Determination of the Mental Adjustment Status of Refugee Children in Primary School Age: The Case of Turkey

INTRODUCTION

This research was conducted as a descriptive study to determine the mental adjustment status of refugee children aged 6 to 14 in Duzce.

METHOD

The sample of the study consisted of 163 refugee children. Data were collected through face-to-face interviews with primary caregivers of children using the Hacettepe Mental Adjustment Scale. The collected data were analyzed in the SPSS 22.0 database using percentages, Mann Whitney U, Kruskal-Wallis H, and chi-square tests.

RESULTS

Adjustment problems were detected in 25.8% of the children participating and behavioral problems were detected in over half (52.4%).

DISCUSSION

In line with the findings obtained from the research, it has been suggested to form a team of mental health experts, including psychiatric nurses, who have adopted the principles of transcultural care to make early diagnosis and effective treatment of psychiatric diseases of refugee children.

First Contact With Transcultural Care: A Phenomenological Study of Practical Turkish Nursing Students' Experiences in a Migrant Health Center

INTRODUCTION

This study examines the subjective experiences of Turkish students who work in immigrant health facilities providing nursing care to people of different cultures. Nurses are often encountered by immigrants in these centers. Although qualitative research on nurses' experiences assisting immigrants has been often cited in the literature, the literature on nursing students' experiences is limited.

METHODOLOGY

The study has a descriptive qualitative design. Data were collected using a face-to-face, in-depth, and semistructured interview form. The data were evaluated using a content analysis method.

RESULTS

The study yielded four themes: (a) inability to control emotions, (b) barriers to care involvement, (c) benefits of intercultural care, and (d) recommendations.

DISCUSSION

Learning intercultural care is critical in these years of increased immigration. Understanding nursing students' experiences is essential for improving the quality of intercultural care.

A Qualitative Analysis of Latina Migrant Farmworkers' Perception of Mental Health: Voices From Wisconsin

INTRODUCTION

Despite evidence showing Latinos' high prevalence of mental health, little is known about Latina migrant farmworkers' mental health experiences, especially those working in Midwestern states. Considering the multiple vulnerabilities observed among Latina migrant farmworkers, it is necessary to gain insight from own accounts and perceptions of mental health and mental health-seeking experiences.

METHOD

A qualitative descriptive approach, using in-depth semi-structured interviews with open-ended questions, served to retrieve data from 34 Latina migrant farmworkers. This study was informed by Chicana, postcolonial, and Black feminist epistemologies.

RESULTS

Thematic analysis identified themes within the data. These findings pertained to the conceptualization of mental health within the contexts of family, capacities, stigma, denial, and faith.

DISCUSSION

Our results demonstrate the need for health care providers to consider Latina migrant farmworkers' perceptions about mental health and apply those in designing and implementing culturally informed policy and practice.

Creating International Student Experiences Through Academic-INGO Partnerships

INTRODUCTION

Short-term experiences in global health (STEGH) provide nursing students with opportunities to develop global health competencies through immersion in another culture. Skills that students obtain by participating in STEGHs can inform future practice with diverse patient populations. However, educators encounter unique challenges to the quality and sustainability of STEGHs.

METHODS

This article describes an academic partnership between a baccalaureate nursing program and a community-based international nongovernmental organization (INGO), how the partnership informed development of STEGH for nursing students, the benefits of the program for students and community, and the lessons learned through the process.

RESULTS

Academic-INGO partnerships provide unique benefits for creating sustainable, rigorous STEGHs that are informed and guided by the needs of the hosting community.

DISCUSSION

By partnering with community-based INGOs, faculty can design STEGHs that offer robust learning opportunities that facilitate the development of global health competencies while providing thoughtful, sustainable outreach for communities.

The Experience of Women From Underrepresented Groups With Urinary Incontinence: A Systematic Review

INTRODUCTION

Urinary incontinence (UI) in women is a global public health issue. However, there is a limited understanding of the experience of women from underrepresented groups suffering from UI. The purpose of this systematic review was to examine current evidence regarding the experience of women with UI from these groups.

METHODOLOGY

A systematic search was undertaken to retrieve research studies that answered the research question. Four qualitative research studies were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this review.

RESULTS

Four themes emerged from this review: the perceived origin of UI, the physical, psychological, and social impact of UI, the impact of culture and religion on UI, and vice versa, and the interaction of women with health services.

DISCUSSION

Social determinants of health, such as religion and culture, need to be considered by professionals providing care if women from underrepresented groups experiencing UI are to receive optimal care.

"Health without Borders": Early Findings and Lessons Learned from a Health Promotion Program for Ethnic Minorities Living in Italy

In multicultural contexts, health promotion can be challenging due to people's differences in beliefs, values, and practices regarding health and healthcare. Using the prototypical case scenario offered by the "Health without Borders" program, this study was generally aimed at summarizing the lessons learned and suggesting implications that are hopefully relevant to future culturally competent health promotion programs. This exploratory study used in-depth interviews, focus groups, and document analyses as primary methodological tools to gather data. A qualitative approach was chosen because it has the potential to explore, in depth, the main characteristics (values, operational domains, and action strategies) behind this prototypical case. The study findings suggest that the multicultural health promotion program under study is characterized by four main intertwined core values (i.e., empowerment; peer education; social embeddedness; tailor-made). In turn, these values are expressed in the ten main operational domains (i.e., proactive approach to health promotion; fostering interculturality in health promotion; fostering multidisciplinarity in health promotion; measuring the impact of initiatives; identifying, training, and activating key community members in the role of peer educators; promoting community engagement; fostering a "domino effect"; building institutional links with the organization of the territory; continuous training of the professionals involved in the initiatives; flexibility and a constant focus on projects' continuous redesign) that orient specific strategies of action. This program is based on a tailor-made principle for intervention design and delivery. This feature allows intervention providers to flexibly incorporate the target population's values in delivering health promotion activities. Therefore, the value of this prototypical case lies in the design of "adjustable" initiatives that fit the "program-as-designed" with the cultural characteristics of target populations involved in the intervention.

Nurses' Experiences as Care Providers for Syrian Refugees With Noncommunicable Diseases: A Qualitative Study

INTRODUCTION

Noncommunicable diseases (NCDs) are the leading cause of disability and death in the world. In Syria, the incidence of NCDs in refugees is 45%. Cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and other NCDs are the most common causes of morbidity in Syria. Nurses have challenges caring for Syrian refugees with NCDs. The purpose of the study was to explore nurses' experiences of caring for Syrian refugees with NCDs in Turkey.

