Showing papers in "Journal of cultural diversity in 2004"

Listening to the experts: provider recommendations on the health needs of immigrants and refugees.

Abstract: A growing body of literature describes what has come to be know as the 'healthy migrant' phenomenon - the fact that immigrants to the United States and Western Europe countries are often healthier than native-born residents in their new countries of residence. Over time, many immigrants lose this health advantage for reasons that are not fully understood. Data are presented from in-depth interviews with 62 health and social service providers working with immigrants in the state of Minnesota. Although the state is home to many refugees who were victims of torture or severe deprivation in their home countries, the majority of providers defi- ned the principal needs of their clients as affordable housing, jobs and access to health services, rather than needs related to health conditions and services per se. The providers' open-ended comments paint a picture of the ways in which post-immigration experiences lead to tangible stresses that compromise immigrants? health and well-being.

From mothers to daughters: transgenerational food and diet communication in an underserved group.

Abstract: Studies show that young girls are highly influenced by their mothers' attitudes toward food and body image. To investigate the nature of the information about food that mothers transfer to their daughters, the researchers used focus groups comprising African American women. Results suggest that when educators work with low-income African American women, they should be cognizant of overeating from the perspectives of early food scarcity, reverence for the mother's authoritative role in the family and respect for cultural differences in body size norms. In addition, nutrition educators should counsel young mothers to understand the impact of their eating habits on their daughters.

Cultural caring in nursing practice: a meta-synthesis of qualitative research.

Abstract: The number of qualitative studies regarding the experience of nurses caring for patients from cultures other than their own has increased, yet there remains a limited understanding of the meanings derived from this work. Using the methodology of Noblit and Hare's metaethnographic comparative method, the main themes and concepts from 13 qualitative studies are reduced to six overall themes that describe over 1000 nurses' experience caring for patients from other cultures. The themes include: (a) connecting with the client, (b) cultural discovery, (c) the patient in context, (d) in their world, not mine, (e) road blocks, and (f) the cultural lens.

Cultural variants of caregiving or the culture of caregiving.

Abstract: Research has shown that ethnic variations in caregiving exist. However, less attention has been given to the common experience of caregiving, across ethnic group affiliation. Semi-structured interviews with African American, Caucasian American, and Latino caregivers were conducted to understand the common experience of caregiving. Four major themes that characterized the caregiving experience across the three ethnic groups were identified. Participants described a tradition of family care, prevalent across the three ethnic groups. Familial conflicts, caregiving dissonance, and low levels of use of formal services also were prominent characteristics of the caregiving experience across the three ethnic groups. Results support the existence of a culture of caregiving prevalent across ethnic group affiliation.

Context and common ground: cultural adaptation of an intervention for minority HIV infected individuals.

Abstract: Understanding social contextual mediators of risk in HIV/AIDS prevention and promoting cultural adaptation of clinical interventions have evolved from new priorities set forth by the National Institutes of Health (NIH) on ecological validity and translational research (NIH, 2001). Thus, emphasis is placed on linguistically and culturally translating promising interventions "for and with" new populations to serve the realities of the particular group. The purpose of this paper is to describe the process involved in developing culturally sensitive interventions to strengthen the ecological validity of a cognitive behavioral stress management (CBSM) intervention for HIV+ individuals. In the past, population risk for human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) was differentiated according to Pattern I, Pattern II, and Pattern III countries (Garrett, 1994). The United States belonged to Pattern I, in which transmission was primarily associated with unprotected sex among gay men and needle sharing. African countries were assigned to Pattern II, dominated by the heterosexual transmission of HIV, while Asian countries, for example, were categorized under Pattern III, with an equal likelihood of infection from heterosexual, homosexual, blood, or needle exposure. What each category had in common, though, was exposure to some kind of marginalization or disparity, either by cultural, socioeconomic, or political determinants. However, talking about HIV/ AIDS in terms of disparities or "marginalized communities," as Fullilove (2000) did before an Institute of Medicine Roundtable, has not always been welcomed. Garrett (1994) has chronicled the uphill battle of the World Health Organization's Global Programme on AIDS in the late 1980s and addressed the disease as a macroeconomic and disparity issue. The United States is no longer a Pattern I country, and perhaps it never really was (Zierler & Krieger, 1997). These authors noted that in 1981, five White gay men caught the attention of the public health community rather than six women who appeared to be from poor racial/ethnic minority neighborhoods. In some ways, Zierler and Krieger were introducing a new story of risk, causality, and intervention with HIV/AIDS. This story parallels one told many years ago by the epidemiologist Joseph Goldberger, although with different characters and a different disease. In 1914, a disease called pellagra distinguished by dementia, diarrhea, and skin lesions was becoming an epidemic in the rural south. Most researchers viewed pellagra as an infectious disease caused by poor hygiene (Akst, 2000; Leslie, 2002). However, Goldberger's work began with observations in mental hospitals, prisons, and orphanages and revealed that the lack or supply and availability of fresh fruits, vegetables, dairy products, and meats at the local level were sources of risk for pellagra; the etiology of pellagra was a dietary deficiency fostered by the sharecropping system (Goldberger, 1914; Kraut, 1996). At that time, pellagra was a serious cause of psychosis and institutionalization, feeding the cycle of poverty and social stasis, particularly among rural African Americans. This story is told to set the stage for understanding the social contextual mediators of risk in HIV/ AIDS prevention and to promote cultural adaptation of interventions, encouraged by new priorities from the National Institutes of Health (NIH) on ecological validity and translational research (NIH, 2001). For both pellagra and AIDS, identifying the etiology, while difficult, was easier than designing effective interventions. The initial intervention for pellagra was distribution of yeast extract by Goldberger through the Red Cross, but symptoms reemerged as people lapsed in their use of the extract or in obtaining their supply. This process resulted in feelings of alienation and stigmatization. Eventually, a solution was devised to fortify grains and cereals with yeast extract, seen on breakfast cereal boxes today. …

