Transitions from jail to rural community for adults with mental illness.

OBJECTIVES: Describe the facilitators and inhibitors of accessing healthcare services for adults with mental illness transitioning from a rural jail to a rural community. DESIGN/SAMPLE/MEASUREMENTS: A qualitative descriptive approach was used to conduct this study in a rural southwest county. Purposive sampling was used to recruit eight adults. Data were collected using semi-structured telephonic interviews and analyzed using open coding and thematic analysis with clustering of emergent data. RESULTS: The overarching theme, "Out of Jail, but No Freedom," is supported by four domains: Situational Transition Facilitators; Situational Transition Inhibitors; Health-Illness Transition Facilitators; and Health-Illness Transition Inhibitors. CONCLUSIONS: Transitions from the rural jail to the community were facilitated by friends, family, and peer navigators. Systemic inequality endemic within the justice system and exacerbated by rurality creates an environment in which marginalization is ubiquitous for persons with mental illness and inhibits their transition from jail to the rural community. Nurses are well positioned to lead systematic reform in public policy, guiding healthcare funding, and jail utilization.

Self-management of chronic disease in Latina Kinship caregivers: an integrative review.

In the United States, Latinos experience a higher prevalence of chronic diseases with concomitant complications when compared to Non-Latino Whites. Older Latina women often manage a chronic illness while also providing kinship care. This article presents an integrative review of Latina kinship caregivers' self-management of chronic disease. An extensive review of the literature was conducted in seven databases. Four resulting studies included qualitative, quantitative, and mixed methods research and suggested health outcomes for Latina kinship caregivers were often worse when compared to other groups. A major gap in the literature identified an absence of disease-specific self-management behaviors for this population.

"My problems aren't their fault": Mexican American women managing diabetes while caring for grandchildren.

Diabetes affects many aspects of family life for the Mexican American (MA) population. Caregiving grandmothers, the traditional family nurturers, are often simultaneously managing their type 2 diabetes (T2DM). The purpose of this qualitative descriptive study was to describe the perceptions of MA grandmothers managing T2DM while caring for a grandchild. Eight participants were interviewed. Participants consistently reported feeling a personal responsibility for their T2DM self-management as well as for the health and wellbeing of their families, including their grandchildren. Regardless of associated caregiving stress, grandchildren were described as the main source of positive motivation for T2DM self-management.

Undocumented migration in the United States: an overview of historical and current policy contexts.

The aims of this overview are to provide a brief historical review of federal, state, and local immigration policies and to examine the historical origin and current constructions of the undocumented immigrant. We discuss how past and current policies promote, regulate, restrict, and deter immigration into the United States and access to health services and draw implications for the profession of nursing.

Undocumentedness and public policy: the impact on communities, individuals, and families along the Arizona/Sonora border.

The focus of this article is the health impact and implications of undocumentedness along the U.S.-Mexico border, particularly the Arizona/Sonora region. We describe the direct and indirect influences of immigration policies on the health of individuals, families, and communities. The Arizona border region maintains close social, cultural, and linguistic ties to Mexico, and the amplified efforts to secure the border have been dramatic on the region and on the people who live there. The 261-mile stretch across the Arizona-Sonora Desert is the most deadly corridor for immigrants crossing into the United States because they are at risk of being killed, kidnapped, and coerced into smuggling drugs or dying in the desert. Gang-related violence is pushing more Central Americans, including unaccompanied minors, to the United States. The impact on individual migrants and their families has been devastating. We examine the health implications of policy and applaud the actions of the Arizona Nurses Association and the American Academy of Nursing to address the health needs of border communities.

The impact and implications of undocumented immigration on individual and collective health in the United States.

A nation of immigrants, the United States currently has more foreign-born residents than any other country; approximately 28% of these foreign-born residents are undocumented immigrants--individuals who either entered or are currently residing in the country without valid immigration or residency documents. The complex and constantly changing social, political, and economic context of undocumented migration has profound effects on individuals, families, and communities. The lack of demographic and epidemiologic data on undocumented immigrants is a major public health challenge. In this article, we identify multiple dimensions of vulnerability among undocumented persons; examine how undocumentedness impacts health and health care access and utilization; and consider the professional, practice, and policy issues and implications for nurses.

