An Ethnohistory of the Transcultural Nursing Scholars and Their Contributions to the Field.

Introduction: The Transcultural Nursing Society (TCNS) recognizes transcultural nursing (TCN) scholars for creative leadership and advancing education, practice, research, and administration. The purpose of this study was to discover the historical context of scholars' professional growth and development and their contributions to and future vision for transcultural nursing. Method: Leininger's Ethnonursing Research Method was used to develop an ethnohistorical qualitative approach that included a semistructured, open-ended interview guide and data analysis plan. Data were analyzed using NVivo software and Leininger's Phases of Ethnonursing Data Analysis Enabler for Qualitative Data. Results: Analysis resulted in the discovery of five themes and 15 patterns related to the sources of scholars' interest in TCN; professional development strategies; contributions to TCN theory development, education, research, practice, service, and consultation; the responsibilities of being a TCN scholar; and their future vision for TCN. Discussion: These findings could inspire and guide TCN scholars as they pursue the study and practice of TCN.

A Quality Improvement Project Using Verbal De-Escalation to Reduce Seclusion and Patient Aggression in an Inpatient Psychiatric Unit.

The use of seclusion is controversial and has been deemed an encroachment on human rights and dignity which can cause psychological trauma and physical injury to patients in the psychiatric setting. This quality improvement project used a quasi-experimental design to implement the TeamSTEPPS educational program, an evidenced-based program to inform nurses about verbal de-escalation to reduce patient aggressive behavior that can lead to patient seclusion. The targeted patient population included all patients admitted 2 months prior to initiation of Team STEPPS (n = 388) and 2 months following completion of the education modules (n = 342). After the implementation of the educational program there was a statistically significant difference in the rate of charting aggressive behavior (p = 0.024). The pre rate was 17.3%, and the post rate was 11.4%. While there was not a statistically significant difference in the rate of seclusion events, (p = 0.349) there was a clinically significant reduction. The pre rate was 5.9%, and the post rate was 4.4%. The results of this study support the importance of educating psychiatric nurses on verbal-de-escalation to reduce patients placed in seclusion and decrease patients' aggressive behavior in the psychiatric settings.

Leininger's Ethnonursing Research Method: Historical Retrospective and Overview.

A historical overview and evolution of Leininger's ethnonursing research method (ERM) is presented along with descriptions of the method's purpose, goal, terminology, and enablers. A succinct guide to using ERM is provided to assist novice and seasoned researchers, as well as mentors and educators, in teaching, mentoring, advising, and/or conducting ethnonursing research studies. Criteria for evaluation of qualitative research studies, such as the ERM, are highlighted.

A quality improvement project to improve diabetes self-management and patient satisfaction in a low-resourced central Kenyan hospital.

BACKGROUND: There is limited evidence about effective strategies for promoting culturally congruent diabetes education in low-resourced primary-care settings. OBJECTIVES: This project, conducted in Central Kenya, examined the effect of an intervention on provider practices and patients' knowledge of diabetes self-care management. METHODS: The intervention consisted of short (30-minute) sessions that offered providers evidenced-based, culturally congruent diabetes education and teaching materials to use with patients. A checklist was used to assess providers' diabetes care practices at baseline and post intervention. Data from semi-structured patient interviews assessed patients' diabetes knowledge at baseline and post intervention. Providers and patients also completed post-intervention satisfaction surveys. RESULTS: Six providers and 74 patients participated in the project. Statistical analysis was completed using SPSS. Significant increases were noted in patients' post-intervention overall diabetes knowledge score (p=.05) and the foot care knowledge subscale (p=.02). No significant differences were noted between patients' baseline and post-intervention scores in the general diabetes (p=.86) or nutrition knowledge (p=.32) subscales. CONCLUSION: These findings suggest supporting providers with culturally congruent tools and resources about diabetes care guidelines can improve knowledge of self-care practices in patients with diabetes.

Implementing a Clinical Practice Guideline on Opioid-Induced Advancing Sedation and Respiratory Depression.

BACKGROUND: Opioid-induced respiratory depression (OIRD) is a serious adverse reaction associated with opioid administration. LOCAL PROBLEM: The purpose of this quality improvement study was to evaluate the impact of implementing a clinical practice guideline for OIRD in a medical-surgical setting lacking standardized monitoring techniques and reporting criteria for patients receiving opioid analgesia. METHODS: An American Society for Pain Management Nursing protocol was implemented in 4 medical/surgical units. The impact on OIRD-related nurse knowledge, documentation, and opioid-related rapid response calls was measured pre- and postimplementation. RESULTS: Nurse OIRD-related knowledge significantly increased. The number of naloxone administrations associated with prior intravenous opioid analgesic administration did not significantly change. However, there was a significant decrease in the postimplementation number of respiratory distress-related rapid response calls. CONCLUSIONS: Implementation of the American Society for Pain Management Nursing guidelines had a positive impact on knowledge, documentation, early intervention of OIRD, and the number of opioid-related rapid response calls.

