Cultural competency and sensitivity in the curriculum for palliative care professionals: a survey in Switzerland

BACKGROUND

Cultural and linguistic diversity in patients and their relatives represents a challenge for clinical practice in palliative care around the world. Cross-cultural training for palliative care professionals is still scarce, and research can help determine and support the implementation of appropriate training. In Switzerland, health policies address diversity and equity issues, and there is a need for educational research on cross-cultural training in palliative care. The aim of this study was to investigate the clinical challenges faced by Swiss palliative care professionals when working with migrant patients and their relatives. We also documented professionals' interests in cross-cultural training.

METHODS

A web survey of professionals working in specialized palliative care in the French- and Italian-speaking areas of Switzerland investigated clinical challenges with migrant populations and interests in various training opportunities.

RESULTS

A total of 204 individuals responded to the survey, 48.5 % of whom were nurses. The major difficulties they reported were communication impediments associated with patients' linguistic and/or cultural backgrounds. In relation to educational needs, they expressed a particular interest in communication techniques that would allow them to deal with these issues autonomously. The professionals expressed less interest in training on collaborating with other professionals and examining one's own stereotypes.

CONCLUSIONS

Palliative care professionals' post-graduate and continuing education must address communication techniques for sensitive palliative and end-of-life topics in cross-cultural contexts. Beginning with their pre-graduate studies, health professionals should assimilate the importance of collaborating with other professionals in complex cross-cultural situations and learn to reflect on their stereotypes and pre-conceptions in clinical practice.

An evaluation of dietary intakes of a selected group of South Asian migrant women with gestational diabetes mellitus

Background: Women of South Asian descent have an increased risk of developing gestational diabetes mellitus (GDM), and type 2 diabetes mellitus compared to Caucasian women. Dietary advice provided by health practitioners to this group has been found to be culturally inappropriate. The aim of this study was to describe the dietary intakes of South Asian women with gestational diabetes and use this information to develop culturally appropriate dietary models for education and support of dietary management.Method: An in-depth diet and lifestyle survey was administered with 13 eligible women. Dietary histories were collected for pre-pregnancy, during pregnancy and post-GDM diagnosis to evaluate changes in dietary intake, diet and health beliefs and traditional foods consumed during pregnancy.Results: The diets of participants did not meet nutrient requirements for pregnancy; specific areas on concern were dietary fibre, calcium, iron, folate and iodine. Vegetarians were particularly at risk with regards to energy and protein intake. Generally dietary intakes of these women with GDM were not consistent with guidelines for management of GDM. Confusion about what they should eat for GDM, health practitioner advice and conflict with cultural expectations about foods to consume during pregnancy was evident.Conclusion: The dietary information collected from these women was used to model sample menus for GDM that were culturally appropriate and consistent with vegetarian and non-vegetarian eating patterns.

Forming an Affiliation Between Two Culturally Different Academic Institutions of Nursing Studies

Introduction

This article describes the association of two culturally different institutions opening a joint Bachelor of Science in Nursing (BSN) program for ultra-Orthodox Jewish (Haredi) women in order to enable them to find jobs due to changes in their society and increasing global demand for nurses in the labor market. The objective of this description is to illustrate the efforts and changes needed to facilitate the affiliation of two culturally and ideologically different organizations and the implications and conclusions of such a program.

Methods

The study is based on interviews with past administrators, a review of the literature, and supporting institution documents.

Conclusions

A joint nursing academic program was founded by two culturally different educational institutions for the ultra-Orthodox Jewish women population. Creating a culturally sensitive nursing academic program helped ultra-Orthodox women acquire an academic profession which enabled their integration into the academic professional's work world and add more nurses to the labor market.The authors reviewed the efforts and changes needed to facilitate the affiliation of two culturally and ideologically different organizations based on the Bolman and Deal four frames model.

