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Jaramillo ET, Haozous E, Willging CE. The Community as the Unit of Healing: Conceptualizing Social Determinants of Health and Well-Being for Older American Indian Adults. The Gerontologist 2022; 62:732-741. [PMID: 35092427 PMCID: PMC9154240 DOI: 10.1093/geront/gnac018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives Multiple racial and social inequities shape health and access to health care for American Indian Elders, who have a lower life expectancy than all other aging populations in the United States. This qualitative study examines how upstream social determinants of health influence Elders’ ability to access and use health care. Research Design and Methods Between June 2016 and March 2017, we conducted individual, semistructured interviews with 96 American Indian Elders, aged 55 and older, and 47 professionals involved in planning or delivering care to Elders in 2 states in the U.S. Southwest. Transcripts were analyzed iteratively using grounded theory approaches, including open and focused coding. A group of American Indian Elders and allies called the Seasons of Care Community Action Board guided interpretation and prioritization of findings. Results Participants described multiple barriers that hindered Elders’ ability to access health care services and providers, which were largely tied to funding shortages and bureaucratic complexities associated with health care and insurance systems. Where available, community resources bridged service gaps and helped Elders navigate systems. Discussion and Implications Longstanding structural inequities for American Indians manifest in barriers to health equity, many of which are situated at the community level. These are compounded by additional disparities affecting older adults, rural residents, and marginalized citizens in general. Findings underscore the importance of health and policy initiatives for American Indian Elders that emphasize the community as the focus of intervention.
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Affiliation(s)
| | - Emily Haozous
- Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
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Sánchez V, Sanchez-Youngman S, Dickson E, Burgess E, Haozous E, Trickett E, Baker E, Wallerstein N. CBPR Implementation Framework for Community-Academic Partnerships. Am J Community Psychol 2021; 67:284-296. [PMID: 33823072 DOI: 10.1002/ajcp.12506] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The Engage for Equity (E2) study is an intervention trial for community-academic research partnerships that seeks to improve partnering practices and health equity outcomes by providing community and academic partners with tools to enhance and advance power sharing and health equity. Twenty-five community/academic research teams completed a two-day training intervention where they were introduced to the CBPR Conceptual Model and corresponding applied tools to their partnerships. We report on team interviews conducted immediately after the training, where teams discussed opportunities and challenges using the CBPR Model as an implementation framework as they considered their own contexts, their partnering processes/practices, actions, and their desired outcomes. We applied Diffusion of Innovation theory to guide data collection and analysis; augmented by intent to use and collective reflection. Results pointed to the flexibility of the CBPR model, concrete use of tools (e.g., planning/evaluation), and broader use in inspiring collective reflection to improve partnering practices and inform equity values. As an implementation framework, the CBPR model incorporates collaborative processes and strategies to mitigate power differentials into key phases of implementation studies, adding factors central to health equity work, not existing in previous implementation frameworks.
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Affiliation(s)
- Victoria Sánchez
- College of Population Health, University of New Mexico, Albuquerque, NM, USA
| | | | | | - Ellen Burgess
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Emily Haozous
- Pacific Institute for Research and Evaluation, Beltsville, MD, USA
| | | | - Elizabeth Baker
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Nina Wallerstein
- College of Population Health, University of New Mexico, Albuquerque, NM, USA
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Sommerfeld DH, Jaramillo ET, Lujan E, Haozous E, Willging CE. Health Care Access and Utilization for American Indian Elders: A Concept-Mapping Study. J Gerontol B Psychol Sci Soc Sci 2021; 76:141-151. [PMID: 31587056 DOI: 10.1093/geronb/gbz112] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Inequities in access to and utilization of health care greatly influence the health and quality of life of American Indian elders (AIEs). This study explores the importance and perceived prevalence of factors affecting health care use within this population and assesses the changeability of these factors to produce a list of action items that are timely and relevant to improving health care access and utilization. METHOD Concept mapping was conducted with AIEs (n = 65) and professional stakeholders (n = 50), including tribal leaders, administrators of public-sector health systems, outreach workers, and health care providers. Data were analyzed using multidimensional scaling and cluster analyses. RESULTS The final concept-map model comprised nine thematic clusters related to factors affecting elder health care: Difficulties Obtaining and Using Insurance; Insecurity from Lack of Knowledge; Limited Availability of Services; Scheduling Challenges; Provider Issues and Relationships; Family and Emotional Challenges; Health-Related Self-Efficacy and Knowledge; Accessibility and Transportation Barriers; and Tribal/National Policy. DISCUSSION Findings suggest that improvements in access to and utilization of health care among AIEs will require actions across multiple domains, including health system navigation services, workforce improvements, and tribal, state, and federal policy. A multilevel socioecological approach is necessary to organize and undertake these actions.
