Scholarly Work - Nursing

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Perspectives of registered nurse cultural competence in a rural state: Part I
(2007) Seright, Teresa J.
Inferences have been made from recent research that there is a correlation between lack of cultural competence and the incidence of health disparity. As our society becomes more global and more diverse, it is apparent that culture can no longer be considered as solely associated with ethnic/racial/cultural groups. Nurses permeate all areas of health care and are therefore in a position to have positive impact on cultural competency. This paper describes the 5 constructs of cultural competence as described by Dr. Josepha Campinha-Bacote: cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire. She emphasizes, as do others in the literature, that cultural desire and awareness are antecedents to knowledge acquisition and skill. Is mere cultural awareness enough? How do healthcare providers in homogenous rural states attain cultural competence when cultural encounters and cultural knowledge may not be readily accessible? This is the first in a series of two articles which explores Cultural Competence of health care providers in a rural state. The first article in the series provides literature review and definitions related to cultural competence as well as the impact of cultural competence. The second article reveal results of a cultural competence self-assessment survey of registered nurses in North Dakota, a sprawling rural state described as 9th in the union for percentage of caucasions and 5th in rank for the most American Indians.
Perspectives of registered nurse cultural competence in a rural state: Part II
(2007) Seright, Teresa J.
The article is the second in a two-article series. The first article in the series provided the reader a conceptual definition of cultural competence, a literature review and a description of the relevance of culturally competent care in a rural state. In this article, the author described the outcomes of a self-assessment survey completed by registered nurses in a homogenous rural state. The purpose of this study was to determine the relationship between cultural competence and educational preparation. It was hypothesized that the North Dakota nurses who reported participation in cultural competency educational programs would rank themselves higher on the IAPCC-R than those who had not reported participation in such programs. A voluntary sample of registered nurses from urban and rural hospitals in the state of North Dakota were surveyed using the Inventory for Assessing the Process of Cultural Competence –Revised version (IAPCC-R) and a demographic survey tool. The data analysis was accomplished through correlational statistics. Results of this research indicate that a majority (>80%) of the participants did not consider themselves culturally competent. While higher self rating scores did correlate to participation in educational activities, the quality and frequency of those activities varies. The author offered suggestions for improved rate and quality of cultural competence education as well as suggestions for further research.
Clinical decision-making of rural novice nurses
(2011-07) Seright, Teresa J.
Introduction: Nurses in rural settings are often the first to assess and interpret the patient’s clinical presentations. Therefore, an understanding of how nurses experience decision-making is important in terms of educational preparation, resource allocation to rural areas, institutional cultures, and patient outcomes. Methods: Theory development was based on the in-depth investigation of 12 novice nurses practicing in rural critical access hospitals in a north central state. This grounded theory study consisted of face-to-face interviews with 12 registered nurses, nine of whom were observed during their work day. The participants were interviewed a second time, as a method of member checking, and during this interview they reviewed their transcripts, the emerging themes and categories. Directors of nursing from both the research sites and rural hospitals not involved in the study, experienced researchers, and nurse educators facilitated triangulation of the findings. Results: ‘Sociocentric rationalizing’ emerged as the central phenomenon and referred to the sense of belonging and agency which impacted the decision-making in this small group of novice nurses in rural critical access hospitals. The observed consequences, which were conceptualized during the axial coding process and were derived from observations and interviews of the 12 novice nurses in this study include: (1) gathering information before making a decision included assessment of: the credibility of co-workers, patients’ subjective and objective data, and one’s own past and current experiences; (2) conferring with co-workers as a direct method of confirming/denying decisions being made was considered more realistic and expedient than policy books and decision trees; (3) rural practicum clinical experiences, along with support after orientation, provide for transition to the rural nurse role; (4) involved directors of nursing served as both models and protectors of novice nurses placed in high accountability positions early in their careers. These novice nurses were often working with a limited staff, while managing an ever-changing census and acuity of patients. The significance of interdependence and welcoming relationships with their co-workers and directors of nursing was pivotal in the clinical decision-making process. Conclusions: Despite access to a number of resources at their disposal (including policy books, decision trees, standing orders, textbooks, and in some cases internet resources), the 12 nurses in this study indicated collaboration with co-workers was a major means of facilitating their decision-making. Rural novice nurses require facilitation of social skills as much as critical thinking skills both within their programs of nursing and during their new employee orientation; however, decision-making must be guided by more experienced nurses who are willing to mentor novice nurses and advise them to to reflect upon their decisions as they care for patients using evidenced based practice. In a rural setting, this is especially important because novice nurses are tasked early in their career with decision-making, which often involves ill-structured problems set in dynamic and changing environments, in high-stakes situations where patient safety is a concern.