Perceived impact of an interprofessional education program on community resilience: an exploratory study.

The purpose of this study was to explore the perceived impact of an interprofessional education (IPE) program for health sciences students on two culturally diverse, underserved communities. A community resilience/capacity framework, consisting of catalysts (primarily the creation of awareness) and capital components: human (workforce development), social (networking and empowerment) and economic (volunteer labor and money spent by the program), provided the conceptual underpinnings for the study. Focus groups with stakeholders in two communities, one rural and one metropolitan, were audio-recorded, transcribed and analyzed by categorizing data according to each capital component. In addition to the concepts contained in the capacity framework a new category, informational capital (data specific to the community) emerged during the analysis. We suggest that by acting as a catalyst a community based interprofessional program can affect components of community resilience/capacity, primarily human, social, and informational capital. Using the community resilience/capacity framework facilitated exploration of the perceived impact of an educational program on one rural and one urban underserved community beyond assessing student outcomes or number of clients served.

Post-Rape Experiences of Undocumented Mexican Women in the U.S.-Mexico Border Region: A Critical Ethnography.

Introduction: Numerous undocumented immigrant women in the United States have survived rape, and many have experienced physical and psychological consequences. Although rape disclosure can facilitate early intervention and improve health outcomes, most undocumented immigrant women do not disclose rape, and little is known about their post-rape experiences. Methods: This critical ethnography explored the post-rape experiences of undocumented immigrant women of Mexican (UIWM) origin living in the U.S. Mexico border region. Data collection and analysis were guided by Carspecken's framework for critical qualitative research. Six women, who identified as UIWM participated in the study. Each was interviewed using a semistructured approach. Results: Interview data revealed three domains: Glimpses of Support, Barrier After Barrier, and Overcoming. In accordance with Carspecken's framework, a theoretical lens was applied to these domains. The application of Feminist Intersectional Theory and Standpoint Theory united the domains into the theme Struggling to Heal. Conclusion: This study suggests that the marginalization of these survivors detrimentally impacts their post-rape experiences and describes the intersections of multiple forces on their experiences, including the cultural and sociopolitical context of the border region. This study lays the foundation for future research aimed at mitigating disclosure and help-seeking barriers for this marginalized group.

Perceived Risk of Diabetes Among Vietnamese Americans With Prediabetes: Mixed Methods Study.

BACKGROUND: Vietnamese Americans have a relatively high risk of developing diabetes at younger ages, yet there are no published studies exploring their risk perceptions. OBJECTIVE: This mixed methods study describes perceived diabetes risk in the context of an underserved population. METHODS: This study was guided by the Common-Sense Model of Self-Regulation. Snowball sampling was used to recruit 10 Vietnamese Americans with prediabetes and achieve data saturation. Qualitative and quantitative descriptive methodologies with data transformation were used to analyze data from semistructured interviews and questionnaires to explore the dimensions of perceived diabetes risk. RESULTS: Participants were between the ages of 30 and 75 years with diversity also noted in diabetes risk factors. The 3 risk perception domains from qualitative data were risk factors, disease severity, and preventing diabetes. The main perceived diabetes risk factors were eating habits (including cultural influences), sedentary lifestyle, and family history of diabetes. Quantitative data supported qualitative findings of a low-to-moderate level of perceived diabetes risk. Despite the lower levels of perceived diabetes risk, Vietnamese Americans do believe that the severity of diabetes is a "big concern." CONCLUSIONS: Vietnamese Americans with prediabetes have a low-to-moderate level of perceived diabetes risk. Understanding the perceived diabetes risk in this population provides a foundation for diabetes prevention interventions that consider cultural influences on diet and exercise.

Stroke-Specific Refinements to Naylor's Transitional Care Model to Address the Storm of Uncertainty and Unmet Survivor and Caregiver Needs.