Recovery-oriented nursing care based on cultural sensitivity in community psychiatric nursing

Transforming to recovery-oriented care is an urgent issue in community psychiatric nursing in Japan. Because traditional psychiatry is still influential, nurses are required to possess cultural sensitivity to objectively view conflicts between values when providing recovery-oriented care. If recovery-oriented care based on cultural sensitivity is clarified, it would help nurses providing recovery-oriented care in non-recovery-oriented environments. Therefore, this study aimed to clarify recovery-oriented nursing care based on cultural sensitivity in community psychiatric nursing in Japan. A semi-structured interview with 21 community psychiatric nurses and participant observations for seven of them were performed. A qualitative description was undertaken to analyse the data. The relationships between categories were examined. The study conforms to the COREQ checklist. Through the analysis, six categories were revealed: 1. Continuously reflecting on one's own practice and the influence of the traditional mental health culture; 2. Constructing a partnership with clients to uphold their rights and responsibilities; 3. Having client-centred dialogue to help them enjoy life and grow; 4. Supporting clients' lives and strengthening their self-management; 5. Working as a team to achieve clients' wishes, which includes some risks, and 6. Maintaining a relationship between clients and the people who care for them. Category 1 was central and enclosed by categories 2, 3 and 4. Categories 5 and 6 were located outside of categories 1 to 4. The results showed cultural sensitivity enables recovery-oriented care even in non-recovery-oriented environments and include recognizing the traditional mental health culture, understanding clients' experiences and accepting other's values.

Applying Public Health Principles to Better Manage the COVID-19 Pandemic: "Community Participation," "Equity," and "Cultural Sensitivity"

Although coronavirus vaccine roll-out is beginning, standard public health practices will, for most people, remain their first line of protection for some time. Three principles guiding the pandemic control process, namely community participation, promotion of equity, and cultural sensitivity, can help people adhere to public health advice. These three principles can enhance intervention effectiveness, decreasing the rate of infection and protecting human rights, promoting social harmony and preventing unrest.

Characteristics of Asymptomatic Bacteriuria in Diabetes Mellitus Patients: A Retrospective Observational Study

Background and objective

The term asymptomatic bacteriuria (ASB) refers to the isolation of bacteria in a urine specimen of individuals without any symptoms of urinary tract infection (UTI). Diabetes mellitus (DM) is a disease involving multiple organ systems, characterized by its chronicity and hence endless complications including ASB. This study aimed to determine the characteristics of ASB and antibiotic susceptibility patterns among patients with diabetes.

Materials and methods

This was a retrospective observational study conducted in a tertiary care hospital. The study included patients with a diagnosis of diabetes with no signs and symptoms of UTI but who still showed the growth of an organism in urine culture. A total of 222 urine cultures were analyzed retrospectively, ensuring that they met the inclusion criteria through non-probability consecutive sampling.

Results

The mean age of the study participants was 62.89 ± 13.77 years; 76% of them were females, and 61% had a family history of diabetes. The most frequent organisms isolated were Escherichia coli (E. coli), Enterococcus, Klebsiella pneumonia, Pseudomonas aeruginosa, and Enterobacter species. A total of 20 subjects had dual bacterial growth in their cultures, with Enterococcus species (n=17) being the most common organism. Gender, family history of diabetes, levels of hemoglobin A1c (HbA1c), and advanced age were all found significantly associated with ASB.

Conclusion

Our study is the first of its kind to analyze and examine the risk factors associated with ASB in DM patients, and to identify the pathogens involved, along with assessing their antibiotic resistance profiles.

Walking in Your Culture: A Study of Culturally Sensitive Outdoor Walking Space for Chinese Elderly Immigrants

OBJECTIVES

This was a study conducted in Atlanta, GA, in the United States with Chinese elderly immigrants, examining the relationship between visual preference and motivation to walk in a particular outdoor space.

BACKGROUNDS

Outdoor walking promotes the well-being of older adults. However, their declined body functions impact their motivation to walk outside. For elderly immigrants living in a country with different cultural backgrounds from their homelands, it is important to find the ways to enhance their motivation of outdoor walking.

METHOD

Visual preference survey was conducted to assess preferences of first-generation Chinese elderly immigrants attending a care facility setting. Preferences included Chinese classical walking spaces or American modern walking spaces. The data were interpreted using descriptive statistics and factorial experiment analysis.

RESULTS

A total of 95 Chinese elderly immigrants gave valid responses to the visual preference survey. Survey results revealed that respondents had a high preference for Chinese classical walking spaces even though they had an average time of 26 years as a U.S. resident. Although the functions and purposes of the walking spaces caused safety and comfort concerns, the interaction effects of design style, design function, and design purpose illustrated that Chinese classical style had high effectiveness to promote outdoor walking of Chinese elderly immigrants.

CONCLUSIONS

These results support the significance of culturally sensitive care environments in promoting outdoor walking for elderly Chinese immigrants. It also indicates that spaces designed with an assigned cultural style had higher attractiveness to older adults from the same assigned cultural background.

