Nurse Practitioner’s Ethical and Legal Dilemma: Caring for a Young Child Without a Parent in the School-Based Health Center Setting

2009 ◽  
Vol 2 (1) ◽  
pp. 19-22
Author(s):  
Mary Huang
Keyword(s):  
Health Care ◽  
Young Child ◽  
Nurse Practitioners ◽  
Access To Health Care ◽  
School Setting ◽  
Young Patients ◽  
The United States ◽  
Health Centers ◽  
School Based ◽  
School Based Health Centers

Since the 1980s, the number of school-based health centers has increased due to funding that lead to recognition by policy makers and health organizations. The mission was to provide comprehensive pediatric health care to children with limited access to health care and the uninsured. The goal was to decrease school absenteeism and missed work days by providing convenient primary and acute care while children are in school. For sponsoring organizations managing school-based clinics, allowing parents to be absent during clinic visits met its mission. However, the ease of young children receiving health care in the school setting without being accompanied by their parents has positioned nurse practitioners in an ethical and legal dilemma. Asking a young child significant health history during a physical examination or having them describe their chief complaints during an acute visit may not be the best way to provide good care to our young patients. Additionally, what are the legal responsibilities of a nurse practitioner when caring for a child without active participation of the parent? Little has been documented in the past about the dilemmas nurse practitioners face in school clinic settings. With increasing use and recognition of school-based health centers in the United States, the need for more discussion is required to explore solutions to provide quality comprehensive care for patients and their families.

scholarly journals The Use of Telehealth in School-Based Health Centers

2019 ◽  
Vol 6 ◽  
pp. 2333794X1988419 ◽  
Author(s):  
Hayley Love ◽  
Nirmita Panchal ◽  
John Schlitt ◽  
Caroline Behr ◽  
Samira Soleimanpour
Keyword(s):  
United States ◽  
Health Care ◽  
Public Schools ◽  
Health Care Access ◽  
Access To Health Care ◽  
Care Delivery ◽  
The United States ◽  
Health Centers ◽  
School Based ◽  
School Based Health Centers

Telehealth is a growing model of delivering health care. School-based health centers (SBHCs) provide access to health care for youth in schools and increasingly use telehealth in care delivery. This article examines the recent growth of telehealth use in SBHCs, and characteristics of SBHCs using telehealth, including provider types, operational characteristics, and schools and students served. The percentage of SBHCs using telehealth grew from 7% in 2007-2008 to 19% in 2016-2017. Over 1 million students in over 1800 public schools have access to an SBHC using telehealth, which represents 2% of students and nearly 2% of public schools in the United States. These SBHCs are primarily in rural communities and sponsored by hospitals. This growing model presents an opportunity to expand health care access to youth, particularly in underserved areas in the United States and globally. Further research is needed to fully describe how telehealth programs are implemented in school settings and their potential impacts.

“Contraceptive Care for Adolescents in School-Based Health Centers Is Essential!”

2017 ◽  
Vol 34 (5) ◽  
pp. 367-379 ◽  
Author(s):  
Alison Moriarty Daley ◽  
E. Carol Polifroni
Keyword(s):  
Lived Experience ◽  
Nurse Practitioners ◽  
Phenomenological Study ◽  
The United States ◽  
Health Centers ◽  
School Based ◽  
Contraceptive Services ◽  
Colaizzi's Method ◽  
School Based Health Centers ◽  
Provide Health Education

Adolescents often face hurdles that may interfere with accessing contraceptive services. School-based health centers (SBHCs) are available to many teens in the United States; however, only half of SBHCs that serve adolescents are permitted to provide contraception. The aim of this descriptive phenomenological study was to describe the lived experience of nurse practitioners (NPs) providing contraceptive care to teens in SBHCs. Twelve NPs were interviewed and Colaizzi’s method of descriptive phenomenological analysis was used to describe the lived experience of NPs providing contraceptive care to adolescents in SBHCs. Three themes emerged: Contraception is an Essential Part of Care for Teens Using SBHCs; Frustration! There are so Many Hurdles to Negotiate; and Walking a Fine Line. Despite the restrictions on SBHC services and the hurdles the NPs encountered, they remained committed to providing contraceptive services and seized available opportunities to provide health education and support for the adolescents accessing the SBHCs.

‘How come they don’t talk about it in school?’ Identifying adolescent barriers to PrEP use

2021 ◽  
Author(s):  
Leslie Gailloud ◽  
Tatiana Gonzalez-Argoti ◽  
Sophia Philip ◽  
Lena S Josephs ◽  
Joanne E Mantell ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Thematic Analysis ◽  
The United States ◽  
Health Centers ◽  
Perceived Need ◽  
School Based ◽  
Immunodeficiency Virus ◽  
School Based Health Centers ◽  
Exposure Prophylaxis

Abstract Although 21% of new human immunodeficiency virus (HIV) diagnoses in the United States are in youth aged 13–24 years, adolescent awareness and uptake of the HIV prevention medication pre-exposure prophylaxis (PrEP) are low. This study explores the attitudes and challenges that adolescents face while taking PrEP. Thirty interviews were conducted with Black and Latine (we use the gender-inclusive term Latine rather than Latinx for more appropriate Spanish pronunciation) students aged 15–17 who received care at school-based health centers (SBHCs) in the Bronx, NY. Transcripts were coded inductively and deductively using thematic analysis. Most participants were unaware of PrEP, but nearly all were enthusiastic when informed about it; a majority denied that they would feel any stigma when taking PrEP. Despite this high receptivity, multiple barriers were identified, particularly confidentiality from parents, low perceived need of PrEP and concerns about daily adherence and side effects. Adolescents overall were enthusiastic about the availability of PrEP and felt it empowered them to have control over their health. SBHCs were considered trusted sources of confidential, accessible care, and we believe that they can be uniquely positioned to mitigate barriers to PrEP distribution in the future.

