Sandra J. Mixer

Ethnonursing: A Qualitative Research Method for Studying Culturally Competent Care Across Disciplines

Nurse anthropologist, Madeleine Leininger, developed the culture care theory and ethnonursing research method to help researchers study transcultural human care phenomena and discover the knowledge nurses need to provide care in an increasingly multicultural world. The authors propose that the ethnonursing method can be useful for research that addresses providing care in other disciplines, including education, administration, physical, occupational, and speech therapy, social work, pharmacy, medicine, and other disciplines in which research findings have implications for human care and health. The authors discuss the culture care theory and describe the ethnonursing research methods enablers, data analysis phases, and qualitative evaluation criteria. The theory is presented as a guide for using research findings to design culturally competent and congruent care to promote well-being among diverse people, groups, communities, and institutions. Resources include a reference list of key source publications, a discussion of exemplar studies, and samples of a theory-based, open-ended interview guide and data coding system.

Emotional Intelligence: A Critical Evaluation of the Literature with Implications for Mental Health Nursing Leadership

Emotional intelligence (EI) is necessary for the development of interpersonal and professional competence in nurses. We argue that the concept of emotional intelligence has particular relevance for mental health nursing leadership. In this critique, we examine the recent empirical evidence (2010–2014) related to emotional intelligence, in general, and nursing, specifically. Correlations between emotional intelligence and better overall health, increased work satisfaction, higher spiritual well-being, and decreased risk of job burnout are noted. We offer suggestions for mental health nurse leaders in developing successful project management teams and improving retention of current leaders. We also provide suggestions for future research.

Developing a perinatal memory-making program at a children's hospital

Most pregnancies are a time of joy and anticipation, but unfortunately there are families who instead suffer one of lifes most difficult events: a perinatal loss. Although grief processes have some common aspects, grief over a child can be especially intense, and those grieving such a loss have unique needs. One of the things that nurses can do to assist families in these situations is to assist them by creating memories of their child to help ease perinatal grief. This article describes the Precious Prints Project, a perinatal memory-making program designed to comfort families grieving the loss of a child. We discuss the development and implementation of this project, explore the literature, and show the strategies used to address the challenges encountered.

Culturally Congruent End-of-Life Care for Rural Appalachian People and Their Families

While death is a universal human experience, the process of dying amplifies cultural similarities and differences. There is insufficient evidence about providing culturally congruent end-of-life care for rural Appalachians. Such care is satisfying and meaningful, fits with people’s daily lives, and helps them face death. This study addressed this knowledge gap, and its findings can serve as the basis for developing strategies to promote a satisfying death experience for people within this underserved cultural group. The purpose of this study was to describe generic (folk) and professional (nursing) factors that health care workers can apply to provide culturally congruent end-of-life care for people in the East Tennessee region of rural Appalachia. Guided by the culture care theory and the qualitative ethnonursing methodology, 15 participants (persons receiving hospice home care, family members, nurses, administrators, and interdisciplinary team members) were interviewed. Data were analyzed using the 4 phases of ethnonursing analysis. Themes abstracted address rural Appalachian culture care needs at end of life related to faith, family care, integrating generic/folk care with professional nursing care, and hospice care decision making. Recommended nursing interventions promote physical, emotional, and spiritual health; address health disparity; and aid in dignified death for rural Appalachian people and families.

USING PARTNERSHIPS TO ADVANCE NURSING PRACTICE AND EDUCATION: THE PRECIOUS PRINTS PROJECT

With the release of the Institute of Medicines (2011) Future of Nursing report, nursing leaders recognized that strong academic-practice partnerships are critical to advancing the reports recommendations. Using established principles for academic-practice partnerships, a manufacturer, childrens hospital, student nurses organization, and college of nursing created the Precious Prints Project (P(3)) to give families who have experienced the death of a child a sterling silver pendant of the childs fingerprint. This article outlines the background, implementation, and benefits of the P(3) partnership with the aim of encouraging readers to consider how similar programs might be implemented in their organizations. To date, the program has given pendants to more than 90 families. In addition, nurses and nursing students have been introduced to the provision of a tangible keepsake for families experiencing the loss of a child and participation in philanthropy and an academic practice partnership.

Profit Status and Delivery of Hospice Care for Infants: The Mediating Role of Pediatric Knowledge

BACKGROUND Infant mortality is a persistent problem in the United States, and yet, hospice care is rarely provided for infants at the end of life. OBJECTIVE To examine the influence of profit status on delivery of hospice care for infants, and to explore the mediating role of pediatric knowledge (pediatric program and pediatric knowledge) on the relationship between profit status and the delivery of infant care. METHODS Our study was a cross-sectional secondary analysis, using data from the 2008 California State Utilization Data File of Home Health Agencies and Hospice Facilities survey. RESULTS Of the hospices in the sample, 13% delivered care for infants. Nonprofit hospices were more likely to delivery care for infants (B=0.67, p<0.05), have a specialized pediatric program (B=0.85, p<0.05) and have more experience caring for pediatric patients (B=1.49, p<0.05). Regarding the mediator variables, hospices with a pediatric program were no more likely to deliver care to infants than hospices without a pediatric program (B=0.82, p>0.05). Experience with greater numbers of any pediatric patients facilitated the delivery of hospice infant care in nonprofits (B=0.86, p<0.05). CONCLUSION Hospices may need to explore ways to direct resources toward assisting hospice staff members in gaining pediatric experience.

