Rebekahs work:
Diabetes Prevalence in the American Indian Population
Proposed Solution
Addressing social determinants of health that have an adverse effect on health outcomes is a complex process that requires the discipline and commitment of interdisciplinary teams (Warne & Wescott, 2019). To begin, the AI community must be involved in the establishment of the proposed solution. Making assumptions about what resources the AI community needs to reduce diabetes prevalence may be harmful and ignorant. Rather, we should include members of the AI community to ensure we are properly addressing relevant issues within the community. This will ensure the proposed solution is culturally competent and respectful to tribal members.
Additionally, federally funded programs, such as Women, Infants, and Children (WIC), must become more widely available to the AI population (Warne & Wescott, 2019). This will allow impoverished women and children to receive access to nutritious foods, which will reduce the risk of obesity and support cardiovascular health (Warne & Wescott, 2019). Additionally, these women will receive education and resources on the benefits of breastfeeding (Warne & Wescott, 2019).
Solving the population health challenge of substance abuse will require community outreach programs and interdisciplinary collaboration amongst public health officials, medical systems, healthcare providers, and more (Warne & Wescott, 2019). Drug addiction and recovery programs must become more accessible on AI reservations to promote participation, accountability, and camaraderie (Warne & Wescott, 2019). Additionally, public health officials must make Narcan (the opioid-reversal agent) more accessible to the AI population to reduce overdose-related deaths (Warne & Wescott, 2019).
The most complex social determinant of health to solve is historical trauma (Warne & Wescott, 2019). It is impossible to provide complete solace for the generational trauma inflicted on the AI community (Warne & Wescott, 2019). However, public health officials can promote healing and support to the AI population through various avenues (Warne & Wescott, 2019). Reconnecting the AI community to their ancestry and culture can have a healing effect for those experiencing historical trauma (University of Minnesota, 2023). Providing AIs with opportunities such as affordable and safe housing, accessible education, and employment, can provide a sense of importance, belonging, and give AIs the voice they have not been allowed to have (University of Minnesota, 2023).
Phases of Implementation
The first phase of implementation would include a needs assessment. This would be completed through the collection of data within AI communities and tribes throughout the United States. In order to guarantee a successful implementation of the proposed solutions, we must ensure we are involving the targeted community (Shin, Kim, & Kang, 2020). By partnering with the Tribal Government Headquarters of several AI tribes throughout the United States, anonymous surveys will be sent to tribal members via mail and email. The surveys will ask questions about the member’s access to healthcare, nutritious foods, and educational resources for children. The survey will allow the AI member’s to anonymously disclose any personal and/or family health history of chronic illness. Additionally, the survey will ask community members if there are any resources they would like more access to, such as WIC, mental health resources, health clinics, recreational centers, etc.
Using the results from the survey conducted in phase one of implementation, priority needs of the community will be identified in phase two. The primary key stakeholder that will be involved in this community outreach program will be the University of Minnesota’s College of Liberal Arts for American Indian Studies. The Minnesota Indian’s Women’s Resources Center (MIWRC) will be an additional key stakeholder.
In phase three, stakeholders will help assist the expansion WIC to underserved tribal communities across the United States through advocacy and grants. Additionally, the community outreach program will partner with volunteer OB-GYN and women’s healthcare professionals to assist in the education of breastfeeding and healthy lifestyle choices for pregnant women and children. The education provided will be culturally sensitive and will include resources and suggestions that are mindful of AI culture. Phase three will also include the partnership of volunteer mental health and substance abuse experts to address substance use disorders and historical trauma within the community. Volunteers will provide culturally relevant counseling services to spread awareness about substance abuse, as well as address the effects of intergenerational trauma in AI communities.
SMART Goals
SMART Goal #1: Conduct an anonymous survey assessing access to healthcare, education, nutrition, and chronic disease prevalence in AI communities in the United States, achieving a 70% response rate within six months.
SMART Goal #2: Analyze survey data and identify priority needs to present to key stakeholders within three months of phase one implementation.
SMART Goal #3: Implement community outreach program that expands WIC to AI communities, offers culturally competent education programs regarding breastfeeding, healthy lifestyle choices, substance abuse, and generational trauma within six months of finalizing phase two.
