Development of Youth-Centered Health Messaging Posters for High School-Based Health Clinics in Hawaii

BACKGROUND

Youth may be reluctant to seek health care from school health providers due to feeling embarrassed or stigmatized in the health office environment or worried about their confidentiality. The purpose of this project was to create a set of youth-centered health posters that promote youth engagement with nursing staff and to standardize health messaging across high schools in Hawaii school-based clinics.

METHODS

Two community advisory boards, 1 composed of 10 youth stakeholders (mean age 17 years) and the other of 7 adult stakeholders, informed poster development utilizing web-based discussion groups. The discussions were transcribed, and additional data was collected using field notes and anonymous digital messages. Adult advisory board members also provided feedback on suggested poster text through an online survey.

RESULTS

Youth and adult advisory board participants identified 4 key health concerns facing youth: confidentiality, sexual health, relationships, and mental health. Based on input from the 2 advisory boards, 4 posters were developed, each centered on 1 key health issue.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

School-based posters can convey important messages to help youth understand their health care rights and responsibilities, as well as identify important issues open for discussion with nurses.

CONCLUSION

Posters are an underutilized tool for school health providers to create welcoming, inclusive health care environments and facilitate health-related conversations with youth. This paper describes participant feedback about the characteristics of a memorable poster and briefly outlines current knowledge and recommendations for school health providers regarding each of the 4 health issues.

"Achieve the best while rushing against time": A grounded theory study on caring for low-income immigrant cancer patients at end of life

BACKGROUND

Between 2000 and 2020, Europe experienced an annual net arrival of approximately 1.6 million immigrants per year. While having lower mortality rates, in the setting of severe diseases, immigrants bear a greater cancer-related burden due to linguistic and cultural barriers and socio-economic conditions. Professionals face a two-fold task: managing clinical conditions while considering the social, economic, cultural, and spiritual sphere of patients and their families. In this regard, little is known about the care provision to low-income immigrant cancer patients in real contexts.

AIM

To investigate the perspective of professionals, family members, and stakeholders on the caring process of low-income immigrant cancer patients at the end of life.

DESIGN

A Constructivist Grounded Theory study.

SETTING/PARTICIPANTS

The study, conducted at a Hospital in Northern Italy, involved 27 participants among health professionals, family caregivers, and other stakeholders who had recently accompanied immigrant cancer patients in their terminal phase of illness.

RESULTS

Findings evidenced that professionals feel they were not adequately trained to cope with immigrant cancer patients, nonetheless, they were highly committed in providing the best care they could, rushing against the (short) time the patients have left. Analyses evidenced four main categories: "providing and receiving hospitality," "understanding each other," "addressing diversity," and "around the patient," which we conceptualized under the core category "Achieve the best while rushing against time."

CONCLUSIONS

The model reveals the activation of empathic and compassionate behavior by professionals. It evidences the need for empowering professionals with cultural competencies by employing interpreters and specific training programs.

Assessing Organizational Cultural Responsiveness among Refugee-Servicing Domestic Violence Agencies

Refugee community members who have experienced domestic violence in the U.S. face complex challenges in seeking help which may ultimately impact their ability to leave violent relationships. When domestic violence organizations are not prepared to serve them in culturally responsive ways, these challenges are exacerbated. This study surveyed 70 executive directors of domestic violence agencies in U.S. resettlement cities about the extent to which their organization’s practices reflected cultural responsiveness in serving refugee populations. The results showed promising indicators of organizational cultural responsiveness but uncovered numerous areas for growth. In particular, the study results underscore the need for organizations to improve their language supports and take active steps to outreach to, hire, and engage refugee communities in order to better serve them. This paper makes recommendations for how DV agencies can be more culturally responsive as they support refugee individuals who are seeking safety from violent relationships.

Promoting perceived insider status of indigenous employees

Purpose

While companies in developed countries are increasingly turning to indigenous employees, integration measures have met with mixed results. Low integration can lead to breach of the psychological contract, i.e. perceived mutual obligations between employee and employer. The purpose of this paper is to identify how leadership and organizational integration measures can be implemented to promote the perceived insider status (PIS) of indigenous employees, thereby fostering fulfillment of the psychological contract.