Managing caregiving at home: Thai caregivers living in the United States.

Abstract: The researchers designed a qualitative descriptive study informed by grounded theory and ethnography to generate a beginning substantive theory that illuminates the process of caregiving in Thai families living in the United States. A purposive sample of seven Thai caregivers of chronically ill relatives in the western and the midwestern regions of the U.S. participated in interviews, provided observations and wrote memoranda. Three categories emerged from "managing caregiving at home;" (a) being caregivers, (b) the consequences of caregiving and (c) coping with the difficulties of caregiving. The study participants describe caregiving as a willing burden and an unavoidable duty, attitudes which are clearly influenced by Buddhist beliefs. The results of this study provide nurses with a better understanding of the caregiving process, especially as it exists in the Thai American population. Key Words: Thai American, Thai, nursing, nurses, caregiving, caregiver, home caregiving, family caregiving, chronically ill, grounded theory, ethnography Approximately 25% of all households in the United States provide home-based health care to family members (National Alliance for Caregiving and the American Association of Retired Persons, 1997). As a result of changes in the institutional nature of health care, as well as advanced technology in health care practice, patients with chronic illness are living longer and are more often being cared for at home by family caregivers. Shifts in health care policy toward community care, the growing number of the elderly and changes in the structure of the family unit (Carlisle, 2000) comprise the social factors that contribute to the importance of home caregiving and its significance for health care providers. Although numerous studies have documented the negative side effects of long-term caregiving, such as fatigue, lack of sleep, faintness, dizziness, stress, anger, short temper, hurt feelings, discouragement, discomfort and boredom (Subgranon & Lund, 2000), evidence also suggests that caregiving can be satisfying work. A sense of fulfillment for the caregivers, an increased feeling of closeness between caregivers and their relatives, and pleasure from day-to-day interactions with care recipients reportedly are some of the positive aspects of caring for dependent relatives (Harper & Lund, 1990; Kinney, Stephens, Franks, & Norris, 1995). Whether caregiving is perceived as rewarding or burdensome, caregiving can potentially improve the quality of family relationships and therefore may improve the quality of life of patients and their families. Although caregiving has been measured in terms of specific empirical variables, the emphasis on measurement in the body of research limits nurses' understanding of the multiple ways in which caregiving is important to caregivers and patients. Therefore a need exists to explore qualitatively the meaning and process of caregiving, and to examine the personal experiences and perspectives of caregivers as they provide care for their relatives. There is limited research on the culturally specific experiences of family caregivers of the chronically ill. For example, research has not focused on the ongoing process of family caregiving to Thai patients with chronic health conditions, particularly from the perspective of Thai caregivers who live far from their homeland. Personal beliefs grounded in religion and culture presumably play a major role in the caregiving process, prompting the researchers to question whether a conceptual, Westsern framework about caregivng can be used effectively in Asian populations, particularly Thai. The lack of an appropriate framework for caregiving that is sensitive to Asian culture and religion may result in a disparity in healthcare delivery. To enhance quality of care and quality of life for patients and caregivers, health care providers must develop appropriate interventions. …

Factors influencing exercise participation and quality of life among elderly Korean Americans.

