Cultural Influences on Childhood Obesity in Ethnic Minorities: A Qualitative Systematic Review

Introduction: Childhood obesity remains an unrelenting public health problem disproportionately affecting ethnic minorities. Although research has examined ethnicity as a factor of childhood obesity, few studies have examined cultural influences. The purpose of this systematic review was to examine the qualitative evidence of cultural influences on childhood obesity in ethnic minority groups. Methodology: Selective sampling of studies since 2008 yielded 251 articles. Twelve articles that addressed cultural influences on childhood obesity were identified for review. The Culture Care Theory Sunrise Enabler factors were used as an a priori framework for theme coding. Results: Nine themes emerged: child feeding, family, gender roles, food, healthy child appearance, physical activity, sedentary activity, food cost, and obesogenic environment. Discussion: Cultural care practices such as traditional foods and family meals are protective factors in childhood obesity and should be encouraged by nurses caring for and working with ethnic minority populations.

Home care for children with multiple complex chronic conditions at the end of life: The choice of hospice versus home health

Families desire to bring their children home at end of life, and this creates a variety of unique care needs at home. This study analyzed the child and family factors associated with hospice versus home health care use in the last year of life among children with multiple complex chronic conditions. Using the Andersen Behavioral Healthcare Utilization Model, the predisposing, enabling, and need factors of the child and family were shown to be significant predictors of hospice and home health care use. Hospice and home health care have advantages, and families may wish to use the service that best fits their needs.

Emotional Intelligence: A Critical Evaluation of the Literature with Implications for Mental Health Nursing Leadership

Emotional intelligence (EI) is necessary for the development of interpersonal and professional competence in nurses. We argue that the concept of emotional intelligence has particular relevance for mental health nursing leadership. In this critique, we examine the recent empirical evidence (2010-2014) related to emotional intelligence, in general, and nursing, specifically. Correlations between emotional intelligence and better overall health, increased work satisfaction, higher spiritual well-being, and decreased risk of job burnout are noted. We offer suggestions for mental health nurse leaders in developing successful project management teams and improving retention of current leaders. We also provide suggestions for future research.

The moral courage of nursing students who complete advance directives with homeless persons

Background:

Homeless persons in the United States have disproportionately high rates of illness, injury, and mortality and tend to believe that the quality of their end-of-life care will be poor. No studies were found as to whether nurses or nursing students require moral courage to help homeless persons or members of any other demographic complete advance directives.

Research hypothesis:

We hypothesized that baccalaureate nursing students require moral courage to help homeless persons complete advance directives. Moral courage was defined as a trait of a person or an action that overcomes fears or other challenges to achieve something of great moral worth.

Research design:

The hypothesis was investigated through a qualitative descriptive study. Aside from the pre-selection of a single variable to study (i.e. moral courage), our investigation was a naturalistic inquiry with narrative hues insofar as it attended to specific words and phrases in the data that were associated with that variable.

Participants and research context:

A total of 15 baccalaureate nursing students at a public university in the United States responded to questionnaires that sought to elicit fears and other challenges that they both expected to experience and actually experienced while helping homeless persons complete advance directives at a local, non-profit service agency.

Ethical considerations:

The study was approved by the Internal Review Board of the authors’ university, and each participant signed an informed consent form, which stated that the study involved no reasonably foreseeable risks and that participation was voluntary.

Findings:

Before meeting with homeless persons, participants reported that they expected to experience two fears and a challenge: fear of behaving in ways that a homeless person would deem inappropriate, fear of discussing a homeless person’s dying and death, and the challenge of adequately conveying the advance directive’s meaning and accurately recording a homeless person’s end-of-life wishes. In contrast, after their meetings with homeless persons, relatively few participants reported having encountered those obstacles. So, while participants required moral courage to assist homeless persons with advance directives, they required greater moral courage as they anticipated their meetings than during those meetings.

Discussion:

Our study breaks new ground at the intersection of nursing, moral courage, and advance directives. It might also have important implications for how to improve the training that US nursing students receive before they provide this service.

