Perceived health needs of urban African American church congregants

Culturally Responsive Interventions to Enhance Immunosuppressive Medication Adherence in Older African American Kidney Transplant Recipients

Context

Immunosuppressive medication nonadherence is variable among older kidney transplant recipients and is a problem in African American recipients despite the severe consequences of this behavior. Many factors place older African American recipients at risk for medication nonadherence.

Objective

To provide an overview of interventions to enhance immunosuppressive medication adherence in older African American kidney transplant recipients using a culturally responsive model. Culturally sensitive, innovative, and transformation interventions are discussed. Situations when each intervention would be most and least appropriate are described.

Conclusion

Moving culturally appropriate interventions forward into practice and testing their effectiveness in improving adherence outcomes in vulnerable, older African American kidney transplant recipients is a worthy practice and research goal for transplant nursing.

Evolutionary conceptual analysis: faith community nursing

The aim of the study was to report an evolutionary concept analysis of faith community nursing (FCN). FCN is a source of healthcare delivery in the USA which has grown in comprehensiveness and complexity. With increasing healthcare cost and a focus on access and prevention, FCN has extended beyond the physical walls of the faith community building. Faith communities and healthcare organizations invest in FCN and standardized training programs exist. Using Rodgers' evolutionary analysis, the literature was examined for antecedents, attributes, and consequences of the concept. This design allows for understanding the historical and social nature of the concept and how it changes over time. A search of databases using the keywords FCN, faith community nurse, parish nursing, and parish nurse was done. The concept of FCN was explored using research and theoretical literature. A theoretical definition and model were developed with relevant implications. The search results netted a sample of 124 reports of research and theoretical articles from multiple disciplines: medicine, education, religion and philosophy, international health, and nursing. Theoretical definition: FCN is a method of healthcare delivery that is centered in a relationship between the nurse and client (client as person, family, group, or community). The relationship occurs in an iterative motion over time when the client seeks or is targeted for wholistic health care with the goal of optimal wholistic health functioning. Faith integrating is a continuous occurring attribute. Health promoting, disease managing, coordinating, empowering and accessing health care are other essential attributes. All essential attributes occur with intentionality in a faith community, home, health institution and other community settings with fluidity as part of a community, national, or global health initiative. A new theoretical definition and corresponding conceptual model of FCN provides a basis for future nursing knowledge and model-based applications for evidence-based practice and research.

State of research for Faith Community Nursing 2009

The aim of this paper is to report the current state of research for Faith community Nursing (FCN), reviewing the related research literature dating back to 1993. Over 20 years old, the practice of FCN is a maturing specialty practice that links religious communities and health through professional nursing, but no review of research literature is published. The review of the literature was done utilizing the Cumulated Index to Nursing and Allied Health Literature (CINAHL) and PubMed. The keyword terms selected for search were: faith community nursing, parish nursing, and/or church nursing for the years 1993-2008. The review identifies four major content areas in the FCN research literature: (1) development and implementation of FCN practices; (2) roles and activities of faith community nurses; (3) FCN evaluation and documentation; and (4) congregation perceptions of FCN. Overall, findings indicate the FCN literature documents successful approaches for developing faith community programs, provides descriptive analyses of this specialty practice and perceptions associated with the practice, yet inadequately addresses the relationship of FCN to patient outcomes. To advance the effectiveness for this growing specialty, emphasis must be placed on measuring FCN components and related outcomes with analyses yielding evaluative data on the efficacy of this practice in terms of educational, psychosocial, spiritual, and physiological care.

Oral health-related cultural beliefs for four racial/ethnic groups: Assessment of the literature

BACKGROUND

The purpose of this study was to assess information available in the dental literature on oral health-related cultural beliefs. In the US, as elsewhere, many racial/ethnic minority groups shoulder a disproportionate burden of oral disease. Cultural beliefs, values and practices are often implicated as causes of oral health disparities, yet little is known about the breadth or adequacy of literature about cultural issues that could support these assertions. Hence, this rigorous assessment was conducted of work published in English on cultural beliefs and values in relation to oral health status and dental practice. Four racial/ethnic groups in the US (African-American, Chinese, Filipino and Hispanic/Latino) were chosen as exemplar populations.