Abstract: The purpose of this study was to identify factors influencing exercise participation and quality of life among elderly Korean Americans. This study used a focus group design. Elderly Korean Americans age 60 and older residing in Seattle, Washington were recruited from a senior house, which serves low-income elderly. Thirteen older adults participated in a focus group discussion. Data analysis used content analysis. Factors influencing exercise participation included health status, advancing age, cultural self-consciousness, and lack of transportation. Factors influencing quality of life included health status, socioeconomic isolation, and spirituality. This study provides useful knowledge for designing future health promotion programs for this cultural minority group.

Grandparent caregiving role in Filipino American families.

Abstract: The purpose of this preliminary study was to explore the Filipino American grandparent caregiver role of grandchildren. This descriptive qualitative study utilized three data collection methods: demographic information sheet, focus group, and field notes. The Filipino American grandparents were recruited from a church in Honolulu, Hawaii. Thematic analysis was used to analyze narrative data. Filipino American grandparents view the grandparenting caregiving role as a normative process rather than a burden in which families take on responsibilities as part of cultural beliefs and norms such as pakikisama, utang na loob, and authoritarianism. Pakikisama is family unity and closeness and Utang na loob is mutual reciprocity "the give and take" and obligation in relationships.

Creating cross-racial primary care relationships in a nurse-managed center.

Abstract: Culturally incompetent communication patterns with provid- ers influence the health disparities of African Americans. Limited knowl- edge exists on cross-racial nurse practitioner nurse-patient relationships (NP-NPRs). The purpose of this paper is to describe how NPs and pa- tients in cross-racial relationships developed primary care relationships in one nurse managed center (NMC). A qualitative design incorporated a social constructivist paradigm and the methodolo^ of Interpretive Interactionism. Twenty cross-racial NP- patient dyads~(White NPS and Black patients) participated in individual 1 to 3-hour audiotaped interviews regarding their ongoing relationships and the impact of the NMC. The analysis uncovered a rich description of the relationship processes from the initial meeting to its current state. Multiple themes for each phase, as well as, four typologies of primary care cross-racial NP-NPRs are de- scribed. Significant relationship work was needed by both partners to overcome communication misunderstandings, contextual aspects of cross-racial in- teractions and other overt and covert perceptions.

Parents experiences of their child's care during hospitalization.

Abstract: Driven by the institutionalization of healthcare, and the attendant financial and regulatory issues, health caregivers now need to objectively define and assess the quality of care that is delivered to patients. Measures of quality care for children lag behind the measures that are utilized for adults. To date, little is understood about how quality care for children is identified and measured. Pediatric literature acknowledges, but has poorly studied, the relationship between health care providers and parents in providing and evaluating quality care for children. This paper applies qualitative descriptive theory that is informed by grounded theory to explore parents' experiences of the care they received for their hospitalized children. From a convenience sample of six parent participants, this study finds that parents experience childcare in a hospitalized setting in terms of four interconnecting, circular processes: (a) facing boundaries, (b) attempting to understand, (c) coping with uncertainty and (d) seeking reassurance from caregivers. The experiences shared by the parent participants in this study convey new meaning to the interactional nature of the parent-caregiver relationship. In particular, the researcher finds that parents use the parent-caregiver relationship to help cope with their child's condition, and this in turn influences the parents' sense that their and their child's needs are being met.

Evidence for racial disparity in cardiac transplantation survival rates.