Mexican American Parental Knowledge and Perceptions of Childhood Obesity: An Integrative Review.

INTRODUCTION: For the past two decades, childhood obesity has remained a national public health concern, particularly among Hispanic populations. Multiple cross-sectoral obesity prevention strategies have been implemented yet remain unsuccessful in generating sustainable lifestyle changes. METHOD: The purpose of this integrative review, using the Whittemore and Knafl method, was to examine the literature from 2009 to 2018 regarding Mexican American parental knowledge and perceptions of childhood obesity. The CINAHL, PubMed, PsycINFO, and ERIC databases were used to search the literature, and 13 peer-reviewed articles met the inclusion criteria. RESULTS: Three main themes emerged from the literature synthesis: (1) parental misperception of child body weight and size, (2) influence of cultural health and growth beliefs on parental perception of child weight, and (3) parental perspectives of causes and consequences of childhood obesity and how to address it. However, cultural variations in parental perceptions were found; therefore, attempts to generalize Mexican Americans' cultural practices should be avoided. CONCLUSION: Studies using qualitative approaches are needed to gain deeper insights about Mexican American culture regarding children's health as it relates to body weight, the roles of different family members in the Mexican American childrearing tradition, and the impact of their associated health beliefs.

Increasing influenza vaccination acceptance in the homeless: A quality improvement project.

The US homeless population is predisposed to serious complications of influenza with increased likelihood of hospitalization and death. This quality improvement project sought to increase influenza vaccination in the homeless population of a rural area in the Midwest and improve provider knowledge of risks and preventive care responsibilities.

Leininger's Theory of Culture Care Diversity and Universality: An Overview With a Historical Retrospective and a View Toward the Future.

An historical overview of Leininger's Theory of Culture Care Diversity and Universality also known as the Culture Care Theory (CCT) and evolution of the Sunrise Enabler are presented along with descriptions of the theory purpose, goal, tenets, basic assumptions, major core constructs, and orientational definitions. Recent articles, books, and book chapters provide relevant exemplars to enhance scholarly understanding and application of theory constructs. Proposed future directions encompass using the CCT to guide research of discovery and translational research projects for evidenced-based nursing practice; develop nursing courses and curricula to prepare culturally competent nurses; guide future culturally competent administrative and leadership policies and procedures; inform public policy related to cultural diversity and underserved populations; promote grant writing initiatives to enhance cultural diversity in hiring nursing staff, supervisors, and faculty; and promote admission of nursing students from underserved and/or diverse backgrounds.

Using a Veterans Affairs Posttraumatic Stress Disorder Group Therapy Program With Refugees.

The PTSD Recovery Program, an intervention based on guidelines for the treatment of combat Veterans diagnosed with posttraumatic stress disorder (PTSD) that includes group therapy as adjunctive treatment to medication and individual therapy, was used for the treatment of PTSD in refugees at a clinic in central Texas. Eighteen clients diagnosed with PTSD completed 10 weekly group therapy sessions in addition to individual therapy and medication use. An in-service presentation educated providers on the PTSD Recovery Program and the group therapy intervention. Data were collected using a pre- and postintervention questionnaire. Statistical analysis supports the effectiveness of the PTSD Recovery Program as an adjunctive treatment for PTSD in the refugee population. Participant statements and provider satisfaction are included as qualitative data. Participant statements about symptom improvement, as well as providers' reported satisfaction with the PTSD Recovery Program, support this intervention as an effective adjunctive treatment for PTSD in the refugee population. [Journal of Psychosocial Nursing and Mental Health Services, 57(5), 21-28.].

Reducing Inappropriate Antibiotics for Urinary Tract Infections in Long-Term Care: A Replication Study.

BACKGROUND: Nursing home providers face challenges in urinary tract infection assessment and treatment, often prescribing unnecessary antibiotics for asymptomatic bacteriuria, a practice that can result in adverse drug reactions, drug resistance, and an increase in antibiotic-associated diarrhea. PURPOSE: The purpose of this project was to replicate the Cooper Urinary Tract Infection Program in another facility and measure its effectiveness. METHODS: Using a pre-post design, this project was implemented at a 120-bed, long-term care and rehabilitation facility located in the Midwest United States. INTERVENTIONS: This project used the multifaceted Cooper Urinary Tract Infection Program that includes the Cooper tool algorithm, didactic education for providers, and change champions. RESULTS: The results were significant improvements in nurse knowledge and reduced rates of urinary tract infections, inappropriate antibiotic treatments, and urinalyses. CONCLUSIONS: These results add to the evidence for implementing the Cooper Urinary Tract Infection Program in long-term care facilities for effective reduction of inappropriate antibiotic usage for urinary tract infection.