Conclusion:

Our results cannot be generalized, but portions of our approach are likely to be transferable to similar social contexts. For example, because homeless persons are misunderstood and marginalized throughout the United States, our design for training nursing students to provide this service is also likely to be useful across the United States. Internationally, however, it is not yet known whether our participants’ fears and the challenge they faced are also experienced by those who assist homeless persons or members of other vulnerable populations in documenting healthcare wishes.

Cultural Aspects of End-of-Life Care Planning for African Americans: An Integrative Review of Literature

Advance directive completion rates among the general population are low. Studies report even lower completion rates among African Americans are affected by demographic variables, cultural distinctives related to patient autonomy, mistrust of the health care system, low health literacy, strong spiritual beliefs, desire for aggressive interventions, importance of family-communal decision making, and presence of comorbidities. An integrative review was conducted to synthesize nursing knowledge regarding cultural perspectives of end-of-life and advance care planning among African Americans. Twenty-four articles were reviewed. Nurses educate patients and families about end-of-life planning as mandated by the Patient Self-Determination Act of 1991. Implementation of advance directives promote patient and family centered care, and should be encouraged. Clinicians must be sensitive and respectful of values and practices of patients of diverse cultures, and initiate conversations with open-ended questions facilitating patient trust and sharing within the context of complex beliefs, traditions, and lifeways.

Use of the Culture Care Theory and ethnonursing method to discover how nursing faculty teach culture care

As the world becomes increasingly multicultural, transcultural nursing education is critical to ensuring a culturally competent workforce. This paper presents a comprehensive review of literature and results of an ethnonursing pilot study using the Culture Care Theory (CCT) to discover how nursing faculty teach culture care. The literature revealed that despite 50 years of transcultural nursing knowledge development through theory, research and practice, there remains a lack of formal, integrated culture education in nursing. The importance of faculty providing generic and professional care to nursing students and using an organising framework to teach culture care was discovered. Additionally, care was essential for faculty health and well-being to enable faculty to teach culture care. This unique use of the theory and method demonstrates its usefulness in discovering and describing the complex nature of teaching culture care. Larger scale studies are predicted to further substantiate the CCT, building the discipline of nursing.

The relationship between the nursing environment and delivering culturally sensitive perinatal hospice care

BACKGROUND

Wide variations exist among perinatal hospices, and barriers to perinatal palliative care exist at the healthcare level. Research in the area of culturally sensitive perinatal palliative care has been scarce, a gap which this study addresses.

OBJECTIVE

To evaluate the relationship between the nurse work environment and the delivery of culturally sensitive perinatal hospice care.

METHOD

This retrospective, correlational study used data from the National Home and Hospice Care Survey, which includes a nationally representative sample of hospice care providers. A multivariate logistic regression model was used to estimate the relationship between the delivery of culturally sensitive care and the nurse work environment.

RESULTS

Accreditation, teaching status, and baccalaureate-prepared registered nurse staff had an impact on the provision of culturally sensitive perinatal care Conclusions: The hospice and nursing unit environments, specifically in regards to education and technology, may be important contributors to the delivery of culturally sensitive care.

Using partnerships to advance nursing practice and education: the precious prints project

With the release of the Institute of Medicine's (2011) Future of Nursing report, nursing leaders recognized that strong academic-practice partnerships are critical to advancing the report's recommendations. Using established principles for academic-practice partnerships, a manufacturer, children's hospital, student nurses organization, and college of nursing created the Precious Prints Project (P(3)) to give families who have experienced the death of a child a sterling silver pendant of the child's fingerprint. This article outlines the background, implementation, and benefits of the P(3) partnership with the aim of encouraging readers to consider how similar programs might be implemented in their organizations. To date, the program has given pendants to more than 90 families. In addition, nurses and nursing students have been introduced to the provision of a tangible keepsake for families experiencing the loss of a child and participation in philanthropy and an academic practice partnership.