ABSTRACT: BACKGROUND: By 2030, there will be approximately 7.6 million stroke survivors (SSs) in the United States, yet comprehensive transitional care (TC) for stroke is not widely available. Stroke strikes without warning and leaves in its wake a "storm" of uncertainty for SSs and caregivers (CGs) as they encounter a myriad of unmet physical, mental, emotional, and financial needs that are not wholly addressed by passive healthcare delivery systems. Needed is a stroke-specific TC model that bridges this storm to active delivery of SS and CG postacute care. Naylor's Transitional Care Model (NTCM) has not been examined for how it can frame comprehensive stroke care. The purpose of this study was to solicit SS and CG descriptions of TC experiences to inform the NTCM with refined operational definitions and exemplars specific to stroke. METHODS: Focus groups conducted for this qualitative descriptive study were guided by interview questions based on the 8 NTCM operational definitions. Data were analyzed using inductive and deductive qualitative content analysis methods. RESULTS: Post-acute-stroke care does not comprehensively meet the needs of SSs and CGs. Participants described TC deficits across all 8 NTCM components. Two new subcomponents that could be applied for a stroke-specific NTCM emerged: psychological and transportation challenges. CONCLUSION: Unmet needs identified by SSs and CGs were used to extend NTCM specific to the stroke population and to develop the Recommendations and Exemplars for Stroke Specific Comprehensive Transitional Care Delivery (see Supplementary Digital Content, available at http://links.lww.com/JNN/A385). Researchers and practitioners can use the findings to develop and deliver more comprehensive TC to SSs and CGs.

The Diné (Navajo) Hózhó Lifeway: A Focused Ethnography on Intergenerational Understanding of American Indian Cultural Wisdom.

Purpose: Hózhó is the cultural wisdom that guides the Diné lifeway. This study examines understanding of cultural wisdom (CW) across three generations: elders, adults, and adolescents. Method: A focused ethnography was conducted on the Navajo Nation. Twenty-two Diné (Navajo) were recruited through convenience sampling. Data were collected via two semistructured interviews and photovoice methods. Data were analyzed using content analysis, thematic analysis, and participatory visual analysis of photos. Results: The Diné elders embodied the greatest in-depth understanding of CW followed by the adolescents. An unexpected finding was the scarcity of understanding of CW among the adults. Conclusion: The Diné understanding of CW is transferred through discussion with elders, listening to and speaking traditional language, cultural preservation activities, and participation in cultural practices. The Diné believe cultural wisdom is a health sustaining protective factor, therefore strategies to restore, promote, and support the intergenerational transfer of cultural wisdom remains a tribal priority.

Race and Gender-Based Perceptions of Older Adults: Will the Youth Lead the Way?

BACKGROUND: Older individuals encounter the greatest racial/gender biases. It is unknown whether younger generations, who often lead culture shifts, have racial and gender biases against older populations. METHODS: Using Amazon's Mechanical Turk's crowdsourcing, we identified how an individual's race and gender are associated with perceptions of individuals aged mid-60s. Participants were asked to rate photograph appearances on Likert Scale (1-10). Interactions between participant and photograph race and gender were assessed with mixed effects models. Delta represents rating differences (positive value higher rating for Whites or women, negative value higher rating for African-Americans or men). RESULTS: Among 1563 participants (mean 35 years ± 12), both non-Hispanic White (WP) and all Other race/ethnicity (OP) participants perceived African-American photos as more trustworthy [Delta WP -0.60(95%CI-0.83, - 0.37); Delta OP - 0.51(- 0.74,-0.28), interaction p = 0.06], more attractive [Delta non-Hispanic White participants - 0.63(- 0.97, - 0.29); Delta Other race/ethnicity participants - 0.40 (- 0.74, - 0.28), interaction p < 0.001], healthier [Delta WP -0.31(- 0.53, - 0.08); Delta OP -0.24(- 0.45, -0.03), interaction p = 1.00], and less threatening than White photos [Delta WP 0.79(0.36,1.22); Delta OP 0.60(0.17,1.03), interaction p < 0.001]. Compared with OP, WP perceived African-American photos more favorably for intelligence (interaction p < 0.001). Both genders perceived photos of women as more trustworthy [Delta Women Participants (WmP) 0.50(0.27,0.73); Delta Men Participants(MnP) 0.31(0.08,0.54); interaction p < 0.001] and men as more threatening [Delta WmP -0.84(-1.27, -0.41), Delta MnP - 0.77(- 1.20, - 0.34), interaction p = 0.93]. Compared with MnP, WmP perceived photos of women as happier and more attractive than men (interaction p < 0.001). Compared with WmP, MnP perceived men as healthier than women (interaction p < 0.001). CONCLUSIONS: Among a young generation, older African-Americans were perceived more favorably than Whites. Gender perceptions followed gender norms. This suggests a decline in implicit bias against older minorities, but gender biases persist. Future work should investigate whether similar patterns are observed in healthcare.