Perceived Needs Versus Predisposing/Enabling Characteristics in Relation to Internet Cancer Information Seeking Among the US and Chinese Public: Comparative Survey Research

Background

Since the rise of the internet, online health information seeking has become a worldwide phenomenon. However, health and health communication are inherently culture bound. A data-driven cross-country comparison enables us to better understand how cultural factors moderate the association between individual-level determinants and online health information seeking.

Objective

The objective of the study was to examine similarities and differences in determinants of internet cancer information seeking between the US and Chinese general public (excluding cancer patients and survivors) under the framework of a behavioral model of health services use.

Methods

This study used Health Information National Trends Survey (HINTS) 2017 (US data) and HINTS-China 2017 data to answer the research question. It focused on people with no cancer history and with internet access. For the HINTS 2017, the sample size was 2153; for the HINTS-China 2017, the sample size was 2358. To compare China and the United States, the researchers selected the same set of study variables for each dataset. Under the framework of the behavioral model of health services use, these predictors were predisposing factors, enabling factors, and need factors.

Results

In terms of the predisposing factors, a higher age, college degree or above, being currently unemployed, and having a family history of cancer were associated with internet cancer information seeking for the Chinese respondents; none of these factors were related to information seeking for the US respondents, although a lower age was associated with information seeking. Regarding the enabling conditions, lower trust in family members and friends as reliable information sources was the only factor associated with information seeking for the Chinese respondents, while no enabling factor was related to information seeking for the US respondents. Regarding the need factors, perceived health status was not related to information seeking for the Chinese respondents, while perception of poorer health condition was related to information seeking for the US respondents. Higher cancer fear was related to information seeking for both groups, but the magnitude of association was smaller for the Chinese respondents than for the US respondents.

Conclusions

Overall, under the framework of the behavioral model of health services use, the results based on multivariate logistic regression reveal clear patterns of cross-country/cultural differences in the factors associated with internet cancer information seeking behaviors: predisposing characteristics and enabling conditions are more important in China, while perceived needs are more significant in the US. Such differences might reflect possible US-China differences in job environment (eg, job pressure) and culture (individualism vs collectivism and family structure).

The Premise and Development of CHECK IN-Check-In for Exchange of Clinical and Key Information to Enhance Palliative Care Discussions for Patients With Limited English Proficiency

Communication regarding serious illness is challenging in most circumstances. Patients with Limited English Proficiency (LEP) have unique language and cultural needs that often require collaboration with a trained medical interpreter, especially when the clinical encounter involves serious illness decision making or elucidation of patient goals, preferences, and values. Although there is mounting evidence to support interpreter/clinician huddles before a serious illness communication encounter, no current initiatives exist to operationalize this evidence. We are currently in the process of developing, evaluating, and implementing a formal interpreter/clinician huddle process to promote high quality care for patients with LEP. Our huddle guide, called the Check-In for Exchange of Clinical and Key Information (CHECK-IN), is designed to facilitate collaboration between an interpreter and clinician during a serious illness encounter by prompting exchange of relevant sociocultural and clinical information between clinicians and interpreters.

Enriching Nutrition Programs to Better Serve the Needs of a Diversifying Aging Population

Racial minorities experience a high burden of food insecurity relative to non-Hispanic whites. Government-subsidized nutrition programs can positively impact food insecurity and nutritional risk among older adults. Yet, in New York City, where nearly 60% of people over 65 years are non-white, older minorities participate in government nutrition programs at very low rates. In this commentary, we focus on 2 programs: the Child and Adult Care Food Program and Older Americans Act Nutrition Services Programs. We identify opportunities for strengthening these programs to improve their reach and engagement with diverse older adults in New York City and similarly diverse urban communities.

Sources of Happiness: A Mixed Methods Phenomenological Study of Factors Affecting Residents' Subjective Wellbeing in Shenzhen, China