The Effect of Pediatric Knowledge on Hospice Care Costs

The cost of hospice care is rising. Although providing care for children at end of life may be costly for hospices, it is unclear whether or not gaining pediatric knowledge and even establishing a pediatric program may be done cost effectively. The purpose of our study was to examine the effect of possessing pediatric knowledge (i.e., pediatric program, pediatric experience) on core hospice care costs. Using 2002 to 2008 California hospice data, the findings of the regression analysis suggest that having pediatric knowledge does not significantly increase nursing, physician, and medical social service costs. Having a pediatric program was related to increased counseling costs. Our findings shed important light on the minimal costs incurred when hospices decide to develop pediatric knowledge.

Transforming RN Roles in Community-Based Integrated Primary Care (TRIP): Background and Content

Given the large body of evidence linking physical and mental health and the impetus provided by health care reform and the Affordable Care Act, the time is ripe to engage nurses in community based, integrated primary care teams to holistically address psychiatric, mental health and substance abuse needs. There is a compelling need for curricular redesign and clinical innovation to prepare an RN workforce for practice in community based integrated primary care teams. To that end, a faculty team of primary care, interprofessional education and content experts developed the Transforming RN Roles in Community Based Integrated Primary Care (TRIP) program for BSN students in a large university in the southeastern United States. The primary goals of the TRIP program are to build/implement an innovative BSN curriculum and expand our academic practice partnership by enhancing student clinical experiences with the goal of preparing an RN workforce for practice in community based integrated care teams. The TRIP program incorporates didactic, simulation and clinical components. Our first student cohort began the TRIP program in the fall of 2018 and will complete the program in spring 2020. In this paper, we provide details about the background, content and activities of this 4-semester (2 year) program.

Exploring faculty health and wellbeing: creating a caring scholarly community

BACKGROUND

Nursing educators worldwide are challenged to integrate the care of culturally diverse people into coursework to prepare a nursing workforce to deliver culturally congruent care (CCC). Care that recipients consider safe, satisfying, and beneficial is the essence of CCC. To effectively teach and role model such care for students, it is important for faculty to experience it at work. While substantive literature exists on promoting health, wellbeing, and a healthy work environment for nurses in practice, there is a limited focus on these topics for nursing faculty.

PURPOSE

The purpose of this study was to discover care practices that helped faculty teach students to provide CCC. This article reports' findings related to the theme that care is essential for the health and wellbeing of general nursing faculty who prepare students to provide CCC.

THEORETICAL FRAMEWORK AND METHOD

This qualitative ethnonursing research study, guided by the culture care theory, used open-ended interviews to discover care practices that enhanced faculty's ability to teach students to provide CCC. The study was conducted in two public university baccalaureate nursing programs in urban and rural settings in the Southeastern United States. Purposive sampling was used to recruit 27 tenured, tenured-track, and clinical nursing faculty. Interview data were analyzed using Leininger's four phases of ethnonursing data analysis. Qualitative criteria were used to ensure rigor and included participant confirmation of patterns and themes.

FINDINGS AND DISCUSSION

Faculty health and wellbeing were described as embracing each other's cultural similarities and differences, caring for self, caring for others, offering respect, and engaging in mentoring/co-mentoring. Evidence-based recommendations to promote faculty health and wellbeing are presented. Creating a caring scholarly community that supports nursing faculty health and wellbeing provided essential support for faculty who prepared students, often through role modeling, to provide CCC.

A comparison of the nurse work environment between perinatal and non-perinatal hospice providers

BACKGROUND

Hospice nurses have a unique role in providing perinatal care, yet little is known about the work environment in which nurses provide care for families and infants at the end of life.

OBJECTIVE

To compare the nurse work environment between perinatal and non-perinatal hospices.

METHODS

Data from the 2007 US National Home and Hospice Care Survey was used. The sample included 526 US hospice agencies. Comparisons were calculated using the Pearson chi-square and Wald tests.