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Affiliation(s)
| | | | - Erik Lujan
- Pacific Institute for Research and Evaluation, Albuquerque, New Mexico
| | - Emily Haozous
- Pacific Institute for Research and Evaluation, Albuquerque, New Mexico
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Willging CE, Jaramillo ET, Haozous E, Sommerfeld DH, Verney SP. Macro- and meso-level contextual influences on health care inequities among American Indian elders. BMC Public Health 2021; 21:636. [PMID: 33794816 PMCID: PMC8013166 DOI: 10.1186/s12889-021-10616-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 03/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND American Indian elders, aged 55 years and older, represent a neglected segment of the United States (U.S.) health care system. This group is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other aging populations in the country. Despite the U.S. government's federal trust responsibility to meet American Indians' health-related needs through the Indian Health Service (IHS), elders are negatively affected by provider shortages, limited availability of health care services, and gaps in insurance. This qualitative study examines the perspectives of professional stakeholders involved in planning, delivery of, and advocating for services for this population to identify and analyze macro- and meso-level factors affecting access to and use of health care and insurance among American Indian elders at the micro level. METHODS Between June 2016 and March 2017, we undertook in-depth qualitative interviews with 47 professional stakeholders in two states in the Southwest U.S., including health care providers, outreach workers, public-sector administrators, and tribal leaders. The interviews focused on perceptions of both policy- and practice-related factors that bear upon health care inequities impacting elders. We analyzed iteratively the interview transcripts, using both open and focused coding techniques, followed by a critical review of the findings by a Community Action Board comprising American Indian elders. RESULTS Findings illuminated complex and multilevel contextual influences on health care inequities for elders, centering on (1) gaps in elder-oriented services; (2) benefits and limits of the Affordable Care Act (ACA); (2) invisibility of elders in national, state, and tribal policymaking; and (4) perceived threats to the IHS system and the federal trust responsibility. CONCLUSIONS Findings point to recommendations to improve the prevention and treatment of illness among American Indian elders by meeting their unique health care and insurance needs. Policies and practices must target meso and macro levels of contextual influence. Although Medicaid expansion under the ACA enables providers of essential services to elders, including the IHS, to enhance care through increased reimbursements, future policy efforts must improve upon this funding situation and fulfill the federal trust responsibility.
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Affiliation(s)
- Cathleen E. Willging
- Pacific Institute for Research and Evaluation, 851 University Blvd. SE, Suite 101, Albuquerque, NM 87106 USA
| | - Elise Trott Jaramillo
- Pacific Institute for Research and Evaluation, 851 University Blvd. SE, Suite 101, Albuquerque, NM 87106 USA
| | - Emily Haozous
- Pacific Institute for Research and Evaluation, 851 University Blvd. SE, Suite 101, Albuquerque, NM 87106 USA
| | - David H. Sommerfeld
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA 92093-0812 USA
| | - Steven P. Verney
- Department of Psychology, University of New Mexico, MSC03-2220, Albuquerque, NM 87131-0001 USA
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Potischman N, Salazar SI, Scott MA, Naranjo M, Haozous E, Bouville A, Simon SL. Methods and Findings on Diet and Lifestyle Used to Support Estimation of Radiation Doses from Radioactive Fallout from the Trinity Nuclear Test. Health Phys 2020; 119:390-399. [PMID: 32881737 PMCID: PMC7497477 DOI: 10.1097/hp.0000000000001303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 05/21/2023]
Abstract