Decreased Cortisol and Pain in Breast Cancer: Bio-Field Therapy Potential
(2015) Running, Alice
Breast cancer is one of the leading causes of cancer death among women of all races. Pain is a common symptom associated with cancer; 75–90% of cancer patients experience pain during their illness and up to 50% of that pain is undertreated. Unrelieved pain leads to increased levels of the stress hormone cortisol. The purpose of this study was to examine the impact of bioenergy on fecal cortisol levels for mice injected with murine mammary carcinoma 4T1 in two separate pilot studies. Using a multiple experimental group design, six to eight week old female BALB/c mice were injected with tumor and randomly assigned, in groups of 10, to daily treatment, every other day treatment, and no treatment groups. Five days after tumor cell injection, bioenergy interventions were begun for a period of ten consecutive days. Fecal samples were collected for each study and ELISA analysis was conducted at the end of both studies. For both studies, cortisol levels were decreased in the every other day treatment groups but remained high in the no treatment groups. Future studies utilizing bioenergy therapies on cortisol levels in a murine breast cancer model can begin to describe pain outcomes and therapeutic dose.
The Montana Radon Study: Social Marketing via Digital Signage Technology for Reaching Families in the Waiting Room
(American Public Health Association, 2015-03) Larsson, Laura S.
Objectives. I tested a social marketing intervention delivered in health department waiting rooms via digital signage technology for increasing radon program participation among priority groups. Methods. I conducted a tricounty, community-based study over a 3-year period (2010–2013) in a high-radon state by using a quasi-experimental design. We collected survey data for eligible participants at the time of radon test kit purchase. Results. Radon program participation increased at the intervention site (t38 = 3.74; P = .001; 95% confidence interval [CI] = 4.8, 16.0) with an increase in renters (χ21,228 = 4.3; P = .039), Special Supplementary Nutrition Program for Women, Infants, and Children families (χ21,166 = 3.13; P = .077) and first-time testers (χ21,228 = 10.93; P = .001). Approximately one third (30.3%; n = 30) attributed participation in the radon program to viewing the intervention message. The intervention crossover was also successful with increased monthly kit sales (t37 = 2.69; P = .01; 95% CI = 1.20, 8.47) and increased households participating (t23 = 4.76; P < .001; 95% CI = 3.10, 7.88). Conclusions. A social marketing message was an effective population-based intervention for increasing radon program participation. The results prompted policy changes for Montana radon programming and adoption of digital signage technology by 2 health departments.
Capillary Tone: Cyclooxygenase, Shear Stress, Luminal Glycocalyx, and Hydraulic Conductivity (Lp)
(2015-04) Williams, Donna A.; Flood, Mary H.
Control of capillary hydraulic conductivity (Lp) is the physiological mechanism that underpins systemic hydration. Capillaries form the largest surface of endothelial cells in any species with a cardiovascular system and all capillaries are exposed to the flow‐induced force, shear stress (τ). Vasoactive molecules such as prostacyclin (cyclooxygenase product, COX) are released from endothelial cells in response to τ. Little is known about how COX activity impacts capillary Lp. The purpose here was to assess Lp in situ following an acute Δτ stimulus and during COX1/COX2 inhibition. Mesenteric true capillaries (TC) of Rana pipiens (pithed) were cannulated for Lp assessment using the modified Landis technique. Rana were randomized into Control and Test groups. Two capillaries per animal were used (perfusate, 10 mg·mL−1 BSA/frog Ringer's; superfusate, frog Ringer's or indomethacin (10−5 mol·L−1) mixed in frog Ringer's solution). Three distinct responses of Lp to indomethacin (TC2) were demonstrated (TC1 and TC2 medians: Test Subgroup 1, 3.0 vs. 1.8; Test Subgroup 2, 18.2 vs. 2.2; Test Subgroup 3, 4.2 vs. 10.2 × 10−7 cm·sec−1·cm H2O−1). Multiple regression analysis revealed a relationship between capillary Lp and systemic red blood cell concentration or hematocrit, plasma protein concentration, and Δτ (Test Subgroup 1, R2 = 0.59, P < 0.0001; Test Subgroup 2, R2 = 0.96, P = 0.002), but only during COX inhibition. Maintaining red blood cell and plasma protein levels within a normal range may control barrier function in a healthy state. Recovering barrier function may be an unrecognized benefit of transfusions during blood loss or edema formation.
