Introduction and Background Childhood obesity affects 17% of children in the United States (Whooten et al., 2018). It is well understood that many social determinants contribute to the manifestation and improvement of this disease. Purpose Statement I aim to compare the impact of increased health education through medical professional to families and obese/overweight children compared to implemented physical activity in social and personal settings on BMI improvement among the obese/overweight children. Literature Review Searches performed through the Sherrod Library data base at East Tennessee State University included the following key words: social determinants, long-term study, physical activity, clinical, community and family. Research was not limited to the United States population. Findings Review of these studies showed marked improvement in BMI for physical activity programs in association with schools. These activities resulted in BMI z-score improvements of -0.22, when 60 minutes of physical activity was implemented 3-day/week prior to school (Whooten et al., 2018). Studies surrounding medical counseling and education alone reported minimal improvements to BMI and limited sustainable of these results at follow-up. However, frequent routine meeting with medical profession and obese children and their family resulted in increased Pediatric Quality of Life scores. Conclusions While implantation of multiple discipline may be required to improved BMI in obese/overweight children, physical activity in the public social setting shows to be promising compared to increased education and counseling from medical professionals alone in reducing BMI.

Abstract Introduction and Background: Minority populations struggle to gain access to equitable healthcare due to cultural variations and language barriers. It is paramount for providers to accommodate to the differing needs of underserved minority groups. Purpose Statement: We analyzed information on the effects of community-based interventions aimed at improving healthcare access for minorities. Literature Review: We used PubMed as our main database. For our search, we looked up the keywords “Healthcare Access AND Minorities.” Next, we filtered articles that had been published since 2017 and sorted to include clinical trials, randomized control trials, and meta-analyses. After that, we came across ninety-eight total articles, and picked five of the most critical. Findings: From the first two articles, patient navigators have been shown to be effective in helping minorities navigating the information and decisions presented to them in healthcare. The researchers in the third study found that minority groups are at a greater risk for a health literacy deficit. Our next article found that African Americans treated with computerized cognitive behavioral therapy saw a significant decrease in anxiety and depression. Our final document found that lack of access to healthcare resources decreased dementia outcomes by missing the early onset of symptoms. Conclusions: It is evident that minorities face healthcare disparities that keep them from receiving access to equitable healthcare. As a nurse, it is important to identify gaps in access to healthcare in minority patients. Interventions aiming to increase health literacy and access in minorities have shown to be effective.

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Unhoused Individuals and Access to Healthcare Introduction & Background: The unhoused, identified as those in shelters, transitional housing, and those who sleep in unhabitable places are prone to exposure to issues such as diabetes complications, tuberculosis, and lack of insurance. This U.S. population of over 560,000 may not prioritize health due to their focus on survival. Purpose Statement & Research Question: The purpose of researching homelessness is to determine if the unhoused population who use community health resources has a better quality of life than the unhoused who do not utilize resources. Literature Review: The literature review included search terms such as unhoused, hospital admissions, homeless programs, and scientific nursing research. A broad inclusion criterion with a focus on the use of local resources within the population was utilized. The CINAHL database was searched. Each source is peer reviewed, less than 5 years old, and authored by at least one registered nurse. Findings: Findings indicate that current systems and tools for the unhoused within healthcare facilities are deficient regarding patient-centered care. Over 50% of unhoused people are male, and 60% of the unhoused seek shelter in some capacity. Trends include region, climate, and available resources. Interviews yield that the unhoused have issues seeking proper care due to a lack of understanding of healthcare systems or referral pathways. Difficulties with transportation, insurance, or perceived negative authority from providers affect this population. Conclusions & Nursing Implications: Professional hypotheses and methodology are portrayed in the viewed research. Different identification strategies and accessible health programs are necessary for this population to improve the well-being of the unhoused and the efficiency of health facilities.

Background: There is limited research on the healthcare experience of Deferred Action for Childhood Arrivals (DACA) recipients both before and after enrollment in the program. DACA is a program designed to defer deportation to children and young adults in the United States for up to 2 years. The goal of this qualitative study is to explore the lived experiences of DACA students with regards to access to healthcare and perceptions of treatment. Method: This study is qualitative and uses a phenomenological approach. DACA Recipients (N = 5) were recruited from the UCF student population and 1:1 interviews were conducted. Interviews were transcribed and manually coded. Results: Thematic analysis revealed the following three themes (1) Meeting Needs (2) It Takes a Village and (3) Documentation­­ Over Insurance Conclusion: The fundamental structure of the findings shows the struggles of receiving healthcare as an undocumented immigrant, and the limitations of DACA as a solution. Health insurance is a more prominent and impactful factor than documentation status in the quality and quantity of healthcare access. The healthcare experience ranges from volunteer clinics to local pharmacies. Although, if DACA recipients have insurance, their healthcare experience is more consistent, regardless of documentation. Their day to day lives is composed of meeting basic needs, receiving only necessary doctor's visits as a child, and being prepared for all circumstances in terms of future citizenship.

