Showing papers in "Journal of Transcultural Nursing in 2015"
TL;DR: The author reviewed cultural competence models and cultural competence assessment instruments developed and published by nurse researchers since 1982 in terms of their components, theoretical backgrounds, empirical validation, and psychometric evaluation.
Abstract: The author reviewed cultural competence models and cultural competence assessment instruments developed and published by nurse researchers since 1982. Both models and instruments were examined in terms of their components, theoretical backgrounds, empirical validation, and psychometric evaluation. Most models were not empirically tested; only a few models developed model-based instruments. About half of the instruments were tested with varying levels of psychometric properties. Other related issues were discussed, including the definition of cultural competence and its significance in model and instrument development, limitations of existing models and instruments, impact of cultural competence on health disparities, and further work in cultural competence research and practice.
176 citations
TL;DR: It is indicated that the nurses need language skills and cultural customs and beliefs training to provide care to culturally diverse patients and support services, such as dieticians, need to be involved in the plan of care to address applicable cultural issues.
Abstract: Purpose: The aim of this study was to describe the cultural factors that have an impact on military nursing care for Iraqi patients. The results were part of a larger study in which the purpose was...
113 citations
TL;DR: A constructivist definition of cultural competence that stems from the conclusions of an extensive critical review of the literature on the concepts of culture, cultural competence, and cultural safety among nurses and other health professionals is proposed.
Abstract: In nursing education, most of the current teaching practices perpetuate an essentialist perspective of culture and make it imperative to refresh the concept of cultural competence in nursing The purpose of this article is to propose a constructivist definition of cultural competence that stems from the conclusions of an extensive critical review of the literature on the concepts of culture, cultural competence, and cultural safety among nurses and other health professionals The proposed constructivist definition is situated in the unitary-transformative paradigm in nursing as defined by Newman and colleagues It makes the connection between the field of competency-based education and the nursing discipline Cultural competence in a constructivist paradigm that is oriented toward critical, reflective practice can help us develop knowledge about the role of nurses in reducing health inequalities and lead to a comprehensive ethical reflection about the social mandate of health care professionals
103 citations
TL;DR: In Saudi Arabia, the health system is mainly staffed by expatriate nurses from different cultural and linguistic backgrounds as mentioned in this paper, and given the potential risks this situation poses for patient car...
Abstract: Purpose: In Saudi Arabia, the health system is mainly staffed by expatriate nurses from different cultural and linguistic backgrounds. Given the potential risks this situation poses for patient car...
81 citations
TL;DR: The concept of storytelling, underpinned by cultural phenomena, is explored for data collection and intervention and a conceptual analysis of storytelling reveals key variables.
Abstract: Storytelling is a basic cultural phenomenon that has recently been recognized as a valuable method for collecting research data and developing multidisciplinary interventions. The purpose of this article is to present a collection of nursing scholarship wherein the concept of storytelling, underpinned by cultural phenomena, is explored for data collection and intervention. A conceptual analysis of storytelling reveals key variables. Following a brief review of current research focused on storytelling used within health care, three case studies among three vulnerable populations (American Indian teen mothers, American Indian cancer survivors, and African American women at risk for HIV/AIDS) demonstrate the uses of storytelling for data collection and intervention. Implications for transcultural nursing regarding storytelling are discussed.
54 citations
TL;DR: Investigation of the utilization of clinical breast examinations and mammograms among Korean American immigrant women and how the six constructs of Health Belief Model are associated with the receipt of breast cancer screening suggest that HBM constructs such as susceptibility, barriers, and confidence should be considered when designing interventions aimed at promoting breast cancer screenings.