METHODOLOGY

A phenomenology design was used. Inclusion criteria were nurses working experience of more than 1 year, caring for Syrian refugees with NCDs, and willingness and ability to participate in an individual interview. The participants were 20 nurses who worked with Syrian refugees at a public hospital in Kilis Province the border with Syria. Data were collected using semistructured interviews and analyzed by the thematic analysis method of Braun and Clarke.

RESULTS

Three major themes and six subthemes were identified. Major themes included the communication experience, cultural differences, and Syrian refugees' lack of knowledge about NCDs.

DISCUSSION

The results provide insight related to nursing care in Turkey for Syrian refugees with NCDs. The study revealed that nurses encountered challenges when caring for Syrian refugees with NCDs. Culturally competent assessment and interventions for refugees with NCDs should be encouraged considering these three themes.

Intergenerational Talking Circles Exploring Psychosocial Stressors for Preterm Birth and Strategies for Resilience among American Indian Women

INTRODUCTION

This study used phenomenological qualitative research design to understand the primary psychosocial stressors American Indian (AI) women face during pregnancy-factors that may be overlooked as contributing to the community's heightened preterm birth rate-and to identify mechanisms of resilience.

METHOD

Using Lakota talking circles (TCs) as the data collection method, researchers collected young mothers' and tribal elders' narratives about pregnancy and parenting. Themes were derived and verified from the transcripts.

RESULTS

During the TCs, the women identified transgenerational/historical trauma and instability in housing, childcare, and relationships as major contributors to pregnancy and parenting stress.

DISCUSSION

Having overcome obstacles while bearing and raising children, AI women exhibit resilience. Participants indicated that the TCs provided support and a cultural connection, thus serving as both a data collection method and an intervention. Future work will involve using TCs to support young mothers, transmit elder wisdom, and increase resilience among AI women.

Diné (Navajo) Female Perspectives on Mother-Daughter Cultural Assets Around the Transition to Womanhood: A Qualitative Study

INTRODUCTION

American Indian (AI) people have protective factors embedded in cultural teachings that buffer against high-risk behaviors. This study applies a qualitative, grounded theory approach to identify cultural assets for a Diné (Navajo) mother-daughter intervention aimed at preventing substance abuse and teen pregnancy.

METHOD

Focus groups and in-depth interviews were conducted with 28 AI females' ages 8 years and older from the Navajo Nation.

RESULTS

Key themes were (a) preserving the Diné way of life, (b) cultural assets related to being a healthy Diné woman, (c) matrilineal networks as a source of strength/pride, (d) historical trauma as a source of resilience, (e) male influences as protective health factors, (f) Western education as a measure of success, and (g) integrating different belief systems.

DISCUSSION

Study findings may be applied as foundational elements for culturally grounded AI substance abuse and teen pregnancy prevention strategies, as well as culturally safe nursing practice.

Intergenerational Talking Circles Exploring Psychosocial Stressors for Preterm Birth and Strategies for Resilience among American Indian Women

INTRODUCTION

This study used phenomenological qualitative research design to understand the primary psychosocial stressors American Indian (AI) women face during pregnancy-factors that may be overlooked as contributing to the community's heightened preterm birth rate-and to identify mechanisms of resilience.

METHOD

Using Lakota talking circles (TCs) as the data collection method, researchers collected young mothers' and tribal elders' narratives about pregnancy and parenting. Themes were derived and verified from the transcripts.

RESULTS

During the TCs, the women identified transgenerational/historical trauma and instability in housing, childcare, and relationships as major contributors to pregnancy and parenting stress.

DISCUSSION

Having overcome obstacles while bearing and raising children, AI women exhibit resilience. Participants indicated that the TCs provided support and a cultural connection, thus serving as both a data collection method and an intervention. Future work will involve using TCs to support young mothers, transmit elder wisdom, and increase resilience among AI women.

Primary Care Clinician's Knowledge of Trafficking in Persons: A Systematic Review

INTRODUCTION

Human trafficking is an enormous global threat. Primary care clinicians are part of a safety net of professionals who may be able to identify and assist trafficking in persons (TIPs). The purpose of this systematic review was to explore clinicians' knowledge, attitudes, and behaviors in identifying and assisting TIPS in health care settings.

METHODOLOGY

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this review. Searches were conducted using PubMed, Medline Plus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases that yielded 130 articles, of which 10 quantitative articles met eligibility criteria. Eligibility determination, data extraction, synthesis, and evaluation were independently conducted by the authors.

RESULTS

Findings revealed deficits in clinician's knowledge, attitudes, and behaviors on identifying TIPs in clinical settings. In addition, cultural influences affect TIP's decision-making.

DISCUSSION

To support the wide-ranging needs of TIPs, education programs that include clinician trainings on the skills required to identify and assist TIPs across cultures is warranted.

Race/Ethnicity Differences in COVID-19 Vaccine Uptake Among Nurses

INTRODUCTION

There is evidence for relatively lower COVID-19 vaccine uptake among people of color in the United States. The purpose of this study was to investigate associations between race/ethnicity and COVID-19 vaccine uptake among nurses.

METHODS

Nurses in Southern California (N = 1183) completed a one-time, web-based survey to assess COVID-19 vaccine perceptions and uptake.

RESULTS

In all, 82.8% of respondents (N = 979) received at least one COVID-19 vaccine dose. Identifying as East Asian was associated with 14% higher odds of COVID-19 vaccine uptake relative to identifying as White (odds ratio [OR] = 1.14/95% confidence interval [CI] = [1.06, 1.24]); identifying as Filipino was associated with 14% higher odds of uptake (OR = 1.14/95% CI = [1.08, 1.20]); and identifying as Hispanic/Latinx was associated with 6% higher odds of uptake (OR = 1.06/95% CI = [1.00, 1.12]).

DISCUSSION

Although nurses and people of color have been identified as groups with low levels of COVID-19 vaccine uptake, this study found that nurses of color received the vaccine at higher levels than their White counterparts.

Traditional partería providing women's health care in Latin America: A qualitative synthesis

AIM

To identify practices, beliefs, and potential gaps in knowledge about partería tradicional in Latin America.