Social Marketing Risk-Framing Approaches for Dental Sealants in Rural American Indian Children
(2015-06) Larrson, Laura S.; Champine, Dorothy; Hoyt, Dee; Lin, Lillian; Salois, Emily; Silvas, Sharon; Weasel Tail, Terri; Williams, Matthew
Objective: To compare three variants of a culturally relevant and theoretically based message to determine the most influential risk-framing approach for improving intention to place dental sealants for preschool children. Design and Sample: A convenience sample of adult, American Indian participants (n = 89) attending a community health fair were assigned to view a gain-framed, loss-framed, or mix-framed dental sealant message. Measures: We compared participants\' scores on a 46-item survey to determine the relative effect of the frame assignment on seven indices of behavior change. Results: The mean difference in participants\' stage-of-change scores (x = 1.17, n = 89, SD = 1.90) demonstrated a significant improvement for all groups after watching the dental sealant message t88 = 5.81, p < .0001, 95% CI [0.77â€“1.57]. Self-efficacy was the only construct for which we detected a statistically significant difference as a function of frame assignment. Overall, the mix-framed message resulted in the highest scores. The gain-framed message was the least influential on four constructs. This finding is in contrast to findings that gain-framed oral health messages are most influential (Gallagher & Updegraff, 2012; O'Keefe & Jensen, 2007). Conclusions: Community advisory board members determined to use the mix-framed approach in an oral health social marketing campaign with a rural, American Indian audience.
Critical Care in Critical Access Hospitals.
(2015-10) Seright, Teresa J.; Winters, Charlene A.
What began as a grant-funded demonstration project, as a means of bridging the gap in rural health care, has developed into a critical access hospital system comprising 1328 facilities across 45 states. A critical access hospital is not just a safety net for health care in a rural community. Such hospitals may also provide specialized services such as same-day surgery, infusion therapy, and intensive care. For hospitals located near the required minimum of 35 miles from a tertiary care center, management of critically ill patients may be a matter of stabilization and transfer. Critical access hospitals in more rural areas are often much farther from tertiary care; some of these hospitals are situated within frontier areas of the United States. This article describes the development of critical access hospitals, provision of care and services, challenges to critical care in critical access hospitals, and suggestions to address gaps in research and collaborative care.
Bioenergy and Breast Cancer: A report on tumor growth and metastasis
(2016) Running, Alice; Greenwood, Mark C.; Hildreth, Laura; Schmidt, Jade
As many as 80% of the 296,000 women and 2,240 men diagnosed with breast cancer in the United States will seek out complementary and alternative medicine (CAM) treatments. One such therapy is Healing Touch (HT), recognized by the National Center for Complementary and Integrative Health (NCCIH) as a treatment modality. Using a multiple experimental groups design, fifty-six six- to eight-week-old Balb/c mice were injected with 4T1 breast cancer tumor cells and randomly divided into intervention and positive control groups. Five days after tumor cell injection, mice in the intervention groups received HT either daily or every other day for 10 minutes by one HT practitioner. At 15 days after tumor cell injection, tumor size was measured, and metastasis was evaluated by a medical pathologist after necropsy. Tumor size did not differ significantly among the groups (F(3,52) = 0.75, p value = 0.53). The presence of metastasis did not differ across groups (chi-square(3) = 3.902, p = 0.272) or when compared within an organ (liver: chi-square(3) = 2.507, p = 0.474; lungs: chi-square(3) = 3.804, ; spleen: chi-square(3) = 0.595, p = 0.898). However, these results did indicate a moderate, though insignificant, positive impact of HT and highlight the need for continued research into dose, length of treatment, and measurable outcomes (tumor size, metastasis) to provide evidence to suggest application for nursing care.
