Impact of an LGBTQ Cultural Competence Training Program for Providers on Knowledge, Attitudes, Self-Efficacy, and Intensions

This paper describes the development and implementation of a robust lesbian, gay, bisexual, transgender, and queer (LGBTQ) cultural competence curriculum for training health and human service providers across New York State. Between 2013-2018, The National LGBT Cancer Network developed and published Best Practices in Creating and Delivering LGBTQ Cultural Competency Trainings for Health and Social Service Agencies and designed a training curriculum. They also conducted Train the Trainer sessions, and evaluated pre- and post- curriculum knowledge, attitudes, self-efficacy and intentions of individuals who attended educational sessions conducted by the certified trainers. Most respondents improved from pretest to posttest, with significant improvements in knowledge, attitudes, self-efficacy and intentions. An increase in self-efficacy was significantly associated with pre- to posttest improvement in respondent intention. Future research should focus on what components specifically bolster self-efficacy and intention. Increasing the number of health and human service providers who are trained to address the needs of this population is an important step toward providing culturally competent care.

Facilitating family needs and support at the end of life in hospital: A descriptive study

BACKGROUND

Caring for family members of dying patients is a vital component of end-of-life care, yet family members' needs at the end of life may be unmet.

AIM

To explore hospital clinician assessment and facilitation of family needs and practices to support families at the end of life.

DESIGN

Descriptive study utilising a retrospective medical record audit.

SETTING AND SAMPLE

Undertaken in a large public hospital, the sample included 200 deceased patients from four specialities; general medicine (n = 50), intensive care (n = 50), inpatient palliative care (n = 50) and aged rehabilitation (n = 50). Data were analysed according to age; under 65-years and 65-years or over.

RESULTS

Deceased patients' mean age was 75-years, 60% were Christian and Next-of-Kin were documented in 96% of cases. 79% spoke English, yet interpreters were used in only 6% of cases. Formal family meetings were held in 64% of cases. An assessment of family needs was undertaken in 52% of cases, and more likely for those under 65-years (p = 0.027). Cultural/religious practices were supported/facilitated in only 6% of all cases. Specialist palliative care involvement was more likely for those aged 65-years or over (p = 0.040) and social work involvement more likely for those under 65-years (p = 0.002). Pastoral care and bereavement support was low across the whole sample.

CONCLUSIONS

Prioritising family needs should be core to end-of-life care. Anticipation of death should trigger routine referral to support personnel/services to ensure practice is guided by family needs. More research is needed to evaluate how family needs assessment can inform end-of-life care, supported by policy.

Spirituality, Community Belonging, and Mental Health Outcomes of Indigenous Peoples during the COVID-19 Pandemic

We aimed to assess the association between community belonging, spirituality, and mental health outcomes among Indigenous Peoples during the COVID-19 pandemic. This cross-sectional observational study used online survey distribution and targeted outreach to the local Indigenous community to collect a convenience sample between 23 April 2020 and 20 November 2020. The surveys included demographic information, self-reported symptoms of depression (PHQ-2) and anxiety (GAD-2), and measures of the sense of community belonging and the importance of spirituality. Multivariate logistic regression was used to model the association between the sense of community belonging and spirituality, and symptoms of anxiety and depression. Of the 263 self-identified Indigenous people who participated, 246 participants had complete outcome data, including 99 (40%) who reported symptoms of depression and 110 (45%) who reported symptoms of anxiety. Compared to Indigenous participants with a strong sense of community belonging, those with weak community belonging had 2.42 (95% CI: 1.12–5.24)-times greater odds of reporting symptoms of anxiety, and 4.40 (95% CI: 1.95–9.89)-times greater odds of reporting symptoms of depression. While spirituality was not associated with anxiety or depression in the adjusted models, 76% of Indigenous participants agreed that spirituality was important to them pre-pandemic, and 56% agreed that it had become more important since the pandemic began. Community belonging was associated with positive mental health outcomes. Indigenous-led cultural programs that foster community belonging may promote the mental health of Indigenous Peoples.