Considerations
Implementing a proposed solution addressing diabetes prevalence in AI communities will require significant financial resources (Hoeft et al., 2019). Funding would be required for operational costs, staffing, infrastructure, and program development (Hoeft et al., 2019). Additionally, investments may be required to expand WIC in underserved AI communities. Financial planning should also include an emergency fund for any unexpected circumstances, such as resources to address health concerns, increase in program demand, and unexpected community engagement programs. It is important to continuously assess the cost-effectiveness of the community outreach program to maximize the utilization of financial resources. Continuous cost-effective analysis will determine resource allocation, short-and-long-term costs, potential for financial savings, and reduced healthcare costs (Hoeft et al., 2019).
Respect for AI communities throughout the duration of the community outreach program is essential to improving the health outcomes of AI community members (Centers for Disease Control & Prevention, 2024). Any intervention that is utilized within the community outreach program should be designed in a way that respects the heritage and traditions of AI culture. Not only is this an ethical responsibility of all interdisciplinary teams associated with the program, but it will also improve the participation of AI community members within the program (Centers for Disease Control & Prevention, 2024). Additionally, addressing health disparities within an underserved population requires advocacy for policies that dismantle systemic racism and discrimination towards AI communities. All personnel involved in the implementation of this community outreach program must share the ethical and moral responsibility to advocate on behalf of AI community members throughout the United States.
References
Centers for Disease Control & Prevention. (2024). Cultural Competence in Health and Human
Services. National Prevention Information Network. https://npin.cdc.gov/pages/cultural-competence-health-and-human-services
Hoeft, T., Wilcox, H., Hinton, L., & Unutzer, J. (2019). Costs of implementing and sustaining
enhanced collaborative care programs involving community partners. Implementation Science, 14(37). https://implementationscience.biomedcentral.com/articles/10.1186/s13012-019-0882-6#citeas
Shin, H., Kim, K., & Kang, P. (2020). Concept analysis of community health outreach. BMC
Health Services Research, 20(417). https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05266-7
University of Minnesota. (2023). Historical trauma and cultural healing: Video series.
University of Minnesota.
https://extension.umn.edu/trauma-and-healing/historical-trauma-and-cultural-healing#how-historical-trauma-is-perpetuated-today-378611
Warne, D., & Wescott, S. (2019). Social Determinants of American Indian Nutritional Health.
Current developments in nutrition, 3(Suppl 2), 12–18. https://doi.org/10.1093/cdn/nzz054
Laura’s work:
Importance of nutritional education in schools
Proposed Solution
Providing children with access to nutritional education in child-friendly applications can be advantageous to the development of the child’s attitudes and beliefs about nutrition and eating habits. Utilizing strategies to make the education entertaining as well as effective, while teaching to the child’s grade school and appropriate learning level has proven to provide improvement in children’s understanding of nutrition and food choices to enable them to make healthier selections (Rasheed, 2023). Early establishment of healthy behaviors in relation to eating provides the basis for developing positive patterns that last into adulthood and eventually support healthy individual adult development for generations to follow (Large, et al., 2023).
Nutrition education does not have to be its own class curriculum. Studies have shown that when subjects integrate nutritional education into other subjects it has a greater effect on nutritional understanding and is better received by children while allowing teachers to still maintain education goals. Providing nutritional education in math class or physical science can enhance the learning and understanding of both subjects. Including all five senses is also beneficial with school aged children and enhances information retention (Large, et al., 2023). Exposure to different flavors, different fruits, vegetables, legumes, and whole grains can help to establish the healthy nutrition in the child’s life (Chan, et al., 2022)
School garden programs can be established in cost-effective ways to help children learn about nutrition while experiencing the different tasks associated with gardening and growing food, while experiencing the different parts of their food’s life cycle. Hands-on activities in the garden expose children to healthy fruit and vegetable production that they can achieve in their climate and possibly even share with their family. School gardens are often able to provide any overabundance to the children’s families so that they can share and show their knowledge of healthy foods with those that they love, as they begin to value the work and effort that it takes to get delicious produce (Chan, et. al., 2022).
Considerations for financial, policy, legal and ethical components of the problem and the proposed solution
The proposed solution for increasing nutritional education in schools deserves and requires frontloading of educational planning programs as well as garden space program development. The initiative of the educational staff should be verified so that continuous support can be provided to create the space for active learning that is influential to the growth of the children.
