Doris M. Boutain

The Relationship between Racial Identity, Income, Stress and C-Reactive Protein among Parous Women: Implications for Preterm Birth Disparity Research

The persistent racial disparity in preterm birth (PTB)remains one of the most obvious yet poorly understood health disparities in the United States, and current evidence suggests that maternal stress, infection and inflammation may play an important role in the etiology of PTB. In this context, we assessed the complex relationships among racial identity; socioeconomic status (SES); psychosocial factors; and serum C-reactive protein (CRP), an inflammatory biomarker, among parous women in King County, WA. African-American women consistently reported a higher number of stressful life events than white American women (4.6 vs. 2.9, p < 0.001), as well as slightly higher levels of perceived stress and lower social support (24.7 vs. 22.2, p = 0.011, and 3.4 vs. 3.6, p = 0.06, respectively). In the multivariate analysis, African-American race, low-income status and their interaction were all independently associated with CRP; when further adjusted for proximal psychosocial, behavioral and infectious factors, race and income associations were significantly reduced. Stressful life events score was the single best proximal predictor of CRP levels (beta = 0.07 per event,p < 0.001), while perceived stress and social support were not significantly related to CRP. These results support the hypothesis that differences in CRP by racial identity and income may be mediated by differences in proximal risk factors, including stressful life events and health behaviors such as smoking. Objective life event stressors may be important to consider in future studies investigating a potential inflammatory etiology for preterm birth.

Critical Nursing Scholarship: Exploring Critical Social Theory with African American Studies

There is a need for nursing research that applies ideas gained from critical nursing scholarship, yet attends to the historical, cultural, and social context of clients analyzed through those frameworks. The revision of critical nursing scholarship to address multicultural perspectives on critical thought will significantly transform nursing knowledge development. This article first provides overviews about critical nursing scholarship and critical social theory. It then explores the union of critical social theory and African American studies. Ideas gained from the combination of critical social theory and African American studies are incorporated subsequently in discussions about the role of theory in representations of social identity, in the development of knowledge, and in the development of nursing research.

Critical Language and Discourse Study: Their Transformative Relevance for Critical Nursing Inquiry

A pragmatic view of language and a critical study of discourse can advance nursing inquiry toward the study of racism, heterosexism, classism, and health. In critical language inquiry notions about humans, health and illness are seen as constructed in societal discourses. Critical language inquiry challenges nurse researchers to theorize not which research questions to ask, but how to ask research questions that broaden knowledge about the interconnections among language, discourse, health, and society. Critical discourse analysis, as a methodology, can be of significant utility in exploring the relationships among health, discourse, power, and society.

Orienting Multiple Interviewers: The Use of an Interview Orientation and Standardized Interview

An interviewer orientation protocol and standardized interview can be an effective way of orienting multiple interviews to qualitative research. A standardized interview involves an actor taught to portray a research participant consistently in several interview encounters. In this article, the authors describe the interview protocol, and the development and application of a standardized interview. The benefits of using a standardized interview as a formative method to orient multiple interviewers include assessing the interviewers’ integration of the interview protocol, the nonverbal and verbal presentation of the interview process between interviewers, and the general flow of the interview from interviewer to interviewer. As more qualitative research is conducted using multiple interviewers, the method of an interview protocol and subsequent standardized interview might be helpful when orienting interviewers to the challenges and promises of conducting research using a critical framework.

Managerial and Organizational Discourses of Workplace Bullying.

OBJECTIVE: To explore how workplace bullying is addressed by hospital nursing unit managers and organizational policies. BACKGROUND: Although workplace bullying is costly to organizations, nurses report that managers do not consistently address the issue. METHODS: This study used discourse analysis to analyze interview data and policy documents. RESULTS: There were differences in the manner in which managers and the policy documents labeled bullying-type behaviors and discussed the roles and responsibilities of staff and managers. Policies did not clearly delineate how managers should respond to workplace bullying. CONCLUSIONS: These differences can allow management variation, not sanctioned by policy. Unclear policy language can also offer insufficient guidance to managers, resulting in differential enforcement of policies.

