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Health, Human Rights, and Structural Violence: Identifying Barriers to Healthcare Access of Deaf American Sign Language Users in Rhode Island
Get PDFDeaf American Sign Language (ASL) users possess both human and legal rights to health. Yet, despite these rights, this linguistic minority group continues to experience challenges in accessing health care services. Using a structural violence framework, this study identifies the barriers to healthcare access of Deaf ASL users in one particular state - Rhode Island. More specifically, this study seeks to uncover the structural and social forces that constrain agency of Deaf ASL users in their attempts to access healthcare. Survey methodology is used to obtain both qualitative and quantitative data from 11 community stakeholder groups. Results show that Deaf ASL users in Rhode Island experience numerous structural barriers to accessing health care, including economic, civil, political, and cultural constraints. The structural disempowerment and reduced agency experienced by Deaf ASL users, perpetuated by the state’s institutionalized social structures, prevents Deaf ASL users from getting their health needs met. Implications for embodied health risks that result from human needs deprivation, trauma, and social disadvantage are discussed. Recommendations are offered on actions toward transformative justice, which can lead to greater fulfillment of human needs and realization of the inherent dignity, worth, and human rights of Deaf ASL users
A Holistic Approach to Health Literacy in Multicultural Communities
No full textThis quality improvement project was initiated to address health literacy appropriateness of educational materials used by primarily Native American Elders at a low-income senior housing complex while engaging with healthcare volunteers; and to develop culturally sensitive educational material for indigenous residents. Health education materials were evaluated using the Patient Education Material Assessment Tool (PEMAT) and the Gunning Fog test. Prior to modification of the health educational materials, residents completed the Stanford survey on self-efficacy and confidence in managing their chronic diseases. The Stanford survey was readministered twelve weeks after using the revised health education materials; resident comments on self-care were also captured. The self-efficacy and confidence survey was analyzed using excel t-test. The two-tailed t-test paired two sample for means p-value was 0.003. The null hypothesis was rejected indicating a statically significant finding on resident self-efficacy and confidence levels after engaging with healthcare volunteers using modified educational materials and culturally sensitive communication practices. This finding is not generalizable due to the small number of participants. The health education materials were evaluated by five different health care providers using the PEMAT. There were inconsistences with the interrater reliability as raters interpreted the instructions differently. The Gunning fog test was done on the modified health education materials and demonstrated readability ranging from second grade to eleventh grade level. Findings suggest readability appropriateness of the modified materials exists for most of the participants in this residential community. This quality improvement project demonstrated that consistent in-person healthcare volunteer connections, using modified health literacy level educational materials, delivered improvement in the confidence and self-efficacy levels for self-care health knowledge in the aggregate of participating elders. Groundwork was established to develop an effective pathway to evaluate health education materials to be used by healthcare volunteers within a culturally diverse senior-living community
BRIDGING COMMUNICATION IN END-OF-LIFE CARE AT A MIDWEST VETERANS HOME
Get PDFPalliative care is specialized care for those with serious disease and focuses on providing relief from symptoms (Radbruch et al., 2020). The goal of palliative care is to improve quality of life for both the patient and the family. As the COVID-19 pandemic continued to change healthcare delivery and visitor restrictions, alternative approaches to safely deliver care to both the patient and family have been uncovered. A Midwest veterans home was looking to bridge the gap in communication between staff, resident, and family during end-of-life care. Creation of an online accessible educational resource for nursing home staff is an alternative format for providing staff education. This project focused on online education supplied in a central location with the expected outcome to be increased communication between staff and family during residents’ end-of-life. Patient care staff participated in this quality improvement project by responding to two online surveys. Results demonstrate that staff were satisfied with the online resources as a tool to promote conversation with family. This can assist in future education and training surrounding end-of-life care and communication while achieving positive palliative care outcomes. Evolving to an online education platform provides flexibility in convenience, equity, service, and access. While the ongoing COVID-19 pandemic demands attention towards traditional end-of life care standards, it also provides the opportunity to create new methods to palliative care amongst a vulnerable population. Additional staff education on end-of-life care will not only meet the needs of palliative care in the Midwest veterans home but will also be a sustainable option for future practice. 5 In 2016, there were more than 19 million living United States (US) veterans, representing almost 10% of the total adult US population (Schaeffer, 2021). Years of US military service often come with a cost, resulting in unique physical, mental, emotional, and spiritual health issues that continue to manifest throughout veterans lives (Schaeffer, 2021). Veteran needs at end of life vary, as they may suffer from a spectrum of challenges related to their time in service (Schaeffer, 2021). Veterans challenges may relate to presumptive diseases from environmental exposures, or other debilitating emotional or spiritual issues (Shamas & Gillespie-Heyman, 2018). Quality healthcare for veterans is essential at all stages of life. It is important to recognize the difficulties veterans may face and to create a care team with the knowledge, skills, and confidence to properly care for veterans in all stages of life. The current end of life care for veterans is done exceptionally well at this veterans home in the Midwest. It has been reported that nursing staff and bereaved family members feel veterans are being well taken care of at the end of their lives (S. Hogan, personal communication, June 2, 2021). For example, there is a final salute for the veteran as they are leaving the home for the last time. This ceremony is significant to the family, staff, and other veterans involved. It is special to have the opportunity to honor America’s heroes until the very end. However, this care has changed within the past two years because of the COVID-19 pandemic and subsequent visitor restrictions in long term care (S. Hogan, personal communication, June 2, 2021). The COVID-19 pandemic has put a strain on communication in long term and residential care to protect the residents. At the veterans home, a strict zero visitor policy except for imminent death was put in place to protect the vulnerable veteran population from COVID-19 (S. Hogan, personal communication, June 2, 2021). The new visitor policy poses a challenge to 6 inclusion of the family in end-of-life care. Many family members have reported feeling ignored, and that opportunities for communications have been missed (S. Hogan, personal communication, June 2, 2021). Military service has affected the individual resident, and the family and care team need to remain mindful of any special needs this requires. The question persists in how to properly educate, include, and communicate with family in end-of-life care, especially given the recent COVID-19 pandemic and visitor restrictions
DEVELOPMENT OF A SCHOOL NURSE PRECEPTORSHIP PROGRAM
No full textPurpose. This quality improvement project aimed to explore the ability and willingness of school nurses (SNs) to precept newly hired nurses and develop a preceptorship program for newly hired nurses (NHNs).