BACKGROUND/INTRODUCTION

Partería tradicional (lay midwifery) refers to ancestral knowledge used by laypersons, mainly parteras tradicionales (lay midwives), to provide health care to women and children. This care, initiated prior to formalization of health care continues today. Descriptions of the intergenerational oral transmission of partería tradicional knowledge and practice in Latin America exist without related synthesis.

METHODS

Qualitative synthesis of the literature, including publications in Spanish, English, and Portuguese indexed in public databases over the previous 22 years concerning partería tradicional. Identification of categories, themes, and bias reporting via PRISMA processes, using the Thomas and Harden's approach and the Noblit and Hare's methodological recommendations.

RESULTS

Partería tradicional themes included "ancestral knowledge," "destiny and a spiritual calling," "woma's heritage," and "a means for providing health care."

DISCUSSION

Parteras tradicionales are key providers of health care for rural and urban marginalized communities. Limited knowledge and understanding of this practice impacts interactions between parteras tradicionales, midwives, and nurses. An interchange of knowledge is fundamental for care congruent with culture and the humanization of women's reproductive health.

CONCLUSIONS AND POLICY IMPLICATIONS

Communities with unresolved health care needs benefit via collaboration between formal health practices and partería tradicional. A compelling need for inquiry to preserve the art of partería tradicional exists internationally. Parteras tradicionales must be considered when formulating health care policy, thereby enhancing their historic role among the most vulnerable populations in Latin America: protecting, caring, and addressing health care needs.

Hidden Tales of Ebola: Airing the Forgotten Voices of Ugandan "Ebola Nurses"

Introduction

According to the Centers for Disease Control and Prevention, Ebola has affected the lives of thousands, including health care workers. With few studies describing the experience of nurses who survived Ebola, the study aimed to describe Ugandan nurses’ experiences.

Method

Using a phenomenological design, in-depth interviews were conducted among five Ugandan nurses who contracted Ebola and survived.

Result

Thematic analysis revealed themes of expectations of dying, hopelessness, loneliness, and betrayal by family, community, and the health system.

Discussion

Results support the need for policies targeting holistic practice protocols to protect all health care professionals during future outbreaks. Last, nursing survivors should have access to government-guaranteed support programs, including free health care and financial stipends. These results and recommendations transcend to the current reality of living with COVID-19 (coronavirus disease 2019). Efficient practice protocols could protect all rights and privileges and contribute to access to treatment and stigma removal.

Interventions to Improve Medication Adherence in Ethnically Diverse Patients: A Narrative Systematic Review

INTRODUCTION

Ethnically diverse patients often have lower medication adherence relative to Whites. Certain ethnic groups are also more susceptible to cardiovascular and related diseases. It is critical to develop culturally tailored interventions to improve medication adherence in these ethnically diverse patients. Thus, the aim of this systematic review was to identify what interventions have been developed and tested to improve medication adherence in ethnically diverse patients with cardiovascular-related diseases.

METHOD

A systematic search of peer-reviewed literature (MEDLINE, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane Central Register of Controlled Trials) was conducted to identify relevant articles. The narrative synthesis was performed based on elements offered by Popay et al. The mixed methods appraisal tool was used to appraise the quality of the included studies.

RESULTS

A total of 11,294 records were retrieved, and 34 articles met the inclusion criteria for this systematic review. Synthesis of the literature revealed four overarching intervention strategies used to improve medication adherence: pharmacist-mediated, primarily nurse-led, community-based and community-health worker led, and text-message and phone-based.

DISCUSSION

Several approaches can be used to improve medication adherence in ethnically diverse patients, although details on the approaches and conditions to produce optimal improvements for particular ethnic groups need to be determined in future studies. How does this affect culturally congruent health care?

Determinants of Breast Cancer Screening in Three Arab American Women Subgroups

INTRODUCTION

Arab American women (AAW) have significantly low mammography screening (MS) rates; religious and sociocultural factors may serve as facilitators or barriers to screening. Understanding associations with screening practices and attitudes is imperative. The purpose of this study was to examine associations of sociodemographic characteristics with perceived benefits and barriers to MS and explore relationships of MS with sociodemographics, and perceived benefits and barriers in Muslim and Christian AAW from three Arab countries, Jordan, Lebanon, and Egypt.

METHOD

In this exploratory, cross sectional study, a convenience sample of 316 AAW completed a survey that combined sociodemographics and the Arab Specific-Culture Barriers instrument.

RESULTS

Religion was significantly associated with perceived benefits and country of birth had a significant association with perceived barriers. Significant relationships were found between some variables and MS.

DISCUSSION

This study provided insights into facilitators and barriers influencing behaviors and attitudes regarding MS in AAW. Additional efforts are to be made to overcome barriers within a religious and cultural context to empower these women.

An Alternative View of a Hemodialysis-Life Balance: Life Reorganization of Korean Patients Undergoing Hemodialysis

INTRODUCTION

Hemodialysis patients in Korea increased 2.3 fold from 2008 to 2018 and continues to rise 7% to 10% annually. Long-term treatment to prevent complications requires understanding patients' hemodialysis-life balance. Our purpose was to explore the process of life reorganization by hemodialysis patients from Korea.

METHOD

Grounded theory methodology was utilized. Participants were hemodialysis patients recruited from four hemodialysis centers in Korea. Data were collected by in-depth individual interviews. Data were analyzed using constant comparative method with theoretical saturation.

RESULTS

Participants (n = 14) experienced four phases with transitions. A traditional Korean belief system, the view of blessing-focused destiny promoted a change in perspective from the focus on a life crisis, and thereby, played a role in buffering negative experience.

DISCUSSION

Nurses should assess the cultural individual needs of patients, which change according to each phase of life reorganization, and provide the right care at the right time to increase positive experiences.

Exploring the Impact of Health Care Provider Cultural Competence on New Immigrant Health-Related Quality of Life: A Cross-Sectional Study of Canadian Newcomers

Introduction:

New immigrants underutilize health care because of multiple barriers. Although culturally competent health care improves access, it is typically assessed by providers, not newcomers whose perceptions matter most.

Methodology:

Surveys that included measures of cultural competence and health-related quality of life (QOL) were completed by 117 new immigrants in Windsor, Ontario, Canada. A series of stepwise linear regression analyses were conducted to identify independent predictors of QOL and its four domains: physical health, psychological, social relationships, and environment.