Type 2 diabetes self-management social support intervention at the U.S.-Mexico border.

OBJECTIVES: To pilot test the efficacy of a culturally tailored diabetes self-management social support intervention for Mexican American adults with Type 2 diabetes (T2DM) living in the U.S.-Mexico border region and to test the feasibility of recruiting and training promotoras to participate in intervention delivery. DESIGN AND SAMPLE: This study used a single-group pretest and posttest design. The convenience sample consisted of 21 Mexican American adults with T2DM. The setting for the study was a community in the Arizona-Sonora, Mexico border region. INTERVENTIONS: A bilingual, bicultural certified diabetes educator (CDE) and a nurse researcher developed the intervention to improve T2DM self-management activities for Mexican Americans. Data were collected using self-report questionnaires, glycosolated hemoglobin (HbA(1c)), and anthropometric measures. RESULTS: Intervention efficacy was demonstrated by an increase in participants' diabetes self-management activities and diabetes knowledge and a decrease in diabetes-related distress and sedentary behaviors. There were no significant changes in physiologic outcomes. Feasibility of recruitment and training of 2 promotoras who participated in intervention delivery was established. CONCLUSIONS: Promotoras, in collaboration with a CDE, successfully delivered a culturally tailored diabetes self-management social support intervention for Mexican American adults with T2DM. This intervention positively affected diabetes self-management behaviors.

The elephant in the room: A concept analysis of communication and childhood adversity among adults.

BACKGROUND: Effective communication by those providing clinical care to adult patients is required to identify and address health disparities associated with childhood adversity. Many primary care NPs are unaware of these relationships, often lacking the communication skills and training needed to elicit this clinically relevant information. OBJECTIVES: A systematic review in the form of a concept analysis was undertaken to increase our understanding about patient-to-provider communication of childhood adversity in the context of the primary care setting. Two key concepts, communication and childhood adversity, were examined using the procedures outlined by Walker and Avant. DATA SOURCES: A focused literature search using the search engines CINAHL, PubMed, and PsycINFO with inclusion criteria of "adverse childhood experiences (ACE)," "childhood adversity," and "communication" provided boundaries for this analysis. No results were found using the defined conceptual terms. Therefore, concept synthesis was driven by the exploration of seminal and current literature from several disciplines. CONCLUSIONS: Findings revealed that effective communication about childhood adversity is an integral and understated element when addressing ACE-related health disparities among adults. Further synthesis is warranted to explore how primary care NPs apply the concepts of effective communication when providing clinical care to adult patients with histories of childhood adversity. IMPLICATIONS FOR PRACTICE: This concept analysis will serve as a catalyst for informing future research and theory development focused on enhancing ACE-specific communication between NPs and adult patients, which will lead to more personalized approaches to developing novel, ACE-specific interventions, a reduction in health disparities, and improved health outcomes.

Perceived Risk of Developing Diabetes in the General Population and Asian Americans: Systematic Review.

Introduction: The purpose of this systematic review was to explore perceived diabetes risk with foci on prediabetic persons and Asian Americans. Persons with prediabetes and of Asian descent are at higher risk for developing diabetes, but little is known about their perceived diabetes risk. Method: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this systematic review. Electronic searches were conducted in three databases. The authors conducted eligibility determination, data extraction, synthesis, and evaluation. Twelve articles were selected. Results: Key findings include (1) limited studies including Asian populations, (2) a low percentage of persons in the general population with moderate to high levels of perceived diabetes risk, (3) a lack of congruency between actual and perceived diabetes risk in the general population, and (4) no interventions effectively changing the level of perceived diabetes risk. Discussion: More studies regarding perceived diabetes risk are needed, especially with a focus on Asian Americans.

