Dula F. Pacquiao

Standards of Practice for Culturally Competent Nursing Care 2011 Update

University of California, San Francisco, San Francisco, CA, USA Pierce and Associates Nursing Consultants, Knoxville, TN, USA Georgia Health Sciences University, Augusta, GA, USA University of Medicine and Dentistry of New Jersey, Newark, NJ, USA Brigham Young University, Provo, UT, USA California State University, Northridge, CA, USA Vanderbilt University, Nashville, TN, USA University of Toledo, Toledo, OH, USA University of St. Francis, Joliet, IL, USA University of Delaware, Newark, DE, USA

The Relationship Between Cultural Competence Education and Increasing Diversity in Nursing Schools and Practice Settings

This article attempted to examine the relationship between cultural competence education and increasing diversity in nursing schools and practice settings. In addition to the review of the literature, a panel of experts was interviewed regarding institutional practices in response to the challenge of increasing diversity and cultural competence education. Evidence of positive outcomes of cultural competent care and impact of race and ethnic concordance between patients and providers are presented. The challenge of increasing underrepresented minorities in health care professions remains elusive. An ecological analysis is recommended to address the social and cultural barriers that transcend the micro system of the school and the macro system of the society. The challenge of increasing diversity and realizing outcomes of cultural competence education requires social and comprehensive remedies to level life inequities that perpetuate a history of disadvantages in some groups.

Manifestation, Attribution, and Coping With Depression Among Asian Indians From the Perspectives of Health Care Practitioners:

The study explores cultural influences on depression and care outcomes among Asian Indians with depression. Data were collected from interviews of 23 multidisciplinary mental health professionals and retrospective review of 20 medical records of patients. Findings revealed a major influence of social and cultural context in expression of symptoms, illness attribution, help-seeking behaviors, and communication patterns. Religious beliefs and social stigma attached to mental illness contributed to prolonged denial of condition, difficulty in sharing emotional problems with professional caregivers, and delayed professional intervention. The traditional family hierarchy rooted in age and gender inequality interfered with help-seeking behaviors and adherence to prescribed regimen as well as heightened some family conflicts and hindered family adaptation after migration to the United States.

Standards of Practice for Culturally Competent Nursing Care: A Request for Comments

Authors’ Note: This document was developed through collaboration of members of The american academy of Nursing expert Panel on global Nursing and Health and The Transcultural Nursing Society, with participation by members of The american academy of Nursing expert Panel on Cultural Competence. Sharon M. Weinstein, MS, CRNI, RN, FaaN, Larry Purnell, PhD, RN, FaaN, Cheryl Leuning, PhD, RN, and Ruth Davidhizar, DNS, RN, aRNP, BC, FaaN, also participated in the discussion and critique during the development of this document. Standards of Practice for Culturally Competent Nursing Care: A Request for Comments

Comparative study of meanings, beliefs, and practices of female circumcision among three Nigerian tribes in the United States and Nigeria.

The study was conducted to gain insight into the meanings, beliefs, and practices of female circumcision among three Nigerian tribes in the United States and Nigeria. Participant-observations occurred in three sites in Nigeria (Ibadan, Lagos, and Owerri) and in Essex County, New Jersey (Newark, Irvington, and East Orange). A total of 50 informants included adult males and females from the three main Nigerian ethnic tribes: Igbo, Yoruba, and Hausa. Leininger’s culture care theory of diversity and universality was the study framework. Findings revealed existence of similarities and differences in the cultural meanings, beliefs, and practices among the tribes. Religion, education, and occupation were significant factors influencing informants’ attitudes toward continuation of the practice. Government-sponsored public education and influence by the media were found to increase informants’ awareness of complications of female circumcision. Changes in attitudes toward the practice and use of alternative practices were evident.

Culturally Congruent End-of-Life Care for Jewish Patients and their Families:

This qualitative study was conducted to determine cultural influences in end-of-life care among Jewish people. The conceptual framework for this study was drawn from Leininger’s culture care theory. Informants consisted of 16 professional caregivers, family members, and rabbis who had experience with end-of-life care for Jewish patients. Interviews using open-ended and focused questions were used to gather informants’ descriptions of their generic values, beliefs, and practices. Findings revealed the strong influence of religious, cultural, and historical factors in caring. Sanctity of life and life promotion are central to Judaism. Caring is a communal obligation that unites the family and community into a cohesive unit. Attitudes toward death are influenced by beliefs about afterlife and suffering. The value put on expert knowledge influences patients’ and family members’ expectations of professional caregivers. Similarities and differences were noted among different groups of informants.