The Trinity nuclear test was detonated in south-central New Mexico on 16 July 1945; in the early 2000s, the National Cancer Institute undertook a dose and cancer risk projection study of the possible health impacts of the test. In order to conduct a comprehensive dose assessment for the Trinity test, we collected diet and lifestyle data relevant to the populations living in New Mexico around the time of the test. This report describes the methodology developed to capture the data used to calculate radiation exposures and presents dietary and lifestyle data results for the main exposure pathways considered in the dose reconstruction. Individual interviews and focus groups were conducted in 2017 among older adults who had lived in the same New Mexico community during the 1940s or 1950s. Interview questions and guided group discussions focused on specific aspects of diet, water, type of housing, and time spent outdoors for different age groups. Thirteen focus groups and 11 individual interviews were conducted among Hispanic, White, and Native American participants. Extensive written notes and audio recordings aided in the coding of all responses used to derive ranges, prevalence, means, and standard deviations for each exposure variable for various age categories by region and ethnicity. Children aged 11-15 y in 1940s or 1950s from the rural plains had the highest milk intakes (993 mL d), and lowest intakes were among 11- to 15-y-olds in mountainous regions (191 mL d). Lactose intolerance rates were 7-71%, and prevalence was highest among Native Americans. Meat was not commonly consumed in the summer in most communities, and if consumed, it was among those aged 11-15 y of age or older who had relatively small amounts of 100-200 g d. Most drinking and cooking water came from covered wells, and most homes were made of adobe, which provided more protection from external radiation than wooden structures. The use of multiple approaches to trigger memory and collect participant reports on diet and other factors from the distant past seemed effective. These data were summarized, and together with other information, these data have been used to estimate radiation doses for representative persons of all ages in the main ethnic groups residing in New Mexico at the time of the Trinity nuclear test.
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Affiliation(s)
- Nancy Potischman
- Office of Dietary Supplements, Office of the Director, National Institutes of Health, Bethesda, MD
| | - Silvia I. Salazar
- Office of Communications and Public Liaison, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mary Alice Scott
- Department of Anthropology, New Mexico State University, Las Cruces, NM
| | - Marian Naranjo
- Special Consultant on Native American communities, Honor Our Pueblo Existence (HOPE), Espanola, NM
| | - Emily Haozous
- Pacific Institute for Research and Evaluation: Albuquerque, NM
| | - André Bouville
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
- Retired
| | - Steven L. Simon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Abstract
BACKGROUND Certain research principles, framed within an indigenous context, are helpful guideposts to practice ethical, relevant, and sensitive inquiries. It is essential to further adapt research approaches based on the unique geographical, sociopolitical, and cultural attributes of partnering tribal communities. These adaptations are largely shaped by trial and error. OBJECTIVES The purpose of this article is to offer the prospective novice nurse researcher lessons that we learned when entering Indian country to conduct research for the first time. As indigenous and nonindigenous researchers, we are not seeking to set down a methodology but rather offer a list of processes, environments, timelines, and barriers that we never learned in didactic, seminar, clinical, practicum, or any other academic setting. METHODS We organized a set of memories and thoughts through a series of semistructured iterative sessions specific to our first encounters as researchers in Indian country. We compiled our written responses and field notes from our dialogue, interpreted these data, and organized them into themes. We have reported what we felt would be the most surprising, frequent, or important information to note. RESULTS We identified three overarching themes in our collective experience: orientation and negotiation, situating ourselves and our work, and navigating our way. Subthemes included perceiving ourselves as outsiders, negotiating distance and time realities, relying on the goodness of gatekeepers, shaping research questions per community priorities, honing our cross-cultural and intercultural communication skills, discovering the many layers of tribal approval processes, and developing sensibilities and intuition. DISCUSSION Our previous experiences as novices leading research projects in Indian country have produced unique sensibilities that may serve to guide nurse researchers who seek to partner with tribal communities.
