Partnering with community agencies to provide nursing students with cultural awareness experiences and refugee health promotion access

How health literacy is taught and evaluated in dentistry, medicine, nursing, law, pharmacy, public health, and social work: a narrative review

BACKGROUND

This narrative review examined the published peer-reviewed literature on how health literacy is taught and evaluated in seven health professional and adjacent disciplines: dentistry, medicine, nursing, law, pharmacy, public health, and social work. The study objectives were to assess how students are educated about health literacy and how their health literacy education and skills are evaluated.

METHODS

Study selection followed guidelines outlined in PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). We searched PubMed, CINAHL, SocINDEX (EBSCOhost), Lexis Advance and Public Health (ProQuest) for English-language publications of health literacy education studies across seven disciplines at U.S.-based institutions. Inclusion criteria included: 1) methods describing a primary health literacy educational intervention, 2) professional education in one or more of the seven disciplines, 3) educational institutions in the United States, and 4) articles published in peer-reviewed journals between 2000 and 2020.

RESULTS

The searches yielded 44 articles. Health literacy education is evident in six of the seven studied disciplines, and varies widely in the quality, quantity, timing and mode of education and evaluation. Despite the presence of health literacy accreditation requirements, none of the seven disciplines has developed and implemented a standard, rigorous health literacy education program for students.

CONCLUSIONS

Graduating institutions and professional accreditation organizations that set the standards for education must lead the way by implementing upstream changes in health literacy professional education. Teaching health literacy to students in health professions is one strategy to help close gaps in patient/client professional communication for graduates and those they serve.

Cultural Competence and Cultural Sensitivity Education in University Nursing Courses. A Scoping Review

When assessing the fragility that characterizes the health of an immigrant person, a culturally competent transformation of the nurse-patient teaching-learning process is necessary. Therefore, it is considered essential to incorporate cultural competence and intercultural communication in higher nursing education.

OBJECTIVE

To determine the content and knowledge of cultural competence and intercultural communication offered in higher education in nursing courses.

DESIGN

The Campinha-Bacote model of cultural competence was used as the primary reference.

METHOD

A scoping review was conducted about studies published in the period 2003 and 2020. The research was conducted between May and October 2020. More than a hundred documents (books, chapters, articles, conference proceedings) have been consulted.

RESULTS

Undergraduate nursing courses and postgraduate education move toward promoting cultural competence and sensitivity through teaching strategies.

CONCLUSIONS

Teaching projects that combine multiple competencies are more effective, including teacher training. A predominant element is a need for continuous and transversal projects. University nursing education must adapt culturally competent curricula.

A Multilingual Integrative Review of Health Literacy in Former Soviet Union, Russian-Speaking Immigrants

Large diasporas of former Soviet Union (FSU) immigrants are found in the USA, Germany, and Israel. To synthesize evidence, identify limitations, and propose future directions we conducted an integrative review on the health literacy of FSU immigrants, migrants, or refugees in four languages. Following integrative review and PRISMA guidelines, we searched four databases in English and performed supplementary searches in Russian, German, and Hebrew to identify qualitative and quantitative studies on FSU immigrants and health literacy. Six articles met inclusion criteria in English and one in German; the majority were published in the last five years. Only two articles measured health literacy of FSU immigrants, which was lower than the general population. Four articles were about immigrants with a mean age ≥50 years. All articles stressed the value of translated, culturally relevant health information. The health literacy of FSU immigrants is understudied, despite clear needs. Future research should include assessments of FSU immigrants’ health literacy and include diverse (e.g., age, gender) yet well-defined populations to determine both barriers and facilitators to their health literacy. This review, an example of a multilingual search, provided a comprehensive understanding of existing literature and is a useful approach for global health literacy research.

Nursing students' experiences with refugees with mental health problems in Jordan: A qualitative content analysis

OBJECTIVES

The aim of this study was to describe Jordanian nursing students' experience of caring for refugees with mental health problems.

BACKGROUND

According to refugees' experiences of crisis, a well-educated staff is needed to provide high quality of care due to mental health problems. Therefore, health professionals play an important role in creating an environment that promotes human rights regardless of ethnic origin.

SETTINGS, PARTICIPANTS, METHOD

The study comprised eight interviews and was analysed using content analysis, a qualitative method that involves an inductive approach, to increase our understanding of nursing students' perspective and thoughts regarding caring for refugees with mental health problems.