Abstract: Studies show that survival rates of cardiac transplantation are lower for African American transplant recipients than for Caucasians. Due to similarities in terms of etiology, treatment modalities and responses to these modalities, the authors examine some potential variables for survival of cardiac transplantation that have been well documented in both the renal transplantation literature and the medically managed congestive heart failure literature. The authors also discuss access to care, socioeconomic factors and immunological differences in attempting to identify relevant factors for survival of cardiac transplantation. Key Words: cardiac transplantation, renal transplantation, transplant survival, congestive heart failure, morbidity, mortality, survival, human leukocyte antigen, HLA, racial disparity Every year, cardiac transplantation gives thousands of people hope of surviving congestive heart disease and improving their quality of life. Cardiac transplantation was largely an unobtainable goal in the 1960s and 1970s, but since the cyclosporine era of the 1980s, cardiac transplantation has become a generally accessible and appropriate form of therapy for end-stage congestive heart failure (CHF). Today, overall survival rates of the transplantation procedure are impressive, with a half-life of 9.3 years (Taylor et al., 2003). Contributing factors to morbidity and mortality following cardiac transplantation must be effectively managed to optimize recipient survival and quality of life. Some of the factors that have been demonstrated to inhibit recipient survival include allograft vasculopathy infection and malignancy. In addition, cardiac allograft rejection remains a significant cause of both early and late post-procedure mortality. Several recipient demographic characteristics are also important to consider, such as older age, previous cardiac surgery, the presence of pulmonary hypertension, insulin dependent diabetes and chronic renal insufficiency. Another post-procedure survival factor - race - has also been discussed in the literature. The differences in survival rates of heart transplant recipients among African Americans compared to Caucasians have been documented by Park, Tolman and Kimball (1997). In their study, survival rates for Caucasian recipients at one, three, five and nine years were 83%, 73%, 63% and 46%, respectively. The transplant survival rates for African American recipients were lower across the board, at 70%, 58%, 51% and 32%, respectively. Park et al. have examined that access to care, socioeconomic factors and immunological differences potentially contribute to lower survival rates. Other studies of race as a factor for morbidity and mortality in cardiac transplantation are limited in the literature, and the few single center studies of this disparity have produced contradictory results. However, some potential variables for cardiac transplantation survival have been well documented in both the renal transplantation literature and the medically managed CHF population. We will examine these two populations because of their similarity to the heart transplant population in terms of etiology of disease (in the case of CHF) and treatment modalities and responses to these modalities (in the case of renal transplantation). We will also discuss access to care, socioeconomic factors and immunological differences. These investigations should further illuminate the potential etiology of racial disparity in overall recipient survival rates following cardiac transplantation. RENAL TRANSPLANTATION: RACE AS A FACTOR FOR MORBIDITY AND MORTALITY Racial disparity has long been noted in the literature on renal disease. Renal graft survival is 30-40% lower for African Americans than Caucasians (Butkus, Meydrech, & Raju, 1992). Prior to the introduction of cyclosporine, this difference was thought to be due to poorer human leukocyte antigen (HLA) matching, unfavorable socioeconomic factors and immunological differences (Butkus, Kirchner, Krueger, Cruse, & Raju, 1991). …

Enhancing cultural competencies of advanced practice nurses: health care challenges in the twenty-first century.

Abstract: Shifting population demographics will have a major impact on the practice of advanced practice nurses (APNs). The ethnic composition of people in this country is becoming increasingly diverse. Massachusetts and, in particular, the city of Worcester is also experiencing changes in the diversity of its population. These trends testify to the great need for APNs who are sensitive to and competent to care for culturally diverse populations. To address these changes, specific curricula enhancements focused on ethnically diverse populations were implemented for the nurse practitioner specialties at the Graduate School of Nursing (GSN), University of Massachusetts Worcester. The processes used for this project included visiting community and clinical sites, identifying key curricular components, and evaluating existing didactic and clinical learning experiences. The GSN faculty developed a systematic plan for integrating these components into the graduate nursing core, advanced practice core, and specialty courses of the respective curricula. A major outcome of this project was the enhanced preparation of APN students to meet the multifaceted needs of ethnically diverse patients, families, and communities.

Culturally relevant HIV interventions: transcending ethnicity.

Abstract: Over the last 2 years, the co-authors produced an HIV prevention film for teens in collaboration with four African American women living with HIV. However, there were initially concerns that the experiences and prevention messages in the film would not be relevant to women of other cultures and ethnic backgrounds. Pretesting of the film was completed with African American and Latina teen girls; adult women who were HIV providers of various ethnicities and cultures; and adult Latina, Cape Verdean, and White women as well as adult Haitian men and women. Findings indicated that cultural relevance was strong for individuals who shared gender identity and socioeconomic status.

New Mexico nurses' cultural self-efficacy: a pilot study.