Abstract: This study examined the utilization of clinical breast examinations (CBEs) and mammograms among Korean American immigrant women and investigated how the six constructs of Health Belief Model (HBM) are associated with the receipt of breast cancer screening. Using a quota sampling strategy, 202 Korean American immigrant women were recruited in metropolitan areas in the northeastern United States. Approximately 64% of the participants reported having had at least one CBE in their lifetime, and about 81% of the sample had undergone at least one mammogram in their lifetime. Women who perceived themselves to be susceptible to breast cancer were more likely to have undergone a CBE, and women who had lower barriers to screening or demonstrated a higher level of confidence were more likely than their counterparts to undergo a mammogram. Findings suggest that HBM constructs such as susceptibility, barriers, and confidence should be considered when designing interventions aimed at promoting breast cancer screening.
45 citations
TL;DR: The social-ecological model is used to explore the personal, socioeconomic, psychosocial, and cultural factors that affect the infant feeding decision-making processes of African American women and the implications for clinical practice and research to eliminate current disparities in rates of breastfeeding are discussed.
Abstract: Despite extensive evidence supporting the health benefits of breastfeeding, significant disparities exist between rates of breastfeeding among African American women and women of other races. Increasing rates of breastfeeding among African American women can contribute to the improved health of the African American population by decreasing rates of infant mortality and disease and by enhancing cognitive development. Additionally, higher rates of breastfeeding among African American women could foster maternal–child bonding and could contribute to stronger families, healthier relationships, and emotionally healthier adults. The purpose of this article is twofold: (a) to use the social-ecological model to explore the personal, socioeconomic, psychosocial, and cultural factors that affect the infant feeding decision-making processes of African American women and (b) to discuss the implications of these findings for clinical practice and research to eliminate current disparities in rates of breastfeeding.
44 citations
TL;DR: A descriptive review of current research literature pertaining to English language challenges, with a focus on oral language, experienced by internationally educated nurses, to facilitate a clearer understanding of the English language and communication challenges experienced by IENs and identify the implications for designing effective educational programs.
Abstract: Achieving English language proficiency, while key to successful adaptation to a new country for internationally educated nurses (IENs), has presented more difficulties for them and for educators than previously recognized. Professional communication within a culturally diverse client population and maintaining collaborative relationships between nurses and other team members were perceived as new challenges for IENs. Learning an additional language is a long-term, multistage process that must also incorporate social and cultural aspects of the local society and the profession. This article provides a descriptive review of current research literature pertaining to English language challenges, with a focus on oral language, experienced by IENs. Educational strategies for teaching technical language skills as well as the socio-pragmatics of professional communication within nursing programs are emphasized. Bridging education programs must not only develop students'academic language proficiency but also their ability to enter the workforce with the kind of communication skills that are increasingly highlighted by employers as essential attributes. The results of this review are intended to facilitate a clearer understanding of the English language and communication challenges experienced by IENs and identify the implications for designing effective educational programs.
41 citations
TL;DR: Whiteness obscured the participants’ understanding and teaching of race; White nursing faculty were not well prepared to teach about race and racism; learning about these topics occurs best over time and through personal relationships.
Abstract: Purpose: Some nursing scholars assert that race and racism require a more explicit focus in cultural nursing education if the profession is to positively impact health care disparities. This study ...
40 citations
TL;DR: Acculturation and health literacy play an important role in illness perceptions of hypertension among Hispanics, and findings could be helpful in the development of tailored health promotion interventions to improve hypertension management among Hispanic adults.
Abstract: Purpose: Hypertension treatment rates are disproportionately lower among Hispanics compared to non-Hispanic Whites and non-Hispanic Blacks. The purpose of this study was to examine the relationship among acculturation, health literacy, and illness perceptions of hypertension among Hispanics. Design: A cross-sectional correlational design was used, including 144 Hispanic adults with a self-reported diagnosis of hypertension. Method: The instruments used included the Short Acculturation Scale for Hispanics, the Newest Vital Sign instrument to measure health literacy, and the Brief Illness Perception Questionnaire. Results: Significant relationships were found among acculturation, health literacy, and several illness perceptions (consequences, control, symptoms, and emotions). Conclusion: Acculturation and health literacy play an important role in illness perceptions of hypertension among Hispanics. Implications: Findings could be helpful in the development of tailored health promotion interventions to impro...
