Deborah Vincent

A feasibility study of a culturally tailored diabetes intervention for mexican americans

Latinos, the fastest growing minority group in the United States, are among the hardest hit by diabetes. Among Latinos, Mexican Americans have the highest rate (23.9%) of diabetes. Good self-management can improve glycemic control and decrease diabetes complications but can be challenging to achieve. The purpose of this study was to test the feasibility and examine the effects of a culturally tailored intervention for Mexican Americans with type 2 diabetes on outcomes of self-management. The study used a pretest/posttest control group design with 10 participants in each group (N = 17). Feasibility and acceptability of the tailored diabetes self-management program was assessed by examining ease of recruitment and retention rates. The behavioral outcomes of self-efficacy, diabetes knowledge and self-care measures, and the biologic outcomes of weight, body mass index, HbA1C, and blood glucose were used to examine intervention effectiveness. Successful recruitment of participants came from personal referrals from providers or the promotora. Retention rates were 100% for the intervention group and 80% for the control group. Findings suggest that the intervention had a positive clinical and statistical effect on diabetes knowledge, weight, and body mass index. Improvements were also noted in self-efficacy scores, blood glucose, and HbA1C, but these changes did not reach statistical significance. A culturally tailored diabetes self-management program may result in improved outcomes for Mexican Americans with type 2 diabetes.

The validity and reliability of a Spanish version of the summary of diabetes self-care activities questionnaire

Background: Translation of data collection instruments, paying careful attention to equivalency between the source and the target language, is important to obtain valid data collection instruments. Objective: To translate the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire (English) into Spanish and to evaluate the reliability and validity of the Spanish version. Methods: Translation and back-translation were used to develop the Spanish version of the SDSCA. The Spanish version of the SDSCA was reviewed by an expert panel for conceptual and content equivalence to the English version. Psychometric properties were assessed further by combining data from three studies that used the Spanish version as a data collection instrument. Results: Correlation of each item of the Spanish and English version of the SDSCA instrument ranged from .78 to 1.00, with no variability in the responses of 2 of the 12 items. Test-retest correlations for the SDSCA ranged from .51 to 1.00. Internal consistency (Cronbachs alpha) for the Spanish version was .68. Items loaded on three factors, with the factors accounting for 61% of the variance in SDSCA. Discussion: The findings for the psychometric properties of the Spanish version of the SDSCA questionnaire suggest that it has conceptual and content equivalency with the original English version and is valid and reliable. However, further testing with larger samples is required.

Culturally tailored education to promote lifestyle change in Mexican Americans with type 2 diabetes

Purpose: The purpose of this article is to report the results of a culturally tailored diabetes intervention for Mexican Americans on physical activity and to report the results of a focus group with intervention participants. Data sources: Seventeen Mexican American subjects with type 2 diabetes participated in the study. The study used a pretest/posttest control group design with 10 subjects in each group (N = 20). Outcome measures included the number of steps walked weekly, weight, and body mass index (BMI). Pedometers were used to measure the daily number of steps in the intervention group. A focus group provided data on participant satisfaction. Conclusions: Results suggest a positive effect of the intervention on physical activity level, weight, and sense of control over diabetes self‐management. Intervention participants had a statistically significant increase in the number of steps walked per day and a statistically significant mean weight loss of five pounds. Focus group results indicate that participants were satisfied with the culturally tailored intervention and that they and their families benefited from the intervention. Implications for practice: A culturally tailored diabetes self‐management program may result in improved outcomes for Mexican Americans with type 2 diabetes.

The dimensions of nursing surveillance: a concept analysis

AIM This paper is a report of an analysis of the concept of nursing surveillance. BACKGROUND Nursing surveillance, a primary function of acute care nurses, is critical to patient safety and outcomes. Although it has been associated with patient outcomes and organizational context of care, little knowledge has been generated about the conceptual and operational process of surveillance. DATA SOURCES A search using the CINAHL, Medline and PubMed databases was used to compile an international data set of 18 papers and 4 book chapters published from 1985 to 2009. REVIEW METHODS Rodgers evolutionary concept analysis techniques were used to analyse surveillance in a systems framework. This method focused the search to nursing surveillance (as opposed to other medical uses of the term) and used a theoretical framework to guide the analysis. RESULTS The examination of the literature clarifies the multifaceted nature of nursing surveillance in the acute care setting. Surveillance involves purposeful and ongoing acquisition, interpretation and synthesis of patient data for clinical decision-making. Behavioural activities and multiple cognitive processes are used in surveillance in order for the nurse to make decisions for patient safety and health maintenance. A systems approach to the analysis also demonstrates how organizational characteristics and contextual factors influence the process in the acute care environment. CONCLUSION This conceptual analysis describes the nature of the surveillance process and clarifies the concept for effective communication and future use in health services research.

Getting through birth in one piece: protecting the perineum.