Abstract: Health care providers must develop a level of comfort in caring for patients/clients from cultures other than their own. A pilot study of 15 registered nurses caring for multiethnic patients in New Mexico was conducted to determine their level of self-efficacy, to test the Cultural Self-Efficacy Scale, and to determine the feasibility of a larger study. The participants were moderately confident with their knowledge of cultural concepts, cultural nursing skills, and three of the five ethnic groups' cultural life patterns. Although no conclusions can be drawn due to the small convenience sample, this study should lead to larger, more rigorous studies. Key Words: Cultural Self Efficacy; New Mexico; Nurses Our society is becoming more and more diverse. Lipson, Dibble, and Minarik (1997) describe a tapestry of culturally diverse societies made up of various threads. Some are thick and fluffy, some thin and strong, while others are sleek and shiny, each adding to the beauty of the whole. Diversity influences society at all levels and nowhere more importantly than in health care. New Mexico is listed as second in the list of the ten fastest-growing states (New Mexico Department of Health, 1999). The U.S. Census Bureau (2000) projects that by 2025, African Americans in New Mexico will increase 36.2%; Native Americans, 83.2%; Hispanics, 88.5%; and Asian Americans, 116.6%. Health care professionals in New Mexico must be able to care for clients from cultural backgrounds different from their own. The efficaciousness of all health care providers in caring for multiethnic patients is especially important since we tend to avoid uncomfortable situations, which can lead to a decrease in health care services (O'Leary, 1985). Health care that is not congruent with a patient's beliefs, values, and expectations can cause conflict, leading to noncompliance with prescribed plans of care, resulting in stress and ethical and moral concerns (Leininger, 1991). Potential negative outcomes can be avoided when there is sensitivity to and respect for our differences (Pachter, 1994). A pilot study was performed to determine the level of self-efficacy of licensed registered nurses (RNs) in caring for multicultural patients/clients in New Mexico, as well as to test the Cultural SelfEfficacy Scale (CSES; Bernai & Froman, 1987) and to determine the feasibility of a larger study. The concepts of culture and self-efficacy were important to this study. Leininger (1991) defined culture as "the learned, shared, and transmitted values, beliefs, norms, and lifeways of a particular group that guides their thinking, decisions, and actions in patterned ways" (p. 46). It is a dynamic concept and therefore in constant flux, always combining the lived experiences of the person or group. Bandura (1977) defined self-efficacy as the belief that one can successfully complete a task or behaviors to accomplish an outcome. METHOD Sample A convenience sample of 15 licensed RNs in New Mexico participated in the study. The size of the sample was based on acceptable pilot study protocol (personal communication, P. Duryea, July 15, 1999). There were no exclusion criteria, and consent to participate was implied by participants completing and returning the survey. This study followed all guidelines for and was approved by The Institutional Review Board of the University or New Mexico. Instrument The CSES, developed by Bernai and Froman (1987) and modified by Kulwicki and Bolonik (1996), was used to measure the confidence level of the licensed RNs in providing cultural care for five ethnic groups (Middle Eastern/Arab American, Hispanic, African American, Native American, and Asian Pacific Islander). The participants were given or mailed the questionnaire with a self-addressed stamped return envelope. Permission to use the tool was obtained from Drs. Bernal and Froman prior to its administration. …

Health disparities in practice and research for aging women with cancer.

Abstract: The purpose of this article is to examine health needs as well as disparities in practice and research pertaining to aging women with cancer. Given the increasing number of aging women with cancer and the concomitant challenges in survivorship, caregivers need research and improved clinical care to identify needs and enhance cancer survivors' quality of life. The authors use inner strength as a theoretical framework to discuss examples of practice and strategies to improve health outcomes and assess health needs in aging women with cancer. Because researchers find it difficult to identify gender-specific and culturally appropriate instruments, the authors conducted a pilot test on an inner strength questionnaire to identify potential problems in instrumentation and data collection with aging women. Ultimately, a therapeutic partnership between patient and care provider should be based on mutual goal setting and identifying all the dimensions of a women's health status with valid and reliable research instruments and practice strategies.

The effect of race and gender on invasive treatment for cardiovascular disease.