Design/methodology/approach

A search for relevant literature yielded 128 texts used to identify integration measures at the level of employee–supervisor relationships (leader-member exchanges, inclusive leadership) and at the level of employee–organization relationships (perceived organizational support, pro-diversity practices).

Findings

Measures related to leadership included recruiting qualified leaders, understanding cultural particularities, integrating diverse contributions and welcoming questions and challenges. Organizational measures included reaching a critical mass of indigenous employees, promoting equity and participation, developing skills, assigning meaningful tasks, maintaining good work relationships, facilitating work-life balance, providing employment security, fostering support from communities and monitoring practices.

Originality/value

While PIS has been studied in western and culturally diverse contexts, it has received less attention in indigenous contexts. Yet, some indigenous cultural values are incompatible with the basic assumptions of mainstream theories. Furthermore, colonial policies and capitalist development have severely impacted traditional indigenous economic systems. Consequently, indigenous people are facing many barriers to employment in ways that often differ from the experiences of other minority groups.

Improving Culturally Congruent Health Care for Children With Disabilities: Stakeholder Perspectives of Cultural Competence Training in an Interdisciplinary Leadership Training Program

INTRODUCTION

Racially/ethnically diverse children with disabilities experience increased risk for health care disparities when compared to non-Hispanic White children with disabilities or racially/ethnically diverse children without disabilities. The purpose of this study was to progress culturally congruent health care by exploring cultural competence (CC) for an interdisciplinary leadership training program designed to improve services for children with disabilities. The study also sought to bridge a gap in the literature by including the perspectives of diverse health care consumers.

METHOD

Q-methodology was used to support participant groups' sorting of CC training outcomes by importance to identify factors of CC.

RESULTS

Data collected from 51 participants were subjected to a by-person factor analysis that yielded six factors explaining 50% of variance.

DISCUSSION

Findings validate some common elements of existing CC models and provide new perspectives regarding potentially overlooked aspects of CC, with many new perspectives provided by racially/ethnically diverse parents of children with disabilities.

Nurse-Environment Interactions in the Development of Cultural Competence

Studies on the development of cultural competence among healthcare providers tend to focus on the clinical encounter, with little attention paid to the environment. In this paper, results from a grounded theory study conducted with nurses and students to understand cultural competence development are presented; with a focus on findings that call particular attention to nurse-environment interactions. Two concurrent processes, as students and nurses develop cultural competence through interactions with their environment, were identified: "dealing with structural constraints" and "mobilizing social resources". These dynamic interactions between healthcare providers and the larger structures of healthcare systems raise critical questions about the power of healthcare providers to influence the structures that shape their practice. The intersection of nursing theory with social and critical theories is essential to gain a comprehensive understanding of cultural competence development and to transform healthcare providers' education in the service of social justice and health equity.

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

Shared decision making (SDM) occurs when patients and clinicians work together to reach care decisions that are both medically sound and responsive to patients' preferences and values. SDM is an important tenet of patient-centered care that can improve patient outcomes. Patients with multiple minority identities, such as sexual orientation and race/ethnicity, are at particular risk for poor SDM. Among these dual-minority patients, added challenges to clear and open communication include cultural barriers, distrust, and a health care provider's lack of awareness of the patient's minority sexual orientation or gender identity. However, organizational factors like a culture of inclusion and private space throughout the visit can improve SDM with lesbian, gay, bisexual, and transgender ("LGBT") racial/ethnic minority patients who have faced stigma and discrimination. Most models of shared decision making focus on the patient-provider interaction, but the health care organization's context is also critical. Context-an organization's structure and operations-can strongly influence the ability and willingness of patients and clinicians to engage in shared decision making. SDM is most likely to be optimal if organizations transform their contexts and patients and providers improve their communication. Thus, we propose a conceptual model that suggests ways in which organizations can shape their contextual structure and operations to support SDM. The model contains six drivers: workflows, health information technology, organizational structure and culture, resources and clinic environment, training and education, and incentives and disincentives. These drivers work through four mechanisms to impact care: continuity and coordination, the ease of SDM, knowledge and skills, and attitudes and beliefs. These mechanisms can activate clinicians and patients to engage in high-quality SDM. We provide examples of how specific contextual changes could make SDM more effective for LGBT racial/ethnic minority populations, focusing especially on transformations that would establish a safe environment, build trust, and decrease stigma.