Results:

Our adjusted results suggest that experiences of discrimination was negatively associated with overall QOL (β = −.313; p < .001) and its psychological (β = −.318; p < .001), social (β = −.177; p = .048), and environmental (β = −.408; p < .001) domains.

Discussion:

Discrimination negatively influences new immigrant QOL. Provider cultural competency training should emphasize the influence of provider discrimination on immigrant health and explore learners’ values and biases.

Cultural Aspects of End-of-Life Advance Care Planning for African Americans: An Ethnonursing Study

INTRODUCTION

Advance directive completion rates among the general population are low, with even lower completion rates among African Americans (AAs). This study's purpose was to identify culturally based meanings, expressions, and traditions of end-of-life (EOL) advance care planning (ACP) and decision making in order to promote culturally congruent nursing care among African Americans.

METHODOLOGY

Leininger's Culture Care Theory and Ethnonursing Research Method guided the study. A convenience sample of 21 informants were interviewed in community settings. Data analysis was guided using Leininger's phases of ethnonursing data analysis for qualitative data.

RESULTS

Three themes emerged that affect EOL decision making: (a) faith in God and belief in life after death, (b) a strong matriarchal family structure, and (c) fear of talking about death and mistrust of the U.S. health care system.

DISCUSSION

AA culture, beliefs, and traditions influence EOL ACP and practices, and must be considered while providing culturally congruent care.

Investigating the Impacts of Acculturation Stress on Migrant Care Workers in Australian Residential Aged Care Facilities

INTRODUCTION

Migrant care workers are a growing portion of the aged care workforce in high-income countries. This study investigated the impacts of acculturation stress on the well-being of migrant care workers.

METHOD

A cross-sectional national survey was conducted among migrant care workers (n = 272) across five Australian states and one territory using the Riverside Acculturation Stress Inventory (RASI) and Depression Anxiety Stress Scale (DASS 21).

RESULTS

Acculturation stress was high (M = 38.4; SD = 14.1; 38.9% scored ≥40 out of 75), but respondents scored in the normal to mild ranges (85% to 93%) on the DASS 21 scale. Enrolled and registered nurses had the highest acculturation stress levels when compared with other occupational roles. Ethnicity, F(4, 254) = 11.0, p < .001; occupational roles, F(3, 254) = 3.0, p = .03; and self-reported English proficiency, F(1, 254) = 4.17, p = .04, were statistically significant.

CONCLUSIONS

Addressing acculturation stress may improve job satisfaction and retention among migrant care workers.

The Influence of Confucianism on the Perceptions and Process of Caring Among Family Caregivers of Persons With Dementia: A Qualitative Study

Introduction: Scant evidence reveals the influences of Confucianism on family caregiving in dementia. The purpose of this study was to explore the influence of Confucianism on the perceptions and process of caring among the Chinese family caregivers. Method: A qualitative study was conducted using semistructured interviews with 15 Chinese family caregivers of persons with dementia in three elderly care centers in Hong Kong. The interviews were audiotaped and transcribed, while a thematic analysis was performed to analyze the transcript at the latent level. Results: Three themes emerged from the interviews: (a) setting family as a top priority, (b) growth and development in families, and (c) enhancing family relationships. Discussion: Our findings provided insights into how Confucianism influences the experience of family caregivers in caring persons with dementia in Chinese communities. These findings help develop culturally adapted interventions to improve the support for family caregivers of persons with dementia.

The Role of Culture in Shaping Health Perceptions and Behaviors of Resettled Karen Refugees

Introduction: While the many health vulnerabilities and challenges experienced by refugees have been previously documented, few studies have addressed the strengths-focused response strategies that women refugees, in particular, engage to navigate health systems and experiences associated with displacement. Our study attempts to document this among members of one group, the Karen, who represent a significant proportion of refugees resettled in the United States over the past decade. The purpose of this study was to explore how a sample of resettled Karen refugee women construct meaning around health, particularly in the context of cultural values, community, and migration. Methodology: This research took place in a series of ethnographic case studies documenting experiences of resilience, identity construction, and mothering among Karen refugee women from Burma. Data were collected through participant interviews with 12 Karen refugee women living in the United States. Interviews were transcribed, coded, and analyzed to identify themes relating to culturally influenced and newly emerging perceptions of health, identity, motherhood, and migration. Results: Participants identified correlates of doing, such as the ability to work and physical energy, as positively related to health, while the inability to do things was negatively related to health. Personal health also encompassed the health of family and community. Discussion: Women in this sample drew on broad, culturally informed ways of being to explain their health experiences. Implications of these findings are presented regarding how organizations and health providers can approach their work with refugees in culturally informed and relevant ways.

American Roma: A Cultural Care Case Study

This case study depicts the cultural conflict that occurred when an American Roma (Gypsy) woman delivered her baby at a small hospital that had no knowledge or experience with the Roma culture. The case is analyzed based on the three modes of nursing actions and decisions for culturally congruent nursing care, an important tenet of Leininger's culture care theory. Culture care preservation and maintenance efforts included enabling family presence, respecting the culture's moral code, and acknowledging child-rearing norms. Cultural care accommodation and negotiation focused on the patient's hospital room accommodation, negotiating adherence to identification and security measures, and formulating the discharge plan. Cultural care repatterning and restructuring was not attempted. Recommendations for nursing practice are made based on this case, migration trends, and recent cultural changes.

Self-Management of Type 2 Diabetes in Adult Haitian Immigrants: A Qualitative Study

Introduction: A large body of literature exists on self-management of type 2 diabetes (T2D) in a variety of populations. However, research is limited on how Haitian immigrants self-manage their T2D despite a prevalence of 6.9% in Haiti. The purpose of this study was to explore and describe the lived experience of adult Haitian immigrants managing T2D living in the United States. Methodology: Moustakas's phenomenological approach guided this qualitative study. Adult Haitian immigrants diagnosed with T2D for at least 1 year were interviewed. Individual interviews were audio-recorded, transcribed verbatim, uploaded into NVivo, and analyzed using Moustakas's existential data analysis process. Results: We interviewed 16 participants (mean age 56;12 females; an average of 11 years living in the United States; mean hemoglobin A1c 8.1%). Four themes emerged: self-reliance, spirituality, nostalgia for home, and a desire for positive patient-provider relationships. Cultural influences and health beliefs may affect individual self-management of T2D in this population. Conclusions: These results may assist clinicians in identifying factors that contribute to suboptimal self-management in Haitian immigrants and help patients reach glycemic control. Culturally competent assessment and interventions for Haitian immigrants with T2D may not be provided without considering these four themes.

