Roberta Waite

Patient-provider race-concordance: does it matter in improving minority patients' health outcomes?

Objective. To understand if patient–provider race-concordance is associated with improved health outcomes for minorities. Design. A comprehensive review of published research literature (1980–2008) using MEDLINE, HealthSTAR, and CINAHL databases were conducted. Studies were included if they had at least one research question examining the effect of patient–provider race-concordance on minority patients’ health outcomes and pertained to minorities in the USA. The database search and data analysis were each independently conducted by two authors. The review was limited to data analysis in tabular and text format. A meta-analysis was not possible due to the discrepancy in methods and outcomes across studies. Results. Twenty-seven studies met the inclusion criteria. Combined, the studies were based on data from 56,276 patients and only 1,756 providers. Whites/Caucasians (37.6%) and Blacks/African Americans (31.5%), followed by Hispanics/Latinos (13.3%), and Asians/Pacific Islanders (4.3%) comprised the majority of the patient sample. The median sample of providers was only 16 for African Americans, 10 for Asians and two for Hispanics. The review presented mixed results. Of the 27 studies, patient–provider race-concordance was associated with positive health outcomes for minorities in only nine studies (33%), while eight studies (30%) found no association of race-concordance with the outcomes studied and 10 (37%) presented mixed findings. Analysis suggested that having a provider of same race did not improve ‘receipt of services’ for minorities. No clear pattern of findings emerged in the domains of healthcare utilization, patient–provider communication, preference, satisfaction, or perception of respect. Conclusions. There is inconclusive evidence to support that patient–provider race-concordance is associated with positive health outcomes for minorities. Studies were limited to four racial/ethnic groups and generally employed small samples of minorities. Further research is needed to understand what health outcomes may be more sensitive to cultural proximity between patients and providers, and what patient, provider and setting-level variables may moderate or mediate these outcomes.

Perspectives About Depression: Explanatory Models Among African-American Women

Depression is a costly illness, with broad social, economic and personal consequences. It affects many black women, yet only 7% of them receive traditional treatment. Given the chronic nature of depression and its broad impact on womens wellness, there is a need for more research examining both the conceptualization and the interpretation of depression within a socio-cultural context. This qualitative descriptive study used Kleinmans explanatory framework to capture focus group data from 14 African-American women recruited from a primary care center. Data was organized and managed with Atlas/ti 5.12, while content analysis was used to disclose the relevant themes presented in the paper.

The Gift of Listening: JUST Listening Strategies

The purpose of this paper is to examine how the simple act of listening deeply to patients serves as a potentially powerful tool in determining treatment plans, improving patient compliance, decreasing costs, increasing efficacy, and improving patient-practitioner relationships. Nonegoic listening is a transformative practice that can be integrated into clinical training and practice. A growing body of experiential and anecdotal evidence indicates that this is an area ripe for further investigation to enhance nursing interventions and cultural competencies. Given the significant role that advance practice nurses have in directing patient care, integrative listening can be valuable in shaping patient care.The purpose of this paper is to examine how the simple act of listening deeply to patients serves as a potentially powerful tool in determining treatment plans, improving patient compliance, decreasing costs, increasing efficacy, and improving patient-practitioner relationships. Nonegoic listening is a transformative practice that can be integrated into clinical training and practice. A growing body of experiential and anecdotal evidence indicates that this is an area ripe for further investigation to enhance nursing interventions and cultural competencies. Given the significant role that advance practice nurses have in directing patient care, integrative listening can be valuable in shaping patient care.

Exploring Depression Among a Cohort of African American Women

BACKGROUND: Depression is a chronic and disabling illness that occurs more often in women than men and commonly goes undetected and/or undertreated in African American women. Understanding sociocultural factors that may influence detection of depression is important for early intervention and treatment. OBJECTIVE: To improve understanding of how African American women articulate and conceptualize depression as well as how they manage depression in their daily life. This information can assist in detecting depression, which is requisite to accessing treatment. STUDY DESIGN: In accordance with this studys exploratory descriptive design, 36 African American women diagnosed with depression by a licensed mental health provider within the past year participated in five focus groups. RESULTS: Main themes included enduring the experience, revealing distress, and coping. CONCLUSION: Womens accounts of how they shaped their views and words used to communicate their depression were influenced by social and cultural experiences, values, and their knowledge about depression. J Am Psychiatr Nurses Assoc, 2007; 13(3), 161-169. DOI: 10.1177/1078390307304996

Assessment for and Response to Adverse Childhood Experiences

Literature strongly suggests that early exposure to adverse childhood experiences (ACEs) disrupts crucial normal stages of childhood development and predisposes these individuals to subsequent psychiatric sequelae. Even with these data, little is found in nursing literature that discusses ACEs and their impact on adult mental health. Therefore, the purpose of this article is to address how nurses approach communication with clients about and assess for traumatic life experiences. In addition, screening measures for ACEs will be presented, along with discussion about ethical responsibilities of health professionals and researchers in asking about abuse.