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Affiliation(s)
- Emily J Jones
- Emily J. Jones, PhD, RNC-OB, is Associate Professor, College of Nursing and Health Sciences, University of Massachusetts Boston. Emily Haozous, PhD, RN, FAAN, is Senior Research Scientist, Pacific Institute for Research and Evaluation, Behavioral Health Research Center of the Southwest, Albuquerque, New Mexico. Laura S. Larsson, PhD, RN, is Associate Professor, Montana State University, College of Nursing, Bozeman. Margaret P. Moss, PhD, JD, RN, FAAN, is Associate Professor, University of British Columbia, School of Nursing, Vancouver, British Columbia
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Wicks MN, Alejandro J, Bertrand D, Boyd CJ, Coleman CL, Haozous E, Meade CD, Meek PM. Corrigendum to Achieving advance care planning in diverse, underserved populations Nursing Outlook 66 (2018), 311-315. Nurs Outlook 2018; 66:495. [PMID: 30205903 DOI: 10.1016/j.outlook.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | | | - Carol J Boyd
- Expert Panel on Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) Health
| | | | | | - Cathy D Meade
- Expert Panel on Cultural Competence and Health Equity
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Winter SS, Page-Reeves JM, Page KA, Haozous E, Solares A, Nicole Cordova C, Larson RS. Inclusion of special populations in clinical research: important considerations and guidelines. J Clin Transl Res 2018; 4:56-69. [PMID: 30873495 PMCID: PMC6410628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Trials that involve human participants call for experiments or observations that are performed in a clinical research setting. Currently, there are over 16,000 clinical trials open in the United States. Despite continuing efforts to include "special populations" in clinical trials, there are gaps in participation for people who are either minors or elderly adults, are from historically under-represented minorities, or live in rural communities. The inclusion of these special populations in clinical trials research is essential for conclusions that benefit all populations. Data suggest that study partic-ipation rates for special populations have fallen to levels that could endanger the successful performance of some types of research. This is particularly concerning in the 21st century, where demographic trends in the United States continue to shift towards an older and Hispanic population with fewer rural dwellers. Trends in New Mexico and other minority-majority states mirror many of these shifts. RELEVANCE FOR PATIENTS In this review, we highlight improvement strategies for enhanced clinical trial participation by members of special populations. Key drivers for disparate clinical trials participation and outcomes often include differences in genetics, physiology, and perceptions of mistrust towards researchers. To overcome these barriers, we focus on best practices in recruitment strategies from the perspectives of the participants, the researchers and the institutions that support clinical trials.
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Affiliation(s)
- Stuart S. Winter
- 1Children's Minnesota Research Institute, Minneapolis, MN, United States
| | - Janet M. Page-Reeves
- 2Department of Family and Community Medicine, University of New Mexico, Albuquerque, United States
| | - Kimberly A. Page
- 3Department of Internal Medicine, Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico, Albuquerque, United States
| | - Emily Haozous
- 4UNM College of Nursing, University of New Mexico, Albuquerque, United States
| | - Angelica Solares
- 5University of New Mexico School of Law, University of New Mexico, Albuquerque, United States
| | - Carla Nicole Cordova
- 6UNM Clinical and Translational Science Center, University of New Mexico, Albuquerque, United States
| | - Richard S. Larson
- 6UNM Clinical and Translational Science Center, University of New Mexico, Albuquerque, United States
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McBride AB, Campbell J, Barr T, Duffy J, Haozous E, Mallow J, Narsavage G, Ridenour N, Theeke L. The impact of the Nurse Faculty Scholars program on schools of nursing. Nurs Outlook 2017; 65:327-335. [PMID: 28416201 PMCID: PMC5568121 DOI: 10.1016/j.outlook.2017.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/11/2017] [Accepted: 01/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Robert Wood Johnson Foundation Nurse Faculty Scholars program was conceptualized as not only promoting the growth and development of early-career faculty but as enhancing the research infrastructure of scholars' schools of nursing. PURPOSE At the completion of the scholars' three years of support, deans/directors were asked to provide feedback regarding the institutional impact of the scholars' participation in the program. METHODS Phone interviews were conducted on the first five completed cohorts and a six-item questionnaire was developed to obtain some quantitative data. DISCUSSION The program was viewed as having accelerated the scholars' leadership and scholarship, and their influence within the school/university and regionally/nationally. Deans/directors generally agreed that the scholars' experience helped build the school's research portfolio. CONCLUSION Looking back on how the participating schools of nursing fared, one can say that the program's institutional expectations were achieved most of the time. The program helped scholars build their own reputations and that in turn had consequences for the school's standing as a whole. A number of components are described that can be replicated singly or in various combinations by schools/universities interested in adopting aspects of this program.
