www.mobilehealthmap.org 617‐442‐3200 New research shows that mobile health clinics improve health outcomes for hard to reach populations in cost‐effective and culturally competent ways . A Harvard Medical School study determined that for every dollar invested in a mobile health clinic, the US healthcare system saves $30 on average. Mobile health clinics, which offer a range of services from preventive screenings to asthma treatment, leverage their mobility to treat people in the convenience of their own communities. For example, a mobile health clinic in Baltimore, MD, has documented savings of $3,500 per child seen due to reduced asthma‐related hospitalizations. The estimated 2,000 mobile health clinics across the country are providing similarly cost‐effective access to healthcare for a wide range of populations. Many successful mobile health clinics cite their ability to foster trusting relationships. Qualitative research in such mobile health clinics has found that patients value the informal, familiar environment in a convenient location, with staff who “are easy to talk to,” and that the staff’s “marriage of professional and personal discourses” provides patients the space to disclose information themselves. A communications academic argued that mobile health clinics’ unique use of space is important in facilitating these relationships. Mobile health clinics park in the heart of the community in familiar spaces, like shopping centers or bus stations, which lend themselves to the local community atmosphere.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

Culture Care Diversity and Universality: A Theory of Nursing edited by Madeleine M. Leininger, PhD, RN, FAAN; Sudbury, MA: Jones and Bartlett, 2001; 448 pages, $34.95 This new release of a book published 10 years ago by the National League for Nursing is said to be the definitive and comprehensive source for Leininger's culture care theory. It is presented in three parts: Part I is a description of the theory and its underpinnings by Leininger. Part II, in nine chapters, describes the research method to study culture care, by Leininger, followed by research by various authors who have used the theory and method. Part III, in three chapters, all by Leininger, focuses on findings from research that have used the theory and the method and use of the theory in education and administration. A final chapter addresses the relevance of the culture care theory in projecting the future of nursing. The reissue of this book is both timely and welcome. Leininger has almost single-handedly transformed our thinking about the need for culture care in all domains, whether it be in nursing care, in educational programs, or administration of patient care services. As our country has become more and more multicultural, and as we have come to see the impact of events in other parts of the world on our daily lives, the theory of "culture care diversity and universality" assumes an importance not previously felt or understood. The author makes some attempt to place her culture care theory within the framework of the broader theory development enterprise in nursing and the different approaches used to develop theory. She concludes that culture care theory does not fit well with existing thinking on theory development approaches, and that theories in nursing have been conceptualized within the logical positivist and quantitative paradigm. Culture care theory, on the other hand, was "conceptualized within the qualitative discovery paradigm with largely inductive emic (people-centered) views and not from the researcher's a priori hypotheses" (p. 24). The central issue of concern to this reviewer is not with the utility and elegance of this theory, for it has both. It is rather, that it claims too much for itself and does not recognize the place, utility, co-existence, or indeed, complementarity, of other theoretical approaches, especially if they are developed within the positivist paradigm, and worse yet, if they demand quantitative approaches for verification of hypotheses derived from them. The book appears to claim that culture care theory and knowledge are sufficient to address all dimensions of nursing. …

Culture Care Diversity and Universality: A Theory of Nursing

SummaryCultural competence has commanded respectable attention since its introduction in cross-cultural discourse. Cultural competence has been presented as a framework capable of promoting cultura...

Cultural competence and cultural humility: A critical reflection on key cultural diversity concepts:

Intersectionality has become a significant intellectual approach for those thinking about the ways that race, gender, and other social identities converge in order to create unique forms of oppression. Although the initial work on intersectionality addressed the unique position of black women relative to both black men and white women, the concept has since been expanded to address a range of social identities. Here we consider how to apply some of the theoretical tools provided by intersectionality to the clinical context. We begin with a brief discussion of intersectionality and how it might be useful in a clinical context. We then discuss two clinical scenarios that highlight how we think considering intersectionality could lead to more successful patient-clinician interactions. Finally, we extrapolate general strategies for applying intersectionality to the clinical context before considering objections and replies.

Intersectionality in Clinical Medicine: The Need for a Conceptual Framework

Increasing Uninsured Patients’ Compliance with Return Primary Care Visits by Dorothy Carleton MS, Walden University, 2016 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2019 Abstract Patients who are unable to comply with their health care regimen are almost 3 times morePatients who are unable to comply with their health care regimen are almost 3 times more likely to have an adverse health outcome and are more likely to suffer irreversible progression of a chronic disease process. Increasing patient return clinic visits is essential, not only to curtail rapidly rising costs of health care but also to improve patient outcomes. This project focused on an uninsured patient population of a clinic in a rural community in the southeastern United States. The purpose of the project was to conduct a systematic review of the literature and identify the barriers and motivating factors for chronic care return primary care visits among uninsured patients. The theoretical models supporting the project were the health belief model and the chronic care model. A search of scholarly databases resulted in 366 articles meeting the inclusion criteria of peerreviewed English-language literature published since 2014 that focused on outpatient care among uninsured populations. All identified articles were reviewed, and several interventions emerged as options to increase patient return rates: care transition and coordination services, patient education, patient follow up, pharmacy assistance programs, food assistance programs, and integration of computer-based literacy interventions. The clinic administrators determined that the best option for the site would be implementation of an on-site food program. The findings of this project have potential to create social change in clinics for uninsured in the community by addressing food insecurity and providing patients an incentive to return for care every 6 months. Increasing Uninsured Patients’ Compliance with Return Primary Care Visits by Dorothy Carleton MS, Walden University, 2016 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice

/pdf/increasing-uninsured-patients-compliance-with-return-primary-2fmxh0lf0w.pdf

Increasing Uninsured Patients' Compliance with Return Primary Care Visits

Cultural competency has been a long held ideal for social work educators and practitioners. However, definitions and approaches to cultural competency vary widely depending on worldview, discipline, and practice context. Within social work and beyond, cultural competency has been challenged for its failure to account for the structural forces that shape individuals' experiences and opportunities. In contrast, the concept ofcultural humility takes into account the fluidity of culture and challenges both individuals and institutions to address inequalities. This article takes a critical look at cultural competence as a concept, examining its explicit and implicit assumptions, and the impact these assumptions have on practitioners. It suggests that cultural humility may offer social work an alternative framework as it acknowledges power differentials between provider and client and challenges institutional-level barriers. The authors advocate a move from a focus on mastery in understanding ‘others’ to a fram...

Suzanne L. Martin

Papers

From Mastery to Accountability: Cultural Humility as an Alternative to Cultural Competence