A Feasibility Study of Muslim Cancer Survivors' Experience in the United States: Recruitment and Data Collection

BACKGROUND

Studies with U.S. Muslims have had difficulty recruiting participants.

METHOD

This article, which was part of a larger qualitative study, aimed to describe the effectiveness of targeted recruitment and data collection strategies in Muslim cancer survivors. The purpose of the larger qualitative study was to gain an understanding of the experiences of Muslim cancer survivors in the United States. Four recruitment approaches were implemented to determine timeliness, diversity in respondents, and success in completing the interview.

RESULTS

Eighteen Muslim cancer survivors participated (12 males, 6 females). Ten Muslim participants were identified by community leaders, two by posted flyers, four using social media, and two by a physician. No burden was voiced by participants related to length, time, or location of interviews.

DISCUSSION

We demonstrated the feasibility of recruiting and interviewing Muslim cancer survivors. Using culturally sensitive approaches is important to encourage recruitment and participation in studies of Muslim cancer survivors.

Culture Care Beliefs and Practices of Ethiopian Immigrants

INTRODUCTION

The purposes of this mini study were to identify and describe the culture care beliefs and practices of Ethiopian immigrants in the mid-Atlantic region of the United States and to advance the science of transcultural nursing.

METHODOLOGY

Leininger's theory of culture care diversity and universality guided the research and was the framework for the design of this qualitative ethnonursing mini study. Data were collected from 15 participants through in-depth interviews.

RESULTS

Five themes and 14 care patterns merged from the data, including preserving cultural heritage, supporting family and friends, importance of religion and prayer, valuing freedom, cultural caring, and therapeutic communication.

DISCUSSION

Participants valued health care and medical technology in the United States. They wanted nurses to inquire about their culture, language preference, food and dietary practices, and family dynamics. Perceived lack of caring by nurses and unavailability of interpreters in health care settings negatively affected access to care.

Marital Violence During War Conflict: The Lived Experience of Syrian Refugee Women

INTRODUCTION

Marital violence increases during times of war. This study aims to describe the lived experience of marital violence toward Syrian refugee women during the current war in Syria.

DESIGN

A descriptive phenomenological research methodology was used to conduct semistructured interviews with 16 purposively selected Syrian refugee women residing in displacement centers in Jordan. Colaizzi's steps of data analysis were used.

RESULTS

Four themes identified were identified: (1) Loss, insecurity, and suffering; (2) Shame and humiliation; (3) Justifying and enduring marital violence; and (4) Ways of coping with marital violence.

CONCLUSION

The Syrian War conflict changed women's lifeway and created a context for marital violence. Study findings suggests addressing marital violence during wartime and allocating resources to provide care and support of victims of violence in the displaced countries.

Culturally Relevant Palliative and End-of-Life Care for U.S. Indigenous Populations: An Integrative Review

PURPOSE

American Indians/Alaska Natives (AIs/ANs) have higher rates of chronic illness and lack access to palliative/end-of-life (EOL) care. This integrative review ascertained the state of the science on culturally acceptable palliative/EOL care options for Indigenous persons in the United States.

DESIGN

Databases searched: CINAHL, PubMed/MEDLINE, SocINDEX, PsycINFO, PsycARTICLES, ERIC, Health Source: Nursing/Academic Edition, and EBSCO Discovery Service 1880s-Present. Key terms used: palliative care, EOL care, and AI/AN.

INCLUSION CRITERIA

peer-reviewed articles published in English. Findings/Results: Twenty-nine articles were identified, 17 remained that described culturally specific palliative/EOL care for AIs/ANs. Synthesis revealed four themes: Communication, Cultural Awareness/Sensitivity, Community Guidance for Palliative/EOL Care Programs, Barriers and two subthemes: Trust/Respect and Mistrust.

DISCUSSION/CONCLUSION

Limitations are lack of research funding, geographic isolation, and stringent government requirements. Palliative/EOL care must draw on a different set of skills that honor care beyond cure provided in a culturally sensitive manner.

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.

Cancer Worry Among Urban Dominican Women: A Qualitative Study

BACKGROUND

Two thirds of respondents of a recent survey, primarily self-identified urban immigrant Dominican females, indicated that cancer was the health problem they worried about the most.

PURPOSE

The purpose of this qualitative study was to gain a greater understanding of the cancer worry experienced by Dominican women.

DESIGN

Giorgi's descriptive existential phenomenological framework and methodology guided the study.

SETTING

Washington Heights/Inwood community, New York City, New York.

PARTICIPANTS

Thirty-eight urban Dominican immigrant women were included in the study.

METHOD

Data were gathered using focus group interviews. All interviews were digitally recorded, transcribed verbatim from Spanish to English. The transcripts were analyzed using Giorgi's existential phenomenological data analysis process.

FINDINGS

Four essences unfolded: Cancer as Destiny, Faith, Influential Relationships, and Knowledge Acquisition.

CONCLUSION

New knowledge was generated on the contextual factors that influence cancer worry among a major Hispanic subgroup. Implications for nursing research and practice are described.

Community-Informed Health Promotion to Improve Health Behaviors in Honduras

BACKGROUND

Honduras is the second poorest country in Central America. The already high burden of disease is disproportionately worse among individuals with less education and limited access to health care. Community engagement is needed to bridge the gap in health care resources with the need for health promotion and education. Culturally relevant health promotion activities can foster transcultural partnerships.

PURPOSE

The purpose of this study was to partner nursing students with village leaders to assess a community's health needs and implement health promotion activities in Honduras.

DESIGN

Participatory action research was used in the study.

METHOD

U.S. nursing students ( n = 4) partnered with a nonprofit organization and community partners in Villa Soleada to interview mothers in Villa Soleada, a Honduran village of 44 families, and implement health promotion activities targeted to the health priorities of their families.

