vietnamese women's hospital

Abstract Background: Nurses in Vietnam, as is typical of many low-income countries, are hampered from impacting health outcomes by low occupational status, overcrowded hospitals and few career development opportunities. In order to understand the current practice environment encountered by nurses in Vietnam in the most realistic way, we listened to the voices of nurses currently performing nursing roles in Vietnam.

PURPOSE

The purpose of this study was to explore the emic (insider) perspectives on cultural meaning applied by nurses at a northern Vietnamese women's hospital to influence professional practice and interpret experience.

DESIGN

A micro-ethnography approach was used.

METHODS

Seven nurses and one Vice Dean of a school of nursing were interviewed. Data collection consisted of open-ended interviews, participant observation and journal recordings. Spradley's (1979, 1980) Development Research Sequence was used to guide data collection and analysis.

RESULTS/FINDINGS

Five themes emerged. These were the big number of patients is a burden for nurses; nurses do not, cannot make their own decisions (but they can and do); my feeling depends on doctor's feeling; nurses learn more from doctor; and just a few nurses can attend the [Vietnamese Nurses Association] meeting.

CONCLUSION

The experiences described by the nurses and the Vice Dean of a nursing school reflect the challenges of practicing nursing in one Vietnamese hospital and the resourcefulness of nurses in overcoming those challenges. Recurrent themes highlight the need to better position nurses in Vietnam to advance toward full expression of the professional nursing role.

Intergenerational transmission of attachment for infants raised in a prison nursery

Within a larger intervention study, attachment was assessed with the Strange Situation Procedure for 30 infants who co-resided with their mothers in a prison nursery. Sixty percent of infants were classified secure, 75% who co-resided a year or more and 43% who co-resided less than a year, all within the range of normative community samples. The year-long co-residing group had significantly more secure and fewer disorganized infants than predicted by their mothers' attachment status, measured by the Adult Attachment Interview, and a significantly greater proportion of secure infants than meta-analyzed community samples of mothers with low income, depression, or drug/alcohol abuse. Using intergenerational data collected with rigorous methods, this study provides the first evidence that mothers in a prison nursery setting can raise infants who are securely attached to them at rates comparable to healthy community children, even when the mother's own internal attachment representation has been categorized as insecure.

Converging Streams of Opportunity for Prison Nursery Programs in the United States

Prison nursery programs allow departments of correction to positively intervene in the lives of both incarcerated mothers and their infant children. The number of prison nurseries in the United States has risen dramatically in the past decade, yet there remains a significant gap between predominant correctional policy in this area and what is known about parenting and infant development. Using Kingdon's streams metaphor, this article examines the recent convergence of problem, policy, and political events related to incarcerated women with infant children and argues that this has created a window of opportunity for development of prison nursery programs. Aday's policy analysis criteria are also used to analyze available evidence regarding the effectiveness, efficiency, and equity of prison nursery programs as policy alternatives for incarcerated women with infant children.

Health-related quality of life of HIV-infected children on complex antiretroviral therapy at home

The study describes quality of life as perceived by parents and measured by the Child Health Questionnaire (CHQ-28) for a convenience sample of 33 HIV-infected children age 5 to 18 years cared for at home on complex antiretroviral drug regimens. When compared with normative data on healthy U.S. children, parent reports for the HIV-infected children did not differ significantly on the following CHQ concepts: role/social related to emotional, behavioral or physical problems; bodily pain; behavior; mental health; self-esteem; impact on parental time; family activities; and family cohesion. Parents perceived their children to be functioning at a level significantly lower than the norm in general health (t -6.47, p = .000), physical functioning (t -2.37, p = .024), and physical summary (t -3.80, p = .001). Parental impact-emotional was impressively higher than the norm (t -3.74, p = .001). Differences were independent of gender, primary language, ethnicity, and Centers for Disease Control and Prevention clinical classifications for pediatric HIV disease.