Why Stay Home? Temporal Association of Pain, Fatigue and Depression with Being at Home
(2016-04) Ravescloot, Craig; Ward, Bryce; Hargrove, Tannis; Wong, Jennifer; Livingston, Nick; Torma, Linda; Ipsen, Catherine
Background: Community participation is important to most people with disabilities despite the fact that common secondary conditions like pain, fatigue and depression may increase the difficulty of leaving home. Despite decades of research on these secondary conditions, little is known about how they are associated with being at home. Objective: We used Ecological Momentary Assessment data to examine within subject fluctuation in these secondary conditions to examine their effect on the likelihood that participants remain at or return home. Methods: Participants (n = 139) were recruited from a population based sampling frame to complete an Ecological Momentary Assessment that queried their location and experience with secondary conditions six times a day for two weeks. Results: Between subjects secondary condition ratings averaged across time periods indicated that pain and depression were associated with the share of measurement periods that respondents reported being at home. Within subject results indicated that a standard unit increase in pain, fatigue and depression was associated with being home one to two days later. Within day results indicated that increases in pain and fatigue were associated with increased likelihood of being home later, but increases in depression were associated with lower likelihood of being home later. Conclusion: These results suggest there may be a complicated relationship among these secondary conditions and community participation with effects observed both across and within days. One interpretation suggests that secondary condition severity is tempered by adjusting participation. These results may have implications for intervening on these secondary conditions.
Principal components analysis to identify influences on research communication and engagement during an environmental disaster
(2016-08) Winters, Charlene A.; Moore, Colleen F.; Kuntz, Sandra W.; Weinert, Clarann; Hernandez, Tanis; Black, Brad
OBJECTIVES: To discern community attitudes towards research engagement in Libby, Montana, the only Superfund site for which a public health emergency has been declared. STUDY DESIGN: Survey study of convenience samples of residents near the Libby, Montana Superfund site. PARTICIPANTS: Residents of the Libby, Montana area were recruited from a local retail establishment (N=120, survey 1) or a community event (N=127, survey 2). MEASURES: Two surveys were developed in consultation with a Community Advisory Panel. RESULTS: Principal components of survey 1 showed four dimensions of community members' attitudes towards research engagement: (1) researcher communication and contributions to the community, (2) identity and affiliation of the researchers requesting participation, (3) potential personal barriers, including data confidentiality, painful or invasive procedures and effects on health insurance and (4) research benefits for the community, oneself or family. The score on the first factor was positively related to desire to participate in research (r=0.31, p=0.01). Scores on factors 2 and 3 were higher for those with diagnosis of asbestos-related disease (ARD) in the family (Cohen's d=0.41, 0.57). Survey 2 also found more positive attitudes towards research when a family member had ARD (Cohen's d=0.48). CONCLUSIONS: Principal components analysis shows different dimensions of attitudes towards research engagement. The different dimensions are related to community members' desire to be invited to participate in research, awareness of past research in the community and having been screened or diagnosed with a health condition related to the Superfund contaminant.
Comparing the Cost of Care Provided to Medicare Beneficiaries Assigned to Primary Care Nurse Practitioners and Physicians
(2016-08) Perloff, Jennifer; DesRoches, Catherine M; Buerhaus, Peter I.
Objective. This study is designed to assess the cost of services provided to Medicare beneficiaries by nurse practitioners (NPs) billing under their own National Provider Identification number as compared to primary care physicians (PCMDs). Data Source. Medicare Part A (inpatient) and Part B (office visit) claims for 2009-2010. Study Design. Retrospective cohort design using propensity score weighted regression. Data Extraction Methods. Beneficiaries cared for by a random sample of NPs and primary care physicians. Principal Findings. After adjusting for demographic characteristics, geography, comorbidities, and the propensity to see an NP, Medicare evaluation and management payments for beneficiaries assigned to an NP were $207, or 29 percent, less than PCMD assigned beneficiaries. The same pattern was observed for inpatient and total office visit paid amounts, with 11 and 18 percent less for NP assigned beneficiaries, respectively. Results are similar for the work component of relative value units as well. Conclusions. This study provides new evidence of the lower cost of care for beneficiaries managed by NPs, as compared to those managed by PCMDs across inpatient and office-based settings. Results suggest that increasing access to NP primary care will not increase costs for the Medicare program and may be cost saving.
Prescribing Practices by Nurse Practitioners and Primary Care Physicians: A Descriptive Analysis of Medicare Beneficiaries
(2017-04) Muench, Ulrike; Perloff, Jennifer; Thomas, Cindy Parks; Buerhaus, Peter I.