Association of Gender and Race With Allocation of Advanced Heart Failure Therapies.

Importance: Racial bias is associated with the allocation of advanced heart failure therapies, heart transplants, and ventricular assist devices. It is unknown whether gender and racial biases are associated with the allocation of advanced therapies among women. Objective: To determine whether the intersection of patient gender and race is associated with the decision-making of clinicians during the allocation of advanced heart failure therapies. Design, Setting, and Participants: In this qualitative study, 46 US clinicians attending a conference for an international heart transplant organization in April 2019 were interviewed on the allocation of advanced heart failure therapies. Participants were randomized to examine clinical vignettes that varied 1:1 by patient race (African American to white) and 20:3 by gender (women to men) to purposefully target vignettes of women patients to compare with a prior study of vignettes of men patients. Participants were interviewed about their decision-making process using the think-aloud technique and provided supplemental surveys. Interviews were analyzed using grounded theory methodology, and surveys were analyzed with Wilcoxon tests. Exposure: Randomization to clinical vignettes. Main Outcomes and Measures: Thematic differences in allocation of advanced therapies by patient race and gender. Results: Among 46 participants (24 [52%] women, 20 [43%] racial minority), participants were randomized to the vignette of a white woman (20 participants [43%]), an African American woman (20 participants [43%]), a white man (3 participants [7%]), and an African American man (3 participants [7%]). Allocation differences centered on 5 themes. First, clinicians critiqued the appearance of the women more harshly than the men as part of their overall impressions. Second, the African American man was perceived as experiencing more severe illness than individuals from other racial and gender groups. Third, there was more concern regarding appropriateness of prior care of the African American woman compared with the white woman. Fourth, there were greater concerns about adequacy of social support for the women than for the men. Children were perceived as liabilities for women, particularly the African American woman. Family dynamics and finances were perceived to be greater concerns for the African American woman than for individuals in the other vignettes; spouses were deemed inadequate support for women. Last, participants recommended ventricular assist devices over transplantation for all racial and gender groups. Surveys revealed no statistically significant differences in allocation recommendations for African American and white women patients. Conclusions and Relevance: This national study of health care professionals randomized to clinical vignettes that varied only by gender and race found evidence of gender and race bias in the decision-making process for offering advanced therapies for heart failure, particularly for African American women patients, who were judged more harshly by appearance and adequacy of social support. There was no associated between patient gender and race and final recommendations for allocation of advanced therapies. However, it is possible that bias may contribute to delayed allocation and ultimately inequity in the allocation of advanced therapies in a clinical setting.

Perspectives for practice: translating estimated average glucose (eAG) to promote diabetes self-management capacity.

PURPOSE: The purpose of this article is to facilitate translation of the Consensus Statement to practice for diabetes educators and other professionals who contribute to the care of individuals with diabetes. METHODS: The 2007 Consensus Statement from the American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), and International Diabetes Federation (IDF) called for the standardization of glycated hemoglobin measurement in reporting and use of average glucose values in clinical practice. RESULTS: Conversion of glycated hemoglobin percentage to average blood glucose was anchored historically in early laboratory techniques linked to disease outcomes rather than to definitive laboratory standardization. Recently, the A1C-Derived Average Glucose (ADAG) study demonstrated that A1C values can be accurately expressed as estimated average glucose (eAG) and endorsed eAG as the best way to standardize the expression of laboratory values of glycated hemoglobin. CONCLUSIONS: Adoption of the 2007 Consensus Statement will influence clinical practice and decision making and subsequently influence self-management for individuals with diabetes.

Effects of a Family-Based Diabetes Intervention on Family Social Capital Outcomes for Mexican American Adults.