RESULTS

Structured interviews with 24 mothers identified gastrointestinal issues, health care access and quality, and malaria as the top three priorities. Ninety-two percent of respondents were interested in nurse-led health promotion. Activities engaged new community partners.

DISCUSSION

This partnership and learning model was well received and sustainable. The U.S. nurses involved in the partnership gained exposure to Honduran health issues and led locally tailored health promotions in Villa Soleada. The community's response to health promotion were positive and future activities were planned.

IMPLICATIONS

Nursing student's immersion experiences to support population-based health activities in low-resource settings are a replicable model that can help build healthier communities with a sustainable local infrastructure. Transcultural nursing experiences enhance students' perspectives, increase personal and professional development, strengthen nursing students' critical thinking skills, and for some students, confirm their desire to practice in an international arena.

Beliefs about diabetes and medication adherence among Lumbee Indians living in rural southeastern North Carolina

This study assessed personal beliefs about the causes and meaning of having diabetes among the members of the Lumbee Indian tribe living in rural southeastern North Carolina. The sample included 20 males (50%) and 20 females (50%); the mean duration of having diabetes was 9.82 years. The average body mass index (BMI) for females was 34.76 (range, 24.21-55.44), whereas the average BMI for males was 35.10 (range, 22.71-59.71). Ninety percent reported a family history of diabetes. The majority of participants held beliefs that diabetes was a serious and chronic condition and that the disease was amenable to personal control. Participants perceived that diabetic medications were an essential and effective part of their treatment regimen, and they reported greater comfort in adhering to prescribed medication regimens than making long-term lifestyle changes. This study highlights the high prevalence of diabetes among Lumbee Indians and also the need for future studies in this area.

Aging, Genetic Variations, and Ethnopharmacology: Building Cultural Competence Through Awareness of Drug Responses in Ethnic Minority Elders

Unique drug responses that may result in adverse events are among the ethnocultural differences described by the Agency for Healthcare Research and Quality. These differences, often attributed to a lack of adherence on the part of the older adult, may be linked to genetic variations that influence drug responses in different ethnic groups. The paucity of research coupled with a lack of knowledge among health care providers compound the problem, contributing to further disparities, especially in this era of personalized medicine and pharmacogenomics. This article examines how age-related changes and genetic differences influence variations in drug responses among older adults in unique ethnocultural groups. The article starts with an overview of age-related changes and ethnopharmacology, moves to describing genetic differences that affect drug responses, with a focus on medications commonly prescribed for older adults, and ends with application of these issues to culturally congruent health care.

Can Faith and Hospice Coexist: Is the African American Church the Key to Increased Hospice Utilization for African Americans?

African Americans are twice as likely as Caucasian Americans to choose aggressive hospital treatment when death is imminent. Repeat hospitalizations are traumatic for patients and drain patient and health system resources. Hospice care is a specialized alternative that vastly improves patient quality of life at end-of-life. This study was conducted to determine if hospices partnering with African American churches to disseminate hospice education materials could increase utilization of hospice services by African Americans. Members of two African American churches (N = 34) participated in focus group discussions to elicit beliefs about hospice care. Focus group transcripts were coded and comments were grouped according to theme. Six themes were identified. Lack of knowledge about hospice services and spiritual beliefs emerged as the top two contributing factors for underutilization of hospice services. Study findings support partnerships between hospices and African American churches to provide hospice education to the African American community.

Understanding Sociocultural Factors Contributing to HIV Risk Among Ayoreo Bolivian Sex Workers

The Bolivian indigenous Ayoreo ethnic people are vulnerable to sexually transmitted infections and HIV. Ayoreo women who also work in sex trades belong to an extremely high-risk group, and prevention programs are not delivering effective outcomes for them. The aim of our study was to explore, describe, and understand behavioral and cultural patterns related to sexual and reproductive health in Ayoreo sex workers. A qualitative-ethnographic study was designed; data were collected through participant observation and in-depth interviews with sex workers and key informants. Two fundamental themes contributing to HIV risk for female Ayoreo sex workers in Bolivia emerged: reproductive/sexual freedom and sociocultural risk determinants. We concluded that the in-depth examination of the sexual-reproductive culture amongst the Ayoreo has provided useful information, which might contribute to the cultural adaptation and design of future policies and prevention programs for sexually transmitted infections and HIV in this group.

Factors Associated With Healthy Lifestyle Behaviors in a Sample of Turkish Adolescents: A School-Based Study

PURPOSE

This was a descriptive-correlational study designed to determine factors associated with the healthy lifestyle behaviors of high school students in Turkey.

DESIGN

The study sample consisted of 812 high school adolescents. The Adolescent Lifestyle Profile scale was used to identify the healthy lifestyle behaviors of adolescents.

RESULTS

The total Adolescent Lifestyle Profile mean score of 2.75 ± 0.33 and the mean score on the Interpersonal relations subscale were found to be the highest scores while the mean score on the Health responsibility subscale was found to be the lowest. Significant predictors of healthy lifestyle behaviors of adolescents were good relationships with family and friends, having a father who was a college graduate, and good health perception.

CONCLUSIONS

The study revealed similar results among adolescents of different cultures.

IMPLICATIONS FOR PRACTICE

These findings can be used as a guide in developing an adolescent health promotion program for school nurses.

Does a Culture of Appalachia Truly Exist?

Some disagreement exists about whether an Appalachian culture exists. Common notions about Appalachia's people are tied to myths that disguise truths about those that claim a heritage tied to place. Living in the region is different from having multiple generations of ancestors and a family legacy associated with place. Conclusions suggest that cultural traits of some residents are recognizable as unique from others in the nation's mainstream, but they are not generalizable to all people living in the Appalachian region.

Nurses leading the fight against Ebola virus disease

The current Ebola crisis has sparked worldwide reaction of panic and disbelief in its wake as it decimated communities in West Africa, particularly in Guinea, Liberia, and Sierra Leone, including its health care workers. This article affirms the crucial role nurses play in maintaining health and preventing diseases, connects the devastating havoc of the Ebola virus disease to another issue of nursing shortage in underdeveloped countries, and asserts the key leadership nurses play in protecting the communities they serve while maintaining their safety and those of other health care workers. Nurses must actively seek a place at the table, as echoed by the American Academy of Nursing and American Nurses Association and the American Nurses Association, when decisions are being made regarding Ebola virus disease: at care settings, in the board room, and at federal, state, and local levels.