Abstract: The purpose of this study was to investigate racial and gender differences in the utilization of invasive procedures for cardiovascular treatment Medical records data of 3,015 patients were abstracted from a Medical System Database from 1999 to 2001 Logit models were used to estimate the adjusted odds in the utilization, referral, and acceptance of invasive procedures, while controlling for confounders (age, race, sex, comorbidity, disease severity, payer type, marital status and family history) simultaneously When considering utilization of invasive procedures, the adjusted odds were lower for African-Americans compared to Caucasians There was a statistically significant difference (p Key Words: Race, Gender, Invasive Treatment Cardiovascular disease (CVD) is the leading cause of death among every racial and ethnic group in the United States An individual's ability to access and use modern cardiac therapy and procedures may have profound implications for improving diagnostic precision, relieving symptoms, and reducing premature mortality from heart-related conditions Research to investigate underlying causes, subsequent outcomes and effective interventions is crucial for reducing racial/gender disparities in medical care Although invasive cardiac procedures have been documented to reduce symptoms and prolong life for those with severe CVD, numerous studies over the past two decades have reported that African Americans are less likely than Caucasians to utilize invasive procedures (Brown, 2002; Ford, Cooper, Castner, Simmons, & Mar, 1989; Giles, Anda, Casper, Escobedo, & Taylor, 1995; Goldberg, Hartz, & Jacobsen, 1992; Hannan, Van Ryn, & Burke, 1999; Kressin & Peterson, 2001; Maynard, Fischer, Passamani, & Pullum, 1986; Watson et al, 2001; Wenneker & Epstein, 1989) Additionally, previous studies have shown that when stratifying by race and sex, African American females are less likely to utilize invasive procedures compared to Caucasians (Ayanian, Udvarhelyi, Constantine, Chris, & Arnold, 1993) Research has shown that disparities regarding use of invasive treatments remain even after controlling for clinical and socioeconomic factors There is concern in the medical community that the race and gender of a patient could be prompting differences in physician behavior Therefore, the purpose of this study was to explore the effect of race and gender on the use of invasive treatment for cardiovascular disease Accordingly, this study proposed to test the following hypothesis: African-Americans and females will be less likely to receive invasive treatment for cardiovascular disease compared to Caucasians and males, respectively METHOD Design A retrospective longitudinal review of hospital patient information was conducted using statewide patient data obtained from a Medical System shared by three urban public health hospitals in the state of Louisiana The use of statewide patient data provided a unique opportunity to examine treatment in the only state in the United States that provides a state system of acute care for its citizens The vast majority of the persons served by this system are indigent or Medicaid recipients Data used in the analysis were from July 1998 to July 2000 Data was obtained from three public health teaching hospitals, which encompass professional schools in medicine, nursing, and dentistry, as well as allied health vocations …

Mothers' voices: culturally diverse mothers' experiences talking with their children about HIV/AIDS.

Abstract: A qualitative analysis of culturally diverse mothers' experiences communicating with their children about HIV/AIDS following their participation in a nationally renowned prevention and education program illuminated some of the challenges and surprises these women encountered. Excerpts of "Mothers' Voices" illustrate the themes that emerged through data analysis. Implications and applications to other contexts are provided. In recent years, the high incidence of sexual activity and HIV contraction by American youth has reached overwhelming proportions. The likelihood that a teenager will engage in sexual intercourse increases throughout the teen years (Dailard, 2001). The Office of National AIDS Policy (2000) reported that 65% of teens are sexually active by the 12th grade, with 20% having had four or more partners. The number of teenagers diagnosed with HIV and AIDS continues to grow at alarming rates; 50% of all new HIV infections presently occur in youth ages 13 to 24, which translates to more than 20,000 teens and young adults per year (Centers for Disease Control [CDC], 2002). While the need for prevention and education programs for children and adolescents continues to grow, many restrictions are placed on school-based education programs. The Alan Guttmacher Institute reported that 25% of sex education teachers are not permitted to discuss contraception, including the use of condoms, as they teach from an abstinence-only perspective (Dailard, 2001). Other programs have more latitude regarding the issues that can be covered and attempt to incorporate the family unit and communication skills into curricula. However, the ongoing debate about whether sex education should be provided in the school or the home continues, while teenagers continue to engage in sexual activity and contract HIV. In the last 10 years, prevention programs have started to target parents to teach them how to educate and communicate with their children about sexual issues (Lederman & Mian, 2003). However, there is little outcome research on the effectiveness of HIV prevention programs that specifically train parents to be HIV educators for their children and adolescents. It is imperative to determine which specific components of family-centered HIV prevention programs are successful. HIV is an area of study that is constantly changing with the advent of technology, research, and new information. Program evaluation studies cost time, resources, and commitment from clinical agencies and organizations. Unfortunately, many prevention and education programs lack the luxury of funding for such evaluation efforts. More and more programs are concluding that well designed and executed evaluation studies are an investment in a program's future (Coyle, Boruch, & Turner, 1991). Findings can lead to changes in program curricula and implementation as well as help improve services to the community by identifying factors that may be facilitating or preventing desired outcomes (Mertens & Carael, 1997). Once preliminary evaluation studies have been completed, future evaluations will be less expensive to conduct, future funding for the program may be obtained, and morale can increase when program staff view how their daily efforts impact others' lives (Coyle et al., 1991; Grembowski, 2001). In studies of parental communication with children about HIV/AIDS, there has been a dearth of information from a multicultural perspective (Finger, 1997; Sigelman, Mukai, Woods, & Alfeld, 1995). Exploration of the perceptions of mothers from various cultural and ethnic groups about their communication with their children about HIV would add to knowledge in this area. The purpose of this paper is to present qualitative findings from a program evaluation of Mothers' Voices South Florida (MVSF). BACKGROUND OF THE ORGANIZATION Mothers' Voices, a national grassroots organization, was founded in 1991 in New York City by a group of five mothers who had concerns about the rise of HIV infection among the nation's youth (Mothers' Voices, 2003). …