35 citations
TL;DR: Financial barriers and social characteristics were significant predictors of mammography in these studies, which were composed almost exclusively of low-income Latinas, and are not likely unique to Latinas.
Abstract: Purpose: A systematic review of the research on barriers and facilitators to mammography in Latinas was conducted to determine if the challenges faced by these women are unique to this population. ...
TL;DR: While knowledge of old age among students increased, preferences for future career in geriatrics declined with education, and ethnicity was a strong predictor of attitudes and future intentions to work with older adults.
Abstract: Background: The aim of this study was to examine the effect of nursing education on students’ knowledge, attitudes, and preferences to work with older adults in an ethnically diverse Israeli societ...
TL;DR: This concept analysis uses Rodgers’s evolutionary method to define “aging out of place” and illustrates why existing theories of elderly migration do not necessarily apply to this population of newcomers.
Abstract: Newcomer elderly immigrants, defined as adults older than the age of 65 who have arrived in the United States in the last 10 years, represent a growing sector of the American population. Newcomers who experience limited English proficiency, financial strain, and acculturative stress are at considerable risk of developing poor health outcomes. Nursing's focus on healthy aging and aging in place has largely ignored the experiences of these older adults, who are said to be "aging out of place." This concept analysis uses Rodgers's evolutionary method to define "aging out of place" and illustrates why existing theories of elderly migration do not necessarily apply to this population. The challenge for nurses is incorporating the family, with whom conflict may arise, into the care of these elders. Community-based strategies that enable social integration and create a greater division of labor in the care of newcomer elders are called for.
TL;DR: Several such strategies including the creative use of blogging, recorded lectures, the online synchronous classroom, social media, and cultural immersion projects are described, allowing educators to support the integration of cultural competence into patient care for distance students.
Abstract: Cultural competence is a mainstay in health care and nursing education. With the expansion in the number of distance-based nursing programs across the country, innovative teaching methods for distance learning faculty are required to instill cultural competence in students. Faculty must be deliberate when planning distance-based learning activities that incorporate cultural experiences. This article describes several such strategies including the creative use of blogging, recorded lectures, the online synchronous classroom, social media, and cultural immersion projects. These methods capitalize on existing information technologies and offer distance-based students the opportunity to connect with one another, as well as develop the awareness, sensitivity, and respect that is required when providing culturally competent care. These teaching methods are modifiable to meet the teaching and learning needs of the faculty and the students, thereby allowing educators to support the integration of cultural competence into patient care for distance students.
TL;DR: The following literature review focuses on experiences of perceived prejudice and discrimination as described by minority migrant nurses.
Abstract: Every day minority migrant nurses (MMNs) work shoulder to shoulder with domestic nurses in health care settings worldwide. Published studies offer reports of research where work-life experiences of MMNs have been explored. The following literature review focuses on experiences of perceived prejudice and discrimination as described by MMNs. Background and significance of the topic are described and the purpose of the review is presented, followed by definitions of relevant terms, search strategy, and theoretical considerations. Feagin and Eckberg's discrimination typology is the framework used to organize MMNs' reported experiences of perceived prejudice and discrimination. A theory-linked summary, including policy, practice, and research implications, concludes the article.
TL;DR: Themes that emerged were the subjective nature of pain, which described pain dimensions and communication; psycho-sociocultural factors,such as personal inclinations and sociocultural background; and health system factors, such as personnel attitudes and health financing.
Abstract: The experience of pain associated with surgery has been a challenge for health care professionals for many years, and culture is said to influence pain. Purpose: This study focused on patients’ experiences of POP and factors that affect POP. Design: The study employed qualitative ethnographic principles. Method: Data were collected through individual face-to-face interviews. Data were saturated after analysing data from 13 patients from two hospitals in Ghana. Findings: Themes that emerged were the subjective nature of pain, which described pain dimensions and communication; psycho-sociocultural factors, such as personal inclinations and sociocultural background; and health system factors, such as personnel attitudes and health financing. Implications for future research and practice: Health professionals need to understand the sociocultural effects of pain in order to give effective care. Conclusion: The study highlighted the need for patient education and the importance that health care professionals understand context-specific factors that influence POP management.