Considerations for what types of spaces are available include site accessibility for students and teachers of all abilities. There will need to be a water source nearby and it should be in a safe area. Parking lots, school yards, and rooftops are all opportunities for gardens, as well as community garden spaces, nature centers, city parks or whatever is nearby and available (United States Department of Agriculture, 2013). Adults should prep the garden and plan what will be grown. Produce grown successfully will be variable based upon climate, physical space availability, sunlight, and garden knowledge of those in charge.
Partnerships through the local community are a great way to procure resources and develop associations with those who may have opportunities and resources to share, like seeds, plants, tools, sources of funding, volunteer help and garden experience. Families within the school district may also take keen interest in the project and offer to learn alongside the children and share in the growth. The United States Department of Agriculture also provides resources to help with advice and assistance (United States Department of Agriculture, 2013). Farmers in the local community could also be utilized for assistance and direction, as well as local participants in farmers’ markets. Contacting individuals that are already practicing environmental education based curriculums may offer to teach and guide or offer tours of their farm or garden to help get started. Explorations in sustainability could be a good way to encourage participation from older students as well, or entomology or plant pathology courses for students in higher grade levels. The student garden that grows healthy nutritional education could serve older students as well as they develop a greater understanding with the framework from their younger class years.
The development of education through experiential outdoor learning can have profoundly positive impacts on children. Researchers have shown that when children are asked about how to increase nutritional education in their communities, they are able to share recommendations. Children have suggested that cooking in the classroom setting and utilizing recipes that are able to mask or enhance the flavors of vegetables allows children the opportunity to experiment with new foods. Older children can serve as positive role models when they consume the prepared recipes and enjoy the process as well as the result (Karpouzis, et al., 2024).
Legally and ethically, if educators follow safe food handling practices, there should not be any legal or ethical considerations concerning teaching young people about growing food and eating a more nutritious diet.
Phases of Implementation
Implementation phases should be based on need. In more rural communities the need for nutritional education may not be as great as in the cityscape. It will be important to know the community engaged and the level of service that can be provided. All children can establish a greater understanding of what helps them to grow and what nutrients are present and available in various food sources. After educators determine the need, they should develop a recipe plan and education materials. As well as the types of food crops possible to grow. The cooking space should also be considered so that they are able to create recipes in the classroom.
Stakeholders
The biggest stakeholders in the development of the importance of nutritional education for children in schools is the children. Outdoor nature-based activities that get children outside of the traditional classroom provide alternative learning opportunities. Research has shown that children who are able to get outside during their school day can have improved health and academic outcomes. Experiential learning that is child-led and exploratory increases the dimensionality of their education and feels more like play. It allows for a better connection with nature and the living world and increases the understanding of healthy eating habits and how it can improve their lives. Developing a taste for fresh fruits and vegetables grown in their school garden increases their likelihood of continuing to consume health foods in their homes and a desire to be outside, play and learn and create a more stable foundation of healthy eating that can sustain them for their lives (Donison & Halsall, 2023).
Children, teachers, families, and community members will develop an increased awareness and importance on health and wellness. This new learning style with practical applications provides opportunities to extend healthy eating to a healthy lifestyle. More time spent outside, more vitamin D for those who need it. Structured play and exploration lead to increases in psychosocial and motor skills. Tasting days and cooking days bring the outdoor work inside to the tasting table. Math and science can easily be incorporated into the cooking, planting, recipe forming and nutritional education criteria. Sharing, working together, playing in the dirt, seeing bugs and butterflies are all essential parts of a well-rounded kid. Getting outside of the traditional classroom for children that need alternative learning opportunities also opens a world of possibilities and a chance to get physical energy out so children can focus when they are required to.
SMART goals in timeline
Classrooms and class times that can be moved outside to foster experiential nutritional education should develop a timeline for implementation. Winter is an excellent time to dream of gardens and plan and understand the growing season ahead. A SMART goal for an elementary school would be to develop a garden plan and associated curriculum. Physical science and math lessons can be developed through indoor seed sowing and starting under grow lights in late winter to pique the children’s interest in growing. The curriculum and garden should have a measurable beginning. Start by growing 5 crops and 2 types of flowers. Pollinator lessons can stem from this humble beginning as well. The first plants sown should be tomatoes and first plant harvested should be lettuce. This also allows children to learn about photosynthesis and what plants need to grow big and healthy, just like they need nutrients from vegetables to grow big and healthy. This goal is achievable and very relevant as it directly relates to nutrition education in schools. It can be modified to fit regional and local tastes, and seasonal interests. Pumpkin seeds sown before school is out for summer break can create harvestable pumpkins in the fall when school starts up again. Allowing children to see and be present for these changes from seed to pumpkin for example teaches them patience and goal setting as well. The garden that gets dreamt up in the winter should be implemented and begin planting in early March in the classroom with outdoor planting happening after the first frost in the area. It could even lead to children volunteering to come and water and visit their garden during the summer months with their families. A SMART goal for elementary schools is to create a curriculum that supports the need for nutrition in the growing child’s body. Measurably, this curriculum should be taught to 100 students, and they should have eaten or at least tasted 2 recipes by the end of the first quarter of class for the year.