Background. SNs have various roles due to medically fragile and chronically ill children attending school, and NHNs are often unclear about their job duties. SNs must evaluate student health and determine if there is an impact or barrier to learning because of a health condition. Proper education for NHNs is essential to perform the many required duties for this unique role. School districts rarely offer a thorough preceptorship program for NHNs due to time and budget constraints resulting in frustration, job dissatisfaction, and potential for increased errors. Secondly, it is unclear if SNs possess the comfort and willingness to precept a NHN.
Methods. Participants were eight SNs at a local school district eligible to precept NHNs. The SNs participated in two educational sessions. Pre- and post-meeting surveys were administered to the SNs to measure perceived knowledge and attitude toward the preceptor role, identify required elements of a preceptorship program, and evaluate newly created preceptorship tools.
Results. The project was implemented during one academic school year. The participants determined that the specially designed tools, materials, and identified resources were beneficial to all SNs and may be used independently or within mentorship. Additionally, the SNs found value in having access to an educational class for preceptorship capacity and skill development.
Conclusions. This project established that structured preparedness is essential for SNs to feel comfortable in a preceptorship role. Therefore, attending a training class to familiarize preceptors with the fundamental skills is beneficial to supporting the growth and development of nurse learners. Developing and creating specifically designed tools for the preceptorship program is advantageous for the SN preceptor and NHNs
The Effects of Goal Setting and Self-Reflection on Student Work Completion and Work Habits in a Montessori Upper Elementary Environment
Get PDFThis study implemented goal setting and self-reflection as self-regulated learning strategies and explored how these affected student work completion and on-task behavior. Students in this environment struggled with self-regulated learning and were observed to not complete work on time and needed redirection to focus on work during the work cycle. The study took place in an upper elementary Montessori environment at a private international school. Thirteen 4th grade students (ages 9-10) participated in the study. During this study, students were given lessons on goal setting and self-reflection and had group discussions about effective goal setting. Students set daily goals for themselves during the study and evaluated their progress at the end of the day. Students met with the guides for pre, mid and post-assessment discussions, where they reflected on their goals and progress. Students were observed twice daily for on and off-task behavior, and follow-up work was checked for completion. Despite the challenges of conducting this study during the COVID-19 pandemic, the results showed that student work completion and on-task behavior increased after students began setting goals. In particular, it proved to be beneficial to students who previously struggled with completing work. Further studies could look into integrating goal setting in a more streamlined manner to increase student engagement and interest
The Impact of Implementing Virtual Science Notebooks on Student Science Achievement in a Primary Classroom
Get PDFThis action research project investigated the impact of implementing virtual science notebooks on primary students’ science achievement. Participants included twenty first grade students and their classroom teacher in a suburban, Minnesota school district. Students used iPads to complete virtual notebook pages after whole group instruction and independent learning time. Qualitative data collected included mid-intervention and post-intervention student and co-teacher interviews and researchers field notes and observations. Quantitative data included pre- and post-intervention rubric scores and a tally count of student inquiry. The data collected showed that students were highly engaged with their virtual notebooks and reported feeling more focused. However, there was no change in academic vocabulary and minimal change in student inquiry. The data collected suggests that more explicit instruction is necessary in academic vocabulary, while science notebooks do increase engagement in the science content and notebook entries
The Presence of Coping Education in American Sign Language Interpreter Education Programs as Perceived by Graduates
Get PDFThis study investigated whether coping strategies were part of the curriculum in various American Sign Language interpreter education programs (ASL IEPs). The researcher conducted a national survey and ten interviews with participants to assess their current coping strategies, where they had been learned, and whether their IEPs had prepared them to cope with the possibility of secondary traumatic stress (STS) and vicarious trauma (VT). The researcher utilized literature regarding risks of STS and VT in several settings for interpreters to position the gap of literature regarding coping strategies interpreters use. This study focused on graduates of IEPs because IEPs provide an appropriate environment in which to learn coping strategies. The study has found that interpreters are not being prepared with the skills to cope with STS or VT, and that graduates’ perceptions of the demand-control schema as a coping strategy do not align with its emphasis in interpreter education
Sleep Promotion in Children with Developmental Disabilities: Implications for Occupational Therapy Practice
Get PDFSleep is foundational for the health and well-being of children. The Occupational Therapy Practice Framework, Domain and Process, 4th Edition (American Occupational Therapy Association, 2020) has categorized rest and sleep as an occupation within the occupational therapy domain. Rest and sleep are defined as “Activities related to obtaining restorative rest and sleep to support healthy, active engagement in other occupations” (p. 32-33). Within this occupation domain, factors related to rest and sleep include rest, sleep preparation, and sleep participation. Rest is a time to relax and engage in quiet actions that do not induce stress or effort. Sleep preparation engages in routines that prepare one for sleep and prepare the environment for rest. And sleep participation is taking care of personal needs for sleep. Sleep is a foundational activity affecting a child’s environment, routines, performance skills, and individual preferences.