RESULTS

A majority of hospices provided perinatal care (60%). Compared with non-perinatal hospices, the perinatal nurse work environment had a significantly higher proportion of registered nurses (mean 0.87 vs mean 0.79), along with clinical nurse specialists and nurse practitioners to support them (95.6% vs 84.9%). Nurses within perinatal care providers worked in a climate of significantly greater safety (95.6% vs 84.9%) and technology (63.7% vs 47.1%).

CONCLUSIONS

Understanding the unique perinatal hospice nurse work environment may be essential for advancing knowledge and compassion for mothers and babies at the end of life.

The Influence of Nursing Unit Characteristics on RN Vacancies in Specialized Hospice and Palliative Care

The nursing shortage is projected to intensify in the United States. Organizations providing specialized hospice and palliative care will be particularly hard hit. The purpose of our study was to examine the influence of the nursing unit on registered nurse (RN) vacancies and test the moderating role of recruitment strategies in perinatal hospices. We estimated the association between the nursing unit and RN vacancies and tested the interaction effects of recruitment strategies (signing bonus and recruitment bonus). Our findings showed that increasing RN unit size and nursing leadership directly affected vacancies and that recruitment bonuses had stronger influence on reducing vacancies than signing bonuses. The findings offer critical insights for hospice administrators in attracting nurses among specialized hospice and palliative care providers.

Visual literacy in the online environment

Visual literacy combines words and graphics to enhance learning. Students are immersed in digital literacy and multimodal learning; therefore, it is important for educators to embrace visual literacy and strike out beyond printed text, PowerPoint slides, and discussion boards. This article describes the use of visual literacy as a tool to enhance student learning. An example demonstrating the application of visual literacy to teach transcultural nursing in an online environment is provided. The Web site containing a copy of the visual literacy teaching tool is also available to readers.

Nurses in Action: A Response to Cultural Care Challenges in a Pediatric Acute Care Setting

Culturally congruent care is satisfying, meaningful, fits with people's daily lives, and promotes their health and wellbeing. A group of staff nurses identified specific clinical challenges they faced in providing such care for Hispanic and underserved Caucasian children and families in the pediatric medical-surgical unit of an urban regional children's hospital in the southeastern U.S. To address these challenges, an academic-practice partnership was formed between a group of nurse managers and staff nurses at the children's hospital and nursing faculty and graduate students at a local, research-intensive public university. Using the culture care theory, the partners collaborated on a research study to discover knowledge that would help the nursing staff resolve the identified clinical challenges. Twelve families and 12 healthcare providers participated. Data analysis revealed five care factors that participants identified as most valuable: family, faith, communication, care integration, and meeting basic needs. These themes were used to formulate nursing actions that, when applied in daily practice, could facilitate the provision of culturally congruent care for these children and their families. The knowledge generated by this study also has implications for healthcare organizations, nursing educators, and academic-practice partnerships that seek to ensure the delivery of equitable care for all patients.

Influence of Spiritual Engagement on Appalachian Older Adults' Health: A Systematic Review

Appalachia leads the country in mortality related to chronic comorbidities, such as heart disease, cancer, depression, and suicide. Appalachian older adults experience disproportionate risks for poor health outcomes. Spirituality is integral to Appalachian culture, and many older adults use spiritual engagement (SE) to cope with health challenges. Despite these connections, there is limited evidence about SE and well-being in this population. Therefore, the current systematic review addresses the literature gap of how SE influences health of Appalachian older adults. Using thematic synthesis, we analyzed 11 qualitative and three mixed methods studies. Major findings indicate that SE positively impacts holistic health through adaptive coping, guided partnerships with God, decreased loneliness, and enhanced sense of purpose. Future studies could examine SE practices among diverse populations, SE virtual experiences, and SE nursing assessments. Understanding how SE influences health of Appalachian older adults could prepare nurses to reduce disparities and improve health outcomes for this vulnerable population. [Journal of Psychosocial Nursing and Mental Health Services, 61(5), 45-52.].