METHODS

The dental literature published in English for the period 1980-2006 noted in the electronic database PUBMED was searched, using keywords and MeSH headings in different combinations for each racial/ethnic group to identify eligible articles. To be eligible the title and abstract when available had to describe the oral health-related cultural knowledge or orientation of the populations studied.

RESULTS

Overall, the majority of the literature on racial/ethnic groups was epidemiologic in nature, mainly demonstrating disparities in oral health rather than the oral beliefs or practices of these groups. A total of 60 relevant articles were found: 16 for African-American, 30 for Chinese, 2 for Filipino and 12 for Hispanic/Latino populations. Data on beliefs and practices from these studies has been abstracted, compiled and assessed. Few research-based studies were located. Articles lacked adequate identification of groups studied, used limited methods and had poor conceptual base.

CONCLUSION

The scant information available from the published dental and medical literature provides at best a rudimentary framework of oral health related ideas and beliefs for specific populations.

Self-management strategies to reduce pain and improve function among older adults in community settings: a review of the evidence

CONTEXT

Self-management strategies for pain hold substantial promise as a means of reducing pain and improving function among older adults with chronic pain, but their use in this age group has not been well defined.

OBJECTIVE

To review the evidence regarding self-management interventions for pain due to musculoskeletal disorders among older adults.

DESIGN

We searched the Medline and Cumulative Index to Nursing and Allied Health Literature databases to identify relevant articles for review and analyzed English-language articles that presented outcome data on pain, function, and/or other relevant endpoints and evaluated programs/strategies that could be feasibly implemented in the community. Abstracted information included study sample characteristics, estimates of treatment effect, and other relevant outcomes when present.

RESULTS

Retained articles (N = 27) included those that evaluated programs sponsored by the Arthritis Foundation and other programs/strategies including yoga, massage therapy, Tai Chi, and music therapy. Positive outcomes were found in 96% of the studies. Proportionate change in pain scores ranged from an increase of 18% to a reduction of 85% (median = 23% reduction), whereas change in disability scores ranged from an increase of 2% to a reduction of 70% (median = 19% reduction). Generalizability issues identified included limited enrollment of ethnic minority elders, as well as non-ethnic elders aged 80 and above.

CONCLUSIONS

Our results suggest that a broad range of self-management programs may provide benefits for older adults with chronic pain. Research is needed to establish the efficacy of the programs in diverse age and ethnic groups of older adults and identify strategies that maximize program reach, retention, and methods to ensure continued use of the strategies over time.

Life chance characteristics of older users of Swedish massage

The characteristics of those who use complementary and alternative medicine (CAM), as an approach to chronic disease management, are poorly understood. They may however be important to nurses and other health professionals given that CAM is increasingly used by their patients with chronic disorders. In these contexts, the purpose of this study was to ascertain unique life chance population characteristics which significantly influence the use of Swedish massage therapy (SMT), a popular form of CAM, by older adults with chronic health dysfunctions. A multi-site and cross-sectional design was used, as well as a pre-tested postal questionnaire. One hundred forty-one (141) urban, non-institutionalized, English-speaking older persons participated, ranging in age from 60 to 94 years. Findings denote the essential role life chances have on individuals accessing alternative forms of care.

Theory-guided intervention for preventing diabetes-related amputations in African Americans

A disproportionate number of individuals of African American descent undergo lower extremity amputations because of complications from diabetes mellitus (American Diabetes Association 2001). It is estimated that up to 85% of lower extremity amputations can be prevented through programs for preventing and treating foot ulcers, preventing reoccurrence of ulcers, and educating patients about proper foot care (American Diabetes Association 2001). The primary purpose of this article is to describe a church-based educational intervention that was developed to assist individuals of African American descent in the prevention of lower extremity amputations resulting from diabetes. The intervention was designed with the Health Belief Model as the framework. The secondary purpose of this article is to demonstrate the feasibility of using the Roy Adaptation Model as a framework for the same intervention. A comparison of the two frameworks is intended to support the use of the Roy Adaptation Model as a useful guide in the development of community-based nursing interventions. The current nursing literature (based on a search in CINHAL 1995-2003 and MEDLINE 1995-2003) exhibits an abundance of use of health behavior theories not authored by nurses that are used to guide interventions. The comparison of a health promotion model such as the Health Belief Model and a nursing theory is essential to address the relative lack of presence of the use of nursing theories in the realm of health-promoting interventions by nurses.