Educating Nurses to Use a Brief Tobacco Cessation Intervention With Patients on a Mood Disorder Unit in a Midwestern U.S. Hospital.

BACKGROUND: Evidence shows that smoking cessation interventions are effective in reducing individual's smoking behavior. Despite tobacco cessation efforts, individuals with mental illness smoke more than do members of the general population. OBJECTIVE: This study's objective was to determine whether educating nurses to use an evidence-based brief tobacco intervention would improve educating patients on smoking cessation and lead to more patients accepting nicotine replacement therapy (NRT). METHODS: This study was conducted on a 28-bed mood disorder unit of a Midwestern U.S. psychiatric teaching hospital and used a pre/postchart review. Fourteen nurses participated in the education program that included a PowerPoint presentation, handouts, and weekly e-mails. RESULTS: Eight weeks after the educational program, statistically significant increases were found in nurses' electronic health record documentation of providing patient education on smoking cessation and patients' acceptance of NRT. CONCLUSIONS: This study's education program was successful in promoting smoking cessation education among psychiatric nurses, with an increase of patients accepting NRT. IMPLICATIONS FOR NURSING: Training nurses to use a brief tobacco intervention proved to be an effective short-term method for addressing the high rate of smoking among a group of psychiatric patients.

An Intervention to Improve Cultural Competence in Graduate Nursing Education.

Noting the small number of studies on the influence of an entire curriculum on graduate nursing students' cultural competence, the researchers examined the effect of a curricular intervention using a pretest-posttest design. The study, conducted from 2012 to 2014, focused solely on the Doctor of Nursing Practice program at a midwestern university. Results from a pre- and postintervention faculty curriculum survey indicated that the percentage of courses including a cultural competence objective increased from 65 percent to 81 percent. Results from the pre- and postintervention administration of the Transcultural Self-Efficacy Tool showed a statistically significant improvement in students' overall score and three subscale scores.

Healthcare provider compliance with the 2013 ACC/AHA Adult Cholesterol Guideline recommendation for high-intensity dose statins for patients with coronary artery disease.

BACKGROUND: Atherosclerotic cardiovascular disease is the foremost cause of death for U.S. adults. The 2013 ACC/AHA Adult Cholesterol Guidelines recommend high-intensity dose statins for individuals with coronary artery disease (CAD). OBJECTIVE: To determine healthcare provider compliance with the Cholesterol Guideline recommendation specific to high-intensity dose statins for patients with CAD. METHODS: A retrospective chart review was conducted to determine compliance rate. A questionnaire was developed to evaluate healthcare provider beliefs, attitudes, and self-confidence toward this recommendation. RESULTS: Of the 473 patients with CAD, 67% were prescribed a high-intensity dose statin. Patients with non-ST segment myocardial infarction and ST segment myocardial infarction were more likely to be prescribed a high-intensity dose statin versus a moderate or low-intensity dose. Healthcare providers strongly agreed with this guideline recommendation. CONCLUSION: There exists a dichotomy between intention to prescribe and actual prescribing behaviors of high-intensity dose statin for patients with CAD.

Can follow-up phone calls improve patients self-monitoring of blood glucose?

AIMS AND OBJECTIVES: To evaluate the effectiveness of follow-up phone calls in improving frequency of glucose monitoring over a three month period in two groups of patients with type 2 diabetes with the goal to lower haemoglobin A1C. BACKGROUND: Telephone intervention has been successfully used in improving adherence to diabetes self-management and other chronic disease conditions. DESIGN: A quality improvement study. METHODS: Forty one Type 2 diabetic patients with HA1C ≥7·5% were included in the study. The patients were assigned to two groups. The first group of patients received standard diabetic care (Group 1) and the second group of patients (Group 2) received standard diabetic care plus follow-up phone calls within two weeks after a monthly clinic visit over a three month period. A haemoglobin A1C if indicated was done at the initial study visit. RESULTS: There were no statistically significant differences in the baseline haemoglobin A1C between the two groups or the three month haemoglobin A1C of the two groups. There were no statistically significant differences in mean haemoglobin A1C change between Group 1 and Group 2. The analysis revealed that there were no statistically significant differences between groups in the number of patients who kept logs of their blood glucose readings throughout the study. CONCLUSION: The intervention using telephone follow-up calls did not show a statistically significant improvement in overall HA1C, but there was a clinically significant change in HA1C in the group of patients that received follow-up phone calls. RELEVANCE TO CLINICAL PRACTICE: The clinical significance of the change in A1C in the follow-up phone call group (Group 2) supports that frequent contact by telephone may likely improve adherence to diabetes self-management.