Maintaining cultural sensitivity has been a challenge in subjective wellbeing (SWB) research involving nonwestern populations, which continues to primarily use a quantitative approach and Westernoriginating measurements. Accounting for culturally specific characteristics of the study area and sample, we employed a concurrent mixed-methods phenomenological approach to uncover factors contributing to urban Chinese residents' SWB in the context of their daily lives. Data from 65 semi-structured interviews in Shenzhen, China revealed five meta-themes, including harmony in interpersonal relationships, financial wellbeing and homeownership, health, physical and social environment, and intentional activities and mentality. Residents' background contextual information was cross-referenced with the meta-themes to enrich data interpretation, unveiling the profound imprint of age and life stages, the broad-scale structural inequities associated with China's household registration system, and the firm grip of traditional family core values and folk wisdom in the form of a transcendental mindset of inner peace and dignity. The results provide a contextualized understanding of the primary sources of SWB relevant to today's urban Chinese residents, and offer valuable insight about the social-cultural complexities involved in "ordinary" Chinese residents' pursuit of happiness that is co-shaped by individual effort, deep-rooted traditional values, and consequential social infrastructure and policies amidst the country's deepening, transformative urbanization. Keywords: China, Cultural Sensitivity, Happiness, Mixed Methods, Phenomenological Approach, Socio-Cultural Context, Sources of Happiness, Subjective Wellbeing, Urban Resident.

Cultivating Cultural Competence Through Academic Community Engagement and Clinical Reflection

INTRODUCTION

Nursing curriculum must include unique ways to enhance students' cultural sensitivity to ensure the provision of culturally competent care to our diverse populations. Academic community engagement (ACE) is a pedagogy used to teach course concepts through service.

METHODOLOGY

This was a qualitative study analyzing nursing students' written reflective journals following their service at a Native American powwow using Lincoln and Guba's model. The purpose was to examine if the ACE experience influenced their development of cultural sensitivity.

RESULTS

Reflective journals of 34 first-semester nursing students, enrolled in a nursing specific culture course, were analyzed. Three themes were identified: (a) engagement, (b) cultural sensitivity, and (c) humility and altruism.

DISCUSSION

The development of self-awareness and the revelation by students of the importance of culturally sensitive care was a key finding supporting the use of ACE as a reliable teaching strategy in nursing education.

Developing a Virtual Multicultural Intervention for University Students

The recent surge in acts of violence motivated by intergroup biases in the United States are of great concern. If allowed to progress, these conditions could create an unwelcoming atmosphere and could foster further division within the United States. Based on previous culture-related studies, multiculturalism is a possible solution to reducing intergroup biases, as it positively affects implicit and explicit cultural attitudes, perceptions, as well as behaviors. The current study developed a virtual multiculturalism intervention as a means to improve intergroup relations and combat cultural biases within the undergraduate student population. Specifically, 249 undergraduate students were randomly assigned to the intervention condition and the control condition. Results showed that participants in the intervention condition had a significantly higher improvement in multiculturalism scores, supporting the incorporation of a virtual multiculturalism intervention in higher education. This study calls for the implementation of a better framework of understanding of how changes in multicultural events are perceived and how this can be used to create a more empathetic population who are more comfortable and understanding with one another. This inexpensive and timesaving model holds the possibility of being used in the future to aid in overcoming cultural differences between student populations and varying ethnics groups alike.

A Culturally Sensitive and Supportive Maternity Care Service Increases the Uptake of Maternity Waiting Homes in Ethiopia

Background

Maternal delays in utilization of emergency obstetric care are impacting on a high maternal mortality, especially in the poor resource countries including Ethiopia. Different strategies are designed and employed to reduce those maternal delays, and one of such strategies employed to overcome the geographic barriers and improve maternal and neonatal health outcomes is utilization of maternity waiting homes (MWHs). Studies related to the utilization of MWHs and associated factors are limited in Ethiopia and there were none in the study area.

Objective

The aim of this study was to assess the utilization of maternity waiting homes and associated factors.

Methods and Materials

A community-based cross-sectional study design was conducted, using multistage sampling technique. Logistic regression analysis with 95% CI for odds ratio (OR) was used to identify significant factors.

Results

A total of 379 women participated in this study, making a response rate of 85%. Of the total participants, 42.5% (95% CI=38–48) of women utilized MWHs. After controlling for potential confounders, women’s decision-making capacity (AOR=12.74; 95% CI=6.18–26.26), women having someone who can care for their children and/or husband at home (AOR=2.71; 95% CI=1.44–5.09), MWHs offering food service (AOR=4.03; 95% CI=2.07– 7.85), offering and/or allowing women to practice their own cultural ceremony (allowing to cook their own food type, porridge, coffee, etc) (AOR=9.55; 95% CI=4.45–20.47), and women’s attitude towards MWHs (AOR=0.09; 95% CI=0.03–0.23) were factors significantly associated with the utilization of MWHs.