"Engaging stakeholders in integrating social determinants of health into electronic health records: a scoping review"

Social, environmental, and behavioural factors impact human health. Integrating these social determinants of health (SDOH) into electronic health records (EHR) may improve individual and population health. But how these data are collectedand their use in clinical settings remain unclear. We reviewed efforts to integrate SDOH into EHR in the U.S. and Canada, especially how this implementation serves Indigenous peoples. We followed an established scoping review process, performing iterative keyword searches in subject-appropriate databases, reviewing identified works' bibliographies, and soliciting recommendations from subject-matter experts. We reviewed 20 articles from an initial set of 2,459. Most discussed multiple SDOH indicator standards, with the National Academy of Medicine's (NAM) the most frequently cited (n = 10). Common SDOH domains were demographics, economics, education, environment, housing, psychosocial factors, and health behaviours. Twelve articles discussed project acceptability and feasibility; eight mentioned stakeholder engagement (none specifically discussed engaging ethnic or social minorities); and six adapted SDOH measures to local cultures . Linking SDOH data to EHR as related to Indigenous communities warrants further exploration, especially how to best align cultural strengths and community expectations with clinical priorities. Integrating SDOH data into EHR appears feasible and acceptable may improve patient care, patient-provider relationships, and health outcomes.

Definition and Recommended Cultural Considerations for Advance Care Planning in Japan: A Systematic Review

Although Delphi studies in Western countries have provided a consensus for practices pertaining to advance care planning (ACP), their findings may not be applicable to Asian countries with distinct, family-oriented cultures. This systematic review aimed to synthesize the definitions of and evidence for ACP and analyze recommended practices in Japan. We conducted a systematic review using narrative synthesis in December 2018. Key words were searched from Ichushi-Web by NPO Japan Medical Abstracts Society, Citation Information by the National Institute of Informatics, and Japanese Institutional Repositories Online databases. In addition, in August 2019, we conducted hand searching using Google Scholar and Google. We included original Japanese articles that addressed factors regarding ACP (e.g. definitions, elements, roles and tasks, and timing of ACP). Data were synthesized using thematic analysis. The study protocol was registered prospectively (PROSPERO: CRD42020152391). Of the 3,512 studies screened, 27 were included: 22 quantitative and 5 qualitative. Five-position statements/guidelines were added by hand searching. Definitions and several distinct practice patterns of ACP and the importance of families' roles were identified. Unique recommendations addressed the importance of properly eliciting patients' preferences that are the best for both patients and families, engaging the public to raise awareness of ACP, and developing policies and guidelines for ACP. We identified the definition of and unique recommendations for ACP based on Japanese cultural values and norms. Further research is needed to evaluate the recommendations provided in this systematic review.

Transcultural Nurse Views on Culture-Sensitive/Patient-Centered Assessment and Care Planning: A Descriptive Study

INTRODUCTION

Culture-sensitive (CS) and patient-centered (PC) care are considered essential to achieve high-quality equitable care. The purpose of this study was to determine how expert nurses incorporate CS/PC care into their assessment and care planning practices, especially for culturally diverse and marginalized patients.

METHODOLOGY

Using a qualitative, descriptive design, we conducted a focus group at the October 2019 Transcultural Nursing Society Conference. Participants (n = 9) discussed how they instilled cultural sensitivity and patient-centeredness into their assessment and care planning skills.

RESULTS

Participants revealed attitudes, knowledge, and skills associated with CS/PC assessment and care planning. They also identified specific strategies for translating CS/PC theory into assessment and care planning practices.

DISCUSSION

Three principles and many pragmatic strategies for incorporating CS/PC care into daily practice emerged from the data. Nurses may find these principles and strategies helpful in integrating CS/PC care into their daily care of patients in busy clinical settings.

Does Culture Matter? Young and Middle-Aged Iranian-American Adults' Perspectives Regarding End-of-Life Care Planning

BACKGROUND

An increase of cultural diversity and treatment options offer opportunities and challenges related to end-of-life (EOL) care for healthcare providers and policymakers. EOL care planning can help reduce confusion and uncertainty when individuals and family members need to make decisions about EOL care options.

