Moving Upstream From the Individual to the Community: Addressing Social Determinants of Health

2020 ◽  
Vol 35 (3) ◽  
pp. 152-157
Author(s):  
Lisa A. Campbell ◽  
Laura Anderko
Keyword(s):  
Social Determinants Of Health ◽  
21St Century ◽  
Social Determinants ◽  
Nursing Practice ◽  
Population Level ◽  
School Nurses ◽  
Determinants Of Health ◽  
School Nursing ◽  
Policies And Programs ◽  
The Individual

School nurses are often the primary health professional promoting children’s health—and address not just individuals, but communities. This article, featuring the key principle of community/public health, is the first in a series focusing on The Framework for 21st Century School Nursing Practice™ and presents a case study on asthma and air quality issues comparing the more traditional individual approaches to health (labeled downstream and midstream) with population-level approaches (labeled upstream). Through collaboration with key community stakeholders, school nurses can successfully implement policies and programs to address social determinants of health and, in turn, improve the health of the entire community. As we look to advance school nursing and support best practices, concentrating on population-level, upstream approaches align with recommendations outlined in the Framework for 21st Century School Nursing Practice™.

scholarly journals Individual and Community Social Determinants of Health Associated With Diabetes Management in a Mexican American Population

2021 ◽  
Vol 8 ◽  
Author(s):  
Kehe Zhang ◽  
Belinda Reininger ◽  
Miryoung Lee ◽  
Qian Xiao ◽  
Cici Bauer
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Mexican American ◽  
Diabetes Management ◽  
Spatial Models ◽  
Neighborhood Context ◽  
Community Level ◽  
Border Region ◽  
Determinants Of Health ◽  
The Individual

Background: Diabetes is a major health burden in Mexican American populations, especially among those in the Lower Rio Grande Valley (LRGV) in the border region of Texas. Understanding the roles that social determinants of health (SDOH) play in diabetes management programs, both at the individual and community level, may inform future intervention strategies.Methods: This study performed a secondary data analysis on 1,568 individuals who participated in Salud y Vida (SyV), a local diabetes and chronic disease management program, between October 2013 and September 2018 recruited from a local clinic. The primary outcome was the reduction of hemoglobin A1C (HbA1C) at the last follow-up visit compared to the baseline. In addition to age, gender, insurance status, education level and marital status, we also investigated 15 community (census tract) SDOH using the American Community Survey. Because of the high correlation in the community SDOH, we developed the community-level indices representing different domains. Using Bayesian multilevel spatial models that account for the geographic dependency, we were able to simultaneously investigate the individual- and community-level SDOH that may impact HbA1C reduction.Results: After accounting for the diabetes self-management education classes taken by the participants and their length of stay in the program, we found that older age at baseline, being married (compared to being widowed or divorced) and English speaking (compared to Spanish) were significantly associated with greater HbA1C reduction. Moreover, we found that the community level SDOH were also highly associated with HbA1C reduction. With every percentile rank decrease in the socioeconomic advantage index, we estimated an additional 0.018% reduction in HbA1C [95% CI (−0.028, −0.007)]. Besides the socioeconomic advantage index, urban core opportunity and immigrant's cohesion and accessibility indices were also statistically associated with HbA1C reduction.Conclusion: To our knowledge, our study is the first to utilize Bayesian multilevel spatial models and simultaneously investigate both individual- and community-level SDOH in the context of diabetes management. Our findings suggest that community SDOH play an important role in diabetes control and management, and the need to consider community and neighborhood context in future interventions programs to maximize their overall effectiveness.

A New Framework for School Nurse Self-Reflection and Evaluation

2019 ◽  
Vol 35 (1) ◽  
pp. 35-42
Author(s):  
Robin Landes Wallin ◽  
Susan Rothman
Keyword(s):  
Clinical Practice ◽  
21St Century ◽  
Nursing Practice ◽  
School Nurse ◽  
Position Statement ◽  
School Nurses ◽  
School Nursing ◽  
Self Reflection ◽  
Standards Of Practice ◽  
New Framework

The purpose of this article is to demonstrate how the Framework for 21st Century School Nursing Practice™ can provide a structure for evaluation using the School Nursing: Scope and Standards of Practice (3rd ed.), thus allowing the school nurse and school nurse evaluators to gain a better understanding of school nursing practice. According to NASN’s Position Statement Supervision and Evaluation of the School Nurse, standards should be used to evaluate the clinical practice of school nurses. Our project accomplishes this integration of the Framework, the standards, and the evaluation of school nursing practice.