RESULTS

The results formed one category: to be challenged by refugees' mental health issues and three subcategories: managing refugees' mental health needs, affected by refugees' mental health, and improve mental healthcare for refugees.

CONCLUSION

Language problems could be managed by using interpreters to decrease cultural clashes to facilitate equal healthcare. In addition, well-educated (theoretical knowledge) and trained (practical knowledge) nursing students have potential to fulfil refugees' care needs regardless of ethnicity or background by using nursing interventions built on communication skills and cultural competences (theory, practice) to facilitate high quality of healthcare.

A critical review of social and health inequalities in the nursing curriculum

CONTEXT

Social and health inequalities are a reality around the world and one of the most important challenges in the current age. Nurse educators can respond to these challenges by incorporating curricular components to identify and intervene in social and health inequalities.

OBJECTIVE

To examine how social and health inequalities have been addressed in the nursing curriculum.

DESIGN

Informed by the work of Paulo Freire, a critical literature review was performed to examine how social and health inequalities have been addressed in the nursing curriculum.

DATA SOURCES AND REVIEW METHODS

In July 2015, we searched for articles published from 2000 to 2015 in ERIC, CINAHL, Web of Science, Scielo, MEDLINE and LILACS databases. Main search terms included "disparity" or "inequality" and "curriculum" and "nursing." We included studies published in academic journals in English, Portuguese and Spanish.

RESULTS

A total of 20 articles were included in this review. Most of the articles (15) were from the United States and described educational experiences in implementing courses in nursing undergraduate curricula. Limited experiences with graduate nursing education were identified. Social and health inequalities were approached in these articles through elements such as social justice, cultural competence, cultural safety, and advocacy. A concern to reduce social and health disparities was noted. We identified three major themes in the articles included in this review: 1) elements in the curricula that can contribute to reducing social and health inequalities; 2) educational and research strategies used to address the theme of inequalities; 3) a focus on socially vulnerable populations to increase awareness on social and health inequalities.

CONCLUSION

Findings suggest that nursing education initiatives align with the recommendations from the World Health Organization to address disparities. There is also a need to identify existing conceptual and practical content on inequalities in the nursing curriculum through future research.

Lessons in Retrospect

Baccalaureate community health education often includes clinical practice in home care agencies. Complexity with securing home care agency practice sites has led to the proliferation of alternative models for community health clinical. Nurse-managed wellness centers (NMWCs) are one such alternative that provides robust clinical experience for students and valuable home health services for vulnerable population groups. Despite anecdotal evidence of the value of the NMWC home care service, sustainability was dependent on the ability to report outcomes. An effort to quantify emergency department and hospital cost and utilization outcomes was unsuccessful. This resulted in failure to obtain financial support, and NMWC services were terminated in one community. In retrospect, the NMWC model was identified as having potential for integration into home care agency services.

A dynamic approach to communication in health literacy education

BACKGROUND

Research within the framework of Self-Determination Theory (SDT) indicates that patients' autonomy is to be considered a critical health care outcome in its own right since it promotes improved mental and physical health. This paper presents an analysis of studies addressing communication and interaction interventions in health literacy curricula for medical and health care practitioners, focusing on patient-oriented skills in "making sense" and "to adapt and self-manage". For evaluating interventions, underlying communication models were traced. The criteria for good practice are "making sense" and "supporting autonomy in making choices". For the search of interventions, keywords from both the framework of the EU-project, Intervention Research on Health Literacy among Ageing population (IROHLA (The IROHLA project received financial support from the European Union through FP7 Grant 305831)), as well as the SDT (Self Determination Theory) were applied. The research question of this paper is to what degree is autonomy supporting communication skills part of the curricula of health literacy (HL) for medical and health care practitioners and providers? A Pubmed search revealed: a) that "making sense" is clearly represented in HL interventions in curricula; however, b) very few interventions teach medical and health care practitioners how to give autonomy support in the interaction with their (future) patients. Four promising, beneficial practices were identified. Several recommendations were presented encouraging curriculum developers to adapt skills of supporting autonomy into their programs.

METHODS

A qualitative content analysis of interventions in the curricula of communication and interaction skills for medical students and practitioners.

RESULTS

A review of literature indicates: a) most interventions in curricula for medical students and practitioners are focusing on skills in adequately providing information to patients by using an underlying (advanced) Sender-Message-Receiver Model; and b) only a few interventions in curricula are available for providing the acquisition of interaction skills in supporting autonomy.