OBJECTIVE

The purpose of this study was to investigate preferences, attitudes, and behaviors regarding EOL care planning among young and middle-aged Iranian-American adults.

METHODS

A cross-sectional national sample of 251 Iranian-American adults completed surveys. Paper and online surveys in English and Persian were offered to potential participants.

RESULTS

All the participants completed online survey in English language. In incurable health conditions, 56.8% preferred hospitalization and intensive treatments. From the 40.6% participants who preferred comfort care, most preferred care at home (29.5%) compared to an institution (11.1%). Those who preferred hospitalization at EOL mostly preferred intensive and curative treatments. The mean score of attitudes toward advance decision-making was moderately high (11.48 ± 2.77). Favorable attitudes were positively associated with acculturation (r = .31, p < .001), age (r = .15, p < .05), and number of years living in the U.S. (r = .26, p < .001). Conversely, spirituality and favorable attitudes were negatively associated (r = -.17, p < .05).

CONCLUSION

Immigrant and culturally diverse individuals have experienced different living and healthcare environments. These differences can influence their EOL care planning and decisions. Knowledge of diverse perspectives and cultures is essential to design culturally congruent plans of EOL care.

Endocrine Nurses Society Position Statement on Transgender and Gender Diverse Care

The Endocrine Nurses Society (ENS) is committed to clinical excellence in the art and science of endocrine nursing throughout the world. ENS recognizes that transgender and gender diverse (TGD) individuals face challenges and inequities that place them in the realm of health disparities. Further, TGD individuals often face substantial barriers to care and have difficulty finding healthcare providers who are knowledgeable about the unique health needs of this patient population. ENS recognizes that endocrine nurses care for young adult and adult TGD individuals. This position statement outlines recommendations for healthcare providers and organizations seeking to embrace a gender-affirming approach to care and increase access to high-quality, comprehensive care for TGD individuals. This Position Statement was accepted by ENS on September 8, 2020 and has been endorsed by the European Society of Endocrinology Nurse Committee, European Society of Paediatric Endocrinology Nurses, Pediatric Endocrine Nursing Society, Endocrine Nurses' Society of Australasia, and the Federation of International Nurses in Endocrinology.

Interventions to Support International Migrant Women's Reproductive Health in Western-Receiving Countries: A Systematic Review and Meta-Analysis

Purpose: The reproductive health outcomes of international migrant women differ in comparison with receiving-country-born women, depending on country of birth and immigrant status. Effective interventions to support the reproductive health of international migrant women are not well known.

Methods: We conducted a systematic review and meta-analysis of studies between 2010 and 2017 evaluating interventions directly or indirectly affecting the reproductive health (as defined by the World Health Organization) of international migrant women in Western-receiving countries.

Results: Sixteen studies representing 5080 migrants were identified. Interventions consisted of linguistically (e.g., translated brochures) or culturally adapted (e.g., cultural narratives) routine care or new interventions. Meta-analysis showed that interventions increased rates of preventive reproductive health activities, including mammography, condom use, and Pap test completion, by almost 18% (95% confidence interval 7.61–28.3) compared with usual care or interventions not adapted to migrant women.

Conclusion: Culturally and linguistically adapted care practices congruent with target populations of international migrant women are effective in improving their reproductive health outcomes, particularly their participation in preventative reproductive health activities.

Assessing price sensitivity in dental education and implications on student diversity