Current research suggests that children with disabilities experience sleep disturbances at a higher rate than children without disabilities. Research also examines the relationship between sleep and occupational performance in children. When children do not get enough sleep, they tend to experience difficulties with engagement in school and academics and delays in attention and focus (Claerkin & Creaven, 2013). Findings from an extensive literature review found evidence-based interventions to promote sleep in children. There are also sleep screening tools that can be utilized to gather information on a child’s sleep behavior. This paper examines evidence-based interventions and sleeps screening tools that can assist children and families in sleeping better. The paper also examines occupational therapy\u27s role in treating behavioral sleep disturbances in children. Gaps in research to practice are identified, demonstrating a lack of confidence among occupational therapy practitioners in treating children who may have a sleep disturbance. This doctoral project aims to find the most effective non pharmacological interventions to promote sleep in children with developmental disabilities.
Three knowledge translation projects disseminated the research and findings gathered during an extensive literature review. The first knowledge translation project was a virtual continuing education class presented through a collaborative event held by the Minnesota Occupational Therapy Association and St. Catherine University. The second project was again a collaborative presentation held by the Minnesota Occupational Therapy Association and St. Catherine University in the form of a virtual poster presentation. The third project is an article titled “Occupational Therapy’s Role in Sleep Promotion in Children with Developmental Disabilities: Assessment and Intervention,” submitted to OT Practice magazine.
Completing the three knowledge translation projects increased awareness of sleep interventions and screening tools that Occupational Therapists (OTs) can utilize to treat sleep disturbance in children. This doctoral project identified a lack of confidence among some OTs about providing sleep interventions and encouraged practicing therapists to become more educated in this area of practice. Some of the implications for practice include more research to develop specific sleep questionnaires/screening tools that evaluate the effect of a lack of sleep on performance. Other research opportunities include evaluating the effectiveness of occupational therapy for improved sleep in the pediatric population and, finally, investigating the physiological effects of improved sleep in children with disabilities
The Relationship Between Teacher Use of Exclusionary Discipline and Using a Problem-Solving Approach to Conflict with Eighth Grade Students
Get PDFThe purpose of this study was to determine the impacts of using a problem-solving approach to behavior instances within the classroom that decreases the use of office referrals. This study focuses on eighth-grade students in math and social studies classrooms. Within this study Pre- and Post-Assessments were used to gauge classroom culture, Behavior Logs to document behavior instances, a Conflict Data Gathering Tool to identify student perceptions of the private conversations, and a Teacher Reflection Chart to identify alternative behavior prevention strategies that could also be implemented. The researchers found that implementing a problem-solving approach to student behavior instances significantly reduced their use of office referrals for discretionary student misbehavior compared to previous years. The researchers plan to continue using a problem-solving approach to student behavior concerns and recommend that other educators implement the problem-solving approach as well
The Impact of Peer-Mediated Support on Social Interactions in a Middle School Inclusive Setting
Get PDFThe purpose of this study is to examine the effects of a peer-mediated support model in an inclusive middle school setting. The study includes a general education teacher, a paraprofessional, and 24 students enrolled in a Ceramics and Sculpture class. More specifically, 20 general education students and four students with Developmental Cognitive Delay (DCD). The inclusive class participated in a peer-mediated support model in which general education students engaged in social interactions and peer-academic support with their peers with DCD. The general education teacher and paraprofessional encouraged interactions and modeled for general education students how to provide support to their peers with DCD. The researcher collected data through teacher and paraprofessional conferences, student questionnaires, interaction counters, and an observational journal. The study found that social interactions will naturally occur when students with DCD are sitting near general education students who are comfortable interacting and willing to support peers with disabilities. For the results of this study to translate to other settings, the general education teacher, special education teacher, and paraprofessional should collaborate to individualize a peer-mediated support model to fit the needs and environment of the specific inclusive class