Guiding the Process of Culturally Competent Care With Hispanic Patients: A Grounded Theory Study

PURPOSE

To explore nursing care actions that lead to culturally competent care for Hispanic patients.

BACKGROUND

Nurses report apprehension when delivering nursing care because of language barriers and a lack of Hispanic cultural understanding. Research is needed to inform culturally aware nursing practice actions for Hispanic patients.

DESIGN

The study used a qualitative, grounded theory design to address the questions: (a) What cultural knowledge should nurses have when caring for Hispanic patients and families and (b) What nursing actions should nurses take to provide culturally competent care? Hispanic lay health promoters and Hispanic community members were interviewed to make recommendations for care.

RESULTS

A model was identified that informs culturally competent nursing care. "Connectedness," the central phenomenon, describes nursing actions and contains subthemes explaining influences on nursing care. "Up to You" and "At the Mercy of the System" are descriptive themes influencing connectedness.

CONCLUSION

Connectedness is central to culturally well-informed nurse-patient interactions.

Impermanence and Sense of Coherence: Lessons Learned From the Adaptive Behaviors of Sri Lankan Buddhist Nuns With a Chronic Illness

PURPOSE

The purpose of this study was to explore the influence of traditional Buddhist spiritual beliefs and practices on coping with chronic illness.

DESIGN

The study was a descriptive ethnography. Participant observation and semistructured interviews were used with 45 Sri Lankan Buddhist nuns with a chronic illness and 20 secondary informants. Cultural domains and taxonomies were explored to uncover themes pertaining to traditional Buddhist spirituality and experiences of chronic illness.

FINDINGS

A repeating cultural theme, responsibility, was identified. Responsibility took four forms: to the Buddha, to the social circle, to self-liberation through meditation, and to finding security in old age. Nuns shaped spiritual practices (some with folk origins) to fulfill these responsibilities. Coping ranged from health-seeking to resigned acceptance.

CONCLUSIONS

Responsibilities and coping were situated in a context of Buddhist spiritual beliefs about impermanence. Findings were congruent with Antonovsky's model of salutogenesis, in particular, the construct of sense of coherence.

Successful aging in the United States and China: a theoretical basis to guide nursing research, practice, and policy

Successful aging is gaining increasing attention given the growth in the older adult population. Criteria and definitions within multiple disciplines vary greatly in Western literature, with no consensus on its meaning. Sociocultural, economic, and political differences between the Western view of successful aging and its view in China add to the confusion. Similarities and differences in the meaning of successful aging in the United States and China are examined, and potential for a common definition useful to nursing in both countries is explored. Using concept analysis, shared criteria for successful aging were the following: decreased incidence of disease and disability, life satisfaction, meaning and purpose in life, and ability to cope effectively to achieve goals based on personal values and priorities. A comprehensive, multidimensional definition of successful aging for nursing and a midrange nursing theory of successful aging were identified that may be useful to guide nursing research, practice, and policy.

Cultural Awareness: Nursing Care of Iraqi Patients

PURPOSE

The aim of this study was to describe the cultural factors that have an impact on military nursing care for Iraqi patients. The results were part of a larger study in which the purpose was to understand nurses' experiences of delivery of care for Iraqi patients.

METHOD

Three focus groups, consisting of military registered nurses and licensed practical nurses, were used to generate rich descriptions of experiences in a military combat support hospital in Iraq. Data were analyzed using thematic analysis methods.

FINDINGS

Culturally, the differences between the Iraqi patients and the nurses included variations in communication, diet, and beliefs and values in reference to gender and patient dependency.

CONCLUSION

The findings indicated that the nurses need language skills and cultural customs and beliefs training to provide care to culturally diverse patients. In addition, support services, such as dieticians, need to be involved in the plan of care to address applicable cultural issues.

IMPLICATIONS

Implementation of learning to provide nurses language skills and cultural awareness of the diet, customs and beliefs of Iraqi people as well as the economic, political, and social factors that have an impact on their lives will promote quality nursing care and optimal health outcomes.

A Korean version of the Appraisal of Diabetes Scale (ADS-K): psychometric evaluation with a population of Koreans with type 2 diabetes

The purpose of this study was to evaluate the psychometric properties of the Appraisal of Diabetes Scale (ADS) in Korean patients with Type 2 diabetes. The English-language version of the ADS was translated into Korean using a forward-and-backward translation technique. The Korean version of the ADS (ADS-K) was administered to 250 patients who were recruited from two university hospitals. The data were analyzed using principal-component analysis, Cronbach's alpha, analysis of variance, t test, and Pearson's correlation. Six of seven items were meaningfully clustered into a two-factor structure by principal-component analysis, these factors accounting for 63.75% of the total variance. The underlying structure was consistent regardless of either gender or the presence of complications. The Cronbach's alpha of the subscales ranged from .71 to .79, indicating an acceptable internal consistency reliability. As hypothesized, the ADS-K score was moderately correlated with the diabetes-specific quality of life and had satisfactory convergent validity. The known-groups validity of the ADS-K was established using depression groups and HbA1c control status. The ADS-K demonstrated good psychometric properties. In addition, it possessed satisfactory practical properties, such as acceptability and feasibility. Therefore, the ADS-K appears to be suitable for use in both clinical research and clinical practice.

Evaluation of the spoken knowledge in low literacy in diabetes scale for use with Mexican Americans

PURPOSE

This article evaluates the Spoken Knowledge in Low Literacy in Diabetes (SKILLD) questionnaire, a measure of essential knowledge for type 2 diabetes self-management, after it was modified for English- and Spanish-speaking Mexican Americans.

METHOD

We collected surveys (SKILLD, demographic, acculturation) and blood for A1C analysis from 72 community-recruited participants to analyze the SKILLD's internal consistency, interrater reliability, item analysis, and construct validity. Clinical experts evaluated content validity.

RESULTS

The SKILLD demonstrated low internal consistency but high interrater reliability and content and construct validity. There were significant correlations in expected directions between SKILLD scores and acculturation, education, and A1C and significant differences in SKILLD scores between and within groups after an educational intervention and between high- and low-acculturated participants.

CONCLUSION/IMPLICATIONS

The SKILLD generates useful information about Mexican Americans' diabetes knowledge. Lower SKILLD scores suggest less diabetes knowledge, lower health literacy, and participants' difficulties understanding items. Further modifications should improve use with low-acculturated Mexican Americans.