CONCLUSIONS

The proposal of Huber and others to change the emphasis in the definition of the WHO definition on health towards "to adapt and self manage" has impact on the training of medical students and practioners in dealing with patients with low levels of health literacy. From the present study it can be concluded that a dynamic approach to communication can be linked to theoretical constructs on self-management. In such an approach interaction techniques like scaffolding can increase the level of HL of the patient.

Approaches to improving the contribution of the nursing and midwifery workforce to increasing universal access to primary health care for vulnerable populations: a systematic review

BACKGROUND

Despite considerable evidence showing the importance of the nursing and midwifery workforce, there are no systematic reviews outlining how these cadres are best supported to provide universal access and reduce health care disparities at the primary health care (PHC) level. This review aims to identify nursing and midwifery policy, staffing, education and training interventions, collaborative efforts and strategies that have improved the quantity, quality and relevance of the nursing and midwifery workforce leading to health improvements for vulnerable populations.

METHODS

We undertook a structured search of bibliographic databases for peer-reviewed research literature using a focused review question and inclusion/exclusion criteria. The quality of retrieved papers was appraised using standard tools. The characteristics of screened papers were described, and a deductive qualitative content analysis methodology was applied to analyse the interventions and findings of included studies using a conceptual framework.

RESULTS

Thirty-six papers were included in the review, the majority (25) from high-income countries and nursing settings (32). Eleven papers defined leadership and governance approaches that had impacted upon the health outcomes of disadvantaged groups including policies at the national and state level that had led to an increased supply and coverage of nursing and midwifery staff and scope of practice. Twenty-seven papers outlined human resource management strategies to support the expansion of nurse's and midwives' roles that often involved task shifting and task sharing. These included approaches to managing staffing supply, distribution and skills mix; workloads; supervision; performance management; and remuneration, financial incentives and staffing costs. Education and training activities were described in 14 papers to assist nurses and midwives to perform new or expanded roles and prepare nurses for inclusive practice. This review identified collaboration between nurses and midwives and other health providers and organizations, across sectors, and with communities and individuals that resulted in improved health care and outcomes.

CONCLUSIONS

The findings of this review confirm the importance of a conceptual framework for understanding and planning leadership and governance approaches, management strategies and collaboration and education and training efforts to scale up and support nurses and midwives in existing or expanded roles to improve access to PHC for vulnerable populations.

eHealth literacy interventions for older adults: a systematic review of the literature

Background

eHealth resources offer new opportunities for older adults to access health information online, connect with others with shared health interests, and manage their health. However, older adults often lack sufficient eHealth literacy to maximize their benefit from these resources.

Objective

This review evaluates the research design, methods, and findings of eHealth literacy interventions for older adults.

Methods

A systematic review of peer-reviewed research articles from 28 databases in 9 fields was carried out in January 2013. Four rounds of screening of articles in these databases resulted in a final sample of 23 articles.

Results

Findings indicated a significant gap in the literature for eHealth literacy interventions evaluating health outcomes as the outcome of interest, a lack of theory-based interventions, and few studies applied high-quality research design.

Conclusions

Our findings emphasize the need for researchers to develop and assess theory-based interventions applying high-quality research design in eHealth literacy interventions targeting the older population.

Evaluation of a Health Professionals' Training Program to Conduct Research in New York City's Asian American Community

BACKGROUND

Because health disparities among Asian Americans are understudied, a partnership program between the Charles B Wang Community Health Center and the Center for the Study of Asian American Health was created to increase awareness and interest in Asian American research.

PURPOSE

To evaluate the process, outcome, and impact of a health professionals' research training program.

METHODS

Mixed research methods were employed to collect data from online surveys administered to mentors and trainees of the program.

RESULTS

Although many trainees did not continue to pursue Asian American health disparities research, results indicate that the program has positive impacts on trainees in their preparedness to conduct CBPR, work within the Asian American community, and network with public health professionals and researchers.

DISCUSSION

This evaluation adds to the current literature of research training programs but more research on Asian American health disparities is needed.

TRANSLATION TO HEALTH EDUCATION PRACTICE

Although the program has helped raise awareness in Asian American health disparities research, more Asian American specific research training programs are needed to stimulate a true generation of researchers.