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Affiliation(s)
| | | | | | - Joanne Duffy
- Indiana University School of Nursing, Indianapolis, IN; QualiCare, Indianapolis, IN
| | - Emily Haozous
- University of New Mexico College of Nursing, Albuquerque, NM
| | | | | | - Nancy Ridenour
- University of New Mexico College of Nursing, Albuquerque, NM
| | - Laurie Theeke
- West Virginia University School of Nursing, Morgantown, WV
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Morris AM, Doorenbos AZ, Haozous E, Meins A, Javid S, Flum DR. Perceptions of cancer treatment decision making among American Indians/Alaska Natives and their physicians. Psychooncology 2016; 25:1050-6. [PMID: 27279001 PMCID: PMC5014590 DOI: 10.1002/pon.4191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/03/2016] [Accepted: 06/06/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE American Indian/Alaska Native (AI/AN) patients are significantly less likely than non-Hispanic whites to receive guideline-concordant cancer care. Our objective was to examine cancer treatment decision making among AI/AN patients and their providers. METHODS From 2011 to 2014, AI/AN cancer patients and their surgeons were identified through a hospital registry in Washington State. Patients were invited to participate in a mailed survey that queried socio-demographics, cultural affiliation, everyday perceived discrimination, and trust in providers. Both patients and surgeons were queried about decision-making quality (collaboration and satisfaction). The primary outcome was association between patient and provider assessments of decision-making quality. The secondary outcome was non-adherence to treatment. RESULTS Forty-nine patients (62% response rate) and 14 surgeons (37% response rate) returned surveys. Half of patients had not completed high school; 41% were living in poverty. Half of patients reported a strong tribal affiliation and most reported experiencing some form of discrimination. Patients endorsed high trust in surgeons and a high quality decision-making process; and surgeons' rated decision-making quality even more highly than patients did in every domain. Non-adherence to treatment recommendations was common (26%) and was significantly associated with lower patient-reported collaboration and satisfaction with decision making. CONCLUSIONS Given the importance of adherence to cancer treatment for survival, the many non-clinical reasons for non-adherence, and the currently demonstrated association between decision-making quality and adherence, it would be worthwhile to investigate how to increase AI/AN patient satisfaction with decision making and whether improving satisfaction yields improved adherence to the cancer treatment plan. Copyright © 2016 The Authors. Psycho-Oncology Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Arden M Morris
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Ardith Z Doorenbos
- University of Washington School of Nursing, Department of Biobehavioral Nursing and Health Systems, Seattle, WA, USA
| | - Emily Haozous
- University of New Mexico College of Nursing, Albuquerque, NM, USA
| | - Alexa Meins
- University of Washington School of Nursing, Department of Biobehavioral Nursing and Health Systems, Seattle, WA, USA
| | - Sara Javid
- University of Washington, School of Medicine Department of Surgery, Seattle, WA, USA
| | - David R Flum
- University of Washington, School of Medicine Department of Surgery, Seattle, WA, USA
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Abstract
OBJECTIVE To describe how nurse-midwives verbally support nulliparous women during second-stage labor and document specific details of each second stage. DESIGN Descriptive qualitative study. SETTING A university hospital labor and delivery unit in the southwestern United States. PARTICIPANTS Nulliparous women (n = 14) older than age 18 and their attendant midwives (n = 9). METHODS A single research midwife observed the entire second stage of each woman and used a standardized data collection form to record spontaneous or directed pushing, position changes, open and closed glottis pushing. A digital audio recorder was employed to capture verbal communication between the midwife and laboring woman. The research midwife and two qualitative experts employed content analysis to analyze the audio transcripts and identify categories of verbal support. RESULTS Analysis revealed four categories of verbal support: affirmation, information sharing, direction, and baby talk. The vast majority of verbal communication by nurse-midwives consisted of affirmation and information sharing. Nurse-midwives gave direction for specific reasons. Women pushed spontaneously the majority of the time, regardless of epidural use. CONCLUSION Nurse-midwives use a range of verbal support strategies to guide the second stage. Directive support was relatively uncommon. Most verbal support instead affirmed a woman's ability to follow her own body's lead in second-stage labor, with or without epidural.