Psychometrics of Child Health Questionnaire parent short form (CHQ-28) used to measure quality of life in HIV-infected children on complex anti-retroviral therapy

The purpose of this report is to expand the psychometric properties of the Child Health Questionnaire parent report short form (CHQ-28) as a measure of well-being for children with chronic illness. The purposive sample included 33 HIV-infected children ages 5-18 years who were patients of a comprehensive specialty clinic in an urban Northeast medical center and were cared for at home on complex anti-retroviral drug regimens. Parents reported the children's functioning in multiple domains using the American Spanish (one-third) or English (two-thirds) versions of the CHQ-28. Internal consistencies ranged from Cronbach's alpha of 0.62-0.83. Correlations between the physical and psychosocial summary scores and their components supported the instrument's conceptualization of health although some overlap between domains was demonstrated. Differences between the CHQ profile for healthy norm children and this clinical sample were logically consistent with the disease characteristics. Individual scales of the CHQ-28 show promise as research outcome measures for health related quality of life in children living in the community with HIV disease and perhaps could be useful for studies of children with other chronic illness.

Conducting research as a visiting scientist in a women's prison

Incarcerated populations have disparities in health risks and illness conditions meriting study, but the history of prison research is marred by unethical conduct. Ethical participation strategies are discussed in the context of studies implemented by the author in a state prison system. This study used ethnographic approaches, observed adherence to federal and institutional review board regulations and corrections department directives, and maintained continuous communication with vested interests to provide entry and long-term access for studies on female prisoners and their civilian infants. A culture clash between the punitive restrictive environment that serves the custody-control-care mission of corrections systems and the open inquiry environment needed for conduct of health research exists. Federal regulations protect prisoners as human subjects but additional vigilance and communication by researchers are required. Gaining and maintaining access to prison inmates for nursing research are leadership challenges that can be met within the caring and collaborative paradigm of nursing.

Reliability of transportable instruments for assessment of infant length

Transportable instruments for use in home and field settings have been used for decades on the basis of assumed reliability. This article describes a study that compares two portable devices for measuring length, the tape measure and the Measure Mat, against a clinical standard stadiometer with two convenience samples of Hispanic and African-American infants in an urban general pediatrics practice setting. Mean net difference between the stadiometer and the tape measure was 1.68 inches in the first sample and 0.92 inches in the second; the difference between the stadiometer and the Measure Mat was 0.92 inches. The least variability and random error (SD = 0.57 inch) was shown in the paired measurements using the stadiometer and the Measure Mat. Bland-Altman plots showed positive bias for both portable devices across the range of measurements.

Culture-derived strategies of a paediatric home-care nursing specialty team

This is an ethnographic study of one paediatric home-care nursing specialty team that cares for children and their families affected by perinatal human immunodeficiency virus (HIV) disease. Observations made by the investigator as part of a larger study suggested that the intricacy and breadth of nursing knowledge and actions that were actually used far exceeded what the standard documentation recorded. Spradley's Developmental Research Sequence, combining methods of participant observation and interviewing, was used to answer the question: What nursing strategies are used in managing the health needs of HIV-exposed infants in a home-care programme? Thematic analyses revealed that the visit process had four essential elements, as perceived and lived by the nurses: the pursuit; the connection; the work; and the disengagement. This full scope of nursing strategies for assisting and empowering these families remains largely invisible, limited to verbal transmission to family caregivers and among nurses. It needs to be documented, claimed and further studied by nursing.

Comparison of two measures of parent-child interaction

BACKGROUND

The numerous parent-child interaction measures available include few that are appropriate to brief clinical encounters or to research settings where time, cost, space, and subject burden are critical factors.

OBJECTIVES

This study compares the newer Mother-Infant Communication Screening (MICS) with the established Nursing Child Assessment Satellite Training (NCAST) Teaching Scale (NCAT).

METHODS

Theoretical foundations, development, administration, support, and published psychometrics for the two scales are contrasted. Videotapes of 171 caregiver-child interactions in an urban, Hispanic, high-risk sample (children aged 5 months to 36 months) were scored by two trained coders who had established inter-rater reliabilities of.90 (NCAT) and.85 (MICS).

