Marilyn K. Douglas

Standards of Practice for Culturally Competent Nursing Care 2011 Update

University of California, San Francisco, San Francisco, CA, USA Pierce and Associates Nursing Consultants, Knoxville, TN, USA Georgia Health Sciences University, Augusta, GA, USA University of Medicine and Dentistry of New Jersey, Newark, NJ, USA Brigham Young University, Provo, UT, USA California State University, Northridge, CA, USA Vanderbilt University, Nashville, TN, USA University of Toledo, Toledo, OH, USA University of St. Francis, Joliet, IL, USA University of Delaware, Newark, DE, USA

Differentiation between dyspnea and its affective components.

This study investigated whether people with chronic obstructive pulmonary disease (COPD) can differentiate distress and anxiety associated with dyspnea from the intensity of dyspnea and the perceived effort of breathing. Fifty-two subjects with COPD rated their perception of the individual components of dyspnea on a 200 mm visual analog scale at rest, after a 6-min walk (6MD), and every 2 min during an incremental treadmill test (ET). Subjects differentiated among the four dyspnea components at the end of the 6MD (p <.0001) and during ET (at rest, p < 0.001; at 75% V02 max, p < 0.0001; and at end exercise, p < 0.0001). Intensity was significantly related to perceived effort of breathing (p < .0001), as distress was to anxiety (p < .0001), suggesting that each pair measures similar components. Subjects were able to differentiate their affective response to dyspnea from the intensity of the symptom. Measurement of a patients affective response to dyspnea may improve the selection of specific treatments and validity of outcomes.

Standards of Practice for Culturally Competent Nursing Care: A Request for Comments

Authors’ Note: This document was developed through collaboration of members of The american academy of Nursing expert Panel on global Nursing and Health and The Transcultural Nursing Society, with participation by members of The american academy of Nursing expert Panel on Cultural Competence. Sharon M. Weinstein, MS, CRNI, RN, FaaN, Larry Purnell, PhD, RN, FaaN, Cheryl Leuning, PhD, RN, and Ruth Davidhizar, DNS, RN, aRNP, BC, FaaN, also participated in the discussion and critique during the development of this document. Standards of Practice for Culturally Competent Nursing Care: A Request for Comments

Nurse Coaching to Explore and Modify Patient Attitudinal Barriers Interfering With Effective Cancer Pain Management

PURPOSE/OBJECTIVES To describe a complex coaching intervention to help patients with cancer pain explore beliefs and attitudinal barriers interfering with pain management. Patients were coached to explore beliefs about pain, communications about pain management, and the use of analgesics and nonpharmacologic interventions. DATA SOURCES Published journal articles, abstracts, and psychology textbooks. DATA SYNTHESIS Personal beliefs, related attitudinal barriers, and associated behaviors impede patient adherence to and success with pain management treatments. Interventions targeting beliefs help patients overcome attitudinal barriers, improve treatment adherence, and obtain better pain relief. CONCLUSIONS Coaching patients to explore beliefs reduces ineffective behaviors and improves pain treatment adherence. IMPLICATIONS FOR NURSING A coaching intervention incorporating assessment of patient beliefs promotes self-management, self-efficacy, and adherence to pain management treatment plans. Advanced practice nurses should consider incorporating this intervention into their communications with patients experiencing cancer pain.

Treadmill Self-Efficacy and Walking Performance in Patients With COPD

As part of a larger ongoing study of nurse-coached practice with dyspnea, 52 subjects (25 men, 27 women) with moderate to severe COPD exercised on a treadmill three times a week for 4 weeks. Subjects were randomized into a coached exercise group, which received nurse coaching during exercise, and a

Symptoms and functional performance in Korean immigrants with asthma or chronic obstructive pulmonary disease.

OBJECTIVES People with chronic obstructive lung diseases often experience a variety of symptoms. Few studies, however, have described these symptoms in detail. This study sought to examine concurrent symptoms, symptom clusters, and the effects of symptoms on functioning in Korean immigrants with asthma or chronic obstructive pulmonary disease (COPD). METHODS Outpatients with asthma or COPD participated in this cross-sectional, correlational study. Symptoms, dyspnea, mood, and functional performance were assessed with questionnaires. Descriptive and inferential statistics were used to analyze the data. RESULTS The most frequently reported symptom was shortness of breath. Three factors emerged from 16 symptoms. Age, mean severity score of 7 symptoms, working status, level of acculturation, and level of education explained significant variance in functional performance. CONCLUSION The symptom cluster, consisting of 7 symptoms, showed the greatest effect on levels of functioning, which emphasizes the importance of assessment for coexisting symptoms in populations with these diseases.