Introduction Nurse practitioner (NP) prescribing continues to be a contentious policy issue, and studies systematically examining NP prescribing are lacking. The aim of this study was to conduct a descriptive analysis comparing the prescribing services of NPs with those of primary care physicians (PCPs) in providing care to Medicare beneficiaries. Methods Part D drug claims of beneficiaries who saw an NP or a PCP in 2009 and 2010 were examined for differences in the types of medications prescribed, the volume of prescriptions, and the duration of prescriptions across all drug classes in Medicare Part D. Results Data for 164,681 beneficiaries were analyzed. Results showed the same top 20 types of medications and the same share of generic medications for NP and PCP prescriptions. Differences in prescribing patterns were found for the number of prescriptions and for the duration of the prescriptions (daysâ€™ supply per claim). NP beneficiaries received, on average, approximately one more 30-day prescription per year than PCP beneficiaries. The mean duration for an NP prescription claim was 3 days shorter than that for a PCP prescription claim, indicating that NP beneficiaries need refills sooner than PCP beneficiaries. This pattern existed in most drug classes and was more pronounced in behavioral drug classes, such as antidepressants, antipsychotics, psychotherapeutics, and opioids and in patients with more comorbidities. Differences in state scope of practice laws did not affect these prescribing patterns. Conclusions Key differences were observed in the number and duration of prescriptions written by NPs and PCPs. Further research is needed to understand the impact of differences in NP and PCP patient populations on provider prescribing, such as the higher number of prescriptions issued by NPs for beneficiaries in moderate and high comorbidity groups and the implications of the duration of prescriptions for clinical outcomes, patient-provider rapport, costs, and potential gaps in medication coverage
Bee SAFE, a Skill-Building Intervention to Enhance CAM Health Literacy: Lessons Learned
(2017-04) Shreffler-Grant, Jean; Nicholas, Elizabeth G.; Weinert, Clarann
The purpose is to describe a feasibility study of a skill-building intervention to enhance health literacy about complementary and alternative (CAM) therapies among older rural adults and share lessons learned. A study was designed to examine the feasibility of an intervention to enhance CAM health literacy. The theme was \Bee SAFE\" for Be a wise user of CAM, Safety, Amount, From where, and Effect. Modules were presented face to face and by webinar with older adults at a senior center in one small rural community. The team achieved its purpose of designing, implementing, and evaluating the intervention and assessing if it could be implemented in a rural community. The implementation challenges encountered and lessons learn are discussed. By improving CAM health literacy, older rural adults with chronic health conditions can make well-reasoned decisions about using CAM for health promotion and illness management. The goal is to implement the Bee SAFE intervention in other rural communities; thus team members were attentive to lessons to be learned before investing time, effort, and expense in the larger intervention. It is hoped that the lessons learned can be instructive to others planning projects in rural communities."
The role of physician oversight on advanced practice nurses' professional autonomy and empowerment
(2017-05) Petersen, Polly A.; Way, Sandra M.
BACKGROUND AND PURPOSE: Little is known about the effects of physician oversight on advanced practice registered nurses (APRNs). Examination of these relationships provides insight into the strength of independent practice. The purpose of this study was to examine whether APRNs' perceptions of autonomy and empowerment varied according to type of physician oversight, whether facilitative or restrictive. DATA SOURCES: A cross-sectional survey design was used to examine whether APRNs' perceptions of autonomy and empowerment varied according to physician oversight, geographical location, and practice setting. Five hundred questionnaires were mailed in March 2013 with 274 returned. Participants were asked about autonomy, empowerment, demographics, physician oversight, geographical location, and practice setting. CONCLUSIONS: Among surveyed respondents, physician oversight was related to increased empowerment, regardless of whether the oversight was defined in facilitative or restrictive terms; both had similar positive effects on empowerment. IMPLICATIONS FOR PRACTICE: If APRNs are to be part of the solution to the growing problem of healthcare access, it is important to study factors that contribute to their success. We speculate that increasing opportunities for collaboration and interaction with physicians, and possibly other healthcare professionals, could facilitate APRN empowerment, optimizing their contribution.
Views on exercise: A grounded theory exploration of the creation of exercise perceptions in Hispanic children with asthma
(2017-06) Shaw, Michele Rose; Katz, Janet; Benavides-Vaello, Sandra; Oneal, Gail; Holliday, Carrie
Introduction: There is a large prevalence of asthma, particularly among Hispanic children. Although physical activity is a good way to manage asthma, more Hispanic children with asthma lack activity than their healthy classmates. Given this, the purpose of this study was to explore the development of exercise perceptions in Hispanic children with asthma and to further develop an existing explanatory theory. Method: Grounded theory was the approach for the study. Grounded theory illuminated components of exercise perceptions from participants. Participants included Hispanic children with asthma, their families, and professionals who work with Hispanic children with asthma ( n = 29). Results: Findings from this study supported the previously identified grounded theory called The Process of Creating Perceptions of Exercise. In addition, two new concepts (cultural and peer influences) were identified that further explain the category of exercise influences. Conclusion: The revised theory can be used to assist in developing nursing interventions aimed at increasing exercise participation among Hispanic children with asthma.