Risk factors for coronary heart disease among Asian Indians living in Australia

The aim of this study was to assess the coronary heart disease risk factors in the Asian Indian community living in a large city in Australia. A cross-sectional survey was conducted at the Australia India Friendship Fair in 2010. All people of Asian Indian descent who attended the Fair and visited the health promotion stall were eligible to participate in the study if they self-identified as of Asian Indian origin, were aged between 18 and 80 years, and were able to speak English. Blood pressure, blood glucose, waist circumference, height, and weight were measured by a health professional. Smoking, cholesterol levels, and physical activity status were obtained through self-reports. Data were analyzed for 169 participants. More than a third of the participants under the age of 65 years had high blood pressure. Prevalence of diabetes (16%) and obesity (61%) was significantly higher compared with the national average. Ten women identified themselves as smokers. Physical activity patterns were similar to that of the wider Australian population. The study has provided a platform for raising awareness among nurses and promoting advocacy on the cardiovascular risk among Asian Indians. Strategies involving Asian Indian nurses and other Asian Indian health professionals as well as support from the private and public sectors can assist in the reduction of the coronary heart disease risk factors among this extremely susceptible population.

The relationship between select demographic characteristics and body mass index among Native Hawaiian and other Pacific Islander caregiving adults

PURPOSE

Native Hawaiian and other Pacific Islanders (NHOPIs) have the highest prevalence of overweight and obesity in the world. We identified the proportion of our NHOPI sample in each body mass index (BMI) category and explored relationships between BMI and demographic characteristics.

DESIGN/METHOD

Our descriptive correlational study included 364 NHOPI caregiver adults in Utah (n = 155) and Hawaii (n = 209). We gathered demographic information with a questionnaire. Height and weight were measured for BMI calculations.

RESULTS

According to the Centers for Disease Control and Prevention's BMI categories, 84.3% of our sample was overweight or obese. Participants in Utah had significantly higher BMIs than participants in Hawaii. Educational attainment was inversely related with BMI; however, age, gender, and income were not significantly related with BMI.

DISCUSSION

NHOPIs on the U.S. mainland may be at greater risk for obesity than those in Hawaii; food price differences between locations may help explain this. NHOPIs in early adulthood had high BMIs; overtime this situation could worsen without intervention.

IMPLICATIONS FOR PRACTICE

NHOPIs with low education levels or in areas of low food prices are at increased risk for obesity. Future research should focus on culturally sensitive interventions to reduce NHOPI obesity and associated risks.

Factors that influence mammography use among older American Indian and Alaska Native women

INTRODUCTION

American Indian and Alaska Native (AIAN) women have relatively high breast cancer mortality rates despite the availability of free or low-cost screening.

PURPOSE

This qualitative study explored issues that influence the participation of older AIAN women in mammography screening through tribally directed National Breast and Cervical Cancer Early Detection Programs (NBCCEDPs).

METHODS

We interviewed staff (n = 12) representing five tribal NBCCEDPs and conducted four focus groups with AIAN women ages 50 to 80 years (n = 33).

RESULTS

Our analysis identified four main areas of factors that predispose, enable, or reinforce decisions around mammography: financial issues and personal investments, program characteristics including direct services and education, access issues such as transportation, and comfort zone topics that include cultural or community-wide norms regarding cancer prevention.

CONCLUSION

This study has implications for nurse education and training on delivering effective mammography services and preventive cancer outreach and education programs in AIAN communities.

Breast cancer in African Americans: from patient to survivor

PURPOSE

The purpose of this synthesis is to explore the experience of the transition from cancer patient to survivor in African Americans with breast cancer, addressing the risk/ protective factors that have an influence on successful transition using the social ecological model.

METHODS

The investigator searched CINAHL, PubMed, and PsycInfo databases. Articles were assessed for content addressing risk and protective factors of transition in African American breast cancer survivorship. Eleven research articles were obtained and synthesized.

RESULTS

Risk and protective factors exist at all levels of the social ecological model. Emotional issues are prevalent after the cessation of cancer treatment, enhanced by the lack of social support in this population. Spirituality was shown to be present in many levels as a protective factor during this period.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The entrance to survivorship represents a time of increased stressors and subsequent coping. Through careful identification of influencing factors, health care providers can develop strategies to attenuate the emotional distress and negative complications of the transition specific to this vulnerable population. Illuminating the experiences of African American women during this transition period provides insight into the interventional needs during and after the cessation of breast cancer treatment.

A Comprehensive Approach to Risk Reduction for Asian and Pacific Islander American Women With HIV/AIDS

As HIV incidence rises globally, Asian and Pacific Islander communities are increasingly affected. While often overlooked, Asian and Pacific Islander American women have shown the greatest percentage increase in HIV diagnosis rates. The development of a multilevel and multistrategy approach to HIV/AIDS education, prevention, and treatment among Asian and Pacific Islander females requires health care providers to identify personal and cultural barriers to prevention and treatment and implement culturally sensitive and specific measures. The purpose of this article is to illuminate barriers to HIV-related prevention, treatment, and care among Asian and Pacific Islander American females and provide practical application-based suggestions for providers, which may enhance Asian and Pacific Islander female inclusion in comprehensive HIV prevention.

Acculturation and its implications on parenting for Chinese immigrants: a systematic review

PURPOSE

To systematically review and synthesize existing findings on acculturation and its implications on parenting for Chinese immigrants.

METHOD

Three electronic databases were searched for original research articles that examined acculturation and its influence on parenting in Chinese immigrants.

RESULTS

Twenty-two studies were included. Findings suggest that acculturation influences parenting beliefs, attitudes, and practices, as well as parent-child relationships among Chinese immigrants. Acculturation discrepancies between parents and children are associated with negative child outcomes.

DISCUSSION AND CONCLUSIONS

Further research is needed to better understand the relationships among acculturation and parenting perceptions, parent-child relationships, and parent-child acculturation discrepancies and associated child outcomes. In particular, longitudinal studies with larger samples and multiple methods are needed to suggest causal inferences and validate these relationships.

IMPLICATIONS FOR PRACTICE

Nurses are at the unique junction to identify these problems through interacting with individuals and families at the clinical and mental/community health levels.