Conclusion

Compared to its contribution in reducing maternal and perinatal mortality, the utilization of MWHs was low in this study area. The integration of culturally sensitive and supportive maternity services, along with community participatory approach, would increase utilization of MWHs and consequently contribute in achieving the SDGs related to maternal and neonatal health.

Cultural Competency Among Pediatric Registered Nurses in Saudi Arabia: A Cross-Sectional Design

INTRODUCTION

Saudi Arabia's culturally diverse population is growing rapidly. The need for cultural competence is greatest in pediatric units where nurses provide care to children in collaboration with their parents.

METHOD

Nonprobability sampling of 394 nurses and cross-sectional descriptive design was used to investigate nurses' cultural competence, and to examine the relationships between the variables and participants' demographic data in pediatric units across five hospitals in Riyadh, Saudi Arabia, by asking nurses to complete a self-report questionnaire.

RESULTS

The results suggest a high degree of cultural competency. Participants' scores indicated high levels of perceived cultural awareness, sensitivity, and cultural competence behavior for performance.

DISCUSSION

This study supports the 3-D Puzzle Model of culturally congruent care for cultural competence, which assumes that cultural competence is deeply influenced by one's experiences. The findings revealed a high level of cultural competence despite a lack of information with respect to patient views.

A systematic review exploring palliative care for families who are forced migrants

AIMS

To explore the palliative care experiences of forced migrant children, families, and healthcare professionals (HCPs) highlighting successes, challenges, and associated practice implications.

DESIGN

Systematic literature review.

DATA SOURCES

The following search engines were searched from 2008 - 2018: Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health, MEDLINE, Embase, ProQuest, Scopus, Psycinfo, and Web of Science. Extensive reference and citation checking were also conducted.

REVIEW METHODS

Systematic review followed PRISMA guidelines with prepared PROSPERO registered protocol #CRD42019129200. English language qualitative, quantitative, or mixed methods studies were eligible for inclusion. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

Eighteen studies (reported in 20 articles) met the final inclusion criteria. Most focused on challenges to care provision. Thematic analysis following methods proposed by Braun and Clarke was undertaken. Five themes were identified: (a) divergence of beliefs and expectations; (b) communication; (c) navigating healthcare systems; (d) burdens and coping strategies; and (e) training and knowledge. A compassionate, collaborative approach with mutual respect crossed themes and was linked to high-quality care.

CONCLUSION

Forced migrant families have multiple needs including physical and emotional support and help in navigating complex systems. Professional interpreters can ease communication barriers when resourced appropriately. Individualized care is crucial to addressing the intricate mosaic of culture such families present. A cultural sensitivity/insensitivity framework is presented that may help guide future interactions and priorities for those working in children's palliative care.

IMPACT

This systematic review explored the international experiences of palliative care for forced migrant families. The findings highlight the plight of families who experience multiple traumas and increased levels of grief and loss through their migration experiences and when caring for a child with a life-limiting condition. This research has potential to have an impact on professionals working with culturally diverse families in all palliative care settings.

Trauma stabilization as an effective treatment for children with post-traumatic stress problems in South-East Asia

High numbers of children and adolescents in South-East Asia are traumatized by either natural disasters or human-made violence. Addressing traumatic sequelae in local populations with empirically based trauma treatments is challenged by the insufficiency inappropriately trained mental health provision. To meet this need for qualified therapists, the humanitarian/trauma capacity-building organization, Trauma Aid Germany, trained 37 therapists in psychotraumatology, including trauma stabilization. This study analyses the impact of trauma stabilization as a sole treatment intervention for post-traumatic stress (PTS) problems in children and adolescents. Each client was screened for PTS problems pre- and post-treatment using the Child Behaviour Checklist. Trauma stabilization (including psychoeducation) was the focus for subsequent data analysis. Those excluded were clients in receipt of trauma confrontation interventions. Trauma stabilization, as a sole treatment intervention, appeared to be sufficiently effective in reducing the PTS problems. The data set suggests that trauma stabilization has the potential to be effective, efficient, and sufficient treatment intervention for PTS problems in children and adolescents. Trauma stabilization techniques have the advantage of being relatively straightforward to teach and easy to integrate into practice. They are clinically safe, flexible, adaptable to the development stage and age of the client, and culturally and spiritually sensitive. A further advantage of trauma stabilization interventions is that they are bespoke - adjusted and adapted to the specific needs of the client. The discussion considers the implications for the potential utilization of mental health nurses and paraprofessionals in low- and middle-income countries in trauma stabilization interventions.

