Mary K. Canales

Othering: Toward an Understanding of Difference

This article proposes a theoretical framework for analyzing how we engage with Others, those perceived as different from self. This engagement, termed Othering, is presented as two particular processes: Exclusionary and Inclusionary. A theoretical framework is developed from a review of the literature and interpretations of completed research exploring the teaching practices of doctorally prepared Latina nursing faculty. Conceptualizing Othering as both exclusive and inclusive processes expands the boundaries for understanding and interacting with those perceived as different. Exclusionary Othering often utilizes the power within relationships for domination and subordination, whereas Inclusionary Othering attempts to utilize power within relationships for transformation and coalition building. The implications of this framework for nursing practice are addressed.

TAKING CARE OF SELF: HEALTH CARE DECISION MAKING OF AMERICAN INDIAN WOMEN

In this article, I report a component of a qualitative grounded theory study on health care decision making of American Indian women (AIW) residing in the Northeastern United States. Analysis was based upon data collected from 20 women who self-identified as American Indian. Taking care of self was a primary factor influencing health care decisions among this sample of AIW. As women moved between their Native, traditional health practices and conventional Western health practices, efforts toward taking care of self were especially salient. The properties of taking care of self include knowing family history; balancing mind, body, and spirit; understanding the body; and integrating natural practices. I also address some implications of the study findings for practitioners working with Native women.

Othering: difference understood??: a 10-year analysis and critique of the nursing literature.

It has been 10 years since Advances in Nursing Science (ANS) published the first article that articulated othering within a nursing framework. This issues topic, Critique and Replication, provided an opportunity for analysis of the influence of the original ANS article on the visibility and application of othering within nursing literature. Comprehensive searches of major health databases identified 32 publications citing the original ANS article. The analysis focused on exclusionary and inclusionary othering, role taking, and constructions of the other. Results indicate that although othering has become more visible within nursing literature, exclusionary othering dominates. The article concludes with thoughts for moving beyond othering and toward engagement.

Moving in Between Mammography: Screening Decisions of American Indian Women in Vermont

Breast cancer is a leading cause of cancer death among American Indian women, with mammography screening rates below the national average for this population. A grounded theory study, conducted with Vermont American Indian women, explicated factors that influence mammography decision making. The authors examined mammography decision making across the breast cancer screening continuum: women with a history of consistent annual mammograms, women who were under users or nonusers of mammography, and women who were breast cancer survivors. The generated theory, Moving in Between Mammography, describes the decision-making process and factors that influenced women’s participation in routine mammography screening. Specific influencing factors addressed include Connecting to Nativeness, Taking Care of Self, Financing Health Care, and (Mis)Trusting the Health Care System. Implications and directions for future research are addressed.

Creating a mentoring partnership model: a university-department of health experience.

The purpose of this project was to increase the number of students participating in public health nursing experiences at Vermont Department of Health through creation of a mentoring partnership model. The model targeted preceptor needs, including roles and responsibilities when working with students; educational needs of faculty, particularly related to evolving roles of public health nurses; and creation of additional clinical opportunities for students. Outcomes included improved working relationships among students, faculty, and public health mentors as measured by narrative evaluative comments of project participants; a 150% increase in the number of students participating in public health nursing clinical experiences; expanded involvement of Vermont Department of Health district offices and central office, with the addition of two new clinical sites and increased numbers of students in sites used prior to this project. Guidelines for preceptors working with students were also developed.

Striving for Congruence: The Interconnection Between Values, Practice, and Political Action

In the current U.S. health care system, both good health and a higher quality of health care are more likely to be experienced by those who have access to money, power, and privilege. Consequently, serious health disparities exist between the rich and poor, White people and people of color, and men and women. The American Association of Colleges of Nursing (AACN) has made explicit the values that form the cornerstone of professional nursing: altruism, autonomy, human dignity, integrity, and social justice. In this article, the authors explore the interconnections between values explicated by the AACN and nursing practices and policies. The authors draw on work in the field of pain management, cultural competency, and harm reduction as exemplars of this interconnection. The authors propose that through political action, nurses can strive for congruence between their professional values, practice, and policies and subsequently effect change and improve health outcomes.

Traditionality and Cancer Screening Practices Among American Indian Women in Vermont

The study purpose was to examine the relationship between cancer screening and traditionality, using a culturally specific survey instrument. American Indian (AI) women were randomly selected from the Vermont Breast Cancer Surveillance System (VBCSS), a statewide mammography database. The 13 items that assessed traditionality examined identity, cultural beliefs, customs, and health practices. The sample of 115 was predominately married, educated, middle class, insured, and rural. Significant associations were found between traditionality and past mammography and clinical breast examination (CBE) behavior, as well as future mammography intention. Results suggest that traditionality scales can be useful for identifying differences in screening behavior, with further testing of traditionality items with other AI women recommended. International implications of the study findings are also addressed.

Changes in newspaper coverage about hormone therapy with the release of new medical evidence.

BACKGROUND: Results of 2 trials of postmenopausal hormone therapy (HT) challenged established practice patterns; 1 was not associated with changes in HT use, whereas the other was associated with substantial decline. Differential coverage by lay newspapers may have contributed to the differential impact.OBJECTIVE: To examine newspaper coverage of HT before and after the publication of the Heart and Estrogen Replacement Study (HERS) in August 1998, and the main findings of the estrogen plus progestin therapy arm of the Women’s Health Initiative (EPT-WHI) in July 2002.DESIGN: Longitudinal review of newspaper articles, 1998 to 2003 (n=663).SETTING: Twenty local and 6 regional/national newspapers.MEASUREMENTS: Number and content of articles about HT.RESULTS: The average number of articles about HT published during the month of the publication of the EPT-WHI was at least 8-fold greater than the number of articles published on the topic during any prior period. While the majority of articles in all periods presented information about the potential benefits of HT, information about harms became more common than information about benefits during the 2 months before the publication of the EPT-WHI, when the trial participants were notified of the early termination of the study. The presentation of specific health harms was more common after the publication of the EPT-WHI than after the publication of HERS. Few articles in any period used visual aids.CONCLUSIONS: The publication of the EPT-WHI was associated with a change in both the volume and content of newspaper coverage about HT.

Of migrants and metaphors: disrupting discourses to welcome the stranger.

An increasing vitriolic anti-immigrant discourse has grown in media venues in the last several years, creating a climate of fear and hatred of immigrants that has spawned violence against some of them at individual and systemic levels. Historically, metaphors have been used to create a public acceptance of policies of discrimination, racism, and even genocide of targeted social groups, including immigrants. This article examines the use of such metaphors, juxtaposing an analysis of nursing journal articles regarding immigrant health, and of major nursing organizations for policy statements that might support immigrant healthcare.

Development of a culturally specific instrument for mammography screening: an example with American Indian women in Vermont.

This article presents the triangulation process for translating qualitative data about mammography screening from a grounded theory study with American Indian women in Vermont, into questionnaire items based on an existing model of behavior change, the Transtheoretical Model (TTM) Stages-of-Change. Qualitative data were used to derive a theory, Moving in Between Mammography, which suggested that traditionality influenced American Indian women’s screening decisions. To examine the relationship between mammography and traditionality, new items were developed for each of three key TTM constructs: Pros, Cons, and Processes-of-Change. The process for developing the new TTM-based items, as well as traditionality items specific for American Indian women living off-reservation, are presented. This article provides one example of how an instrument can be developed within a culturally competent nursing framework.