Before during After: A Nursing Handbook for Substance Abuse

Abstract: BEFORE DURING AFTER: A NURSING HANDBOOK FOR SUBSTANCE ABUSE Taylor, A (2004) Before, during, after: A nursing handbook for substance abuse McLean, VA: International Medical (ISBN: 1-58808-264-4; $895;126 pages) Listening to the voice of a nurse who is on the recovery journey of substance abuse can have a powerful influence on other nurses experiencing a struggle with addiction Before, During, After: A Nursing Handbookfor Substance Abuse is such a journey and can be useful to addicted nurses, administrators dealing with addicted nurses, and colleagues of nurses struggling with addiction The author presents a broad view of addiction and provides a glimpse of what it is like prior to recognizing addiction, the difficulties in admitting the problem, and the road to recovery Taylor (2004) emphasizes the issue of chemical dependency in the health professions and focuses attention on its impact in nursing Nurses have a similar incidence of abusing substances as the general population; however, health professionals have a higher incidence of prescriptive drug abuse partly due to their ability to obtain drugs from calling prescriptions into pharmacies themselves, having prescriptions written for them, or diverting medications form patients Nurses engaged in drug seeking behaviors hurt themselves, their patients, and other health care professionals The consequences for chemical dependency include both losing their licenses and possibly facing criminal charges There has been an increase in substance abuse among nurses and State Boards of Nursing report that 70% of their actions against nurse's licenses are related to substance abuse disorders Most states have Recovering Nurse Programs (RNP) and the State of Louisiana Board of Nursing reports that even though there was a 30% relapse rate for nurses who go through residential treatment and that more than 60% of participants have relapsed more than once, the success rate of Louisiana's RNP is 65% The author presents these statistics to emphasize the point that no nurse entering rehabilitation is doing it alone The "before" section of the book describes what it is like for an individual prior to intervention and recovery Taylor (2004) suggests there are characteristics of at-risk nurses such as family history of chemical dependency, solitary not social use of chemicals, ambitious, achievement-oriented, graduates near the top of their class, and those who possess advanced degrees Demerol is the drug of choice, and alcohol is the largest choice for addicted professionals The signs of an impaired professional can be categorized into job performance and attendance, physical symptoms, behavior changes, and nursing unit specific signs The observation of a pattern of behaviors in any of these categories is imperative in identifying an addicted nurse The "during" section of the book discusses confidentiality issues, employees assistance programs, and the investigation process - all issues important prior to starting treatment The loss of confidentiality is a major concern for a nurse starting a treatment program; however, there are measures in place to assure confidentiality, such as required confidentiality at treatment centers, HIPPA privacy rule, and the confidentiality of details leading up to disciplinary actions by State Boards of Nursing …

Special delivery: when the pills "absolutely, positively" can't be delivered at home.

Abstract: The practice of storing and dispensing medications by providers at an inner city neighborhood health center that serves predominantly ethnic minority clients was terminated due to accreditation regulations This practice promoted adherence since many clients did not want to receive medications by mail at home due to confidentiality concerns or were unwilling to present to their local pharmacy due to fear of discrimination related to HIV status The purpose of this paper is to describe an alternative means to access HIV medications in a safe and supportive environment for clients confronted with cultural ana social barriers through a unique collaboration between an HIV specialty care program and HIV specialty pharmacy Early in the epidemic in this country, HIV/ AIDS was a disease that affected mostly gay White males and intravenous drug users (IVDU's) However, the epidemiology of this dis ease has changed dramatically over the past 20 years HIV infection is becoming increasingly prevalent in ethnic minority groups Combining the prevalence of HIV infection in African Americans and Hispanics, these two ethnic groups account for over 60% of all HIV/AIDS cases in the United States (Centers for Disease Control [CDC], 2004; DeSantis & Patsdaughter, in press) Immigrants from various countries also have unique HIV-related risk behaviors and face disparities in relation to HIV testing and treatment (Rendiro, 2003) Since the development of highly active antiretroviral therapy (HAART) in the 1990s, adherence to HAART has been a concern Successful viral suppression and maintenance of CD4+ (t cell) counts to prevent opportunistic infections and premature death depend on adherence to the prescribed antiretroviral regimen To avoid viral mutations and subsequent viral resistance, clients on HAART cannot miss more than one dosage of the prescribed regimen per week (Andrews & Friedland, 2000) During preparation for a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) site visit at an inner city neighborhood health center (NHC) in the Northeast, the established practice by HIV nurse case managers of storing and redispensing highly active antiretroviral therapy (HAART) medicines after initial preparation by a pharmacist was terminated by administrators in order to comply with JCAHO regulations This practice had promoted medication adherence to HAART for a select group of clients who received their HIV care via a comprehensive care program at this inner city NHC for the previous 4 years Clients who participated in this intervention did not want to receive their medications by mail at home due to confidentiality concerns or were unwilling to present to local pharmacies due to fear of discrimination related to their HIV positive status When clients were informed that the continued storage of prescribed and overthe-counter (OTC) medications and re-dispensing of medication previously sealed by a pharmacist could no longer continue at the NHC, clients overwhelmingly responded that they would be "unable to continue to take their HAART as prescribed" due to their particular psychosocial and/or socioeconomic situations The purpose of this paper is to describe an alternative means to access HIV medications in a safe and supportive environment for clients confronted with cultural and social barriers through a unique collaboration between an HIV specialty care program and HIV specialty pharmacy case examples and outcome data will also be presented Review of Literature Adherence in Ethnic Groups Since HAART is the predominant treatment for HIV infection, adherence is of paramount importance to the successful suppression of viral replication Adherence, formally referred to as compliance, has become the focus of HIV research and treatment Numerous factors probably influence adherence to HAART When the importance of adherence in HIV treatment became apparent, researchers wanted to identify the factors that promoted adherence and the factors that were barriers to adherence …