The Impact of Service Learning on Associate Degree Nursing Students' Cultural Competence

Associate's Degree in Nursing (ADN) programs rarely offer international service learning experiences. A project involving an ADN program in a southwestern U.S. border city and a care facility in a nearby city in Mexico was initiated to address cultural competence. The purpose of this study was to assess the impact of an international service learning experience on ADN students' cultural competence as measured by pre- and post-scores on the student version of the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Student Version (IAPCC-SV). Twenty third-semester ADN students participated in a 1-day cross-border international experience. Descriptive statistics provided summaries about the participants and their IAPCC-SV scores. Results indicated a positive effect between participating in an international service learning experience and increased levels of cultural competence. Increasing ADN students' cultural competence through international service learning may help reduce health care disparities among different cultures, promote care that enhances communication between nurses and patients, and build upon therapeutic relationships. International service learning provides ADN students the opportunity to incorporate classroom learning into their care of populations living within diverse communities.

Cinematherapy with African American couples

Cinematherapy is the use of movies as an intervention with clients. When done well, it is used to evoke and process emotion, psychoeducate, increase empathy, and problem-solve. However, there is no literature on utilizing movies as an intervention with African American couples. Based on literature and research about culture-informed interventions and media literacy, cinematherapy with African American couples would be more meaningful and effective if clinicians utilize Black-oriented movies.

Meaningful Engagement With Aboriginal Communities Using Participatory Action Research to Develop Culturally Appropriate Health Resources

Introduction: This article outlines the processes used to meaningfully and authentically engage Australian Aboriginal communities in Northern New South Wales, Australia, to develop culturally appropriate stroke health resources. Methodology: Participatory action research using the research topic yarning framework is a collaborative, culturally safe way to uncover vital information and concepts. There were two stages in the participatory action research project: community engagement and evaluation of the processes involved in developing the localised, culturally appropriate health resources. Results: Establishing relationships built on trust, mutual sharing of knowledge, and bringing together the wider community, enabled the health message to be embedded within the community, ensuring the message was culturally appropriate and sustainable. Discussion: The stroke education resource is a tangible outcome and a major achievement; however, the process of authentic engagement to achieve the final product was the ultimate accomplishment.

Patient Navigation: Addressing Social Challenges in Dialysis Patients

Members of racial and ethnic minority groups make up nearly 50% of US patients with end-stage kidney disease and face a disproportionate burden of socioeconomic challenges (ie, low income, job insecurity, low educational attainment, housing instability, and communication challenges) compared with non-Hispanic whites. Patients with end-stage kidney disease who face social challenges often have poor patient-centered and clinical outcomes. These challenges may have a negative impact on quality-of-care performance measures for dialysis facilities caring for primarily minority and low-income patients. One path toward improving outcomes for this group is to develop culturally tailored interventions that provide individualized support, potentially improving patient-centered, clinical, and health system outcomes by addressing social challenges. One such approach is using community-based culturally and linguistically concordant patient navigators, who can serve as a bridge between the patient and the health care system. Evidence points to the effectiveness of patient navigators in the provision of cancer care and, to a lesser extent, caring for people with chronic kidney disease and those who have undergone kidney transplantation. However, little is known about the effectiveness of patient navigators in the care of patients with kidney failure receiving dialysis, who experience a number of remediable social challenges.

Committing to my mission: Faculty experiences with student veterans in baccalaureate nursing education

Veterans transition to baccalaureate nursing education with significant experiences from their military service. Faculty play a role in facilitating this transition, in and out of the classroom. Approaches to enhance nursing education programs to better meet student veterans' needs have been proposed. However, less is known about the experiences of faculty teaching student veterans. A qualitative descriptive design was used to examine nursing faculty experiences teaching veterans, and in facilitating veterans' transfer of learning and knowledge from their military experience to baccalaureate nursing education. Semi-structured interviews with twelve faculty from the United States were conducted and data analyzed using content and thematic analysis. Three major themes included: committing to my mission, facilitating a shared understanding between military service and nursing, and appreciating a new duty. Results support faculty purposefully engaging in activities to increase their cultural sensitivity, while continuously developing humility and competence, to be successful teaching student veterans. Nursing faculty are positioned to leverage education as a means to improve the social status of veterans, ultimately improving their health and well-being, as well as academic success. It is recommended schools of nursing encourage and support faculty in attending professional development activities aimed at improving individual cultural sensitivity.

