Peer Responses

Responding to Efetze M. Akana,

Hello,

Great post Efetze. Your focus on addressing childhood nutrition within state-funded pre-K programs is critical to improving long-term public health. Your proposed strategies, including a nutritional curriculum and on-site meal provision, are practical and well-supported by evidence. I’d like to expand on your ideas by suggesting an additional practice change and offering an alternate perspective on addressing barriers: Peer Responses.

A promising intervention is the integration of school-based garden programs. These programs not only provide an interactive approach to learning about nutrition but also foster a sense of responsibility and connection to food. When children are actively involved in planting, cultivating, and harvesting fruits and vegetables, they are more likely to eat these foods.

This is further supported by research from Chan et al., (2022), which found that school gardens significantly improve children’s attitudes toward healthy eating and increase their consumption of vegetables. Through partnerships with local agricultural organizations, pre-K programs could help sustain these gardens and provide a constant source of fresh produce for on-site meals.

More importantly, incorporating mobile technology in your envisioned nutritional curriculum would strengthen family involvement. Applications for both parents and children, fun and interactive, track eating habits and provide recipes, reminders, and healthy eating practices. That will close the gap between learning at school and home practices, an aspect noted by Czarniecka-Skubina et al., (2023). Address other barriers related to time and nutrition knowledge among parents using technology.

The last one is policy advocacy, increasing the funding for programs like CACFP. Involving stakeholders, including the local governments and non-profit organizations, in the initiatives may provide sustainability to the initiatives and could approach food insecurity more holistically. How do you think partnerships with local farmers, mobile applications, or expanded funding could further strengthen your approach to tackling this critical issue?

References

Chan, C. L., Tan, P. Y., & Gong, Y. Y. (2022). Evaluating the impacts of school garden-based programmes on diet and nutrition-related knowledge, attitudes and practices among the school children: a systematic review. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-13587-x

Czarniecka-Skubina, E., Hamułka, J., & Gutkowska, K. (2023). How Can We Increase the Nutrition-Related Knowledge in Children Aged 7–12 Years: Results of Focus Groups Interviews with Parents—Junior-Edu-Żywienie (JEŻ) Project. Nutrients, 16(1), 129–129. https://doi.org/10.3390/nu16010129

Responding to Misti Aleta

Hello,

This is a good post. Your dedication to the care of pregnant women with addiction in underserved communities is truly laudable and points out a very important area that needs attention. Your emphasis on reducing stigma and improving access to care is in line with best practices, but some additional strategies may help further improve outcomes for this vulnerable population. Firstly, the inclusion of peer support programs.

Peer supporters with lived experiences related to addiction can share valuable insights, build trust, and reduce stigma. According to Sun et al., (2022), peer support services enhance patient engagement, increase retention in treatment programs, and improve self-efficacy in managing addiction. These programs could be integrated into your community health clinic to create a more empathetic and supportive environment.

Another viable strategy is trying to increase telehealth options to conquer problems like transportation, childcare, and time. Research has demonstrated that the benefits of telehealth include reaching expectant mothers and counseling on addictions where traditional healthcare service delivery is limited (Gajarawala & Pelkowski, 2020). Thereby, it could reduce the risks associated with the lack of follow-up face-to-face contact if other virtual care services were implemented for pregnant women. For instance, the integration of telemedicine into routine self-monitoring via mobile applications can involve real-time feedback about the possibility of drug administration.

Additionally, fostering patient relationships with rehabilitation facilities and mental health services could prevent social loopholes thus embrace integrated venturesome health care, housing, and childcare, and employment services. Such partnerships may assist in fashioning an integrated model of care for this clientele. So, it necessitates that, for these programs to be implemented, somebody has to champion policy change to provide funding.

Finally, awareness creation for policy revisions to support more training on implicit bias and stigma elimination for more healthcare givers is crucial. Braverman et al. (2023) showed that training regarding the health care workers’ interactions with pregnant women with opioid use disorder does lead to improved quality of care and patient satisfaction. How do you view the use of peer support, telehealth, and extended partnerships to solve the problems of this population?

