Lauren Clark

Perceived home care needs of cancer patients and their caregivers

The purpose of this study was to identify perceived home care needs of outpatients receiving treatment for cancer and their caregivers. The purposive subsample consisted of 16 subjects. 8 patients receiving treatment as outpatients and their 8 caregivers. Two interview guides, one for the patients and the other for their caregivers, were based on the Neuman Systems Model to assess patient and caregiver stressors (1). The data were analyzed in relation to intrapersonal stressors (within the individual), interpersonal stressors (between the individual and others), and extrapersonal stressors (between the individual and the environment) (1). Several stressors within each category were identified by both the patients and caregivers. Intrapersonal stressors included treatment uncertainty and role change, the interpersonal stressor of lack of social support, and the extrapersonal stressors of lack of transportation and limited finances. In addition, patients identified specific intrapersonal stressors in relation to their situation. These included assistance in coping with physical restrictions resulting in subsequent anger and depression. On the other hand, intrapersonal stressors identified by the caregivers included support in coping with the added responsibilities in relation to patient care, the fear of being alone, guilt, and the interpersonal stressor of limited knowledge regarding the patient situation. The stressors identified by both the patients and caregivers can serve as a beginning means to explore the needs encountered by this population group.

Using Focus Groups to Develop a Culturally Competent Diabetes Self-management Program for Mexican Americans

Purpose: The purpose of this study was to describe factors that facilitate or hinder diabetes self-management and elicit participants’ preferences and recommendations about the essential components of a culturally competent diabetes self-management program. Methods: Latino patients with type 2 diabetes and their family caregivers were interviewed in focus groups. Four focus groups consisted of patients, and 2 groups consisted of family caregivers for a total of 40 participants. Participants were assigned to groups based on break characteristics of gender and preferred language. Results: “Being in the dark” emerged as an important concern, and patient respondents wanted timely access to information that they deemed understandable about how to manage their diabetes. Family members’ support and understanding were crucial in maintaining lifestyle changes. Patient and family caregiver participants wanted a self-management program to incorporate information on how to modify traditional foods, home remedies, and stress management. Preferences for information delivery included group didactic and interactive sessions, written information, and videotapes. Higher technology strategies using computers were not seen as useful. Conclusions: Culturally competent diabetes self-management for Latinos should incorporate the family and include techniques for stress management as well as diet modification. Information delivery should include a variety of techniques.

Conceptualizing and critiquing culture in health research

Given the growing diversity of U.S. society, the federal mandates for health research with multicultural populations, and persistent confusion about the concept of culture, the purpose of this article is to present various definitions and biases of culture as found in current nursing research. By addressing various definitions and biases, the debates can help investigators become more culturally sensitive, avoid serious pitfalls, and eventually ensure the provision of culturally competent health care. Authors familiar with concepts of culture in research recommend investigators use culture in their health research, including strengthening research designs, embedding culture into research models, using culture-sensitive instruments, employing emic perspectives, and replicating interventions across diverse and changing populations.

Why patient summaries in electronic health records do not provide the cognitive support necessary for nurses’ handoffs on medical and surgical units: Insights from interviews and observations

Patient care handoffs are cognitively intense activities, especially on medical and surgical units where nurses synthesize information across an average of four to five patients every shift. The objective of this study was to examine handoffs and nurses’ use of computerized patient summary reports in an electronic health record after computerized provider order entry (CPOE) was installed. We observed and audio taped 93 patient handoffs on 25 occasions on 5 acute care units in 2 different facilities sharing a vendor’s electronic health record. We found that the computerized patient summary report and the electronic health record were minimally used during the handoff and that the existing patient summary reports did not provide adequate cognitive support for nurses. The patient summary reports were incomplete, rigid and did not offer “at a glance” information, or help nurses encode information. We make recommendations about a redesign of patient summary reports and technology to support the cognitive needs of nurses during handoffs at the change of shift.

Mexican-Origin Mothers’ Experiences Using Children’s Health Care Services:

A focused ethnographic study in an urban Latino community in the western United States describes Mexican-origin mothers’ experiences obtaining and using health services for their children. Repeated interviews with mothers, participant observation, and children’s medical records composed the data sources. Qualitative findings suggest access to health care begins in the household, where women negotiate a working diagnosis for the children’s illness with family members and coalesce support for health care seeking. Immigrant mothers described more barriers to children’s health care than more acculturated mothers. Quantitative analyses of medical records supported this finding, with children of the least acculturated mothers demonstrating fewer well-child visits, increased emergent visits, and lower levels of immunization completeness. The results suggest health care providers can better meet the needs of Latino families with children by offering better explanations about children’s diagnoses and treatment plans and demonstrating personalismo, or a friendly, kind, and social approach to care.