A constructivist theoretical proposition of cultural competence development in nursing

Cultural competence development in healthcare professions is considered an essential condition to promote quality and equity in healthcare. Even if cultural competence has been recognized as continuous, evolutionary, dynamic, and developmental by most researchers, current models of cultural competence fail to present developmental levels of this competence. These models have also been criticized for their essentialist perspective of culture and their limited application to competency-based approach programs. To our knowledge, there have been no published studies, from a constructivist perspective, of the processes involved in the development of cultural competence among nurses and undergraduate student nurses. The purpose of this study was to develop a theoretical proposition of cultural competence development in nursing from a constructivist perspective. We used a grounded theory design to study cultural competence development among nurses and student nurses in a healthcare center located in a culturally diverse urban area. Data collection involved participant observation and semi-structured interviews with 24 participants (13 nurses and 11 students) working in three community health settings. The core category, 'learning to bring the different realities together to provide effective care in a culturally diverse context', was constructed using inductive qualitative data analysis. This core category encompasses three dimensions of cultural competence: 'building a relationship with the other', 'working outside the usual practice framework', and 'reinventing practice in action.' The resulting model describes the concurrent evolution of these three dimensions at three different levels of cultural competence development. This study reveals that clinical experience and interactions between students or nurses and their environment both contribute significantly to cultural competence development. The resulting theoretical proposition of cultural competence development could be used not only to guide initial and continuing nursing education, but also to help redefine quality of care in a culturally diverse context.

Reviewing the topic of migration and health as a new national health target for Germany

OBJECTIVES

To review migration and health as a potential new national health target for Germany.

METHODS

The theme was evaluated along 13 standardized criteria preset by the Health Targets Network. For each of the criteria an expert opinion based on an extensive (but nonsystematic) review of literature is presented.

RESULTS

Migrants differ in many health-related aspects from the majority population in Germany. Despite having some health advantages, their health status, on average, is lower than that of non-migrants. They also experience barriers in health care and cannot participate in the society on equal terms with the majority population. Different measures to improve the health situation of migrants are available, but their current implementation in the health system is limited in several ways. Present data on the health of migrants is inadequate and limits migrant-sensitive health reporting.

CONCLUSION

The evaluation of potential health targets based on standardized criteria is a valuable tool for health policy formulation. The present documentation can assist other countries in evaluating migration and health as a national health target. It may also contribute to similar activities at the European level.

Implementation of Mindfulness Training for Mental Health Staff: Organizational Context and Stakeholder Perspectives

Occupational stress and burnout adversely impacts mental health care staff well-being and patient outcomes. Mindfulness training reduces staff stress and may improve patient care. However, few studies explore mental health setting implementation. This qualitative study used focus groups to evaluate stakeholders' perceptions of organizational factors affecting implementation of an adapted version of Mindfulness-Based Stress Reduction (MBSR) for staff on adolescent mental health units. Common facilitators included leadership securing buy-in with staff, allocating staff time to participate, and quiet space for training and practice. Other facilitators were past staff knowledge of mindfulness, local champions, and acculturating staff with mindfulness through a non-mandatory training attendance policy. Common barriers were limited staff time to attend training sessions and insufficient training coverage for some staff. Staff also reported improved focus when interacting with adolescents and improved social cohesion on the units. We conclude that a mindfulness-based program for reducing occupational stress can be successfully implemented on adolescent mental health units. Implementation appeared to change the social context of the units, including staff and patient interactions. More broadly, our findings highlight the importance of environmental factors in shaping attitudes, diffusion of innovation, and acculturation of wellness program implementations.

A Multicultural Approach to Health Psychology

The North American continent comprises a diverse array of individuals. Although the majority of them prescribe to the beliefs and treatments of Western biomedicine, a substantial number also practice diverse approaches to health. This article summarizes the basic tenets of major non-Western approaches to health, including the main beliefs and treatments. It bases this discussion in the context of health disparities, the existence of which presents a major problem for health care in America, and with an eye toward aiding the development of cultural competence for clinicians and health care providers nationwide.