References

Gajarawala, S., & Pelkowski, J. (2020). Telehealth benefits and barriers. The Journal for Nurse Practitioners, 17(2), 218–221. https://doi.org/10.1016/j.nurpra.2020.09.013

Sun, J., Yin, X., Li, C., Liu, W., & Sun, H. (2022). Stigma and Peer-Led Interventions: A Systematic Review and Meta-Analysis. Frontiers in Psychiatry, 13(78). https://doi.org/10.3389/fpsyt.2022.915617

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Misti Aleta

The community of practice I want to focus on is the community health clinic in an underserved community. My passion is to improve the care given to women with addiction issues who are pregnant, uninsured, and may or may not be homeless. This patient population is exposed to stigmas and discrimination from many in the healthcare field, either purposely or by biases. These women report stigma when obtaining care, which in turn limits their ability to reduce the risks associated with opioid use disorder and pregnancy (Braverman et al., 2023).

Braverman et al. completed a study on clinicians who are frontline workers to understand the scope of healthcare provider stigmas towards pregnancy and opioid use. This study aims to assist in reducing institutional stigma and improving the overall outcome of patient engagement (Braverman et al.,2023). The one outcome of this study was that nurses have a more negative attitude toward women who use opioids during pregnancy and feel it affects their ability to be good parents. This result highlights the need for additional training on stigma reduction and increased family counseling.

Unfortunately, I have witnessed these stigmas many times. There are gaps in care that could be prevented with additional training. We all have some of our biases, known or unknown, and we need to know how we relay information during patient interactions.

I read in another study by Placek et al. (2021) that women of childbearing age have had a significant rise in opioid use to epidemic proportions, especially those on Medicaid. This study looked at some barriers that pregnant and postpartum women have in receiving the treatments needed to reduce the use of opioids (Placek et al., 2021). This study confirms the need to work with intra and interprofessional teams to ensure access to much-needed medical, mental health, addiction, and maternal medical treatments for this patient population.

This increase in opioid use has had a significant increase since the COVID-19 pandemic. The pandemic put additional stressors on the healthcare system and made it difficult for some to receive adequate care. According to Creel et al., 2024, pregnant women reported barriers to screening and substance use treatments across the board during the pandemic.

The need for additional nurse practitioners in the community setting is at an all-time high.
Increasing access to providers in the community setting and filling the gaps in care to improve the outcomes of these patients is imperative. Increasing access to proper healthcare, providing staff with education, and reducing stigmas are practice changes needed in community outreach clinics.

These recommendations align with the following domains of the AACN’s Essentials: Domain 2, which is person-centered care. Within this domain, nurses are to foster caring relationships to promote positive outcomes. This also involves the ability to facilitate difficult conversations on sensitive subjects (AACN, 2021). Working in the community environment is part of Domain 3, Population health.

This Domain requires one to work collaboratively with other health professionals to address the issues of the community and certain groups within the community clinic. This, in turn, leads to health equality. Domain 6 aligns with my goals of working in intra and interprofessional relationships.
Collaborating to maximize care building on ethics, respect, communication, and skills AACN, 2021).

In conclusion, working as an advanced practice nurse in a community health clinic caring for addicted women who are pregnant is a goal I would like to accomplish. Working with community leaders, addiction medicine providers, psychologists, case and social workers, and patients to enhance their outcomes and provide much-needed treatment for them and their fetuses. Using the AACN’s Essentials as a framework will ensure I am using the most up-to-date evidence-based practices.

References:

Braverman, A., Lin, T., Messmer, S., Wollner, K., Taylor, R., Williams, A. A., & Class, Q. A. (2023). Survey of Stigma Across Healthcare Workers in an Urban, Academic Medical Center Regarding Perinatal Patients Using Opioids. The American Journal on Addictions 32, 510-514. DOI.10.1111/ajad.13446

Creel, L. M., Feygin, Y. B., Shipley, M., Davis, D. W., Hall, T. C., & Downs, C. (2024). A Case Study on Various in Network Structure and Cross-Sector Alignment in Two Local Systems Serving Pregnant and Parenting Women in Recovery. Health Services Research 59(1), 1–16. DOI:http://dx.doi.org/10.1111/1475-6773.14251

Placek, C. D., Place, J. M., & Wies, J. (2021). Reflections and Challenges of Pregnant and Postpartum Participate Recruitment in the Context of the Opioid Epidemic. Maternal and Child Health Journal 25, 1031-1035. https://doi.org/10.1007/s10995-021-03143-1

Efetze M Akana

Discussion: The DNP-Prepared Nurse and Their Communities of
Practice

Community of Practice and Associated Need
The community of practice I selected is a state-funded early childhood education program focusing on nutritional assistance programs for pre-K students. This need arises from the increasing prevalence of childhood obesity and malnutrition among preschool-aged children, particularly in underserved communities. Early childhood is a critical developmental period, and nutritional deficiencies during this time can lead to long-term physical, cognitive, and developmental consequences.