TL;DR: A new theoretical model for explaining health outcomes and health responses for older individuals in unique ethno-cultural groups and how this model can enhance nursing’s contributions to reducing health disparities is proposed.
Abstract: By 2050, for the first time in U.S. history, almost half of elders will be from ethnic minority groups. To meet the needs of this rapidly diversifying population, nurses need to be able to marry tr...
TL;DR: This study supports previous research where positive changes were found in students’ TSE based on the inclusion of cultural interventions in the nursing curriculum, and identifies social orientation as the demographic variable most predictive of the TSE level.
Abstract: Addressing the health care needs of a 21st-century nation that is experiencing increased diversity and disparity will require new models of educating future providers. The cultural competence and confidence model was the guiding framework in a study evaluating the influence of cultural educational offerings on the transcultural self-efficacy (TSE) perceptions in baccalaureate nursing students. The Transcultural Self-Efficacy Tool was used to measure perceived TSE in a pretest (N = 260), posttest (N = 236) study over an academic year. Significant changes were demonstrated in overall self-efficacy and on the cognitive, practical, and affective subscales. A classification and regression tree analysis identified social orientation as the demographic variable most predictive of the TSE level. This study supports previous research where positive changes were found in students' TSE based on the inclusion of cultural interventions in the nursing curriculum.
TL;DR: Focus groups conducted in line with HBM and HPM were effective in explaining barriers and facilitators toward participation of women in screening behaviors, and Lack of information, indifference, and cultural factors are the most important barriers of women.
Abstract: Aim: The purpose of this study was to examine facilitators and barriers that migrant women in Turkey identified related to breast self-examination, clinical breast examination, and mammography. Design: Focus group method was conducted with 39 women. An interview guide based on the Health Belief Model (HBM) and the Health Promotion Model (HPM) was used. Results: Three main themes became apparent as a result of data analysis: (a) knowledge and awareness about breast cancer, (b) personal factors, and (c) medical service provider and social environment. Conclusions: Focus groups conducted in line with HBM and HPM were effective in explaining barriers and facilitators toward participation of women in screening behaviors. Lack of information, indifference, and cultural factors are the most important barriers of women. Recommendations for Practice: The study will shed light on health care professionals working in primary health care organizations for developing the health training programs and consulting strateg...
TL;DR: This cross-sectional exploratory descriptive study examines the relationship between depression and IPV and whether living in the United States 10 or more years decreases barriers to reporting intimate partner violence and depression in a sample of Arab American women 19 years and older.
Abstract: How intimate partner violence (IPV), depression, and barriers to services affect Arab American women in the United States is not very well documented. This cross-sectional exploratory descriptive s...
TL;DR: Analysis of population-specific risk factors that increase emerging adults’ risk of acquiring sexually transmitted infections, including the human papillomavirus, revealed inconsistent condom use, reasons for not using condoms, and a need for more culturally specific intervention strategies.
Abstract: Purpose: The authors examined population-specific risk factors that increase emerging adults’ risk of acquiring sexually transmitted infections (STIs), including the human papillomavirus (HPV). Design and Method: A cross-sectional sample of 335 diverse, emerging adults ages 18 to 24 years was recruited from a health center at a large university in the Southeastern United States. The mean age was 20.6 ± 1.9 years, majority were females (74.0%), and 61.0% were Hispanic. Results: Findings revealed inconsistent condom use, reasons for not using condoms, and a need for more culturally specific intervention strategies. Discussion and Conclusions: Healthcare providers should identify culturally specific reasons for inconsistent condom use, examine cultural and geographic differences in sexual risk behaviors among groups and communities, and modify communication, educational programs, and interventions accordingly. Implications for Practice: By adopting a multicultural approach to the control of STIs, nurses can ...