<p>Postpartum depression (PPD) is a mental health condition present in 13% of new mothers. It is a serious public health issue that profoundly impacts the health of mothers, their children, and their partners. While the short- and long-term implications of maternal mental health for children’s growth and development have been well documented, little has been written about the impact of maternal PPD on partners. In particular, the effects of PPD on new fathers have received little attention. This qualitative descriptive study examined, through the sharing of photographs by participants and in-depth interviews (n = 10), the experience of the transition to parenthood for first-time fathers whose partners have PPD. It also compared their expectations of fatherhood with the lived reality of the experience and explored fathers’ perceptions of, and access to, health services and supports. The main themes that emerged from the data analysis were: From two to three, Connecting with baby, PPD and the partner relationship, Heightened involvement with baby, and Available and desired supports. Sub-themes that captured more specific patterns in the data also were identified. The study findings have implications for establishing best practices that are inclusive of support and education for partners.</p> / Master of Science (MSc)

<p>Introduction</p> <p>Canadian health and social service systems need to adapt to new challenges posed by the unique primary health care (PHC) needs of recent immigrant families. Community-based service providers are the first to experience changing responsibilities. Providers in communities with limited experience in working with immigrants may benefit from shared skills and modeled cultural competencies when working with new arrivals.</p> <p>Purpose</p> <p>This case study describes how a set of community-based service organizations addressed the PHC needs of recent immigrant families with young children living within a mid-sized urban centre in Atlantic Canada. The roles of organizational brokers and of <em>competence trust</em> among service providers were examined to determine their influence on the capacities of the service network overall.</p> <p>Methods</p> <p>Methods from social network analysis and descriptive qualitative inquiry were applied in this study. Organizational ecology contructs framed the research questions and propositions. An intersectoral approach to PHC was adopted to define the services network. Results derived from the network survey and key informant interviews were triangulated to develop a final interpretation.</p> <p>Results</p> <p>The study network constituted a relatively cohesive group of service providers. Network participation became more selective depending on the issue experienced by families. Network interactions were facilitated by broker organizations; some brokers actively engaged in the development of cultural competency capacities among network members. Trust in the other provider organization’s cultural competencies (<em>competence trust</em>) with recent immigrant families positively influenced the quality of working relationships.</p> <p>Conclusions</p> <p>Broker organizations can play a significant role in network capacity development through the promotion of cultural competencies in partnering organizations and by making connections across service sectors. The cultural competence of partnering organizations is an important pre-condition of trust for service providers committed to the needs of recent immigrant families. Having trusting relationships among providers can facilitate exchange and enable access to services. Nurses have the potential to participate in the advancement of culturally competent service systems.</p> / Doctor of Philosophy (PhD)

In 1998 World Health Organisation Europe outlined a vision of a new community-based nurse called the Family Health Nurse (FHN) who would help individuals, families and communities to cope with illness and to improve their health. Scotland was the first European country to develop this idea through policy, education and practice. The two phase national pilot project (2001-2006) primarily involved remote and rural regions. Despite its vanguard position, Scottish family health nursing has been subject to little in-depth critical analysis. This thesis addresses this deficit by analysing why and how family health nursing developed in Scotland. The research methods used are: critical review of textual sources; empirical research into policy, education and practice; and critical review and application of relevant theoretical perspectives to enable interpretation. Grounded primarily in constructivism, this approach builds explanation of the development of family health nursing in Scotland as a phenomenon in contemporary nursing history. This explanation highlights the importance of key factors and processes, particularly: agency at policy formulation level; use of the piloting mechanism to mediate knowledge production, containment and expansion; tensions between generalism and specialism as manifest within the promulgated FHN concept, the educational programme, and the FHN role as it was variously enacted in practice; related difficulty in engaging substantially with families; and the strong influence of local context on the nature and scope of FHN role development, especially in terms of situated power and embedded culture of place. The explanation is summarised as a synoptic story. A new integrative, explanatory model of the development of family health nursing in Scotland is also posited. This knowledge is then examined in relation to contemporary community nursing and primary care in order to understand influence and implications. This highlights the importance of the development of family health nursing in shaping the new Community Health Nurse (CHN) role which emerged from the Review of Nursing in the Community in Scotland 2006. The new explanatory model constructed within the thesis is then applied in its more generic MAPPED format (Model for Analysing Policy to Practice Executive Developments) to analyse the new policy formulation advancing the CHN role and to anticipate key developmental factors and processes. On this basis, the thesis argues that the MAPPED model is potentially valuable for the analysis of developments that require purview from policy through to practice. The thesis concludes by summarising its contributions to understandings of community nursing policy, practice, research and theory, and makes a number of related recommendations.

Aim: This thesis aimed to explore community nursing middle manager role enactment in managing change within Community Health Partnerships (CHPs) in three regions of Scotland from 2008-2011. Background: CHPs were established to play a key role in shifting care from the acute to the community setting. Within this context the community nursing workforce has been adapting roles in response to Scottish Government (SG) directives. However literature review demonstrated there has been very little research into the role of Community Nurse Middle Managers (CNMMs) in the midst of this change. This investigation sought to address this deficit in the literature. Design and Methodology: The study was conducted in four distinct phases comprising of the reflexive, foundational, recursive and expansive. A total of 42 semi-structured interviews were conducted over the period of investigation. The investigation was qualitative and phenomenological in character. A hermeneutic approach was adopted, broadly based on Heideggerian philosophy. More specifically this study drew on the Interpretative Phenomenological Analysis (IPA) approach of Jonathan Smith (1996). Main findings: In general CNMMs perceived that their jobs had become more complex, with the pace and intensity of work having increased. They held a wide range of responsibilities managing the challenges of driving change within a hierarchy and professional bureaucracy. Opportunities for education and learning were felt to have reduced. A small but significant proportion had left and some were considering leaving the NHS service. A primary motivation for CNMMs was maintaining an implicit connection with service users. They were proud to be members of the nursing profession and aligned their identity with their career history. This was perceived to influence their management and leadership style. In overcoming some of the personal challenges they faced they identified protective factors or “assets” to counteract stress. The application of a salutogenic perspective emerged as important in supporting this. Conclusion: The study has addressed a knowledge gap in literature. It contributes to understandings of NHS community nursing, middle management, role, change and Community Health Partnership literature. In particular it gives a voice to the perspectives of community nursing middle managers in Scotland. It suggests that much more attention needs to be paid to the needs, constitution and sustenance of middle managers in Scottish community nursing and that this has policy, practice, education and research implications.