Journal of Transcultural Nursing

Newcomer elderly immigrants, defined as adults older than the age of 65 who have arrived in the United States in the last 10 years, represent a growing sector of the American population. Newcomers who experience limited English proficiency, financial strain, and acculturative stress are at considerable risk of developing poor health outcomes. Nursing’s focus on healthy aging and aging in place has largely ignored the experiences of these older adults, who are said to be “aging out of place.” This concept analysis uses Rodgers’s evolutionary method to define “aging out of place” and illustrates why existing theories of elderly migration do not necessarily apply to this population. The challenge for nurses is incorporating the family, with whom conflict may arise, into the care of these elders. Community-based strategies that enable social integration and create a greater division of labor in the care of newcomer elders are called for.

By 2050, for the first time in U.S. history, almost half of elders will be from ethnic minority groups. To meet the needs of this rapidly diversifying population, nurses need to be able to marry transcultural nursing knowledge with gerontological nursing knowledge. The purpose of this article is to propose a new theoretical model for explaining health outcomes and health responses for older individuals in unique ethno-cultural groups and to discuss implications and applications of the model to transcultural gerontological nursing practice and research. The discussion will include (1) an overview of currently available theoretical knowledge in the area, (2) a description of the theory development process, (3) presentation of the proposed ethno-cultural gerontological nursing theoretical model, and (4) discussion of how this model can enhance nursing’s contributions to reducing health disparities. This model is presented not as a finished product but as a basis for future discussion and refinement.

Successful aging is gaining increasing attention given the growth in the older adult population. Criteria and definitions within multiple disciplines vary greatly in Western literature, with no consensus on its meaning. Sociocultural, economic, and political differences between the Western view of successful aging and its view in China add to the confusion. Similarities and differences in the meaning of successful aging in the United States and China are examined, and potential for a common definition useful to nursing in both countries is explored. Using concept analysis, shared criteria for successful aging were the following: decreased incidence of disease and disability, life satisfaction, meaning and purpose in life, and ability to cope effectively to achieve goals based on personal values and priorities. A comprehensive, multidimensional definition of successful aging for nursing and a midrange nursing theory of successful aging were identified that may be useful to guide nursing research, practice, and policy.

Introduction: American Indian and Alaska Native (AIAN) women have relatively high breast cancer mortality rates despite the availability of free or low-cost screening. Purpose: This qualitative study explored issues that influence the participation of older AIAN women in mammography screening through tribally directed National Breast and Cervical Cancer Early Detection Programs (NBCCEDPs). Methods: We interviewed staff (n = 12) representing five tribal NBCCEDPs and conducted four focus groups with AIAN women ages 50 to 80 years (n = 33). Results: Our analysis identified four main areas of factors that predispose, enable, or reinforce decisions around mammography: financial issues and personal investments, program characteristics including direct services and education, access issues such as transportation, and comfort zone topics that include cultural or community-wide norms regarding cancer prevention. Conclusion: This study has implications for nurse education and training on delivering effective mammography services and preventive cancer outreach and education programs in AIAN communities.

Purpose: This study explores the perception of cultural competence of personal support workers (PSWs) in a long-term care (LTC) home in Ontario. As Canada’s demography becomes older and more diverse, LTC homes will increasingly accommodate residents from various cultural backgrounds. However, few studies have examined cultural competence among PSWs in the LTC home setting. Design: The study employed a qualitative case study approach. Data collection and analysis were conducted in three phases: document analysis of organizational policies, a key informant interview with the Director of Care, and two focus groups with PSWs. Results: Our findings illuminated the PSWs’ broad definition of culture, the process of developing cultural competence and its strong connections to person-centered care, and the organizational factors that facilitate or hinder PSWs’ cultural competence. Implications: The ambiguous perception of cultural competence reported by PSWs suggests the need for more education and further research on this topic.

Purpose: The purpose of the present study was to learn about the perspectives on end-of-life decision making among older Chinese people in Macau. Method: A qualitative approach was used, and interviews were conducted with 18 Chinese aged 65 years or older. Results: Four major themes were identified: (a) institutionalized care at the end of life was preferred as not to be a burden on family, (b) life-prolonging measures were not preferred, (c) funeral arrangement preferences were based on personal and religious beliefs, and (d) end-of-life decision making would be deferred to others. Discussion and Conclusions: These themes provide an understanding of personal preferences of older Chinese on end-of-life issues, and personal preferences are always secondary to their respect toward family and medical doctors. This compliance with family and medical authority can be understood through Chinese cultural beliefs. Implications for Practice: Knowledge of cultural influences is needed for nursing professionals to deal effectively with older adults and families regarding end-of-life issues.

