Journal of Transcultural Nursing

Children in families with parents from refugee backgrounds are often viewed as a vulnerable group with increased risks of developing physical or psychological problems. However, there is very little research regarding the strategies that parents might use to parent their children in a new country while they also manage the interrelated challenges of poverty, social isolation, maternal stress, and mental ill health that often go along with resettlement. We explore the application of ecological modeling, specifically at individual, institutional, and policy levels, within an Australian context to critique the factors that shape the development of parenting capacity within refugee families settling in a new Western country. Ecological modeling enables examination of how public policy at local state and national levels influences the individual and family directly and through the organizations that are given the task of implementing many of the policy recommendations. Recommendations for health practice and research are made.

Purpose: The purpose of this synthesis is to explore the experience of the transition from cancer patient to survivor in African Americans with breast cancer, addressing the risk/ protective factors that have an influence on successful transition using the social ecological model. Methods: The investigator searched CINAHL, PubMed, and PsycInfo databases. Articles were assessed for content addressing risk and protective factors of transition in African American breast cancer survivorship. Eleven research articles were obtained and synthesized. Results: Risk and protective factors exist at all levels of the social ecological model. Emotional issues are prevalent after the cessation of cancer treatment, enhanced by the lack of social support in this population. Spirituality was shown to be present in many levels as a protective factor during this period. Conclusions and Implications for Practice: The entrance to survivorship represents a time of increased stressors and subsequent coping. Through careful identification of influencing factors, health care providers can develop strategies to attenuate the emotional distress and negative complications of the transition specific to this vulnerable population. Illuminating the experiences of African American women during this transition period provides insight into the interventional needs during and after the cessation of breast cancer treatment.

Purpose: To determine the community resources most often used, most needed, and most difficult to use for immigrants. Design: A naturalistic study using principles of community-based participatory research. Method: A group of 106 abused immigrant women were interviewed in person with the Community Agency Use, Frequency, Helpfulness, and Difficulty form as part of a 7-year prospective study. Results: The most frequently noted service needed most was counseling (n = 34, 33.0%) followed by legal services (n = 23, 22.3%) and social services (n = 13, 12.6%). Law enforcement was the most commonly used service (n = 63, 59.4%) and the most difficult to receive (n = 16, 48.5%). Counseling (n = 6, 18.2%) and legal services (n = 5, 15.2%) were also reported as difficult. Discussion: Law enforcement is often called on to help in partner violence, but immigrant women report difficulty in using this service. Conclusions: Abused immigrant women have risk factors for abuse, and they face barriers in accessing the services they need. Implications for Practice: It is important for service providers in the community to be aware of the unique challenges of abused immigrant women and to address their needs accordingly.

Purpose: To critically analyze the power relations underpinning New Zealand maternity, through analysis of discourses used by Korean migrant mothers. Design: Data from a focus group with Korean new mothers was subjected to a secondary analysis using a discourse analysis drawing on postcolonial feminist and Foucauldian theoretical ideas. Results: Korean mothers in the study framed the maternal body as an at-risk body, which meant that they struggled to fit into the local discursive landscape of maternity as empowering. They described feeling silenced, unrecognized, and uncared for. Discussion and Conclusions: The Korean mothers’ culturally different beliefs and practices were not incorporated into their care. They were interpellated into understanding themselves as problematic and othered, evidenced in their take up of marginalized discourses. Implications for Practice: Providing culturally safe services in maternity requires considering their affects on culturally different women and expanding the discourses that are available.

The purpose of this study was to explore diabetes self-management strategies and underpinnings of behaviors among Vietnamese with type 2 diabetes. Using Leventhal’s illness representation model, semistructured interviews were conducted with a convenience sample of 23 participants, 14 women and 9 men. NVivo 8 software was used for content analysis. Data revealed that participants constructed implicit theories of the identity, causes, consequences, timeline, and controllability of diabetes, which were inconsistent with the biomedical literature. Participants labeled diabetes by their symptoms of hypo-/hyperglycemia, and they focused on the relief of these symptoms. However, the participants’ focus on symptomatology undermined their use of blood glucose monitoring to manage diabetes as a majority of the participants had diabetes-related complications. Participants integrated the continuum of Eastern and Western treatment belief systems to achieve a balance to create harmony between the two systems.