Pilot study of the Korean parent training program using a partial group-randomized experimental study.

PROBLEM Korean American (KA) parents need a culturally tailored parent training that helps them bridge the Korean and American cultures and divergent parenting practices. METHODS The Korean Parent Training Program (KPTP) was pilot tested with 48 KA mothers of children between 3 and 8 years old using a partial group-randomized controlled experimental study design. Researchers gathered self-report survey and observation data. FINDINGS Analyses, which used generalized estimating equations, indicated the intervention group mothers increased use of effective parenting practices and their children decreased behavioral problems and reported less acculturation conflict with their mothers. CONCLUSION The KPTP is a promising way to promote effective parenting and increase positive child mental health in KA families.

An investigation of organizational and regulatory discourses of workplace bullying

Organizations use policies to set standards for employee behaviors. Although many organizations have policies that address workplace bullying, previous studies have found that these policies affect neither workplace bullying for targets who are seeking assistance in ending the behaviors nor managers who must address incidents of bullying. This article presents the findings of a study that used critical discourse analysis to examine the language used in policies written by health care organizations and regulatory agencies to regulate workplace bullying. The findings suggest that the discussion of workplace bullying overlaps with discussions of disruptive behaviors and harassment. This lack of conceptual clarity can create difficulty for managers in identifying, naming, and disciplining incidents of workplace bullying. The documents also primarily discussed workplace bullying as a patient safety concern. This language is in conflict with organizations attending to worker well-being with regard to workplace bullying.

Unmet need for mental health and addictions care in urban community health clinics

OBJECTIVE To facilitate planning to improve care delivery in community health clinics, this study provides an in-depth description of the social, cultural, and organizational factors that create the context for mental health and addictions treatment delivery in this setting. METHODS Seventeen community health clinic providers and personnel were interviewed for 45-90 minutes with open-ended questions to elicit the context of their frontline provider experiences. Major themes and subthemes of responses were identified with content analysis. RESULTS Issues that create significant barriers to care included complex patient comorbidity and demographic characteristics; clinic organization, resources, and funding shortfalls; communication barriers with specialty mental health and addictions agencies; and stigmatizing aspects of mental health, addictions, and disadvantaged status. CONCLUSIONS The unique barriers to care in the community health care setting, as well as the unique characteristics of patients served, are likely to require context-specific solutions. These solutions will determine the viability of existing chronic disease management models, such as collaborative care, when applied to this setting.

Collective knowledge sharing as a social justice strategy: the difference it made in a service project about preterm birth disparity.

Knowledge about how health disparities are created and sustained from those affected is needed. Collective knowledge sharing is one way to redefine and revalue dialogue and critique processes with the aim of promoting just relationships of knowledge production. This article describes how a community service project focused on using collective knowledge sharing as a social justice strategy with health ministry volunteers produced insights about preterm birth disparity issues. Project insights related to (1) the connection between faith and health, (2) the significance of family and congregational stories, and (3) the importance of praising assets in the context of disparity recognition.

Nurturing educational multiculturalism in psychosocial nursing: Creating new possibilities through inclusive conversations

The increasingly diverse populations served by nurse practitioners require the preparation of graduate students with special emphasis on diversity issues that affect the mental and physical health of the underserved and populations of color. Although initiatives to recruit and retain a multicultural student group in nursing are not new, the current need to establish a diverse work force in nursing remains urgent given the changing demography within the United States. One challenge in nursing graduate education lies in the development of innovative ways to educate students committed to working with people of color and underserved populations in the area of psychosocial health. This article presents the theoretical underpinnings of, and practical strategies for, recruitment and retention developed by the Psychosocial Nurse Practitioner training grant team, in collaboration with others at the University of Washington School of Nursing. This program, partially funded by the Division of Nursing, Bureau of Health Professions, is designed to educate future nurse practitioners to work with clients and families who have comorbid psychiatric, substance abuse, and physical conditions.