Purpose: To describe the care relationships between caregivers and elderly people in Uruguayan nursing homes. Design: A qualitative study with an ethnographic approach conducted at nine nursing homes for elderly people located in four Uruguayan departments. Twenty-three purposively and theoretically selected participants were interviewed and observed between January 2011 and January 2012. Results: Study of relationships among caregivers, managers, and residents revealed a number of issues: perception and experience of elder abuse, suffering when faced with death, and existential pain. Conclusion: A cultural context of discrimination against the elderly and other factors converge to perpetuate elder abuse and suffering in care homes: the lack of adequate regulations covering safety and quality of care, lack of a care model and regular inspections, absence of minimum training requirements for caregivers, and lack of support in situations that have psychic and spiritual repercussions. The inclusion of nurses could promote the development of educational interventions to modify abusive conduct. Nursing home managers need knowledge, skills, and communication strategies to identify and manage inappropriate behavior. An urgent review of nursing home regulations is required to protect elderly people’s rights.

Purpose: Few studies have examined the behavioral and clinical indicators of sleep difficulty among older African Americans diagnosed with arthritis. This study aimed to examine the association of sleep, pain, and comorbid indicators among this population. Method: Using a cross-sectional design, 193 older African Americans (70.4 ± 9.11 years of age) completed a series of questions assessing health, pain, and sleep. Results: Findings showed that young old participants (β = −.28, p < .001) reported more difficulty sleeping and being awakened due to pain (β = −.17, p < .05) than the old old adults. Conclusion: There is significant within-group variability, with young old adults being most affected by sleep difficulties. Implications for Practice: While the relationship between pain and sleep may be intuitive for majority populations, the dynamics of this association may be useful in promoting sleep awareness and providing resources for caregivers and health care professionals to better meet the needs of this population.

Objective: To explore the perception of care of the elderly in long-term centers. Design: Qualitative study through participant observation and 23 in-depth interviews with administrators, caregivers, and residents between January 2011 and January 2012 in nine long-term care centers in Uruguay. From analysis, three care-perception factors emerged: (a) meaning of care, (b) experience of care, and (c) care continuity. Conclusion: Care of the elderly in nursing homes is perceived as a duty. There is an exchange of feelings and recognition of the caregiver is needed. However, the need for technical or specialized training is not mentioned. Recognition of the task of care provision, duty as a moral determinant, the exchange of affection and solidarity between staff and the elderly allows care continuity despite the centers’ lack of resources. Clinical Relevance: This study contributes information that may help improve the care conditions of elderly institutionalized people.

As ethnic diversity increases in the United States with the anticipated increase in dementia, it is critical to understand the implications of dementia and culturally appropriate communication for ethnic minority older adults with dementia. Utilizing the Ethno-Cultural Gerontological Nursing model and the Progressively Lowered Stress Threshold model, this article describes the relationship between nursing assistants’ communication style and behavioral symptoms of dementia, focused on Korean American older adults with dementia residing in nursing homes. The discussion includes reviewing currently available studies, nursing implications, and suggestions for future studies.

Background: The aim of this study was to examine the effect of nursing education on students’ knowledge, attitudes, and preferences to work with older adults in an ethnically diverse Israeli society. Methods: In a cross-sectional design, Kogan’s Old People Scale was used to measure attitudes toward older adults and Palmore’s Facts on Aging Quiz-1 to assess the level of knowledge of nursing students in four cohorts. Results: Of the 224 nursing students who responded to the survey, 55% were Jewish and 45% were Arabs. Ethnicity and knowledge were the strongest correlates (p < .0001) of attitudes, and attitudes and ethnicity (p < .0001) correlated with work preferences. Conclusions: While knowledge of old age among students increased, preferences for future career in geriatrics declined with education. Ethnicity was a strong predictor of attitudes and future intentions to work with older adults. Culturally tailored educational programs focused on changing the attitudes toward aging are critically needed.

Purposes: To identify attitudes and bias toward aging between Asian and White students and identify factors affecting attitudes toward aging. Methods: A cross-sectional sample of 308 students in a nursing program completed the measure of Attitudes Toward Older People and Aging Quiz electronically. Findings: There were no differences in positive attitudes and pro-aged bias between Asian and White groups, but Asian students had significantly more negative attitudes and anti-aged bias toward older people than White students. Multiple regression analysis showed ethnicity/race was the strongest variable to explain negative attitudes toward older people. Feeling uneasy about talking to older adults was the most significant factor to explain all attitudinal concepts. Conclusions: Asian students were uneasy about talking with older people and had negative attitudes toward older adults. To become competent in cross-cultural care and communication in nursing, educational strategies to reduce negative attitudes on aging are necessary.