Evelyn Ruiz Calvillo

Community-Based Approaches to Strengthen Cultural Competency in Nursing Education and Practice

This article explores existing informal as well as formal approaches that address health disparities in the communities where they occur, enhancing the opportunity to strengthen the cultural competency of providers, students, and faculty. A particular focus centers on the community-based participatory research approaches that involve community members, providing opportunities to develop mutually respectful, trusting relationships through co-teaching and co-learning experiences. With community-based participatory research approaches to community involvement in place, the stage is set for partnerships between communities and schools of nursing to collaboratively design, implement, and integrate informal and formal cultural competence components in nursing curricula.

Predictors of Successful Diabetes Management in Low-Income Hispanic People:

The specific aim of this predictive, correlational study was to test a culturally sensitive diabetes-specific health protection model to determine predictors of successful diabetes management in a newly diagnosed, type 2, low-income Hispanic population. Using a research-based Hispanic Health Protection Model (HHPM) as a framework, 240 adult participants with low levels of acculturation, strong beliefs about illness attribution and control of health, and low literacy levels were interviewed in a three-phase process over 4 to 6 months. The data analysis resulted in support of the HHPM based on relationships between 11 variables in four partial structural equation models, including lifestyle profile, acculturation, health beliefs, professional and social support, self-efficacy, diabetes knowledge, quality of life (self-satisfaction and impact of diabetes), and changes in hemoglobin a1c and body mass index. The study established carefully translated measures that held up to strong psychometric criteria. There was support for the HHPM for this population, and the results suggest future intervention with strengthening enablers, such as professional support and diabetes self-efficacy, in relation to this groups health beliefs.

A grounded theory of the process of adherence to oral chemotherapy in Hispanic and caucasian children and adolescents with acute lymphoblastic leukemia.

Children and adolescents with acute lymphoblastic leukemia (ALL) receive treatment that relies on daily self- or parent/caregiver-administered oral chemotherapy for approximately 2 years. Despite the fact that pediatric ALL is uniformly fatal without adequate treatment, nonadherence to oral chemotherapy has been observed in up to one third of patients. Little is known about the reasons for nonadherence in these patients. This study used Straussian grounded theory methodology to develop and validate a model to explain the process of adherence to oral chemotherapy in children and adolescents with ALL. Thirty-eight semistructured interviews (with 17 patients and 21 parents/caregivers) and 4 focused group discussions were conducted. Three stages were identified in the process of adherence: (a) Recognizing the Threat, (b) Taking Control, and (c) Managing for the Duration. Doing Our Part was identified as the core theme explaining the process of adherence and involves the parent (or patient) taking responsibility for assuring that medications are taken as prescribed. Understanding the association between taking oral chemotherapy and control/cure of leukemia (Making the Connection) appeared to mediate adherence behaviors.

Cultural Competencies for Graduate Nursing Education

Nursing is challenged to meet the health needs of ethnic and socioculturally diverse populations. To this end, American Association of Colleges of Nursing (AACN) charged an expert nursing faculty advisory group to formulate competencies for graduate nursing education, expanding them to integrate leadership and scholarship. The Cultural Competency in Baccalaureate Nursing Education served as the springboard for the initiative. In formulating the graduate cultural competencies and the toolkit, the advisory group reviewed all AACN Essentials documents and the cultural competency literature, drew upon their collective experiences with cultural diversity, and used cultural humility as the supporting framework. Six core competencies were formulated and endorsed by the AACN board of directors and key professional nursing organizations. A companion toolkit was compiled to provide resources for the implementation of the competencies. A 1-day conference was held in California to launch the cultural competencies and toolkit. Dissemination to graduate nursing programs is in process, with emphasis on faculty readiness to undertake this graduate educational transformation. The AACN Cultural Competencies for Graduate Nursing Education set national standards to prepare culturally competent nurses at the graduate level who will contribute to the elimination of health disparities through education, clinical practice, research, scholarship, and policy.

Predictors of diabetes outcomes in Mexico: testing the Hispanic health protection model.