Visual Literacy in the Online Environment

Visual literacy combines words and graphics to enhance learning. Students are immersed in digital literacy and multimodal learning; therefore, it is important for educators to embrace visual literacy and strike out beyond printed text, PowerPoint slides, and discussion boards. This article describes the use of visual literacy as a tool to enhance student learning. An example demonstrating the application of visual literacy to teach transcultural nursing in an online environment is provided. The Web site containing a copy of the visual literacy teaching tool is also available to readers.

The relationship between the nursing environment and delivering culturally sensitive perinatal hospice care

BACKGROUND Wide variations exist among perinatal hospices, and barriers to perinatal palliative care exist at the healthcare level. Research in the area of culturally sensitive perinatal palliative care has been scarce, a gap which this study addresses. OBJECTIVE To evaluate the relationship between the nurse work environment and the delivery of culturally sensitive perinatal hospice care. METHOD This retrospective, correlational study used data from the National Home and Hospice Care Survey, which includes a nationally representative sample of hospice care providers. A multivariate logistic regression model was used to estimate the relationship between the delivery of culturally sensitive care and the nurse work environment. RESULTS Accreditation, teaching status, and baccalaureate-prepared registered nurse staff had an impact on the provision of culturally sensitive perinatal care Conclusions: The hospice and nursing unit environments, specifically in regards to education and technology, may be important contributors to the delivery of culturally sensitive care.

The moral courage of nursing students who complete advance directives with homeless persons

Background: Homeless persons in the United States have disproportionately high rates of illness, injury, and mortality and tend to believe that the quality of their end-of-life care will be poor. No studies were found as to whether nurses or nursing students require moral courage to help homeless persons or members of any other demographic complete advance directives. Research hypothesis: We hypothesized that baccalaureate nursing students require moral courage to help homeless persons complete advance directives. Moral courage was defined as a trait of a person or an action that overcomes fears or other challenges to achieve something of great moral worth. Research design: The hypothesis was investigated through a qualitative descriptive study. Aside from the pre-selection of a single variable to study (i.e. moral courage), our investigation was a naturalistic inquiry with narrative hues insofar as it attended to specific words and phrases in the data that were associated with that variable. Participants and research context: A total of 15 baccalaureate nursing students at a public university in the United States responded to questionnaires that sought to elicit fears and other challenges that they both expected to experience and actually experienced while helping homeless persons complete advance directives at a local, non-profit service agency. Ethical considerations: The study was approved by the Internal Review Board of the authors’ university, and each participant signed an informed consent form, which stated that the study involved no reasonably foreseeable risks and that participation was voluntary. Findings: Before meeting with homeless persons, participants reported that they expected to experience two fears and a challenge: fear of behaving in ways that a homeless person would deem inappropriate, fear of discussing a homeless person’s dying and death, and the challenge of adequately conveying the advance directive’s meaning and accurately recording a homeless person’s end-of-life wishes. In contrast, after their meetings with homeless persons, relatively few participants reported having encountered those obstacles. So, while participants required moral courage to assist homeless persons with advance directives, they required greater moral courage as they anticipated their meetings than during those meetings. Discussion: Our study breaks new ground at the intersection of nursing, moral courage, and advance directives. It might also have important implications for how to improve the training that US nursing students receive before they provide this service. Conclusion: Our results cannot be generalized, but portions of our approach are likely to be transferable to similar social contexts. For example, because homeless persons are misunderstood and marginalized throughout the United States, our design for training nursing students to provide this service is also likely to be useful across the United States. Internationally, however, it is not yet known whether our participants’ fears and the challenge they faced are also experienced by those who assist homeless persons or members of other vulnerable populations in documenting healthcare wishes.

Home care for children with multiple complex chronic conditions at the end of life: The choice of hospice versus home health

ABSTRACT Families desire to bring their children home at end of life, and this creates a variety of unique care needs at home. This study analyzed the child and family factors associated with hospice versus home health care use in the last year of life among children with multiple complex chronic conditions. Using the Andersen Behavioral Healthcare Utilization Model, the predisposing, enabling, and need factors of the child and family were shown to be significant predictors of hospice and home health care use. Hospice and home health care have advantages, and families may wish to use the service that best fits their needs.