The Embodiment of Authentic Leadership

Development of student leadership capacity and efficacy is critical to the nursing profession, and vital to this process is a strong foundation in critical thinking that includes a depth of understanding of self (i.e., authentic leadership development). This article will (a) present a theoretical overview of authentic leadership as compared with other popular leadership theories, (b) provide an overview of development/implementation of an authentic leadership course, the first in a series of six one-credit courses as an integral component of the Macy Undergraduate Leadership Fellows Program for upper-level nursing students, and (c) discuss related implications for nursing education. Findings from an investigator-developed quantitative pre-post survey and qualitative evaluation questions are provided. Student feedback regarding the comprehensive nature of the course was extremely positive and affirmed the value of introspection associated with authentic leadership in ongoing personal and professional development. Critical pedagogy and action-oriented learning strategies also proved beneficial to student engagement.

An evolutionary concept analysis of school violence: From bullying to death

&NA; School violence has evolved into an identifiably pervasive public health problem. Adverse consequences of school violence vary from bullying to death. In 2007, 457,700 youth (ages 12–18) were victims of serious crimes with 34% occurring on school grounds or on the way to school. A concept analysis of school violence can expand and enhance awareness of the pervasive phenomenon of school violence. Rodgers and Knafl (1993) evolutionary concept analysis method was used to provide a guiding framework for examination of school violence. Related manuscripts from the extant interdisciplinary school violence literature were obtained from relevant health science databases, the Education Resources Information Center, and various governmental and specialty websites within the contemporary time frame of 2000–2010. Analysis revealed the enormous scope and complexity of the problem of school violence including bullying, physical fighting, weapon carrying, alcohol/substance use and street gang presence on school property, school‐associated violent death, safe schools legislation, and violence prevention strategies. Forensic nurses across practice settings are uniquely positioned to intervene to improve health of these youth through identification, assessment, treatment, and referral.

Explanatory Models and Help-Seeking Behavior for Attention-Deficit/Hyperactivity Disorder Among a Cohort of Postsecondary Students

The authors present findings from a qualitative descriptive study that explored how a diverse ethnic group of postsecondary students diagnosed with attention-deficit/hyperactivity disorder (ADHD) conceptualized their condition and how this conceptualization shaped their efforts to seek help. Kleinmans explanatory model, the organizing framework, called for participants to describe the etiology, symptom onset, pathophysiology, course, and treatment of ADHD. Twenty-seven participants from four academic institutions took part in the study. A common explanatory model of ADHD was not shared; however, gender and age differences were apparent. These finding have implications for nurses when providing culturally appropriate care to individuals with ADHD in their practice settings.

Psychiatric Nurses: Transitioning from Student to Advance Beginner RN

BACKGROUND: The transitional experience from student nurse to advance beginner registered nurse (RN) is met with significant stressors, challenges, rewards, and thrills. The process and experience undergone by the RN can be the deciding factor for his or her commitment to the profession. Identifying factors to enhance retention is critical given the nursing shortage and changes within the health care environment. OBJECTIVE: The purpose of this research was to describe and explore the transitional process and the lived experience of advance beginner nurses employed in mental health facilities. STUDY DESIGN: This was a qualitative study, which used a phenomenologic approach with audio-taped interviews of 15 nurses. RESULTS: There were significant variances regarding the nurses’ expectations, orientation process, responsibilities, and supportive interventions from colleagues. These participants identified several beneficial concepts that could mitigate negative affective states, which, in turn, may effectively reduce the premature exit of new nurses from the profession. CONCLUSIONS: The process of connecting educational experiences and practice was inadequate. However, participants identified strategies that might be useful in increasing retention and positively influencing the transitioning from student to RN.

Short-form mindfulness-based stress reduction reduces anxiety and improves health-related quality of life in an inner-city population.

Mindfulness-based stress reduction is a mindfulness-based intervention that is an effective treatment modality for many conditions including stress, anxiety, and depression. Using data from 23 patients who completed a short-form mindfulness-based stress reduction course at a federally qualified health center, a quasi-experimental design was used to assess the impact of participation on self-reported anxiety, stress, mindfulness, and quality of life. Mindfulness and stress showed improvements from pre- to posttests, but neither difference achieved statistical significance. Participants showed statistically significant decreases in anxiety (7-item Generalized Anxiety Disorder scale score: 7.8-4.4; P = .005) and improvements in health-related quality of life including the 36-item Medical Outcomes Study Short Form Health Survey Mental Component Summary (+9.1; P = .001), Physical Functioning (+6.6; P = .039), Vitality (+16.1; P = .001), Social Functioning (+16.9; P = .003), Role Physical (+16.8; P = .016), and Mental Health (+15.6; P < .001) subscales. These findings suggest that an abbreviated mindfulness-based stress reduction course can serve to reduce anxiety and improve quality of life in an underserved population.