Increasingly, the price of professional school is seen as a potential deterrent for interested students. Data collected by the American Dental Association (ADA) from the 66 U.S. dental schools showed the average 4-year nonresident tuition and fees totaled $321,575 in 2018-2019, 35% greater than in 2008-2009, after adjusting for inflation. The aim of this study was to assess whether dental education pricing has impacted applications, enrollments, and yield rates, particularly among students underrepresented in dentistry. Utilizing 7 years of ADA data across all 66 U.S. dental schools, OLS regression, fixed effects, and random effects models were used to examine the data in both cross-sectional and longitudinal analyses. OLS regression results show higher priced schools have higher rates of applications, admittances, and enrollment but lower yield rates. The inverse relationship between yield and tuition prices suggests, on average, students are sensitive to price when deciding whether to accept a spot at dental schools. Focusing on students underrepresented in dentistry, the results indicate that African American and Hispanic or Latino students are price sensitive: fewer of these students enroll in higher priced dental schools, and the relationship persists over time. In other words, fewer African American and Hispanic or Latino students enroll in U.S. dental schools as tuition increases over time. The salary potential is high for dental graduates, but social and cultural capital are significant factors in making students aware of a dental career. These findings suggest the breadth and scope of pipeline programs need to be enhanced to reach these potential students.

Female genital mutilation - a blind spot in Dutch general practice? A case-control study

BACKGROUND

Women with female genital mutilation or cutting (FGM/C) often suffer from physical and psychosexual problems related to FGM/C. As gatekeepers to the medical system, GPs are often the first to be consulted about these problems. It is as yet unknown if, and to what extent, Dutch GPs identify women with FGM/C or related health problems.

AIM

To investigate how often Dutch GPs register FGM/C and related health problems.

DESIGN & SETTING

A case-control study of anonymised patient records was performed in the Netherlands.

METHOD

Medical records were checked for information on country of origin. Records of women, aged ≥15 years, from countries where FGM/C is practised were compared with those of a case-control.

RESULTS

Although many migrants were registered with the participating GPs, information on country of origin was seldom recorded. Only 68 out of 16 700 patients were identified as women from countries where FGM/C is practised; 12 out of these 68 records contained information about the FGM/C status, but none on the type of FGM/C. There were no significant differences in health problems related to FGM/C between patients with FGM/C and the controls.

CONCLUSION

FGM/C may be a blind spot for GPs and registration of information on migration background could be improved. A larger sample in a future study is needed to confirm this finding. Given the growing global migration, awareness and knowledge on FGM/C, and other migration-related health issues should be part of GP training.

"It's hard for me to tell my story" the experiences of Aboriginal and Torres Strait Islander male clients at a residential drug and alcohol rehabilitation centre using primary health care

ISSUE ADDRESSED

Aboriginal males who use drug and alcohol may experience unique barriers accessing primary health care. This study explores the perceptions of Aboriginal males in treatment for drug and alcohol use around their experiences accessing primary health care, and barriers to access.

METHODS

Twenty male Aboriginal clients at a fee-paying residential drug and alcohol rehabilitation centre completed semi-structured interviews about their primary health care experiences before their stay. Interpretative phenomenological analysis was used to inductively develop themes.

RESULTS

About half the males had regular General Practitioners at a mainstream primary health care service or Aboriginal Medical Service. Positive experiences included having medical needs met or understanding the health information provided; and negative experiences included inefficient health service or system processes or experiencing cultural bias or racism. Barriers included limited access to appointments or to the same GP regularly, long wait times, lack of access to transport, worry or fear about their health or the visit or their complex lives taking priority.

CONCLUSION

This research showed that the participants sought out health care and identified barriers to accessing care and potential improvements. SO WHAT?: Access to a regular General Practitioner, continuity of care and culturally appropriate and comprehensive communication techniques are important to facilitate access to primary health care by Aboriginal males. Efforts to enhance access may focus on inherent strengths within Aboriginal communities including focusing on relationships between clinicians and families, providing a welcoming environment and encouraging clients to bring a trusted family member to appointments.

School Nurses' Experiences of Health Promotion for School-Age Asylum Seekers

The number of school-age asylum seekers and refugees worldwide is increasing. Health promotion provided by school nurses can be crucial for the well-being of young asylum seekers, yet research on these nurses' experiences is limited. This qualitative study aims to describe school nurses' experiences of providing health promotion to school-age asylum seekers. Semistructured interviews were conducted with 12 school nurses, and inductive content analysis was then used. The results were grouped under the following themes: (1) difficulties in providing health services to school-age asylum seekers, (2) considering the vulnerable circumstances of asylum seekers, (3) the importance of family-centered health promotion, and (4) the importance of time management. School nurses face challenges that stem from individual asylum seekers' unique circumstances, nursing competency, and the school health care system. To deepen the existing knowledge, further research is needed from the perspective of asylum seekers.

