Journal of Transcultural Nursing

Introduction: Because virtually no theories were available to explain unique characteristics of Asian women’s leadership in nursing, a middle-range theory on women’s leadership in Asian culture was previously published. To reflect recent political and social changes in different countries, there is a necessity to refine the theory. The purpose of this article is to present the refined middle-range theory on Asian women’s leadership in nursing. Methodology: Using an integrative approach, the theory was further developed based on two major sources: literature reviews and exemplars/cases from six different countries. Results: The Refined Middle-Range Theory on Women’s Leadership in Asian Culture has two main domains: (a) leadership frames and (b) leadership contexts. The domain of leadership contexts has been extended with two additional main concepts including demographic contexts and health workforce/system contexts. Discussion: The refined theory is expected to guide Asian women’s leadership in nursing across the globe.

Introduction: The Guatemalan maternal mortality rate is among the highest in Latin Americans, and lay midwives (LMs) attend home births. The study’s purpose was to explore LMs’ knowledge of, attitudes toward, and practices regarding obstetrical complications and emergencies. Method: In the remote Peten region, a descriptive ethnographic study held focus group discussions before education programs to teach/boost LMs’ awareness about obstetrical complications. The long-table approach of analyses developed a matrix of common themes. Results: Nearly 200 LMs participated in 11 groups. Six themes emerged: LMs attribute their knowledge to God, recognize signs of obstetrical danger, want more training and equipment, encounter resistance from a patriarchal culture, feel fear and despair in addressing obstetrical complications/emergencies, and experience arduous logistics in emergency hospital transfers. Discussion: Contrary to published literature, LMs were able to verbalize basic knowledge of obstetrical complications. Information learned can guide future, action-research studies to address the maternal mortality rate in resource-poor settings.

Introduction: The United States is experiencing a maternal-child health (MCH) crisis including racial inequalities in mortality. This study explored the roles of lay experts who provide information and support to women of childbearing age (i.e., Wise Women) and cultural norms for sharing MCH information and support in an urban, predominantly African American community. Methodology: This qualitative community-engaged study (N = 49) of social networks utilized a semistructured guide and brainstorming activities with eight focus groups (three community leader, three community women, and two Wise Women). Results: Although several sources of MCH information and support were noted, Wise Women were the most frequently reported culturally normative sources. Emergent themes included positive affirmations for informal exchange of MCH information among women and roadblocks to MCH information exchange and support. Discussion: Results suggest a need for culturally relevant interventions that would strengthen lines of communication and social connectedness among African American women.

Introduction: The aim was to examine the risk factors of anternatal depression among immigrant and native pregnant women in Spain. Method: A total of 1,524 pregnant women completed the Patient Health Questionnaire and the Postpartum Depression Predictors Inventory–Revised form. Results: The native group reported a lower prevalence (15.2%) compared with immigrant group (25.8%). For immigrants, primiparity, moving, and perceived lack instrumental support from friends or emotional support from partners and family members were significant risk factors. Discussion: The study identified risk factors that can be used for preventive interventions during pregnancy. Significance: Screening and interventions for depression during pregnancy should take migration status into account to maximize effective health care. Also, health providers should consider how migration status can result in different risk factors that affect depression during pregnancy.

Introduction: Postpartum warming is widely practiced among women in Asian countries despite unsubstantiated health claims. This study aimed to identify sources of knowledge and explore the practices of postpartum warming among mothers in Brunei. Methods: A cross-sectional study using a self-administered questionnaire was conducted on 124 mothers who had experience in postpartum warming. Results: Coal was commonly used for heat. Main source of knowledge came from family members. Older women had significantly lower intention to perform the practice in future pregnancies. Women who lived in nuclear families practiced it to a significantly higher frequency compared with those living in extended families. Discussion: Women still practice warming to adhere with family expectations and traditions although noticeable changes have been observed as society modernizes. It still poses a risk of carbon monoxide poisoning and fire hazard from burning coal. Future studies should focus on health and safety aspects to provide evidence on the actual health benefits and ameliorate risk factors.

