Janet R. Katz

Community-based participatory research and American Indian/Alaska Native nurse practitioners: a partnership to promote adolescent health.

Purpose: To make recommendations for American Indian/Alaska Native (AI/AN) nurse practitioners (NPs) and university partners who are partnering on community‐based participatory (CBPR) research projects. An example of a CBPR study using focus groups to assess an important adolescent health problem is used to illustrate opportunities and challenges for AI/AN NPs. Data sources: Thirteen focus groups were held with 95 participants on the reservation where the AI/AN NP was a member and working. Results indicated that a majority of the community represented in the focus groups were concerned about substance abuse among its youth. Conclusions: The NP faced several challenges, including remembering emotional events recounted during focus groups differently than participants. This necessitated debriefing and a recommendation to carefully form policies and procedures before collecting data to anticipate such events. By far, the benefit of the NPs involvement was her ability to identify key members for focus groups, to assist in tribal council meetings, and to schedule meetings. Implications for practice: CBPR research partnerships are enhanced by NPs that are members of the community. CBPR partnerships present opportunities for NPs and university faculty to work on relevant community problems together.

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

Culturally Competent Care of Patients with Acute Chest Pain

Purpose To inform nurse practitioners (NPs) about the influence of culture on patients’ responses to pain using the example of acute chest pain. Data sources Selected clinical and research articles on pain and culture and the authors’ clinical experiences providing care across a variety of cultures. Conclusions There is very little written and even fewer studies on the connection of culture and the response to acute chest pain. This topic needs more attention by nurse researchers. Implications for practice If NPs are not aware that some patients may not demonstrate behavior typically expected in acute myocardial infarction, they may miss the diagnosis and fail to treat or refer these patients for immediate treatment.

Retention of native American nurses working in their communities

Purpose: The purpose of this study was to describe the experiences of Native American nurses working in their tribal communities to address retention. Design: An interpretive phenomenological study guided by a Native American research agenda and a Native American nursing practice model. Methods: In-depth interviews with nine Native American nurses were conducted. Data analysis used interpretive phenomenological procedures including an iterative process with Native American consultants and researchers to develop themes. Conclusions: Native American nurses experienced a great deal of stress and illness as they attempted to fulfill their mission to help their people. The three themes were: (a) paying the price to fulfill my mission, (b) being and connecting holistically, and (c) transcending the system. Recommendations include strategies for nurse educators, tracking the ethnicity of nurses in each Indian Health Service area, documenting their reasons for leaving, and conducting further research to develop community-based interventions to improve retention.

Measuring the Success of a Pipeline Program to Increase Nursing Workforce Diversity.

The purpose of this study was to understand changes in knowledge and opinions of underserved American Indian and Hispanic high school students after attending a 2-week summer pipeline program using and testing a pre/postsurvey. The research aims were to (a) psychometrically analyze the survey to determine if scale items could be summed to create a total scale score or subscale scores; (b) assess change in scores pre/postprogram; and (c) examine the survey to make suggestions for modifications and further testing to develop a valid tool to measure changes in student perceptions about going to college and nursing as a result of pipeline programs. Psychometric analysis indicated poor model fit for a 1-factor model for the total scale and majority of subscales. Nonparametric tests indicated statistically significant increases in 13 items and decreases in 2 items. Therefore, while total scores or subscale scores cannot be used to assess changes in perceptions from pre- to postprogram, the survey can be used to examine changes over time in each item. Student did not have an accurate view of nursing and college and underestimated support needed to attend college. However students realized that nursing was a profession with autonomy, respect, and honor.

Using the generative nursing model to reframe nursing student transition to practice.

New nurses are leaving hospitals in record numbers after fulfilling their initial employment obligations. Reasons for turnover relate to job dissatisfaction in the form of stressful working conditions, disempowerment, insufficient resources, difficult working relationships, and poor management. The authors discuss an approach for preparing students to manage factors that lead to burnout and new nurse turnover using the Generative Leadership Model as a framework.

A Systematic Review of the Literature on Screening for Exercise-Induced Asthma: Considerations for School Nurses.

Asthma is a major cause of illness, missed school days, and hospitalization in children. One type of asthma common in children is exercise-induced asthma (EIA). EIA causes airway narrowing with symptoms of cough and shortness of breath during exercise. The purpose of this article is to review the literature relevant to screening children and adolescents for EIA and to inform development of a school nurse–led EIA screening program. A systematic review of EIA screening tests was conducted by searching PUBMED for key terms. Sixty-seven articles were identified; after review only seven met the inclusion criteria. The most common screening test was the 6-min exercise challenge. School-based screening programs have the potential to identify EIA among undiagnosed children and adolescents. School nurses are health professionals with the knowledge and skills necessary to develop successful screening programs in the school setting. Based on results of the literature review, we present implications for developing screening programs in schools to identify children with undiagnosed EIA.

Nursing and health sciences workforce diversity research using PhotoVoice: a college and high school student participatory project.

This participatory study used PhotoVoice and qualitative description to (a) mentor baccalaureate nursing and college students in workforce diversity research; (b) explore barriers and facilitators encountered by rural American Indian, Hispanic, and other high school students when attending college and pursuing careers in nursing or the health sciences; and (c) model a process of social action to help existing and future students. Baccalaureate nursing and graduate students participated in all stages of research, including dissemination. Five themes emerged from analysis of PhotoVoice data: (a) being afraid; (b) believing; (c) taking small steps; (d) facing fears; and (e) using support systems. Findings underscore the importance of helping students participate in efforts to increase work-force diversity through research. Increasing nursing and health sciences workforce diversity may require strategies developed within and tailored to specific cultures and communities.

Creating a path: American Indian/Alaska Native high school students pursuing college and a career in nursing.

The purpose of this quantitative descriptive pre- and post-survey study was to analyze four years of data documenting differences in pre- and post-test responses by American Indian/Alaska Native high school students attending a weeklong residency program. The program was designed to provide information and role models to motivate students to go to college and pursue a career in nursing. The survey measured student perceptions of college and nursing. In addition, the analysis included comparisons of responses between students who lived on reservations and those who did not. Results demonstrated that students changed their views of nursing as a profession, how they would be perceived by their tribe, and the financial security they could gain. Students living on their reservations were concerned that college might be too far from home. Recommendations include the need to provide indigenous students with role models and accurate information as well as mentors to support them.

Case Study: Building Trust Among American Indian/Alaska Native Communities—Respect and Focus on Strengths

Maria, a community health registered nurse, was living in rural Northwestern USA. She was seeking a position in an Indian Health Services (IHS) clinic. Maria knew that Native Americans suffered some of the worst health disparities in the USA, as did most indigenous peoples around the world (Katz et al. 2016), and she wanted to help. Maria had met several Native American nurses when she was in school but had never talked to them about their communities. She would later see this as a great missed opportunity.