References
Donison, L., & Halsall, T. (2023). “I’d rather learn outside because nature can teach you so many more things than being inside”: Outdoor learning experiences of young children and educators. Journal of Childhood, Education & Society, 4(3), 373–390. https://doi.org/10.37291/2717638X.202343281
Karpouzis, F., Walsh, A., Shah, S., Ball, K., Lindberg, R. (2024). Primary-school-aged children inspire their peers and families to eat more vegetables in the KiiDSAY project: a qualitative descriptive study. BMC Pediatrics, 24(1), 1–15. https://doi.org/10.1186/s12887-024-04643-z
United States Department of Agriculture. (2013). Start a School Garden- Here’s How… https://www.usda.gov/media/blog/2013/08/13/start-school-garden-heres-how
Jamie’s work:
Nursing Workload in Critical Care: Implications for Patient Outcomes
I. Proposed Solution
In order to see improvements in nursing workloads, a multifaceted approach should be utilized so that workload management and enhanced patient care are the priority. A few approaches for this could include the following:
1. Implementing evidence-based staffing ratios so staff can effectively meet the needs of critically ill patients.
Evidence-based staffing includes the use of the patient acuity-based model. This model of staffing strategically places patients with nurses based on their experience and the patient’s level of acuity. This model optimizes workload by allowing nurses more time for patients when needed and has been proven to reduce complications and shorten hospital stays (Juvé-Udina et al., 2020).
Risks of this approach include micro and macro-level challenges. On a micro level, change in practice and how staff are matched with their patients may be met with staff resistance. Some members within a hospital are comfortable with the existing practices and may have a hard time accepting any changes that occur. On a macro level, an organization with a change like this would require updating policies and may require more resources. Determining staff-to-patient ratios while adopting a new patient acuity-based model of nursing is a significant undertaking, and while it may decrease burnout rates in the long run, it will require collaboration with stakeholders and an approach of implementation that is completed in phases to ensure a transition which maintains high standards of patient care.
2. Establishing systems that monitor and continuously assess workload while practicing quality improvement aimed at fostering change and updated practices.
Utilizing tools to monitor nurses’ workload can facilitate the establishment of safe and suitable workload standards. Tools that can be utilized to measure nurse-to-patient ratios include the American Nurses Association Staffing Method, which provides guidelines for staffing ratios based on a handful of aspects: patient acuity, nursing skill, and the specific unit (ANA, 2019). Another tool that is specific to critical care is the Workload Intensity Measurement in Critical Care (WIMCC) Tool. This tool also assesses nursing workload based on patient acuity and nursing skill to determine workload thresholds.
Risks associated with this approach involve financial constraints. In order to monitor workload effectively and initiate continued quality improvement programs, a significant investment will need to be made into resources that can help maintain improvements. A few resources will include proper training and education to staff on the tools being utilized, new technology that will collect and present data results, and staff that could continuously monitor these approaches to improving workload and patient outcomes. This financial constraint could ultimately drain financial resources if organizations are not seeing regular profits.
3. Enhancing clinical skills and critical thinking through continued education initiatives.
Implementing further training and continuing education for nursing staff can provide ongoing development of skills and patient management. Demonstrated in a systemic review in 2019, furthering nurses’ training and education in critical care settings resulted in better management of ventilation care and cardiac support, which ultimately improved patient outcomes and reduced the length of time in the intensive care unit (Martinez et al., 2019).
A couple of risks associated with this approach include time constraints and the willingness of staff to engage. Ongoing education to build and maintain clinical skills requires an investment in training programs, and it may present scheduling challenges and a lack of staff engagement if education initiatives are not required.
Implementing a multifaceted approach to improving nursing workloads and patient outcomes includes various strategies that are aimed at optimal staffing ratios, managing workload, and enhancing clinical skills. However, the implementation of these suggested strategies for improvement also poses risks that must be considered.
