Juliene G. Lipson

Current Approaches to Integrating Elements of Cultural Competence in Nursing Education

Cultural competence in nursing education is receiving renewed emphasis. Curricular input to incorporate such knowledge, attitudes, and skills encompasses a wide variety of teaching and learning methods. Five are described here: specialty focus, required courses, models, immersion experiences, and distance learning or simulation. Despite progress in incorporating cultural content into nursing curricula, several issues characterize all levels of nursing programs, including lack of consensus on what should be taught, lack of standards, limited and inconsistent formal evaluation of effectiveness, a decline of curricular specialty courses on culture, a focus on the microlevel of the nurse-patient encounter, and the need for, support of, and preparation of faculty.

Ethnicity and health among five Middle Eastern immigrant groups.

The relationships among immigration, ethnic identity, and health were investigated in subjects who emigrated from the Middle East to the United States. Egyptian, Yemeni, Iranian, Armenian, and Arab immigrants ( N = 88) were interviewed to determine the relationship among ethnic group (country/culture of origin), strength of ethnic identity (four factors and perceived ethnic identity), and mental and physical health (perceived health, physical and psychological symptoms, and morale). The findings show significant differences among the five groups on cultural attitudes, social attitudes, family orientation, the number of physical symptoms, the number of psychological symptoms, perceived health status and positive morale. Subjects who perceived themselves to be more traditionally ethnic tended to have more physical symptoms and less positive morale. Ethnic group accounted for a significant percentage of variance in positive morale and perceived health status. Ethnic identity accounted for a significant proportion of variance in physical symptoms. The results support the need for considering ethnic identity as well as country of origin in providing care for clients.

PREGNANCY, BIRTH, AND DISABILITY: WOMEN'S HEALTH CARE EXPERIENCES

This qualitative study examined the pregnancy, birth and postpartum experiences of 12 women with mobility-limiting physical disabilities. Analysis of semi-structured interviews of one to two hours revealed that the womens experiences were influenced by their own perspectives and the characteristics of health care system within which they were treated. The womans experience included the effect of her disability, her resources, and her personality and approach. Health care system factors included provider attitudes, knowledgeThis qualitative study examined the pregnancy, birth and postpartum experiences of 12 women with mobility-limiting physical disabilities. Analysis of semi-structured interviews of one to two hours revealed that the womens experiences were influenced by their own perspectives and the characteristics of health care system within which they were treated. The womans experience included the effect of her disability, her resources, and her personality and approach. Health care system factors included provider attitudes, knowledge about disability and structural and political factors. Implications for health care providers are described.

Assessing Arab-American health care needs

A health needs assessment was conducted with Arab-American immigrants in northern California. Data were obtained from community forums, key informants, the U.S. Census, and from a survey of 47 Arab immigrants. In the community forums, parenting difficulties, marital conflicts, and health risks were identified. Key informants (clergy, community leaders, health professionals) identified mental health problems related to child rearing, referrals for appropriate services, education to assist Arab women interface with the health and education systems, and translation and cultural interpretation for Arab patients and health care providers. Arab patients requesting health care identified referrals for appropriate care, advocacy, education about the medical regimen, and technical assistance obtaining care. Social indicators indicated potential needs for health services for those of lower income. A survey of 47 Arab-Americans indicated that predominant illnesses experienced in the past year were upper respiratory infections, cardiovascular and hypertension, diabetes, and family and social stress. Health-related problems reported most frequently were family stress, adjusting to the U.S., managing acute illness, coping with adolescents, and marital stress. For the most part, this group was satisfied with medical care received and stated that their most important health services were health education, availability of Arab speaking health providers, and referrals for appropriate treatment.

Psychological integration of the Cesarean birth experience.

A womans perception of her birth experience is likely to affect her psychological integration of it. This process may be prolonged and particularly difficult for cesarean mothers, whose number has been growing. Five phases of assimilation are outlined, and implications for health care professionals are presented.

The Cultural Context of Suicide Stigma in Taiwan

In the ethnographic study on which this article is based, the authors investigate experiences after a suicide attempt from the perspective of patients and their familymembers in Taiwan. Thirty-four patients and 49 family members or colleagues participated in interviews from the point of patients’ hospitalization to their return to the community. The postsuicide stigma suffered by patients and their families was based on such cultural themes as Suicide is bu-hsiao (non–filial piety), Suicide results in an inability to transmigrate the soul, and Suicide is inherited. Patients, family members, and colleagues cope with the stigma through explaining suicide as due to “bad luck” or “akan-huo (hot energy) problem,” or by insisting that it was “not a true suicide.” These findings suggest that health professionals can move closer to patients and their families and suggest appropriate health care policy through understanding the patient’s and the family’s explanation of suicide experiences.

An ethnographic study of a day care center for Iranian immigrant seniors.

Late-in-life immigrants are often at risk for psychological stress and social isolation because of language problems, small social networks, and cultural differences from the host society. Community intervention programs can reduce such stress and isolation. In this article, the authors describe a Swedish municipality’s culturally appropriate intervention program for elderly Iranian immigrants based on ethnographic data gathered during a 12 month period. The description includes the activities provided by the program and the experiences of the elderly Iranian immigrants who participate regularly in these activities. The findings document the positive impact of regular participation in the center’s activities on the elders’well-being and health.

Afghan refugees in California: Mental health issues.

Refugees are a particularly vulnerable population that is at risk for mental health problems for a variety of reasons: traumatic experiences in and escapes from their countries of origin, difficult camp or transit experiences, culture conflict and adjustment problems in the country of resettlement, and multiple losses--family members, country, and way of life. Afghan refugees comprise the largest refugee population in the world, at its peak numbering more than 6 million, living mainly in Pakistan and Iran. Based on an ethnographic study of Afghan refugees in Northern California, this article describes common antecedents to and examples of mental health problems in this population, such as depression, somatic symptoms, and posttraumatic stress disorder. It reviews some of the literature on traumatized refugees and makes some suggestions to mental health providers.

Bosnian and Soviet refugees' experiences with health care.

Studies of refugees in the United States rarely address health the first few years following resettlement in part because the refugees become subsumed under the foreign-born or immigrant category. A national study reaffirmed the so-called healthy immigrant effect, but fewer sick days and less physician use may actually reflect access problems, economic concerns, and health beliefs or practices that clash with American health care. Because statistics may mask differences in health and why people seek professional care, it is important to combine qualitative and quantitative approaches. This study examined health, illness, and health care use patterns of refugees in Northern California using a database analysis, a medical record review, and an ethnographic study of the Bosnian and former Soviet Union refugee communities. This article describes some ethnographic findings from participant observation, semistructured interviews, and focus groups, with an emphasis on peoples experiences with health care, health risk behaviors, and self-care.

Health issues among Afghan women in California

Afghan refugee women are part of the largest refugee population in the world. In the United States, they deal with loss of family members, property, and status and cultural, familial, religious, role, and generational conflict in making the transition from a traditional patriarchal society to a more egalitarian postindustrial society. Findings from a San Francisco Bay Area Afghan community health assessment conducted from 1992 to 1993 are presented. The assessment included 38 telephone interviews, seven community meetings, and a survey of 196 Afghan families. Six years of ethnographic study with more than 200 Afghans and their health providers provide contextual data. We describe cultural characteristics that influence womens access to health care, womens approach toward preventive care, control of information regarding sexuality, and spouse abuse.