Professional Development and Appraisal System for School Nurses

2002 ◽  
Vol 18 (4) ◽  
pp. 229-236
Author(s):  
Jane Tustin ◽  
Gloria Canham ◽  
Joanne Berridge ◽  
Deborah Braden ◽  
Thora Starke
Keyword(s):  
Evaluation System ◽  
Nursing Practice ◽  
Evaluation Model ◽  
School Nurse ◽  
School Nurses ◽  
School Nursing ◽  
Professional School ◽  
Appraisal System ◽  
Nurse Administrators ◽  
The Individual

Dissatisfied with current school nurse evaluation instruments, school nurse administrators sought to develop an appraisal system that would emphasize the professional role of the school nurse and provide a means to enhance individual practice. The newly revised Standards of Professional School Nursing Practice and the creation of a state teacher evaluation model presented the opportunity to produce an instrument that could be adapted within the educational setting for school nursing practice. The appraisal system included not only the methods to evaluate practice, but the means to involve the individual school nurse through goal setting. The process also included a structured intervention plan that facilitated remediation. This article describes the development of the appraisal system, the components, and the implementation of an evaluation system for school nurses.

scholarly journals Framework for 21st Century School Nursing Practice™: Clarifications and Updated Definitions

2020 ◽  
Vol 35 (4) ◽  
pp. 225-233 ◽  
Author(s):  
Keyword(s):  
21St Century ◽  
Nursing Practice ◽  
School Nurses ◽  
National Association ◽  
School Nursing ◽  
Common Understanding

The National Association of School Nurses developed the Framework for 21st Century School Nursing Practice™ (Framework) to guide school nursing practice and help school nurses articulate their role to educators. Since its introduction, the Framework has been accepted and adopted by many. At the same time, several misunderstandings and misinterpretations of the Framework have come to light. The purpose of this article is to clarify the terminology in order to create a common understanding among practicing school nurses to be able to implement the Framework more fully and with integrity.

Shaping Your Practice and Changing Mindsets: Framework for 21st Century School Nursing Practice™

2018 ◽  
Vol 33 (4) ◽  
pp. 236-238 ◽  
Author(s):  
Keyword(s):  
Nursing Education ◽  
21St Century ◽  
Best Practice ◽  
Nursing Practice ◽  
School Nurses ◽  
School Nursing ◽  
Professional School ◽  
Continuing Nursing Education ◽  
Nursing Activity ◽  
Graphic Illustration

NASN’s Framework for 21st Century School Nursing Practice™ (the Framework) provides a graphic illustration of the key principles of professional school nursing practice, reflects NASN’s stance for evidence-based best practice and provides a focus when prioritizing school nursing activity. In order to ensure fidelity of the Framework and to provide professional development for school nurses, NASN is embarking on an exciting new project: Focus on the Framework, a series of five Continuing Nursing Education (CNE) modules, along with a certificate of proficiency in the Framework, which will be earned after the completion of all five modules and the successful completion of a culminating activity. We invite your feedback and suggestions as the certificate process is developed.

scholarly journals Population-Level Data on Child Development at School Entry Reflecting Social Determinants of Health: A Narrative Review of Studies Using the Early Development Instrument

2021 ◽  
Vol 18 (7) ◽  
pp. 3397
Author(s):  
Magdalena Janus ◽  
Caroline Reid-Westoby ◽  
Noam Raiter ◽  
Barry Forer ◽  
Martin Guhn
Keyword(s):  
Early Childhood ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Early Childhood Development ◽  
Developmental Outcomes ◽  
Population Level ◽  
Determinants Of Health ◽  
School Entry ◽  
Childhood Development ◽  
Developmental Health

Background: The Early Development Instrument (EDI) was developed as a population-level assessment of children’s developmental health at school entry. EDI data collection has created unprecedented opportunities for population-level studies on children’s developmental outcomes. The goal of this narrative review was to synthesize research using the EDI to describe how it contributes to expanding the understanding of the impacts of social determinants on child development and how it applies to special populations. Methods: Select studies published in peer-reviewed scientific journals between 2015 and 2020 and incorporating the social determinants of health perspectives were chosen to highlight the capability of the EDI to monitor children’s developmental health and contribute knowledge in the area of early childhood development. Results: A number of studies have examined the association between several social determinants of health and children’s developmental outcomes, including hard-to-reach and low-frequency populations of children. The EDI has also been used to evaluate programs and interventions in different countries. Conclusions: The ability of the EDI to monitor children’s developmental outcomes in various populations has been consistently demonstrated. The EDI, by virtue of its comprehensive breadth and census-like collection, widens the scope of research relating to early childhood development and its social determinants of health.

scholarly journals Power of the Past, Celebrate the Present, Force of the Future Part 4: 50 Years of School Nursing Practice—From Then Until Now

2018 ◽  
Vol 34 (1) ◽  
pp. 44-54 ◽  
Author(s):  
Beth Mattey
Keyword(s):  
21St Century ◽  
Nursing Practice ◽  
School Nurses ◽  
School Nursing ◽  
The Past ◽  
The Future