Utilizing evidence-based guidelines to develop a language barriers simulation

BACKGROUND

The United States population is becoming increasingly diverse. Despite this trend, diversity in the nursing profession lags. In order to provide patient-centered care, students must learn the nuances of providing culturally competent care. There are many ways to assess the impact of culture on healthcare behaviors and norms, and can include, but are not limited to, ethnicity, sexual orientation, or religious preference. Clinical experiences offer inconsistent opportunities for students to interact with potentially diverse patients.

OBJECTIVE

The aim of this project was to develop a simulation that built upon curricular objectives and evidence-based guidelines for healthcare providers communicating across language barriers.

FINDINGS

Regulations and evidence-based guidelines describe how to provide quality patient-centered care to diverse groups of patients. These guidelines can be adapted at the clinician and systems level to facilitate culturally sensitive and linguistically appropriate services to patients. These guidelines were applied in an educational setting, and combined with best practices in simulation, to enhance undergraduate nursing students' experience in caring for diverse patients.

CONCLUSION

The use of simulation can be optimized when based on evidence-based guidelines encountered in clinical care.

Acceptability of the culturally adapted ASQ-TRAK developmental screening tool to caregivers of Aboriginal children

AIM

The Ages and Stages Questionnaire-Talking about Raising Aboriginal Kids (ASQ-TRAK) culturally adapted developmental screening tool is widely used in Australian Aboriginal communities. However, there has been limited exploration of the tool's acceptability to caregivers. The aim of the study is to determine the acceptability of the ASQ-TRAK developmental screening tool to caregivers of Aboriginal children in urban, regional and remote South Australia.

METHODS

Caregivers of Aboriginal children completed a survey regarding acceptability of the ASQ-TRAK. Convenience samples of caregivers were invited to a telephone interview.

RESULTS

Ninety-two caregivers completed the survey (96% response). Acceptability (92%) and caregiver satisfaction (73%) were high. Families perceived the screen as easy to use and understand, strengths-based and providing valuable information about their child's development.

CONCLUSIONS

The ASQ-TRAK tool was highly acceptable to caregivers in Aboriginal communities in South Australia. The study highlights the importance of culturally safe practice and supports ASQ-TRAK implementation. Broader use and further evaluation of the ASQ-TRAK in Aboriginal communities needs consideration.

Palliative care in adult intensive care units: A nationwide survey

BACKGROUND

There are no data on the provision of palliative nursing care in Egyptian adult intensive care units (ICUs). The Palliative and End-Of-Life (PEOL) Care Index is reliable and content valid; however, its construct and criterion validities have not been examined.

AIMS AND OBJECTIVES

First, to assess palliative care education, practice, and perceived competence among adult ICU nurses in Egypt. Second, to explore factors related to palliative care nursing practice and perceived competence. Third, to assess the construct and criterion validities of the PEOL Care Index.

DESIGN

A cross-sectional survey.

METHODS

Nurse managers and staff nurses in 33 adult ICUs completed self-administered questionnaires. The questionnaires assessed nurses' palliative care practice and perceived competence. A multilevel regression analysis was used to determine the best predictors of palliative care practice and perceived competence. Theory evidence construct validity and predictive criterion validity of the PEOL Care Index were examined.

RESULTS

Thirty-three nurse managers and 403 staff nurses participated in the study-response rate = 100% and 72.5%, respectively. On a 0-100 scale, the mean scores of undergraduate education, practice, and perceived competence were 54.0 ± 18.7, 49.7 ± 18.1, and 54.5 ± 17.0, respectively. Palliative care practice was significantly related to receiving in-service training on palliative care or end-of-life care (regression coefficients: 3.39), higher job satisfaction (0.97), and higher organizational support (1.85). Palliative care perceived competence was significantly related to older nurses' age (0.20), higher job satisfaction (0.97), and higher palliative care undergraduate education (0.63).