Introduction: A wide gap in knowledge exists about the factors associated with newborn care in rural Zambia. In this year of the nurse and midwife, the purpose of this article is to provide transcultural researchers with an example of how Bronfenbrenner’s Ecological Systems Theory (EST) can be used to guide an exploration of the cultural practices, knowledge, and beliefs of newborn care and health-seeking behaviors in rural Zambia. Methodology: Based on the EST, maternal knowledge represents the microsystem while family and community members embody the mesosystem. Health care organization denotes the exosystem with culture representing the macrosystem and health policy the chronosystem. Results: Numerous implications for transcultural nursing practice emerged from this adaptation of the ecological systems approach. Findings reveal a maternal dualism faced by Zambian mothers as they navigate the complex interplay between cultural newborn care practices and evidence-based newborn care promoted by the health care system. Discussion: Based on our proposed operationalization of the EST for a transcultural nursing study, the EST can be applied globally, further validating the theory.

Introduction: This study aims to examine the challenges faced by migrant Arab Muslim women in accessing maternity services and to suggest ways to improve the childbirth experience for them. Methodology: An interpretive ontological–phenomenological perspective guided by the philosophical tenets of Heidegger was used to examine the childbirth experiences of Arab Muslim women. Results: The sample size was 24 in-depth semistructured audiotaped interviews with eight women in the United Kingdom. The “Vulnerable Woman” was the main theme of our findings, which was discussed in five subthemes: language exclusion, discrimination and prejudice, bureaucracy and “stiff upper lip,” conflicting ideology, and the conventional as strange. Conclusions: Maternity care should be culturally competent and emphasize the importance of recognizing differences as well as creating trusting relationships. At the same time, midwives should be aware of the dangers of labeling women because of their cultural and religious beliefs.

Introduction: Data on immigrant and refugees’ access to services in Canada typically focus on adult populations generally but not children specifically. To fill this gap, this study explored immigrant and refugee mothers’ perceptions of barriers and facilitators for mental health care for their children in Edmonton, Alberta, Canada. Method: In this qualitative descriptive study, researchers conducted 18 semistructured interviews with immigrant and refugee mothers who live in Edmonton, self-identify as women, and have children living in Canada. Results: Barriers included financial strain, lack of information, racism/discrimination, language barriers, stigma, feeling isolated, and feeling unheard by service providers. Facilitators included schools offering services, personal levels of higher education, and free services. Discussion: Nurses can improve access to mental health services by addressing issues related to racism within the health system, by creating awareness related to mental health, and by providing trained interpreters to help bridge barriers in communications.

Introduction: Despite the research on left-behind children, less is known about left-behind women across transnational spaces. The purpose of this scoping review was to assess the extent, range, and nature of the existing body of literature on left-behind women whose partners have migrated across borders. Method: This scoping review was guided by the five-step approach of Arksey and O’Malley. Fifty-four articles that focused on left-behind women across transnational spaces were included. Data were synthesized using descriptive statistics and conventional content analysis. Results: Left-behind women were primarily from Mexico (n = 13) and the migrants’ place of destination was primarily the United States (n = 14). We identified two major themes: (a) women’s social, economic and cultural conditions and (b) women’s well-being. Discussion: We identified significant knowledge gaps regarding left-behind women in the context of transnational migration. Implications for future research and practice are discussed.

Introduction: Culture and traditions influence people’s health beliefs and these influence their actions and behaviors to prevent ill health and promote health and well-being. This qualitative study explored nurses’/midwives perspectives of culturally sensitive care in a neonatal setting to infants born to parents from the Traveler community. Method: A descriptive qualitative approach was used to interview 10 nurses/midwives from a neonatal unit in Ireland. Data were analyzed using Burnard’s framework. Results: Themes identified were as follows: (a) barriers to breastfeeding for women from the Traveler community, (b) cultural issues affecting care provision to Traveler families in the neonatal unit, and (c) concerns of neonatal staff for infants born within the Traveler community. Discussion: The culture of the Traveler group was recognized as a major influence on decision making and interactions within the neonatal unit. Strategies are identified that could enhance the care of this group and the care of other ethnic groups.