TL;DR: Urban AI girls reported similar social and structural influences on sexual risk behavior as urban adolescents from other racial and ethnic groups, however, differences were noted in the family structure, cultural heritage, and unique history of AIs.
Abstract: Purpose: The purpose of this study was to explore factors that influence urban adolescent American Indian (AI) girls’ sexual risk behavior. Design: A qualitative study was conducted with grounded theory methodology to reveal factors and processes that influence sexual risk behavior. Method: Talking circles, individual interviews, and event history calendars were used with 20 urban AI 15- to 19-year-old girls to explore influences on sexual risk behavior. Results: The generated theory—framing sexual risk behavior—describes social and structural factors and processes that influenced the girls’ sexual risk behavior. The theory extends Bronfenbrenner’s ecological model by identifying microsystem, mesosystem, and macrosystem influences on sexual risk behavior. Discussion: Urban AI girls reported similar social and structural influences on sexual risk behavior as urban adolescents from other racial and ethnic groups. However, differences were noted in the family structure, cultural heritage, and unique history ...
TL;DR: Perceived self-efficacy, severity, and response efficacy were identified as significant predictors of intention to experience vaginal birth and the extended parallel process model provides a useful framework to assess women’s intention to have a vaginal birth.
Abstract: Purpose: To explicate whether knowledge, perception of health threat, efficacy, and personal beliefs act as predictors for women’s intention to have a normal vaginal birth. Design: The study uses a mixed approach. Simultaneously, 290 pregnant women who visited prenatal clinics completed the study. Quantitative and qualitative data were collected using a structured questionnaire based on Witte’s extended parallel process model and four focus groups, respectively. Results: Women perceived lower risk but higher levels of efficacy. Perceived self-efficacy, severity, and response efficacy were identified as significant predictors of intention to experience vaginal birth. Participants’ insufficient knowledge and misconceptions about birth methods were dominant. Two major themes were identified and divided into negative and positive beliefs about vaginal birth. Discussion: The extended parallel process model provides a useful framework to assess women’s intention to have a vaginal birth, especially when it is co...
TL;DR: The crucial role nurses play in maintaining health and preventing diseases, the devastating havoc of the Ebola virus disease to another issue of nursing shortage in underdeveloped countries, and the key leadership nurses play are asserted in protecting the communities they serve while maintaining their safety and those of other health care workers.
Abstract: The current Ebola crisis has sparked worldwide reaction of panic and disbelief in its wake as it decimated communities in West Africa, particularly in Guinea, Liberia, and Sierra Leone, including its health care workers. This article affirms the crucial role nurses play in maintaining health and preventing diseases, connects the devastating havoc of the Ebola virus disease to another issue of nursing shortage in underdeveloped countries, and asserts the key leadership nurses play in protecting the communities they serve while maintaining their safety and those of other health care workers. Nurses must actively seek a place at the table, as echoed by the American Academy of Nursing and American Nurses Association and the American Nurses Association, when decisions are being made regarding Ebola virus disease: at care settings, in the board room, and at federal, state, and local levels.
TL;DR: Findings support the importance of comprehending Asian Indians’ unique cultural background and experiences in the health care system and support the foundation for culturally competent care to advance the body of transcultural nursing knowledge.
Abstract: Purpose: The study explored health care experiences among Asian Indian immigrants living in the Southeastern United States. Design and Method: A concurrent triangulation mixed methods design was used with a purposive sample of 125 Asian Indian immigrants aged between 40 and 64 years in the survey and 10 participants in the focus group. Results: The majority of the participants had health insurance and higher socioeconomic status. They had a moderate level of knowledge on the U.S. health care system and health insurance while presenting moderate satisfaction with the system. Barriers to health care services and needs in the health care system were identified from both quantitative and qualitative data. Some of the barriers were high costs, dissatisfaction with services, and inconvenience in accessing services. Participants called for self-management and community-based health programs as well as culturally tailored health care services. Discussion and Conclusion: Findings congruent with prior studies furth...