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Affiliation(s)
- Noelle Borders
- Department of Obstetrics and Gynecology, Midwifery Division, MSC10 5580 1, University of New Mexico, Albuquerque NM 87131, USA.
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Haozous E, Doorenbos AZ, Demiris G, Eaton LH, Towle C, Kundu A, Buchwald D. Role of telehealth/videoconferencing in managing cancer pain in rural American Indian communities. Psychooncology 2010; 21:219-23. [PMID: 22271543 DOI: 10.1002/pon.1887] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 10/16/2010] [Accepted: 10/21/2010] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This project is aimed at determining the feasibility and effect of using videoconferencing to deliver cancer-related pain management education and case consultation to health care providers in rural AI/AN communities. METHODS The project provided four educational sessions and nine case conferences to health care providers at tribal clinics in Washington State and Alaska using videoconferencing with pain experts at the University of Washington. A cross-sectional, descriptive study design was used to survey the participating providers. Measures included satisfaction with the telehealth system and self-perceived competence in pain management. RESULTS Fifty-two providers from 11 sites attended the educational sessions. Ninety-three providers from 16 sites participated in the case conferences. Case conference participants scored significantly higher on perceived competence in treating pain compared with clinic providers who did not attend. Educational session participants and case conference participants both reported a high level of satisfaction with videoconferencing. CONCLUSIONS Telehealth is a feasible and effective way to deliver cancer-related pain management education and increase competence among rural health care providers.
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Affiliation(s)
- Emily Haozous
- School of Nursing, University of New Mexico, NM, USA
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Doorenbos AZ, Eaton LH, Haozous E, Towle C, Revels L, Buchwald D. Satisfaction with telehealth for cancer support groups in rural American Indian and Alaska Native communities. Clin J Oncol Nurs 2010; 14:765-70. [PMID: 21112853 PMCID: PMC3133610 DOI: 10.1188/10.cjon.765-770] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A descriptive study was conducted to determine the information needs of American Indian (AI) and Alaska Native (AN) cancer survivors and assess satisfaction with and acceptability of telehealth support group services for cancer survivors in AI and AN rural communities. AI and AN cancer survivors were asked to complete the Telehealth Satisfaction Survey and two open-ended questions, one regarding information needs and one seeking comments and suggestions about cancer support group meetings. Thirty-two surveys were returned. Information about nutrition during treatment and treatment-related side effects were the most sought after topics. Participants valued the opportunity to interact with other AI and AN cancer survivors who also lived in remote locations and the usefulness of the information presented. The link with geographically distant survivors was valuable to participants as they felt they were no longer alone in their cancer experiences. Determining survivors' information needs provides meaningful topics for future support group education. Telehealth is a viable way to facilitate cancer support groups to AI and AN cancer survivors in rural communities.
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Knobf MT, Juarez G, Lee SYK, Sun V, Sun Y, Haozous E. Challenges and strategies in recruitment of ethnically diverse populations for cancer nursing research. Oncol Nurs Forum 2008; 34:1187-94. [PMID: 18024345 DOI: 10.1188/07.onf.1187-1194] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe common barriers, identify challenges for researchers, and provide strategies for recruitment and retention of ethnic minority groups for cancer nursing research. DATA SOURCES Computerized search of databases, published articles, abstracts, master's theses, and doctoral dissertations. DATA SYNTHESIS Social, economic, and cultural factors present challenges to recruitment of minorities into research. Knowing the culture of the target population, developing trust, engaging the community, and using tailored materials are strategies for recruitment and retention of minorities. CONCLUSIONS Knowledge of potential barriers and challenges to research with diverse populations provides the foundation for the development of strategies for successful recruitment of minorities in cancer nursing research. IMPLICATIONS FOR NURSING Increasing ethnic minorities in research will generate knowledge that will contribute to culturally competent cancer care.
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Affiliation(s)
- M Tish Knobf
- The School of Nursing, Yale University, New Haven, CT, USA.
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