Pain assessment practices with nursing home residents.

The purpose of this research was to describe the kinds of pain assessments nursing home staff use with nursing home residents and the characteristics and behaviors of residents that staff consider as they assess pain. Twenty-one focus groups were held in 12 nursing homes. Nurses and other nursing home staff attended the focus groups. Coding techniques consistent with ethnographic methodology were used for data analysis. Four themes identified an underlying uncertainty in assessing residents’ pain, the staff relationship-centered approach to pain assessment, the resident cues that alert staff to pain, and residents’ characteristics important to the nursing assessment. Composition of focus groups made a difference in participation of certified nursing assistants in focus group discussion. Urban and rural differences were noted across the focus groups. Research is needed to further refine pain assessment techniques specifically for nursing home settings.

La Familia: methodological issues in the assessment of perinatal social support for Mexicanas living in the United States

Do Mexicanas receive social support from a close network of family and friends during the perinatal period? To answer this question, a longitudinal ethnographic study followed 28 urban Mexican-origin women living in the US from their last trimester of pregnancy through their first month post-partum. A total of 93 interviews with Mexicanas focused on health and social support. All of the women lived in a large western city in the US but varied in their acculturation and income levels. Analyses identified four social support themes from womens experience (the emic analysis) and four social support typologies from the researcher (etic) analyses. The kinds of support women described as emanating from their support networks were inductively identified as Helping with Daily Hassles, Showing Love and Understanding, Being There for Me, and My Family Failing Me. Approximately half of the women reported densely supportive networks. The other women were disconnected from their support networks, or dealt with antagonism or instability in their networks. Womens perceptions of social support differed from the judgements made by the researcher about received support. Specifically, women perceived more network members in the supportive category than did the researcher by a factor of 1.4, and fewer network members in the disconnected category by a factor of 0.7. From an emic perspective, women listed only half as many antagonistic network members compared to the etic analysis (a factor of 0.50). These emic/etic discrepancies complicate clinical assessment of social support, but suggest that data on social support should be collected as part of the clinical processes of perinatal risking. To enhance assessment of social support, a clinically relevant guide is proposed for use by practitioners caring for Mexicanas in the perinatal period.

What We Learned from a Photographic Component in a Study of Latino Children's Health

This article reviews the contributions of three different kinds of photographs taken in a study of Latino childrens health. The three photographic methods were photos of children taken by their mothers who were given disposable cameras, photos taken by research staff during regular home visits, and photos taken in a day-long period of intense observation. Using qualitative and quantitative comparisons of the photos generated by these methods, the authors conclude that the Day in the Life method—although the most expensive—also provided more new information. Specifically, the authors learned more about the childrens family relationships, feeding patterns, and the safety and stimulation of their home environments.

Nurses' Information Management and Use of Electronic Tools During Acute Care Handoffs

Little evidence is available about nurses’ use of electronic tools during handoffs. This qualitative study explored information management and use of electronic tools during nursing handoffs. The sample included 93 handoffs by 26 nurses on 5 medical/surgical units in 2 western hospitals with a robust electronic health record (EHR). Data collection included audiotaping handoffs, semi-structured interviews, observations, and fieldnotes. The dataset was inductively coded into 33 categories and 5 themes: good nurse expectations for handoffs, paper forms are best, information at a glance, only pertinent information please, and information tools that work. Two-thirds of the nurses abandoned use of the leadership-endorsed electronic handoff form, preferring personal paper forms. The findings suggest effective electronic solutions will require extensive contextually-based information, information integrated across EHR modules and portable, electronic support throughout shifts. This is a call to action for leaders and informaticists as they select and design future electronic tools.

Maternal responsibility for health in the household

Maternal responsibility for household health is a fusion of love and labor; affective concern for health coexists with health-related activities. I examined household health production experiences from the perspective of poor women living in the southwestern United States. The responsibilities described by poor Mexican American and Anglo American women for health in their households differed along cultural lines. The Mexican American women emphasized they were responsible for cures and for caregiving beyond the nuclear household. In comparison, Anglo American women stated they were responsible for prevention and minimized their health responsibilities outside their household. Negotiation of maternal health responsibility among household members generated conflict and divisiveness. Poor and minority womens experiences expand the traditional concept of self-care.