TL;DR: Perceived unsatisfactory care emerged as the major barrier to self-management, including communication barriers (distrust, misunderstanding, and educational methods) and organizational barriers (quality of care and access issues).
Abstract: The prevalence of diabetes and related complications are disproportionally higher in Native Americans. Diabetes self-management (DSM) is instrumental in preventing complications. The results presented here are a part of a larger hermeneutic phenomenology study to explore living with diabetes for one Pacific Northwest tribe. This study identified barriers to DSM within the worldview of the tribal people. Using purposive sampling, 10 Coeur d’Alene tribal members, ages 26 to 86 years, participated in in-depth interviews. Data interpretation used a three-step method leading to integrated themes across the transcripts. Perceived unsatisfactory care emerged as the major barrier to self-management, including communication barriers (distrust, misunderstanding, and educational methods) and organizational barriers (quality of care and access issues). Findings highlight the need to improve cross-cultural communication and calls for different approaches to diabetes education. Our profession is challenged to create ne...
TL;DR: This study provides nurses and others with insights into the experiences of Indonesian women with early motherhood, their feelings about taking on the mothering role, and some of their needs during this period.
Abstract: Purpose: The purpose of the study was to provide a greater understanding of the experience of the new Indonesian mother. Design: This study was a hermeneutic phenomenological study. Data were obtained from 13 first time Indonesian mothers through semi-structured interviews. Findings: Two main themes were identified: “trying to be a good mother “ and “confirming my destiny as a woman.” A number of subthemes were identified to understand of how women in rural West Java perceived the meaning of being a new mother. These themes and subthemes described the woman’s responsibilities as a new mother and some of the challenges that she accepted as a part of her destiny. Conclusion: This study provides nurses and others with insights into the experiences of Indonesian women with early motherhood, their feelings about taking on the mothering role, and some of their needs during this period.
TL;DR: This exploratory study offers the perspectives of Native and non-Native health care professionals regarding palliative care specific to NAs and reveals two main themes and five subthemes.
Abstract: Purpose: Palliative care options are limited for Native Americans (NA) in South Dakota (SD). This exploratory study offers the perspectives of Native and non-Native health care professionals regarding palliative care specific to NAs. Design: Semi-structured interviews were conducted (N = 7) with participants representing NA (4) and non-Native (3) ethnicities. Non-Native participants were practicing health care professionals in palliative medicine, whereas the NA health care professionals had experience with palliative care. Findings: Concept analysis revealed two main themes and five subthemes: (a) barriers to palliative care, for example, insufficient funding, lack of infrastructure, and misconceptions; and (b) implementation strategies, for example, openness and listening and creating the right team. Discussion: Genuine interest and concern exists for the provision of palliative care to NA communities using collaborative and innovative approaches. Implications: To address the health disparities of the N...
TL;DR: A comprehensive, multidimensional definition of successful aging for nursing and a midrange nursing theory of success aging were identified that may be useful to guide nursing research, practice, and policy.
Abstract: Successful aging is gaining increasing attention given the growth in the older adult population. Criteria and definitions within multiple disciplines vary greatly in Western literature, with no consensus on its meaning. Sociocultural, economic, and political differences between the Western view of successful aging and its view in China add to the confusion. Similarities and differences in the meaning of successful aging in the United States and China are examined, and potential for a common definition useful to nursing in both countries is explored. Using concept analysis, shared criteria for successful aging were the following: decreased incidence of disease and disability, life satisfaction, meaning and purpose in life, and ability to cope effectively to achieve goals based on personal values and priorities. A comprehensive, multidimensional definition of successful aging for nursing and a midrange nursing theory of successful aging were identified that may be useful to guide nursing research, practice, and policy.
TL;DR: There is significant within-group variability in the association of sleep, pain, and comorbid indicators among older African Americans diagnosed with arthritis with young old adults being most affected by sleep difficulties.
Abstract: Purpose: Few studies have examined the behavioral and clinical indicators of sleep difficulty among older African Americans diagnosed with arthritis. This study aimed to examine the association of ...