RESULTS

Validity correlation coefficients were r =.504, p <.001 for total scores and r =.492, p <.001 for the two most comparable subscales. Distress was defined more narrowly by the MICS. Internal consistencies were.89 to.94 (MICS total scores) (depending on choice of subscales used) and.79 (NCAT).

CONCLUSIONS

The NCAT has established strengths for use in clinical practice and research and provides dyadic and separate mother and child scores. The MICS is more feasible for brief clinical screening and performed in this study with promising correlate validity and internal consistency across ages (infancy through 3 years). Interpretation would be strengthened if more clinical studies verifying scores with risk categories were performed and if normative data were established.

Continuing nursing care needs of children at time of discharge from one regional medical center in Sweden

Hospital nurses used an investigator designed survey instrument to record demographics and anticipated nursing needs of 29 children discharged from 7 units during a 1 month period. The median age of the children was 18 months and 77% of the sick children had one or more siblings. Parental leave enabled most parents to participate in the child's hospital care. Over three quarters of the families reported no support person available to assist them at home. At time of discharge 42% of the children required long-term nursing interventions related to chronic illness. Nurses trained parents visiting in the hospital for an average of 3 hours and 40 minutes per family before discharge. Nurses also arranged an informal system of follow-up telephone contact but few community referrals. With decreasing length of hospital stay, parents need a formal system of nursing support before and after the discharge of their child from a hospital.

Feeding interactions in a cross section of HIV-exposed infants

In a purposive sample of HIV-exposed infants, Nursing Child Assessment Satellite Training (NCAST) Feeding Scale measurements of caregiver-infant interaction during one feeding occasion in a clinic demonstrated both strengths and weaknesses in the interaction. Twelve dyads included 6 birth mothers, 2 biological fathers, 3 foster mothers, and 1 kinship guardian, who were primary caregivers for 4 Hispanic, 1 Vietnamese, and 7 African American infants, ranging in age from 2 weeks to 12 months. Caregivers were sensitive to infants' cues and responsive to their distress, and infants were clear in conveying cues and responsive to their caregivers. The use of the feeding interaction to foster social-emotional growth was less than expected. Contingency of behavior between caregivers and infants was also deficient. Four dyads had caregiver scores at or below the risk cutoff point.

Productive international faculty exchange: one Columbia University to Gothenburg University example

This article describes the preparation, implementation and outcomes of a visiting professor exchange experience from the United States to Sweden, and provides recommendations for other faculty who may be asked to enact a similar international role. The major goals of the visit were to coalesce the themes of the earlier administrative contacts into specific projects, and to model a scholarly faculty role consistent with the Columbia University School of Nursing mission as a World Health Organization Collaborating Centre for International Nursing Development. Professional nursing activities during the exchange visit were comprised of three main categories: teaching, consultation, and socialization. Strategies are described that enhanced the bilingual lectures for the Swedish students. The relationships that developed from consulting at the college and on site at various clinical locations culminated in the mutual identification of collaborative research projects and plans for the cross-cultural adaptation of the author's parent education model. Recommendations are made concerning the range of philosophical, institutional, professional and personal resources needed for international exchanges.

Room-to-grow: responding to community cultural needs to support positive parenting

Preventive services to assist parents to understand their children's developmental needs and to devise positive, culturally appropriate strategies for managing them are not recognized as important by most third party health service payers, especially managed care programs. Room-To-Grow is an intervention designed to meet identified community needs in a culturally appropriate and sensitive way. This article discusses the evolution of this intervention and the problems encountered in finding appropriate reimbursement streams.

Helping nursing students communicate with high-risk families. An educator's challenge

Lerner and Byrne advocate that students care for high-risk families during their maternity experience. Communication problems, client resistance, and newness of maternal care skills make this assignment a challenge for students and faculty as well.