CONCLUSIONS

Palliative care education, practice, and perceived competence among adult ICU nurses in Egypt are inadequate, especially in terms of spiritual and cultural care. The PEOL Care Index is construct and criterion valid.

RELEVANCE TO CLINICAL PRACTICE

Palliative care education should begin in nursing schools and extend through clinical in-services. Guidelines should be developed to maximize staff collaboration and the utilization of chaplains in ICUs.

Self-Reported Cultural Competence of Nurses Providing Nursing Care in Slovakia

PURPOSE

The goals of this study were to determine and evaluate the perception of cultural competence of nurses in the Slovak healthcare system, identify factors that influence their perception, and ascertain opportunities to improve nurses' cultural competence.

DESIGN

Cross-sectional nonexperimental study.

METHODS

Nurses from Slovakia were surveyed in this cross-sectional study using the standardized Cultural Competency Assessment (CCA) questionnaire. Statistical analysis was conducted using SPSS version 22 (IBM Corp., Armonk, NY, USA).

RESULTS

In total, 267 nurses responded. Only 28% perceived themselves as very culturally competent to care for people from other cultures. Over 68% received no diversity training. Age (p < .011) and prior diversity training (p < .006) were significantly associated with culturally competent behavior (CCB). A significant relationship (r = 0.17; p < .015) was also confirmed between the self-reported CCA and CCB.

CONCLUSIONS

Culturally competent care is a professional imperative. The ability to deliver high-quality, culturally congruent care may be enhanced by cultural diversity education and training. Further research is needed to identify other influences on cultural competency and the impact on patient care and outcomes.

CLINICAL RELEVANCE

There is a need for nurses to enhance their knowledge and skills related to cultural competency, awareness, sensitivity, and behaviors. Education and training contribute to nurses' ability to provide high-quality, culturally competent nursing care to patients from different cultures, and may possibly contribute to decreased health disparities.

Women from diverse minority ethnic or religious backgrounds desire more infertility education and more culturally and personally sensitive fertility care

STUDY QUESTION

What are the views, experiences and healthcare needs of infertile women from a minority ethnic or religious background living in Wales?

SUMMARY ANSWER

Women from ethnic and religious minority backgrounds consider that their communities have highly pronatalistic attitudes and stigmatize infertility, and express the need for more infertility education (for themselves and their communities), as well as more socio-culturally and interpersonally sensitive fertility care.

WHAT IS ALREADY KNOWN

Some people from minority ethnic or religious groups perceive pressure to conceive from their communities, experience social costs when they are unable to have children and stressful interactions with the fertility healthcare system while attempting to conceive.

STUDY DESIGN, SIZE, DURATION

This study was based on a one-day drawing workshop to collect visual (artwork produced by participants) and textual (all conversations and discussions during the workshop) data about the participants' views and experiences of infertility and their fertility care needs.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants were nine adult women with a minority ethnic or religious status living in Wales, UK, who were experiencing or had experienced infertility in the past. The workshop comprised five activities: (i) small and large group discussion of infertility-related drawings, (ii) lide-based lecture consisting of an introduction to the basics of drawing objects and people and (iii) thoughts and feelings, (iv) free drawing session and (v) group sharing. Audio recordings of the workshop were transcribed verbatim. Textual data was analysed with thematic analysis. Risk for bias was addressed via individual coding by two authors followed by joint presentation and discussion of results with the research team and participants.

MAIN RESULTS AND THE ROLE OF CHANCE

Forty-one themes were identified and grouped into eight distinct higher order themes. These themes described the emotional, relational and social burden of infertility experienced by women, which they perceived to result from their communities' highly pronatalistic attitudes and stigmatization of infertility. Themes also captured women's adaptive coping strategies and critical attitude towards pronatalist ideologies. Lastly, themes captured their overall positive evaluation of their fertility health care, their desire for more infertility education (for themselves and their communities) and for culturally competent and interpersonally sensitive care.