Native American Death Taboo: Implications for Health Care Providers
(2017-07) Colclough, Yoshiko Yamashita
This study was conducted to highlight Native American (NA) perspectives on death taboo in order to examine the cultural appropriateness of hospice services for NA patients, if any. Searching literature that addressed taboo and death from historical, psychological, sociological, and anthropological aspects, a comparison of death perspectives was made between NAs and European Americans. A culturally sensitive transition from palliative care to hospice care was suggested for NA patients and their family.
A Story of Emergent Leadership: Lived Experiences of Nurses in a Critical Access Hospital
(2017-08) Pare, Judith Maria; Sharp, Dayle Boynton; Petersen, Polly A.
Purpose: The purpose of this study was to understand the lived experiences of nurses working in a predominantly rural care setting. In order to meet the needs of an aging population with multiple comorbidities, it is essential for leaders to understand the strategies to recruit and retain highly qualified nurses in CAHs settings. Sample: Nine registered nurses working both full and part time with one to 40 years of experience participated in the interview process that queried their attitudes regarding working in a rural setting. Findings: Five major themes included self-reliance, social responsibility, empathy, isolation, and emergent leadership. Conclusions: The findings from this study support the notion that there is not a universal response to the lived experience of nurses working in CAHs. The unique needs of each nurse should be considered to enhance the practice environment and diminish experiences that result in feelings of isolation. Isolation impacted the five themes; if nurses are not able to maintain current knowledge and skills in a supportive environment, their self-reliance is compromised.
Preliminary Psychometric Evaluation of the Hamilton Depression Rating Scale in Methamphetamine Dependence
(2017-08) Hellem, Tracy; Scholl, Lindsay; Ferguson, Hayden; McGlade, Erin; Yurgelun-Todd, Deborah; Renshaw, Perry; Hildreth, Laura
OBJECTIVE: The purpose of this study was to test the initial psychometric properties of the 17-item Hamilton Depression Rating Scale (HAM-D) in individuals with and without major depressive disorder who use methamphetamine. We used data from two completed studies and two ongoing clinical trials. The HAM-D has well established reliability and validity in a variety of populations. However, there are no published reports of reliability and validity of the HAM-D in a methamphetamine using population. METHODS: HAM-D and depression status data were extracted from four separate studies for this psychometric assessment. Using these data, we evaluated three measures of construct validity: internal consistency, contrasted groups validity and factorial validity. RESULTS: We found potential concerns with the construct validity of the HAM-D in users of methamphetamine. Intercorrelations between items were primarily less than 0.20 and the Cronbach's alpha value in this sample was 0.58 indicating potential issues with internal consistency. The results of a two sample t-tests suggest concerns with contrasted group validity, as no significant difference in average scores were found for nine items. Consistent with previous studies, a principal component analysis indicates that the HAM-D is multidimensional. CONCLUSIONS: The 17-item HAM-D might not reliably and validly measure depression severity in a methamphetamine using population. Given our small sample, additional research is needed, though, to further test the psychometric properties of the HAM-D in individuals who use methamphetamine.
Interprofessional oral health initiative in a nondental, American Indian setting
(2017-09) Murphy, Kate L.; Larsson, Laura S.
Background and Purpose Tooth decay is the most common chronic childhood disease and American Indian (AI) children are at increased risk. Pediatric primary care providers are in an opportune position to reduce tooth decay. The purpose of this study was to integrate and evaluate a pediatric oral health project in an AI, pediatric primary care setting. Methods The intervention set included caregiver education, caries risk assessment, and a same-day dental home referral. All caregiver/child dyads age birth to 5 years presenting to the pediatric clinic were eligible (n = 47). Conclusions Most children (n = 35, 91.1%) were scored as high risk for caries development. Of those with first tooth eruption (n = 36), ten had healthy teeth (27.8%) and seven had seen a dentist in the past 3 months (19.4%). All others were referred to a dentist (n = 29) and 21 families (72.4%) completed the referral. Implications for Practice In fewer than 5 min per appointment (x = 4.73 min), the primary care provider integrated oral health screening, education, and referral into the well-child visit. Oral health is part of total health, and thus should be incorporated into routine well-child visits.