PurposeTo identify factors related to perineal trauma in childbirth, replicating the work of Albers et al. (1996). Study Design and MethodA retrospective descriptive analysis of pregnancy and birth data recorded into the Nurse Midwifery Clinical Data Set for women (N = 510) with a singleton pregnancy and largely uncomplicated prenatal course. Prenatal care occurred at four prenatal clinics with births at a tertiary care facility during 1996–1997, with care provided by nurse midwifery faculty. Multivariate statistics detailed clinical characteristics associated with perineal trauma. ResultsEpisiotomy was related to parity, marital status, infant weight, fetal bradycardia, prolonged second stage labor, and lack of perineal care measures. Factors related to laceration were age, insurance status, and marital status. For all women, laceration was more likely when in lithotomy position for birth (p = .002) or when prolonged second stage labor occurred (p = .001). Factors that were protective against perineal trauma included massage, warm compress use, manual support, and birthing in the lateral position. Albers et al. (1996) found that ethnicity and education were related to episiotomy and that warm compresses were protective. In this study, use of oils/lubricants increased lacerations, as did lithotomy positioning. Laceration rates were similar in both studies. Episiotomy use was lower in this study. Clinical ImplicationsSide-lying position for birth and perineal support and compress use are important interventions for decreasing perineal trauma. Strategies to promote perineal integrity need to be implemented by nurses who provide prenatal education and care for the laboring woman.

The Effects of a Community-Based, Culturally Tailored Diabetes Prevention Intervention for High-Risk Adults of Mexican Descent

Purpose This article reports the results of a community-based, culturally tailored diabetes prevention program for overweight Mexican American adults on weight loss, waist circumference, diet and physical activity self-efficacy, and diet behaviors. Methods The intervention used content from the Diabetes Prevention Program but culturally tailored the delivery methods into a community-based program for Spanish-speaking adults of Mexican descent. The design was a randomized controlled trial (N = 58) comparing the effects of a 5-month educational intervention with an attention control group. The primary study outcome was weight loss. Secondary outcomes included change in waist circumference, body mass index, diet self-efficacy, and physical activity self-efficacy. Results There were significant intervention effects for weight, waist circumference, body mass index, and diet self-efficacy, with the intervention group doing better than the control group. These effects did not change over time. Conclusions Findings support the conclusion that a community-based, culturally tailored intervention is effective in reducing diabetes risk factors in a 5-month program.

Challenges and Success of Recruiting and Retention for a Culturally Tailored Diabetes Prevention Program for Adults of Mexican Descent

Purpose The purpose of this article is to describe methods used to recruit and retain high-risk, Spanish-speaking adults of Mexican origin in a randomized clinical trial that adapts Diabetes Prevention Program (DPP) content into a community-based, culturally tailored intervention. Methods Multiple passive and active recruitment strategies were analyzed for effectiveness in reaching the recruitment goal. Of 91 potential participants assessed for eligibility, 58 participated in the study, with 38 in the intervention and 20 in the attention control group. The American Diabetes Association Risk Assessment Questionnaire, body mass index, and casual capillary blood glucose measures were used to determine eligibility. Results The recruitment goal of 50 individuals was met. Healthy living diabetes prevention presentations conducted at churches were the most successful recruiting strategy. The retention goal of 20 individuals was met for the intervention group. Weekly reminder calls were made by the promotora to each intervention participant, and homework assignments were successful in facilitating participant engagement. Conclusions A community advisory board made significant and crucial contributions to the recruitment strategies and refinement of the intervention. Results support the feasibility of adapting the DPP into a community-based intervention for reaching adults of Mexican origin at high risk for developing diabetes.

Affordable Care Act: Overview and Implications for Advancing Nursing

The Affordable Care Act (ACA) confronts nursing with opportunities as well as challenges. The authors provide an overview of the ACA and highlights opportunities for nursing practice, research, and doctoral education. The importance of disciplinary foundations is also addressed as relevant to envisioning the future of practice and education in the context of healthcare reform.

Treatment patterns and outcomes in a low-risk nurse-midwifery practice

Childbirth, which represents more than 20% of all hospitalizations for women, is often accompanied by technical intervention, and identifying best practices is crucial. This study analyzed data entered into the Nurse-Midwifery Clinical Data Set (ACNM, 1990) to ascertain treatment patterns and associated outcomes, using Kanes Model of Treatment and Outcomes (Kane, R. L. [1997]. Understanding health care outcomes research. Gaithersburg, MD: Aspen Publishers, Inc.). Low-risk women (N = 510) received prenatal care from nurse-midwives and delivered at a university facility. Significant relationships were found between patient characteristics (age) and clinical factors (parity, body mass index, number of prenatal visits, comorbidities) and between treatment interventions (activity, intake, invasive monitoring) and outcomes (infant Apgar scores, complications).

Down the rabbit hole: examining outcomes of nurse midwifery care.

Care of the laboring woman and subsequent birth interventions have generally been based on tradition rather than a systematic examination of the cost-effectiveness of the interventions. This retrospective study examined the outcomes of nurse midwifery care at a large metropolitan university clinic setting. Findings suggest that more sensitive cost and quality indicators of nurse midwifery care need to be developed, and the effect of these on outcomes needs to be elucidated.