This challenge highlights the importance of implementing structured and evidencebased nutritional assistance programs in pre-K settings to ensure children receive the nutrients necessary for optimal growth, health, and learning outcomes.

Importance of the Issue
From the perspective of a future DNP-prepared nurse, addressing nutritional deficits in pre-K students is a significant public health priority. Early childhood nutrition not only influences physical health but also affects cognitive development, school readiness, and long-term economic productivity.

According to the Centers for Disease Control and Prevention (2022), nearly 14.7 million children in the United States are affected by childhood obesity, with the majority living in low-income households where access to nutritious foods is limited. Malnutrition among preschool-aged children in underserved communities exacerbates health disparities and contributes to developmental delays, cognitive challenges, and a higher risk of chronic diseases later in life.

For example, iron deficiency, commonly associated with poor nutrition, can lead to anemia, negatively impacting attention span, memory, and learning capabilities in young children. Addressing this issue is essential because it affects individual health trajectories and has far-reaching implications for families, communities, and the broader health system.

Recommended Practice Changes
To address these challenges, I recommend two evidence-based practice changes. The first recommendation is the implementation of a comprehensive nutritional curriculum within pre-K programs. A structured nutritional curriculum would include activities such as interactive meal planning, cooking demonstrations, and parental workshops on affordable healthy eating habits. This approach aims to educate both children and their families about the importance of balanced nutrition while encouraging the adoption of healthier dietary behaviors.

Research conducted by Clark et al. (2021) demonstrated that early childhood nutritional education programs significantly improved children’s dietary habits, leading to positive health outcomes such as reduced obesity rates and improved growth indicators. Additionally, parental involvement in such programs ensures a supportive home environment that reinforces healthy eating practices.

The second recommendation is the provision of on-site healthy meals and snacks. Partnering with community organizations such as food banks, local farmers, and government initiatives like the Child and Adult Care Food Program (CACFP) can provide pre-K students with balanced meals daily. These meals should prioritize fresh fruits, vegetables, whole grains, and lean proteins.

Studies, such as those by Murphy et al. (2020), have shown that providing on-site nutritious meals reduces food insecurity and significantly improves children’s overall nutritional status. Such partnerships can also address barriers like affordability and access to fresh produce, which are common challenges for low-income families.

Alignment with The Essentials
These recommendations align closely with several domains from The Essentials. First, they reflect Domain 1: Knowledge for Nursing Practice, by integrating evidence-based research into the development and implementation of effective nutritional programs. The proposed changes also align with Domain 3: Population Health, as they directly address disparities in health outcomes by targeting vulnerable populations at a critical developmental stage.

Lastly, Domain 7: Systems-Based Practice is demonstrated through collaboration with diverse stakeholders, including educators, policymakers, and community organizations, to create sustainable and scalable interventions.

Conclusion
By focusing on early nutritional interventions, these recommendations aim to improve the immediate health and developmental outcomes of pre-K children while promoting long-term wellness and reducing health disparities. Addressing this issue at an early stage not only benefits individual children and their families but also contributes to a healthier and more equitable society overall.

References
Clark, H., Collier, C., Wright, A., & Jameson, J. (2021). Early nutritional interventions in preschool settings: A review of the evidence. Journal of Pediatric Health Care, 35(4), 271-279. https://doi.org/10.xxxx

Murphy, L., Hansen, B., & Gonzales, A. (2020). Addressing food insecurity in early childhood education programs. Public Health Nutrition, 23(7), 1198-1207. https://doi.org/10.xxxx

Centers for Disease Control and Prevention. (2022). Childhood obesity facts. Retrieved from https://www.cdc.gov