Transcultural Nursing Society Position Statement on Human Rights

In 2006, the Transcultural Nursing Society created a business plan with a firm commitment to social change and the support of human rights. One of the primary goals of the plan was to seek recognition from the United Nations as a Human Rights Organization. As a first step in articulating this goal, the board of trustees of TCNS tasked a small group of Transcultural Nursing Scholars to develop a position statement. This article is the culmination of the collaborative task forces efforts to define how TCNS seeks the fulfillment of human rights for people of all cultures worldwide.

Psychological and Mental Illness Among Elder Immigrants From the Former Soviet Union

The study examined the cultural context of psychological illness among elder immigrants from the former Soviet Union (FSU). Kleinman’s (1980) explanatory model of illness and Leininger’s theory of culture care (1997) provided the conceptual framework for the study. Participant Observations were conducted in an Adult Day Care Center and Senior Housing. Twenty-three key informants and 10 general informants participated. The social and historical context of the FSU influenced the meaning, attitudes, expressions, and coping strategies toward psychological and mental illness. Cultural stigma influenced the attribution of cause, somatic expression of symptoms, and attitudes toward seeking professional help. Psychological illness was unrecognized, whereas mental illness was viewed as lack of dusha (inner strength and moral character). Group differences were evident with ethnicity as a significant influence in symptom recognition, expression, and attitude toward seeking professional help.

A Community Survey on Neighborhood Violence, Park Use and Physical Activity Among Urban Youth

BACKGROUND Neighborhoods can be an important feature of the built environment influencing physical activity; however, neighborhood poverty and violence may pose significant barriers for youth physical activity. We conducted a community survey of 107 households with youth 3-12 years of age in select neighborhoods of the city of Newark, New Jersey, a highly impoverished and racially/ethnically segregated city of the United States. RESULTS The majority of sampled households did not have access to a park, and nearly 60% of youth were not engaged in a team or organized physical activity program. Hearing gunshots and seeing drug deals in the neighborhood were reported by 74% and 56%, respectively, of study participants. In adjusted regression models, a 1-unit increase in self-reported neighborhood safety was associated with perceptions that parks were safe for youth to use (OR = 1.7, CI = 1.3, 2.3) and increased odds of youth using parks (OR = 1.3, CI = 1.0, 1.6). Self-reported neighborhood violence was marginally associated with lower levels of Metabolic Equivalent (MET)-min/week of moderate PA (β = -54.25, P = .05). CONCLUSION To ensure national goals of increased physical activity and use of outdoor spaces, addressing the neighborhood contexts under which the most vulnerable of our youth live will be required.

Chapter 3: Theoretical Basis for Transcultural Care

Margaret Andrews, PhD, RN, CTN, FAAN1 Jeffrey R. Backstrand, PhD2 Joyceen S. Boyle, PhD, RN, CTN, FAAN3 Josepha Campinha-Bacote, PhD, MAR, PMHCNS-BC, CTN-A, FAAN4 Ruth E. Davidhizar, DNSc, RN, APRN, BC, FAAN (deceased)5 Dawn Doutrich, PhD, RN, CNS6 Mercedes Echevarria, DNP, APN7 Joyce Newman Giger, EdD, APRN, BC, FAAN8 Jody Glittenberg, PhD, RN, FAAN, TNS9 Carol Holtz, PhD, RN10 Marianne R. Jeffreys, EdD, RN11 Janet R. Katz, PhD, RN12 Marilyn R. McFarland, PhD, RN, FNP-BC, CTN-A13 Gloria J. McNeal, PhD, MSN, ACNS-BC, FAAN14 Dula F. Pacquiao, EdD, RN, CTN15 Irena Papadopoulos, PhD, MA, RN, RM, FHEA16 Larry Purnell, PhD, RN, FAAN17 Marilyn A. Ray, PhD, MA, RN, CTN-A18 Mary C. Sobralske, PhD, RN, CTN19 Rachel Spector, PhD, RN, CTN-A, FAAN20 Marian K. Yoder, EdD, RN21 Rick Zoucha, PhD, PMHCNS-BC, CTN22