LIMITATIONS, REASONS FOR CAUTION

Our participants were a small, non-random sample recruited in collaboration with a local charity, which may mean that all participants were well integrated in their communities. Analysis focused on capturing commonalities in participants' experiences and this may sometimes result in homogenising diverse experiences.

WIDER IMPLICATIONS OF THE FINDINGS

More education about the infertility experiences of minority ethnic and religious groups at the community and healthcare delivery level may translate into lessened negative attitudes towards infertility and more culturally competent care, which can be beneficial for women.

STUDY FUNDING/COMPETING INTEREST(S)

This research was funded by Welsh Crucible. The authors have no conflict of interests to declare.

Taiwanese Nurses' Attitudes Towards and Knowledge About Sexual Minorities and Their Behavior of Providing Care to Sexual Minority Patients: Results of an Online Survey

PURPOSE

To assess Taiwanese nurses' attitudes toward and knowledge about sexual minorities, and their awareness and behavior of providing care to sexual minority patients.

DESIGN

A cross-sectional descriptive design was employed.

METHODS

A total of 323 Taiwanese nurses 20 years of age or older completed an online questionnaire between September and November 2019. It included five sections: demographics, the Attitudes Toward Lesbians and Gay Men Scale, Knowledge About Homosexuality Questionnaire, Gay Affirmative Practice Scale, and nurses' needs for promoting culturally competent care.

RESULTS

Taiwanese nurses held positive attitudes, and demonstrated high levels of awareness and behaviors of providing care to sexual minority patients. However, they had limited knowledge regarding homosexuality. More so, nurses who were older, self-identified as heterosexuals, were married, had more than 10 years' work experience, and were Buddhists had poor knowledge about homosexuality. Nurses reported that for providing culturally competent care they required knowledge about sexual minorities' physical and mental health issues; the populations' social and welfare resources; communication skills training; privacy; and safe space.

CONCLUSIONS

Information on homosexuality and health issues among sexual minority populations, communication skills training, privacy, and safe space should be provided to Taiwanese nurses to improve their abilities to provide culturally competent care and to reduce health inequalities among sexual minorities.

CLINICAL RELEVANCE

This study's results could be used as evidence for designing and providing training programs for nurses regarding culturally competent care, and thus promote quality nursing care and decrease difficulties of accessing healthcare services among sexual minority patients.

Exploring the Provider Preferences of Multiracial Patients

BACKGROUND

Patient-provider race concordance has been argued as one way to improve patient-provider communication, patient satisfaction, and even patient outcomes. However, much of this literature focuses on or assumes that both patients and providers identify with only one race.

OBJECTIVE

The purpose of this study was to understand multiracial patients' preferences in choosing a health-care provider.

METHODS

We conducted 15 interviews and 3 focus groups. We performed a directed content analysis to understand participants' expressed preferences.

RESULTS

Thirty-one participants shared their health-care preferences. Participants described proximity to their homes or work, convenience in terms of availability, and health insurance coverage as reasons for selecting a provider. The majority articulated preferences related to provider gender and race. However, participants noted key barriers to receiving care from their preferred providers.

CONCLUSION

This study highlights the preferences for health-care providers and the factors influencing those preferences and decisions among multiracial individuals. Findings illustrate the need to increase health workforce diversity, especially among primary care providers. Findings also show the need for increased empathy and cultural sensitivity among health-care professionals.

Challenges in the Provision of End-of-Life and Palliative Care to Ethnic Nepali Refugees

After over a decade of resettlement of ethnic Nepali refugees in the U.S., a significant population of seriously ill refugees will require palliative care and hospice care. The refugee experience and culturally specific factors affect the end-of-life care of this population. Challenges in the end-of-life care of Nepali refugees include challenges related to social and health inequities, such as significant chronic respiratory disease burden; lack of protocols for deferral of illness disclosure; lack of support for group decision making; unfamiliarity with spiritual, religious, and traditional health practices; and difficulty with cross-cultural communication. Culturally competent care of ethnic Nepali refugees can be accomplished through respectful exploration of patients' and families' preferences regarding the challenges identified. This article presents recommendations that can guide primary and specialist palliative care for this population.