The Relationship Between Posttraumatic Stress Disorder, Mood States, Functional Status, and Quality of Life in Oncology Outpatients

CONTEXT Oncology patients are at risk for developing posttraumatic stress disorder (PTSD) and other comorbid mood states, which are associated with decreases in functional status and quality of life (QOL). However, few studies have investigated the relationship between PTSD, other mood states, functional status, and QOL in oncology outpatients. OBJECTIVES This study had four aims: 1) determine the percentages of patients with PTSD and partial PTSD; 2) evaluate for differences in demographic and clinical characteristics among patients with PTSD, partial PTSD, and no PTSD; 3) evaluate for differences in mood states, functional status, and QOL among the three PTSD groups; and 4) evaluate whether demographic and disease characteristics were predictors of PTSD. METHODS As part of a larger clinical trial that evaluated the effects of a cognitive-behavioral intervention on cancer pain management, 289 adult oncology patients (M(age)=61.3, SD=11.6) completed self-report measures that assessed PTSD, other mood states, functional status, and QOL. RESULTS Forty-five percent of the sample met the diagnostic criteria for PTSD (n=78) and partial PTSD (n=53) and were younger than those with no PTSD. Patients with PTSD had a significantly lower Karnofsky Performance Status, shorter time since diagnosis, higher ratings of mood disturbance, lower ratings of functional status, and lower QOL than patients with no PTSD. A lower Karnofsky Performance Status, fewer months since diagnosis, and presence of bone metastases predicted a higher likelihood of being classified as having PTSD. CONCLUSION Early identification and interventions may mediate the onset of psychological distress and improve health outcomes.

Auxiliary nurses in Mexico: Impact of multiple roles on their health

As more women worldwide enter the labor force, debate has been generated over how this additional work role influences womens health. In this study, we explored the work, maternal, and spousal roles of 59 auxiliary nurses in two university-affiliated Mexican hospitals. Participants completed questionnaires that included demographics, a womens roles interview protocol, a self-rating of health status, and the Cornell Medical Index (CMI). No significant correlation was found between the perception of their health status and the number of roles, amount of role involvement, or their perceived levels of stress and satisfaction in any of their three roles. Work stress was significantly correlated with the number of physical symptoms (r = .30, p < .05), longer periods of standing (r = .31, p < .05), more muscle strain (r = .53, p < .01), eye problems (r = .43, p < .01), frequent changes in environmental temperature (r = .30, p < .05), and perceptions of economic inadequacy (r = .37, p < .01). Years of education was not related to any health measure or degree of stress or satisfaction in any of the roles. The greater the degree of role integration, that is, the greater the sum of satisfactions minus stresses of each role, the fewer the physical symptoms (r = .48, p < .05) and the fewer total symptoms (r = .43, p < .05) reported on the CMI. Those with more spousal stress reported more work-related muscle strain (r = .35, p < .05), and working mothers with three or more children tended to perceive themselves as less healthy (r = .75, p < .01). Thus, analyzing the interrelationship of womens multiple roles is a better predictor of health than examining specific role stresses in isolation.

Dyspnea Coping Strategies in Korean Immigrants With Asthma or Chronic Obstructive Pulmonary Disease

Purpose: Patients with lung disease develop coping strategies to relieve dyspnea. The coping strategies of Korean immigrants, however, are poorly understood. The purpose of this study was to describe the strategies that Korean immigrants with asthma or chronic obstructive pulmonary disease (COPD) use to cope with dyspnea and to compare similarities and differences in coping strategies between the two conditions. Design: Outpatients with asthma (n = 25) or COPD (n = 48) participated in a cross-sectional descriptive study. Method: Open-ended questions and a structured instrument were used to describe coping strategies for dyspnea. Descriptive and inferential statistics were used to analyze the data. Results: The most prevalent strategy was “I keep still or rest.” Korean immigrants also used traditional therapies to manage dyspnea. Conclusions: Although the coping strategies of Korean immigrants were similar to those of other ethnic groups, they incorporated elements of Asian medical practice and herbs. This finding enables health care providers to better understand Korean immigrants’ efforts to overcome dyspnea and to guide their patients’ approach to coping.

Standard della pratica per un’assistenza infermieristica culturalmente competente (Aggiornato al 2011)

The purpose of this document is to initiate a discussion of a set of universally applicable standards of practice for culturally competent care that nurses around the globe may use to guide clinical practice, research, education, and administration. The recipient of the nursing care described in these standards is assumed to be an individual, a family, a community,or a population. These standards are based on a framework of social justice (Rawls, 1971), that is, the belief that every individual and group is entitled to fair and equal rights and participation in social, educational, economic, and, specifically in this context, health care opportunities. Culturally competent care is informed by the principles of social justice and human rights regardless of social context. Through the application of the principles of social justice and the provision of culturally competent care, inequalities in health outcomes may be reduced.