A Statewide Profile of Frequent Users of School-Based Health Centers: Implications for Adolescent Health Care

2016 ◽  
Vol 86 (4) ◽  
pp. 250-257 ◽  
Author(s):  
Kevin T. Koenig ◽  
Mary M. Ramos ◽  
Tara T. Fowler ◽  
Kristin Oreskovich ◽  
Jane McGrath ◽  
...  
Keyword(s):  
Health Care ◽  
Adolescent Health ◽  
Health Centers ◽  
Frequent Users ◽  
School Based ◽  
School Based Health Centers

“Do Their Own Thing”: Radical Health Care and the Fair Haven Community Health Center

2021 ◽  
pp. e1-e9
Author(s):  
Ezra S. Lichtman
Keyword(s):  
Health Care ◽  
Community Health ◽  
Nurse Practitioners ◽  
Community Health Centers ◽  
Community Health Center ◽  
The United States ◽  
Health Centers ◽  
Free Clinics ◽  
Fee For Service ◽  
Alternative Health

Radical health reform movements of the 1960s inspired two widely adopted alternative health care models in the United States: free clinics and community health centers. These groundbreaking institutions attempted to realize bold ideals but faced financial, bureaucratic, and political obstacles. This article examines the history of Fair Haven Community Health Care (FHCHC) in New Haven, Connecticut, an organization that spanned both models and typified innovative aspects of each while resisting the forces that tempered many of its contemporaries’ progressive practices. Motivated by a tradition of independence and struggling to address medical neglect in their neighborhood, FHCHC leaders chose not to affiliate with the local academic hospital, a decision that led many disaffected community members to embrace the clinic. The FHCHC also prioritized grant funding over fee-for-service revenue, thus retaining freedom to implement creative programs. Furthermore, the center functioned in an egalitarian manner, enthusiastically employing nurse practitioners and whole-staff meetings, and was largely able to avoid the conflicts that strained other community-controlled organizations. The FHCHC proved unusual among free clinics and health centers and demonstrated strategies similar institutions might employ to overcome common challenges. (Am J Public Health. Published online ahead of print September 16, 2021: e1–e9. https://doi.org/10.2105/AJPH.2021.306417 )

scholarly journals The Pursuit of Nurse Practitioner Practice Legislation: A Case Study

2020 ◽  
Vol 21 (4) ◽  
pp. 222-232
Author(s):  
Catherine Moore ◽  
Angela Kabbe ◽  
Tiffany S. Gibson ◽  
Susan Letvak
Keyword(s):  
Health Care ◽  
Nurse Practitioners ◽  
Policy Development ◽  
Access To Health Care ◽  
Single Case ◽  
The United States ◽  
Regulatory Change ◽  
Decision Making Processes ◽  
Legislative Changes

Across the United States, nursing practice acts (NPAs) have been revised to include provisions that promote full practice authority (FPA) for nurse practitioners (NPs). Such revisions provide a mechanism to better utilize the full scope of NP services to address growing demands for access to health care. Modernized NPAs that facilitate FPA for NPs are imperative, especially now with the unprecedented health care crisis that the world now faces: Coronavirus Disease 2019. This is the first known study to use an embedded single-case study design, guided by the Kingdon policy stream model, to provide a detailed account of how stakeholders for NP FPA determine the appropriate time to pursue legislative changes to NP scope of practice regulations. Qualitative data analysis revealed four themes which comprised the components considered by stakeholders during their decision-making processes related to NP FPA: participants, problem, policy development, and politics. Themes were further collapsed within concepts from the Kingdon model to form the case description. Study findings can be used to increase the competency among NP FPA stakeholders in determining the timing of legislative pursuits for regulatory change.

scholarly journals Oregon School-Based Health Centers

2004 ◽  
Vol 2 (SI) ◽  
pp. 11-21 ◽  
Author(s):  
Robert J. Nystrom ◽  
Kathy Lovrien ◽  
Loretta Gallant ◽  
Anne K. Johnston-Silverberg ◽  
Stacie Shelton
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Developmentally Appropriate ◽  
Behavioral Health Care ◽  
Health Centers ◽  
Care Services ◽  
School Based ◽  
Prevention Messages ◽  
School Based Health Centers ◽  
Satisfaction With Services

Oregon’s School Based Health Centers (SBHCs) have grown from five in 1986 to the 41 state certified centers currently in operation. The centers provide developmentally appropriate primary care and behavioral health care services to elementary, middle, and high school sites. SBHC program goals include increasing student access to care, and improving both health and educational outcomes. In the 2000-2001 service year, the Oregon SBHC program began the administration of a new patient satisfaction survey designed to measure satisfaction with services, access, receipt of prevention messages, and number of missed classes. A proportional random survey sample was achieved with a 98% response rate. Results indicate that SBHC patients had high levels of satisfaction and compliance, an increased likelihood of accessing care, high levels of compliance and satisfaction with services, decreased time from school for health care reasons, and were likely to have received one or more prevention messages. This experience demonstrates how public health surveillance can be incorporated into a SBHC clinical setting with minimal disruption to services and can inform SBHC program evaluation and improvement.

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