PURPOSE: The purpose of the study is to test the effects of a culturally tailored family-based self-management education and social support intervention on family social capital with Mexican American (MA) adults with type 2 diabetes (T2DM) and their family member. METHODS: Using a 2-group, experimental repeated-measures design, 157 dyads were randomly assigned to an intervention (group education and social support, home visits, and telephone calls) or a wait list control group. Data were collected at baseline, immediately postintervention (3 months), and 6 months postintervention. A series of 2 × 3 repeated-measures analyses of variance with interaction contrasts were used to test the hypotheses regarding the differential effects on family social capital. RESULTS: Social capital outcomes included social integration, social support, and family efficacy. Social integration scores, high for family members and friends and low for community engagement, did not change over time for participants or family members. Participants perceived high support from family for physical activity with an immediate increase postintervention and moderate sabotage for healthy eating with no change over time. A sustained intervention effect was noted for family efficacy for general health and total family efficacy in participants and family members. CONCLUSIONS: This family-based culturally tailored intervention demonstrated the potential to improve social capital, specifically social support for physical activity and family efficacy for diabetes management for MA adults with T2DM. Ongoing research that examines the family as a critical context in which T2DM self-management occurs and that targets strategies for sustained family social capital outcomes for T2DM is needed.

A Gender- and Culturally Sensitive Weight Loss Intervention for Hispanic Men: Results From the Animo Pilot Randomized Controlled Trial.

Background. Hispanic males have the highest rates of overweight and obesity compared with men of all other racial/ethnic groups. While weight loss can significantly reduce obesity-related health risks, there is limited research examining effective gender- and culturally tailored behavioral weight loss programs for Hispanic men. Objective. To assess the feasibility and preliminary efficacy of a 12-week gender- and culturally sensitive weight loss intervention (GCSWLI) as compared with a waist-list control (WLC) in sedentary, Hispanic males with overweight/obesity. Method. Fifty Hispanic males (age: 43 years [SD = 11]; BMI: 34 ± 5 kg/m2; 58% Spanish monolingual) were randomized to one of two groups: GCSWLI (n = 25) or WLC (n = 25). GCSWLI participants attended weekly in-person individual sessions with a bilingual, bicultural Hispanic male lifestyle coach, and were prescribed a daily reduced calorie goal and 225 minutes of moderate-intensity physical activity per week. The WLC were asked to maintain their usual diet and physical activity habits for 12 weeks. GCSWLI participants continued with 12 additional weeks of follow-up including biweekly phone calls with lifestyle coaches. Results. At Week 12, the mean weight loss in the GCSWLI was -6.3 kg (95% confidence interval [CI; -8.1, -4.4]) compared with -0.8 kg (95% CI [-2.5, 0.9]) for the WLC (difference = -5.5 kg, 95% CI [-8.0, -2.9], p < .01). At Week 24, weight loss in the GCSWLI was maintained. Conclusions. The GCSWLI appears to be a feasible strategy to engage Hispanic males in short-term weight loss. Our pilot study indicates preliminary evidence of efficacy, though confirmation of these findings is needed in a larger study.

Does Race Influence Decision Making for Advanced Heart Failure Therapies?

Background Race influences medical decision making, but its impact on advanced heart failure therapy allocation is unknown. We sought to determine whether patient race influences allocation of advanced heart failure therapies. Methods and Results Members of a national heart failure organization were randomized to clinical vignettes that varied by patient race (black or white man) and were blinded to study objectives. Participants (N=422) completed Likert scale surveys rating factors for advanced therapy allocation and think-aloud interviews (n=44). Survey results were analyzed by least absolute shrinkage and selection operator and multivariable regression to identify factors influencing advanced therapy allocation, including interactions with vignette race and participant demographics. Interviews were analyzed using grounded theory. Surveys revealed no differences in overall racial ratings for advanced therapies. Least absolute shrinkage and selection operator regression selected no interactions between vignette race and clinical factors as important in allocation. However, interactions between participants aged ≥40 years and black vignette negatively influenced heart transplant allocation modestly (-0.58; 95% CI, -1.15 to -0.0002), with adherence and social history the most influential factors. Interviews revealed sequential decision making: forming overall impression, identifying urgency, evaluating prior care appropriateness, anticipating challenges, and evaluating trust while making recommendations. Race influenced each step: avoiding discussing race, believing photographs may contribute to racial bias, believing the black man was sicker compared with the white man, developing greater concern for trust and adherence with the black man, and ultimately offering the white man transplantation and the black man ventricular assist device implantation. Conclusions Black race modestly influenced decision making for heart transplant, particularly during conversations. Because advanced therapy selection meetings are conversations rather than surveys, allocation may be vulnerable to racial bias.