Somali Immigrant Perceptions of Mental Health and Illness: An Ethnonursing Study.

PURPOSE: Knowledge of Somali immigrants' mental health care beliefs and practices is needed so that nurses can promote culturally congruent care. The purpose of this study was to explore, discover, and understand mental health meanings, beliefs, and practices from the perspective of immigrant Somalis. METHOD: Leininger's qualitative ethnonursing research method was used. Thirty informants (9 key and 21 general) were interviewed in community settings. Leininger's ethnonursing enablers and four phases of analysis for qualitative data were used. RESULTS: Analysis of the interviews revealed 21 categories and nine patterns from which two main themes emerged. The themes are the following: (a) Our religion significantly influences our mental health and (b) Our tribe connectedness, cultural history, and khat usage are significant in mental health. CONCLUSIONS: Somali cultural and religious beliefs and practices influence their health care choices. IMPLICATIONS: The findings will improve care by promoting culturally congruent care for the Somali immigrant population.

Exploring faculty health and wellbeing: creating a caring scholarly community.

BACKGROUND: Nursing educators worldwide are challenged to integrate the care of culturally diverse people into coursework to prepare a nursing workforce to deliver culturally congruent care (CCC). Care that recipients consider safe, satisfying, and beneficial is the essence of CCC. To effectively teach and role model such care for students, it is important for faculty to experience it at work. While substantive literature exists on promoting health, wellbeing, and a healthy work environment for nurses in practice, there is a limited focus on these topics for nursing faculty. PURPOSE: The purpose of this study was to discover care practices that helped faculty teach students to provide CCC. This article reports' findings related to the theme that care is essential for the health and wellbeing of general nursing faculty who prepare students to provide CCC. THEORETICAL FRAMEWORK AND METHOD: This qualitative ethnonursing research study, guided by the culture care theory, used open-ended interviews to discover care practices that enhanced faculty's ability to teach students to provide CCC. The study was conducted in two public university baccalaureate nursing programs in urban and rural settings in the Southeastern United States. Purposive sampling was used to recruit 27 tenured, tenured-track, and clinical nursing faculty. Interview data were analyzed using Leininger's four phases of ethnonursing data analysis. Qualitative criteria were used to ensure rigor and included participant confirmation of patterns and themes. FINDINGS AND DISCUSSION: Faculty health and wellbeing were described as embracing each other's cultural similarities and differences, caring for self, caring for others, offering respect, and engaging in mentoring/co-mentoring. Evidence-based recommendations to promote faculty health and wellbeing are presented. Creating a caring scholarly community that supports nursing faculty health and wellbeing provided essential support for faculty who prepared students, often through role modeling, to provide CCC.

Nurse practitioner management of chronic musculoskeletal pain: a chart review.

This study explored NPs' management of chronic musculoskeletal pain via a record review of 50 uninsured patients. The findings include a summary of the utilization of services and treatments along with demographic data. Recommendations for education, practice, and further research are discussed.

Mortality, mauling, and maiming by vicious dogs.

OBJECTIVE: Maiming and death due to dog bites are uncommon but preventable tragedies. We postulated that patients admitted to a level I trauma center with dog bites would have severe injuries and that the gravest injuries would be those caused by pit bulls. DESIGN: We reviewed the medical records of patients admitted to our level I trauma center with dog bites during a 15-year period. We determined the demographic characteristics of the patients, their outcomes, and the breed and characteristics of the dogs that caused the injuries. RESULTS: Our Trauma and Emergency Surgery Services treated 228 patients with dog bite injuries; for 82 of those patients, the breed of dog involved was recorded (29 were injured by pit bulls). Compared with attacks by other breeds of dogs, attacks by pit bulls were associated with a higher median Injury Severity Scale score (4 vs. 1; P = 0.002), a higher risk of an admission Glasgow Coma Scale score of 8 or lower (17.2% vs. 0%; P = 0.006), higher median hospital charges ($10,500 vs. $7200; P = 0.003), and a higher risk of death (10.3% vs. 0%; P = 0.041). CONCLUSIONS: Attacks by pit bulls are associated with higher morbidity rates, higher hospital charges, and a higher risk of death than are attacks by other breeds of dogs. Strict regulation of pit bulls may substantially reduce the US mortality rates related to dog bites.