This article is the fourth in the series examining 50 years of NASN’s history. It looks at the needs of our students and the practice of school nursing from 1968 through 2018 using the structure provided by NASN Framework for 21st Century School Nursing Practice™. The article examines the destiny of school nursing practice as determined by the needs of our students, the strength and resolve of school nurses, and the education and resources provided by NASN.

scholarly journals Canadian Senate Report on Obesity: Focusing on Individual Behaviours versus Social Determinants of Health May Promote Weight Stigma

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Angela S. Alberga ◽  
Lindsay McLaren ◽  
Shelly Russell-Mayhew ◽  
Kristin M. von Ranson
Keyword(s):  
Public Health ◽  
Health Promotion ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Weight Stigma ◽  
Unintended Consequences ◽  
Determinants Of Health ◽  
Health Issue ◽  
Public Health Issue ◽  
The Individual

Very little attention has been given to unintended consequences of government reporting on obesity. This paper argues that the 2016 Senate report, “Obesity in Canada: A Whole-Of-Society Approach,” exemplifies the systemic public health issue of weight stigma. The purpose of this viewpoint is to critique the approach taken in the Report, by illustrating that it (1) takes a weight-centric approach to health, (2) does not acknowledge important limitations of the definition and measurement of obesity, (3) reifies obesity as a categorical phenomenon that must be prevented, and (4) uses aggressive framing and disrespectful terminology. The Report perpetuates a focus on the individual, thereby failing to recognize the role that governments can play in reducing weight stigma and addressing social determinants of health. If steps are taken to avoid propagating weight stigma, future reports could more constructively address health promotion, equity, and social determinants of health in their policies.

scholarly journals Statewide Impact of COVID-19 on Social Determinants of Health - A First Look: Findings from the Survey of the Health of Wisconsin

2021 ◽  
Author(s):  
Kristen M.C. Malecki ◽  
Amy A. Schultz ◽  
Maria Nikodemova ◽  
Matt C. Walsh ◽  
Andrew J. Bersch ◽  
...  
Keyword(s):  
Coping Strategies ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Family Dynamics ◽  
Well Being ◽  
Determinants Of Health ◽  
Economic Shocks ◽  
Policies And Programs ◽  
And Coping ◽  
Health And Well Being

ABSTRACTThere is an urgent need to track the early and ongoing impact of the COVID-19 pandemic on population health from local to global scales. At the same time, there is an overall lack of U.S. state-specific surveillance data tracking social determinants of health (SDOH) and associations with population well-being, individual mitigation and coping strategies, family dynamics and other economic shocks of the pandemic in populations. Statewide data can offer important insights into how SDOH shape the long-term effects of COVID-19 in the population since implementation of many policies and programs varied widely early on in the pandemic. In May of 2020, the Survey of the Health of Wisconsin (SHOW) program launched a statewide online/phone survey of early and ongoing impacts of COVID-19 on health and well-being across diverse communities and families. The goal of this study is to provide descriptive data including perceived COVID-19 risks, access to and results of COVID-19 antigen testing, individual mitigation and coping strategies, family dynamics and other economic shocks of the pandemic on health and mental health in populations. Key findings include higher rates of testing and perceived past infection from COVID-19 among non-white respondents. Higher economic shifts and job changes in female vs male respondents. Families with children reported overall higher levels of stress, and stress from the pandemic. There were urban and rural differences in changes to access to care. Rural regions, which had a lower prevalence of infections early in the pandemic as compared to urban areas, also reported fewer delays or missed appointments due to COVID-19. Key findings show that SDOH are shaping impacts of health and well-being early on in the pandemic and future longitudinal follow-up will be important to shape policies and programs well into the future.

scholarly journals Addressing the Social Determinants of Health: A Call to Action for School Nurses

2018 ◽  
Vol 34 (3) ◽  
pp. 182-191 ◽  
Author(s):  
Krista Schroeder ◽  
Susan Kohl Malone ◽  
Ellen McCabe ◽  
Terri Lipman
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Well Being ◽  
School Nurses ◽  
Determinants Of Health ◽  
Call To Action ◽  
School Based ◽  
The Social ◽  
Care Coordinators ◽  
Student Advocates

Social determinants of health (SDOH), the conditions in which children are born, grow, live, work or attend school, and age, impact child health and contribute to health disparities. School nurses must consider these factors as part of their clinical practice because they significantly and directly influence child well-being. We provide clinical guidance for addressing the SDOH when caring for children with three common health problems (obesity, insufficient sleep, and asthma). Given their unique role as school-based clinical experts, care coordinators, and student advocates, school nurses are well suited to serve as leaders in addressing SDOH.

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