Discovery of the Meanings, Expressions, and Practices Related to Malaria Care Among the Maasai

Purpose: Although malaria is preventable and treatable, morbidity and mortality from this disease continue among the Maasai of Southern Kenya. Prior to this study, the Maasai’s generic and professional malaria care/cure practices were largely unknown. The purpose of this study was to discover, describe, and systematically analyze meanings, expressions, and practices that promote culturally congruent malaria care among this population. Design: The qualitative, ethnonursing research method was used to conduct in-depth examination of the Maasai ethnohistory and culture relevant to malaria care and analyze data from 48 interviews conducted in Maasailand. Findings: Guided by the “culture care theory,” four themes were discovered related to Maasai community, traditional, spiritual, and professional care/cure practices. These significant findings filled a research gap and contribute to nursing knowledge and caring practice. Practice Implications: These study findings have implications for culturally congruent malaria care education, practice, research, policy, and partnership with traditional and professional caregivers.

Transforming RN roles using an academic-practice partnership to improve healthcare access for underserved populations

There is a national call to improve healthcare access for underserved populations by preparing BSN students to practice at the full scope of their license in community-based, integrated primary care settings upon graduation. In response to this call, a robust academic-practice partnership-using interprofessional education and practice and primary care and leadership development- is preparing BSN students to practice in community-based integrated primary care settings where culturally diverse rural and urban underserved populations receive care. In this article, academic-practice partners describe the implementation, lessons learned, and initial outcomes of a grant-funded program that is transforming nursing education and practice. All partners viewed communication, collaboration, and flexibility as key to a successful partnership. Our work serves as a template to help others shift nursing culture to create a sustainable RN workforce prepared to improve the health and wellbeing of underserved populations.

Piloting the Transforming RN Roles in Community-Based Integrated Primary Care (TRIP): Student Responses

In this manuscript, we report the pilot results of the Transforming RN Roles in Community Based Integrated Primary Care (TRIP) undergraduate nursing curriculum. Junior nursing students participated in TRIP didactic, simulation and clinical activities and completed a focus group at the midpoint and conclusion of year one. Focus group themes addressed recruitment, understanding or primary care, connections between clinical and didactic, and team based care. TRIP offers the first comprehensive community based integrated primary care training for students in our region. Overall, the TRIP curriculum enhanced student learning and promoted leadership.

Community-Academic Partnership: Intervention to Prepare Community Members for the End-of-Life Journey

Despite research findings that rural Appalachians prefer to die at home, few people access palliative and hospice care services, and many report limited knowledge about palliative/end-of-life care resources. A community-academic partnership was formed to address this need. Train-the-trainer workshop and materials were co-developed. This study tested the feasibility and cultural acceptability of the training intervention to increase community members' knowledge about palliative/end-of-life care resources for East Tennessee Appalachian people. Community-based participatory research design and culture care theory guided the project, intervention, and research. After engaging in end-of-life training, participants completed a retrospective pretest-posttest survey. Paired samples t tests were used to compare knowledge before and after training. Means and standard deviations were used to report training material usefulness and cultural acceptability. Short-answer qualitative data were analyzed using content analysis. Sixty-six adults completed the survey. Ratings for training materials and cultural/theological acceptability were high. Participant knowledge rankings showed significant improvement after training at the P <.001 level. Qualitative feedback was positive. The training intervention was feasible, culturally acceptable, and effective for increasing East Tennessee Appalachian persons' palliative/end-of-life care knowledge. Community member expertise/collaboration integrated into every stage of the project is the bedrock of cultural acceptability and feasibility.

"Turn It over to God": Faith Enhances Mental Health of Rural Appalachian Older Adults

In Appalachia, rates of depression and suicidality are higher than national averages. Additional disparities of age, geographic isolation, economic distress, and mental healthcare provider shortages contribute to mental health challenges among rural Appalachian older adults (RAOAs). Based on ethnonursing research in East Tennessee, this article expands on findings about how RAOA faith beliefs and practices enhance mental health. Faith was found to decrease worry, improve coping, facilitate a sense of peace, and deepen thankfulness and joy. Implications for nursing practice and education indicate the importance of providing spiritual care to promote mental health and well-being for this vulnerable population.