II. Stakeholders and Phases of Implementation
For this particular approach to improving nursing workload, there are important stakeholders that should be considered for proper execution and implementation.
Hospital administrators carry the responsibility of overseeing new adoptions of policy and practice throughout the organization and are key stakeholders in how each strategy would be adopted and then implemented. Other important stakeholders include nurse leadership, clinical educators, and nurses who work in critical care settings, all of whom play an important role in the strategy being successful.
The first phase of implementation for this approach would include assessing the need, identifying a plan that outlines SMART goals, and determining resources that will allow for success. By first assessing the current workloads and care practices, the data presented will create areas for opportunities and growth. Setting goals for assessment will also help further this process by having measurable and attainable goals.
The second phase of this approach will include a round of pilot testing in a unit that would benefit from these proposed changes. Ideally, this unit will vary in patient acuity and have staff that are prebriefed on the changes so goals and initiatives are understood. Monitoring the implementation of these strategies and obtaining feedback from the frontline workers will allow for further understanding of adjustments that may need to be made.
The third and final phase of this approach will be the actual implementation of the suggested strategies and the evaluation of its overall effectiveness. Using insights from the pilot testing, refinements to the strategy can ensure a smoother transition. It will be important to keep an open mind to the changes being implemented and to remain flexible in making necessary adjustments.
By following these phases of implementation, organizations can introduce a new approach to improving nursing workloads and promoting positive patient outcomes.
III. SMART Goals
SMART goal for Phase One of Implementation: Conduct a needs assessment regarding nursing workloads and current nursing care practices. Data on patient acuity, ratios, and patient outcomes will be measured through surveys, open to all stakeholders, and completed within 60 days of proposing the plan.
SMART goal for Phase Two of Implementation: A unit that would benefit from these proposed changes, such as the ICU or NICU, will be selected, and implementation of the strategies and monitoring of the program will be conducted over 4-6 months to ensure ample time for transition.
SMART goal for Phase Three of Implementation: Each of the strategies will be implemented in all critical care units in an organization for one year. Resources, proper training, and technology will be utilized to ensure the success of the program.
IV. Considerations- Financial, policy, legal, ethical
Implementation of the proposed solution to address nursing workload and patient outcomes will require a significant financial investment in training programs, resources, and adequate staffing. To get proper funding for this program, approval for financial support and other resources may require time to obtain, so this should be factored into the phases of implementation.
As for considerations to policy, updates to support the patient-acuity-based model of nursing may need to be modified. Modifications to the policy will require educating staff on changes and how the updated policies will ensure safer workloads and better patient outcomes.
Legal considerations for this proposed solution lie within compliance with regulations and standards in nursing practice. Being able to identify legal barriers that may present from these changes will help mitigate any legal challenges that could sabotage the proposed solution.
Finally, ethical considerations included in this proposed solution will include confirming that each strategy aligns with the standards of practice for nurses and is within their scope of practice. This will ensure the integrity of the proposed solution.
By considering the proposed solution’s financial, policy, legal, and ethical components, the successful implementation of each strategy initiative will improve nursing workloads and patient outcomes.
References
Juvé-Udina, M. E., González-Samartino, M., López-Jiménez, M. M., Planas-Canals, M., Rodríguez-Fernández, H., Batuecas Duelt, I. J., Tapia-Pérez, M., Pons Prats, M., Jiménez-Martínez, E., Barberà Llorca, M. À., Asensio-Flores, S., Berbis-Morelló, C., Zuriguel-Pérez, E., Delgado-Hito, P., Rey Luque, Ó., Zabalegui, A., Fabrellas, N., & Adamuz, J. (2020). Acuity, nurse staffing and workforce, missed care and patient outcomes: A cluster-unit-level descriptive comparison. Journal of nursing management, 28(8), 2216–2229.
Martinez, M., Karamchandani, K., & Chakraborti, C. (2019). The impact of specialized nursing education on patient outcomes in the intensive care unit: A systematic review. Nursing Education Perspectives, 40(2), 92-97.
ANA. (2019). Nurse staffing. https://www.nursingworld.org/practice-policy/nurse-staffing/
Please review the rubric and grade each section of the three students work acorrding to the rubric, include what is said in the feedback requirments and give good recommendations, I would like to give rebakah emerging for one of her sections, grade appropriate for the rest. I need to hit all the objectives listed on the rubic. no citations needed just feedback for all three students