The expert site visitor chairperson: supportive, effective, efficient.

Abstract: In much of nursing academe the words "self-study" and "accreditation site visit" are enough to squeeze the coronary arteries of nurse administrators and faculty. Such words conjure up images of months of labor intensive work, anxiety and concerns that all might not go well and that the program's accreditation will be placed in jeopardy. Both the completion of a self-study, designed as a self-assessment of program strengths and weaknesses, and preparation for the on-site visit are an addition to the normal tasks of nurse administrators and thus often result in overtaxing resources allotted to maintenance of the program. Key Words: Accreditation, Site Visitor Chairperson, National League for Nursing Accrediting Commission (NLNAC) It is a recognized fact that nursing education accreditation visits are important to ensure the quality of programs and services and that, in the worst case scenario, the outcome of the site visit can result in closure of the nursing program (Burke, 2003). Accreditation is seen as an indication of a program's competence, excellence, and quality thus increasing it's viability (Burke, 2003). The acquisition of accreditation when a program is initiated and the continuation of accreditation by ongoing reassessment is critical for many programs. Accreditation enables institutions to apply for federal, corporate, and foundation funds, aids the department in competition for campus resources, and for students since there is higher status associated with a degree from an accredited institution (Burke, 2003). How can fears of the nurse administrator and faculty be calmed by the site visitor chairperson so that the program can be showcased in a positive light? The evaluation site visit team chairperson plays a central role in the process of lowering the stress of the nursing program and increasing the productivity of an accreditation visit. There are a number of ways the chairperson can be effective, efficient, and supportive before, during, and following the site visit. A professional, ethical manner is critical in the implementation of the accrediting body's guidelines. The chairperson of a National League for Nursing Accrediting Commission (NLNAC) team can also be assisted by noting the outline of the responsibilities of team chairperson and members which can be found in the current NLNAC Accreditation Manual and Interpretive Guidelines by Program Type(2002) (See Table 1).* Prior to the Visit Planning prior to the visit involves both the site visitor team members and the nursing administrator of the program. Strategic elements are involved in planning with both the team and the nursing administrator if the team and nursing administrator are to feel mentored and supported. The first step begins with the team chairperson's contact with members of the site visit team and the nurse administrator of the program to be visited. Planning with the Team The initial call to team members should include setting a collegial tone, establishing e-mail communication, obtaining information on areas of expertise, discussing travel plans, dividing responsibilities for the standards in the site visit report, and soliciting input into the agenda (see Table 2). It is the responsibility of the site team member chairperson to set the tone for the meeting and to facilitate a collaborative attitude. The tone should be professional yet collegial to put team members at ease. Setting the tone begins with the first contact. In spite of the availability of e-mail a personal phone call is more likely to set a positive tone and should be used for the first contact. Utilizing e-mail connections early on in the process to facilitate communication among the chairperson and team members as well as between the chairperson and the nurse administrator at the nursing program is a wise choice today. Technology has changed the context of how work gets done and e-mail easily fosters collaborative work across borders (Pulley, Sessa & Malloy, 2002). …