Purpose: Substantial health disparities exist between Māori—the indigenous people of Aotearoa New Zealand—and non-Māori New Zealanders. This article explores the experience and impact of racism on Māori registered nurses within the New Zealand health system. Method: The narratives of 15 Māori registered nurses were analyzed to identify the effects of racism. This Māori nursing cohort and the data on racism form a secondary analysis drawn from a larger research project investigating the experiences of indigenous health workers in New Zealand and Canada. Jones’s levels of racism were utilized as a coding frame for the structural analysis of the transcribed Māori registered nurse interviews. Results: Participants experienced racism on institutional, interpersonal, and internalized levels, leading to marginalization and being overworked yet undervalued. Discussion and Conclusions: Māori registered nurses identified a lack of acknowledgement of dual nursing competencies: while their clinical skills were validated, their cultural skills—their skills in Hauora Māori—were often not. Experiences of racism were a commonality. Racism—at every level—can be seen as highly influential in the recruitment, training, retention, and practice of Māori registered nurses. Implications for Practice: The nursing profession in New Zealand and other countries of indigenous peoples needs to acknowledge the presence of racism within training and clinical environments as well as supporting indigenous registered nurses to develop and implement indigenous dual cultural-clinical competencies.

Childhood obesity affects approximately 20% of U.S. preschool children. Early prevention is needed to reduce young children’s risks for obesity, especially among Hispanic preschool children who have one of the highest rates of obesity. Vida Saludable was an early childhood obesity intervention designed to be culturally appropriate for low-income Hispanic mothers with preschool children to improve maternal physical activity and reduce children’s sugar-sweetened beverage consumption. It was conducted at a large southwestern United States urban health center. Presented here are the methods and rationale employed to develop and culturally adapt Vida Saludable, followed by scoring and ranking of the intervention’s cultural adaptations. An empowered community helped design the customized, culturally relevant program via a collaborative partnership between two academic research institutions, a community health center, and stakeholders. Improved health behaviors in the participants may be attributed in part to this community-engagement approach. The intervention’s cultural adaptations were scored and received a high comprehensive rank. Postprogram evaluation of the intervention indicated participant satisfaction. The information presented provides investigators with guidelines, a template, and a scoring tool for developing, implementing, and evaluating culturally adapted interventions for ethnically diverse populations.

Minority involvement in clinical trials is necessary to promote diversification in health-related research. The clinical trials nurse is uniquely qualified to advocate for and ensure the success of the minority participant in clinical trials research during the processes of recruitment, informed consent, and retention of subjects. This article incorporates a review of literature in conjunction with the American Nurses Association’s standard of practice number 7 regarding ethics to demonstrate how the role of the clinical trials nurse as subject advocate can facilitate successful participation of minorities in clinical trial research.

The 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, challenges the nursing profession to take a key role in redesigning the health care system. Intended to shape the future of nursing in the United States, the IOM report has implications for nursing worldwide. While individual states and nursing organizations are developing initiatives to implement the IOM recommendations in the United States, there must be a concomitant effort to examine the ripple effect on global health and the nursing community. This article addresses four IOM recommendations that are directly relevant to internationally educated nurses who practice across borders: nurse residency programs, lifelong learning, leading change to advance health, and interprofessional health care workforce data. The article discusses the IOM recommendations through a global perspective and offers policy implications for legislators, health care organizations and nurse educators, regulators and administrators.

Purpose: To explore Australian nursing students’ perceptions of spirituality, religiosity, and personal belief. Background: Spiritual and religious literature support the benefits to patients’ physical and mental health. Nurses have an ethical obligation to understand and incorporate patient’s spiritual beliefs and values into the care plan. Method: A cross-sectional survey was conducted using the 32-item WHO-QOL-SRPB questionnaire. Sample: The sample consisted of 483 undergraduate nursing students in Sydney, Australia. Results: There were 21% male and 79% female students; age ranged from 18 to 56 years, with a mean age of 26.53 (SD = 7.32). There were no significant difference between male and female nursing students, but there were difference in SRPB scores between first-, second-, and third-year students and between religious affiliations. Conclusions and Implications: Spirituality is multidimensional and multilevel and is interconnected with religiosity and personal belief. Nurses need to understand their own spirituality before they can incorporate spirituality in their patient care.

The purpose of this pilot study was to examine the effect of a 9-week instructional intervention designed to increase 24 Caucasian American occupational therapy students’ awareness of personal racial attitudes toward African Americans. The learning content focused on specific cognitive-perceptual biases thought to play a role in the formation of racial attitudes. A pre- to posttest implicit measure of racial bias indicated an increase in bias in some students following the intervention and a decrease of bias in others. Students’ perception of the instruction and subsequent stereotype activation are discussed as possible moderators of the intervention’s effectiveness. Several implications for future instruction and research are suggested to address factors that may limit antibias instruction.

Many challenges exist when providing international education to those who care for people at the end of life. Though issues related to culture and language may vary, the one commonality that crosses all nations is that its people die. In general, societies seek to provide the best care they are trained to give. Many have few resources to provide this care well. Traditions of the past influence norms and dictate policies and procedures of the present. Since its inception in 2000, the End-of-Life Nursing Education Consortium Project has provided palliative care education to nurses and other members of the interdisciplinary team in six of the seven continents. This article describes the efforts of this project to improve education around the globe, with the goal of providing excellent, compassionate palliative care, irrespective of location, financial status, political views, religion, race, and/or ethnicity.