Given the high morbidity and mortality rate of Hispanic immigrants to the United States, a study of the Hispanic Health Protection Model (HHPM) was replicated with 109 residents in Mexico who were newly diagnosed with diabetes. People with diabetes from rural clinics in Tlaxcala underwent a three-phase interview process with laboratory and weight follow-up over 4 to 6 months following a confirmed diagnosis of diabetes. This predictive, correlational study replicated the HHPM and the previous U.S. findings, including relationships between lifestyle profile, health beliefs, professional and social support, self-efficacy, diabetes knowledge, quality of life (self-satisfaction and impact of diabetes), and changes in HbA1c and body mass index. The study found that participants frequently followed good lifestyle practices while continuing to adhere to culturally based treatment and attribution beliefs. There were moderate perceptions of diabetes self-care efficacy, low ratings of support, very poor understanding of diabetes, continued obesity, acceptable quality of life ratings, and near-normal HbA1c levels.

The Adequacy and Scope of Roy's Adaptation Model to Guide Cross-Cultural Pain Research

The purpose of this study was to examine the adequacy (operational, empirical, and pragmatic) and scope of the Roy adaptation model and the gate control theory of pain to guide the cross-cultural study of pain. The sample consisted of 60 Mexican-American and Anglo American women undergoing elective cholecystectomy. The conceptual-theoretical-empirical structure developed by Fawcett and Downs (1986) provided the framework for designing the study. Operational adequacy was determined by examining the reliability and validity of the empirical indicators used; it was judged adequate. Empirical adequacy was evaluated by comparing empirical data to hypothesized expectations. Only some of the conceptualtheoretical relational statements were supported. Pragmatic adequacy was assessed by determining whether innovative practice strategies might be derived from the data; several were recommended. Finally, the scope was determined by examining the variables identified by the model and several additional variables. Scope was judged adequate to the current stage of the models development.

Using Culturally Competent Community-Based Participatory Research With Older Diabetic Chinese Americans: Lessons Learned

The purpose of this article is to share culturally competent strategies and lessons learned from a study that used a community-based participatory research (CBPR) approach with older adult diabetic Chinese Americans. This approach was essential to gain insight into the health beliefs, attitudes, and practices of selected communities. The vulnerable population conceptual model (VPCM) provided a framework for the study. The CBPR, a collaborative research approach, and the VPCM provided the basis for the development of culturally competent research strategies. Strategies and lessons learned to be particularly effective for this CBPR study included (a) developing an in-depth understanding of the community ethnic culture; (b) developing mutual respect and trust with community members and study participants; (c) appreciating and praising community partners’ knowledge, expertise, and experiences; (d) developing a sense of ownership by incorporating their needs, ideas, suggestions, and opinions and empowering study participants to make decisions concerning the study approach and wording; (e) soliciting participant feedback and clarification of study results and involving them in disseminating the study findings to their community; and (f) having fun with them and encouraging them to have fun.

Psyche and soma: susto and diabetes.

The field of mental health in the United States and Western countries has had a varied history in dealing with the issue of the separation of mind and body. Mental health practice has shifted back and forth from considering psychiatric illness as organic, as “purely psychological,” or as integrated, with therapies to match the respective conceptualization. Through the years, specialists in psychiatry have been separated from those in the rest of nursing and medicine, and treatment services have been housed separately. Currently under the influence of neuropsychiatry, mind and body are again merging together in psychiatric practice with the use of a combination of somatic and psychological assessments and therapies. At its most recent conference in Miami, Florida, the Academy of Nursing focused on integrating physical and mental health care. These developments recognize that the majority of today’s consumers of health care do not separate psyche and soma and seek treatment for a variety of symptoms from a single care provider. Despite the waxing and waning of opinion among professionals, many nonwestern cultures never joined in conceptualizing the mind and body as separate and always treated ailments as a unified whole with explanations, etiology, diagnosis, and treatments that addressed physical, psychological, spiritual, and social aspects of a disease. Diabetes and susto provide an excellent example for illustrating this viewpoint. Latinos make up the largest minority in the United States and in some areas have reached majority status. The largest percentage of Latinos in the U.S. is of Mexican origin. They have a disproportionate occurrence of type 2 diabetes relative to their numbers in the population. Mexican Americans diagnosed with diabetes often believe that a previous experience of susto caused their diabetes (Coronado et al., 2005; Jezewski &