Social relations between students from two groups in conflict: Differences in stereotypes and perceived social distance between Jewish and Arab nursing students

BACKGROUND

The heterogeneous nature of the nursing profession generates encounters between members of different groups. Thus, nursing education should include programs focusing on cultural sensitivity to enhance cultural competence. Due to the ongoing conflict between Arabs and Jews, Israel is an appropriate setting for examining cultural sensitivity programs.

AIM

This study explores how Jewish-Israeli and Arab-Israeli nursing students studying together perceive their social relations by examining attribution of stereotypes (positive and negative) to members of the other group and willingness to engage in social interactions with individuals from the other group.

SETTING

The Department of Nursing at the Max Stern Yezreel Valley College.

PARTICIPANTS

180 Jewish and Arab nursing students at two different points in their studies, beginning students and those at more advanced stages.

METHODS

The students completed questionnaires examining their perceptions of the social relations between the two groups. The questionnaires measured stereotypes and perceptions of social distance regarding members of the other social group.

RESULTS

More positive stereotypes and fewer negative stereotypes were found among the Jewish students than among the Arab students. Nevertheless, the Jewish students exhibited less willingness to reduce social distance. No differences were found between beginning students and advanced students with respect to stereotypes, though advanced students expressed greater willingness to reduce social distance than did beginning students.

CONCLUSIONS

The findings show that perceptions of social relations are influenced by two different contexts: the students' specific context (joint studies and joint work in the future) and the broader general context of relations between the groups. The findings indicate that programs aimed at developing cultural sensitivity and improving relations in a divided society should provide differential responses for each group and should focus on willingness to cooperate and reduce social distance rather than attempting to eliminate stereotypes.

A Scoping Review of Ethical Considerations in Spiritual/Religious Counseling and Psychotherapy

Four overarching themes from this scoping review were identified, namely: (a) clients' right for autonomy and self-determination; (b) cultural sensitivity; (c) practitioner competency issues; and (d) recommended guidelines for ethical practice. These themes were aligned with the moral principles that guide professional ethical practice. A competency-based model was designed based on findings to enhance counselor/clinician competencies by enhancing sensitivity to spiritual and religious sentiments, which allows greater responsiveness to the clients' needs, values and preferences.

Case of Paradoxical Cultural Sensitivity: Mixed Method Study of Web-Based Health Informational Materials About the Human Papillomavirus Vaccine in Israel

BACKGROUND

Designing web-based informational materials regarding the human papillomavirus (HPV) vaccine has become a challenge for designers and decision makers in the health authorities because of the scientific and public controversy regarding the vaccine's safety and effectiveness and the sexual and moral concerns related to its use.

OBJECTIVE

The study aimed to investigate how cultural sensitivity (CS) is articulated in the explanatory informational materials on the HPV vaccine that are posted on the websites of the Israeli health authorities. In addition, the study examined the effect of transparency on the expression of CS in the informational materials.

METHODS

The study employed a quantitative and qualitative content analysis of the texts of explanatory informational materials published on the Arabic and Hebrew websites of the Israel Ministry of Health and the Clalit health maintenance organization (HMO).

RESULTS

The findings revealed the differences in the dimensions of CS (based on the CS model by Resnicow) between the informational materials targeting the majority Jewish population and those targeting the minority Arab population. Indeed, the research findings point to a paradox. On the one hand, the materials appealing to the conservative Arab population exhibited CS, in that the sexual context of the vaccine was missing. On the other hand, analysis of Resnicow's deep dimensions showed that disregarding the sexual context does not allow the relevant target audience to reflect on the barriers and concerns. In addition, the way the information was provided exhibited a lack of transparency regarding the CS dimensions (surface and deep).

CONCLUSIONS

The public health authorities have 2 main objectives in the context of vaccinations. One is to raise the vaccination rates and the other is to provide full and culturally sensitive information to give the public the tools to make intelligent decisions. The findings of this study indicated that despite the high uptake rate for HPV vaccination in the Arab population, the health authorities did not exercise full transparency and CS in transmitting the association between engaging in sexual relations and the necessity of the vaccination. Thus, the major challenge for the health authorities is to find ways to implement the objective of communicating information about the vaccination in a way that is transparent and culturally sensitive, even if this raises questions and fears among the public deriving from their culture.