Factors associated with utilisation of health care interpreting services and the impact on length of stay and cost: A retrospective cohort analysis of audit data

ISSUE ADDRESSED

Utilisation of professional health care interpreting services improves the quality and safety of health care among patients with limited English proficiency. Health care interpreter service utilisation is inconsistent and suboptimal in Australia. Evidence of the impact of interpreter service use on patient outcomes and costs is limited. This study aimed to identify the proportion of hospitalised patients who received a health care interpreter during admission and describe the characteristics and outcomes for those requiring interpreter services.

METHODS

A retrospective cohort analysis of linked admitted patient data with internal interpreter audit data. This study included all inpatients in a health district-wide clinical audit of interpreter service use conducted between July 2016 and March 2018. The dataset comprised 74 patients (including 79 unique hospital stays and 90 episodes) from eight hospitals in one regional health district in New South Wales, Australia.

RESULTS

Interpreting services were utilised at least once for 54.4% (n = 43) of admissions. Females were more likely to receive an interpreter (65.1% vs 47.1%, P = .04). Age, preferred language, hospital, Diagnosis-Related Group partition and comorbidities were not associated with interpreter service utilisation. Differences in length of stay and cost associated with use of interpreter services were not statistically significant after casemix adjustment.

CONCLUSIONS

Approximately half of those who required an interpreter received one during their hospital stay. Further investigation is needed to establish whether regular clinical audits contributed to this rate of utilisation, which is higher than reported elsewhere in the literature. SO WHAT?: A detailed understanding of regional interpreting service use with evidence from the literature provides compelling and contextual evidence for change, at the level at which the service is delivered. This supports meaningful action to increase utilisation, and improve the quality and safety of health care delivered to patients with limited English proficiency.

Integrating Culturally Competent Advance Care Planning for Korean Immigrants: An Integrative Review

AIMS

This review aims to explore the extant literature on the current utilization of ACP in Kisin order to obtain a comprehensive understanding of their health disparities and to determineevidence-based best practices to integrate culturally-competent ACP for EOL care of KIs.

DESIGN

A systematic integrative review of the literature Data Sources:  Four electronic databases including PubMed, the Cumulative Index of Nursing and Allied Health Literature, the Cochrane Library, and Embase.

METHOD

The detailed search strategy for databases implicated a combination of MeSHkeywords and associated terms, which can be found in Table A.Results: Three themes emerged in relation to fundamental components in the integration of culturally-competent ACP for EOL of KIs: (1) cultural characteristics of KIs; (2) disparities in ethnic-oriented ACP and EOL care resources in KIs; and (3) KIs' perspectives on ACP.

CONCLUSION

The findings of this review indicate that culturally-competent ACP resources for KIsare presently quite insufficient. It is determined that much future research is needed on howculturally-competent ACP can best augment the quality of EOL care for KIs, and on howspecific interventions can effectively implement ACP in community settings. Impact: Such ongoing research dedicated to the development of feasible culturally competent practice guidelines is anticipated to markedly reduce health disparities and promote ACP in KIs. The recommendations in this review may support Korean primary HCPs, Korean health care center administrators, Korean health maintenance organizations (HMOs), Korean advance care nurse practitioners in hospice and palliative care, and nurse researchers in their work.

Transgender pediatric surgical patients-Important perioperative considerations

Transgender describes a variety of identities in which an individual's gender identity is different from expected based on the sex assigned at birth. In the United States, it is estimated that over 1 million adults and 150 000 youth identify as transgender, with increasing numbers being seen in healthcare and surgical settings. These numbers will continue to rise as visibility and acceptance grow. Current guidelines recommend transition-related surgeries be reserved for older adolescents and adults. However, this is not the only circumstance in which the pediatric anesthesiologist may find themselves caring for a transgender patient. In order to provide the safest and most affirming care, it is crucial that the pediatric anesthesiologist develop a working knowledge of this unique and vulnerable population, including the potential impacts of gender-affirming treatment on their perioperative care.