Lydia DeSantis

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.

Building Healthy Communities with Immigrants and Refugees

Immigration fueled by large population shifts across international borders will be an ongoing phenomenon throughout the world for the foreseeable future. Forces raising concern for the development of healthy immigrant communities in the United States are the scapegoating of immigrants as the cause of many of the problems of society, a growing lack of tolerance for diversity, and the need for rapid acculturation. A construct of what constitutes healthy communities for immigrants is discussed. The construct is built around the concepts of convergent stereotyping, solidarity, and agency. To help build healthy communities, transcultural nurses must assist other nurses and health care providers to function from a transcultural posture to develop culture competence, reconceptualize how immigrants are viewed, avoid reductionism of the immigrant experience into a psycho-emotional phenomenon, and actualize human development as part of community development.

Brief History of Inclusion of Content on Culture in Nursing Education

Nursing has a long history of focusing on the cultural dimension of care, dating back to Florence Nightingale and the early days of public health nursing. Nursing education studies advocated for including social science concepts in nursing curricula well before the founding of the first university school of nursing in the United States in 1910. A brief review of the highlights of major nursing curriculum, licensing, funding, accreditation studies, and initiatives reveals that culture competence in nursing education continues to receive increasing emphasis and support.

Healing With Bach® Flower Essences: Testing a Complementary Therapy

Bach® Original Flower Essence (BFE) Rescue® Remedy, a modality used since 1930 but not yet thoroughly investigated scientifically, was evaluated for the reduction of acute situational stress. A double-blind clinical trial comparing a standard dosage of BFE Rescue Remedy against a placebo of identical appearance was conducted in a sample of 111 individuals aged 18 to 49, randomized into treatment (n = 53) and control (n = 58) groups. The Spielberger State-Trait Anxiety Inventory (STAI) was administered before and after the use of Rescue Remedy or placebo. Downward trends in anxiety level measurements were discovered in both the treatment (Rescue Remedy) and control (placebo) groups. Statistical analyses indicated that only the high-state anxiety treatment subgroup demonstrated a statistically significant difference between pretest and posttest scores. The results suggest that BFE Rescue Remedy may be effective in reducing high levels of situational anxiety.

Development of substantive theory in nursing

The lack of a comprehensive, substantive theory base has resulted in the profession of nursing borrowing theoretical assumptions, concepts, and research instruments from other disciplines to examine nursing phenomena. Nurse researchers have focused their attention primarily on applied research leaving the development of substantive theory to others. If the nursing profession is to develop a scientifically-based practice, nurses will need to engage in debates about the need for and methods of generating substantive theory and shift from the use of borrowed knowledge and methods to original nursing research. In order to broaden the theoretical conceptualisations and directions of nursing research for the development of a substantive theory base, multi-method perspectives are necessary. Triangulation of qualitative and quantitative methods is one way to design research that will allow for development of substantive theory through the use of multiple methodology. This paper describes one method of preparing doctoral nurse students for triangulation of methods and to develop substantive theory for nursing practice.

A model for counterparts in international nursing

The concept of counterpart is used by international health agencies to achieve the transfer of skills necessary for the ongoing viability of international nursing programs. The goal of the counterpart relationship is for the host group counterpart to assume responsibility for the project. The counterpart relationship is seen as a spectrum across which knowledge is transferred from counterpart to counterpart. Where each counterpart relationship falls on the spectrum depends on the degree of knowledge each brings to the relationship and changes across the life of the project. The tasks each counterpart must accomplish to ensure a successful relationship are illustrated by a faculty preparation program developed in the Peoples Republic of China.

Health care orientations of Cuban and Haitian immigrant mothers: Implications for health care professionals

In the mid 1980s health professionals interviewed Cuban and Haitian women in the Miami-Dade Florida area Florida to determine child rearing beliefs and practices and concepts of illnesses affecting their children <5 years old. Differences in health care orientations and actions existed between the Cuban and haitian mothers probably due to the interaction of these variables: educational and health care systems of the countries; political and socioeconomic situations; household structure and function; and beliefs about child behavior. Both parents made decisions about medical care for infants and children among the Cuban immigrants. Grandmothers assisted when the infants and children were ill. Yet Haitian mothers made most of the decisions about medical care. Further few grandmothers or other relatives could help with child care. Cuban mothers learned towards preventive health care because of the preventive care orientation in Cuba and they actively stimulated desired child behavior. On the other hand the Haitian mothers viewed all events (normal growth child development health and illness) as results of Gods will therefore nothing could be done to influence events. Yet they did believe in some control since they intervened when signs/symptoms emerged. The results showed health professionals that not all immigrant groups from developing countries and/or from lower socioeconomic groups operate from an ethnomedical health care orientation. Further if an immigrant indeed has such an orientation it does not always meant that he will not use the biomedical health care system. They should also put the health beliefs and practices in the sociocultural contexts of the country of origin and the recipient nation. They must also determine each persons individual explanatory model of the illness. In conclusion the process of determining culture specific care is similar regardless of ethnic group health care orientation or socioeconomic status.

Parental Attitudes Toward Adolescent Sexuality: Transcultural Perspectives

The problem of teenage pregnancy continues to impact private and public resources, affecting all socioeconomic and cultural groups. A key factor for nurse practitioners to consider when planning sex education programs is the differing parental attitudes toward teenage sexuality. These attitudes are especially important to keep in mind when dealing with parents from minority cultural groups, as these groups are often highly influential in determining the nature of adolescent sexual behavior and attitudes toward reproduction. A study of Cuban and Haitian child-rearing practices clearly demonstrates two divergent parental views of adolescent sexuality. Nurse practitioners must recognize these differing views, and individualize their approach, in order to develop culturally sensitive sex education programs for adolescents and their parents. Suggestions are provided for development of such programs for Cuban and Haitian parents and children.

Feeding and Weaning Practices of Cuban and Haitian Immigrant Mothers

The decline of breast feeding among immigrant mothers is of concern to transcultural nurses and other health care professionals. A descriptive survey of 30 Cuban and 30 Haitian immigrant mothers in South Florida explored their feeding and weaning beliefs and practices. Findings revealed that social, economic, and political factors in their country of origin and in South Florida affected their traditional health-culture beliefs and practices related to breast and bottle feeding and weaning, initial fluid intake, introduction of supplemental foods, and administration of vitamins, minerals, and medications. Implications for transcultural nursing care are presented.

Development of a nurse-instructor preparation program in China

Preparation of nurses to function as instructors in schools of nursing has proved a continuing problem in the effort to upgrade nursing and nursing education in third-world nations. Development of a nurse-instructor preparation program in China is discussed. Methods of adapting the program to local and national needs, abilities and resources are described along with the use of the counterpart concept to assure program continuation once foreign nurse-experts are no longer available. Use of a Phase Model program is seen as a method of maximizing use of nurse-consultants while alleviating their recruitment problems and preserving the continuity and integrity of the program.