Inspiring Careers in Mental Health: Piloting a Pipeline Program for Underserved High School Students.

OBJECTIVE: Given mental health workforce shortages, academic psychiatry departments have a compelling interest in developing pipeline programs. This article examines a pilot program for high school students within an academic psychiatry department, assessing whether it successfully informs students about mental health career options and increases their interest in them. METHODS: The authors recruited all program participants in 2022 and 2023 during data collection. The program served as an intervention, teaching participants about mental health career options, clinical practice, and client experiences via presentations from psychiatrists and other mental health professionals. Participants completed a pretest at the start of the two-week program and a posttest at the end. On both the pretest and posttest, participants rated their agreement with 22 statements relating to mental health career knowledge, attitudes, and interest. The authors analyzed the data using dependent means t tests. RESULTS: The program increased participants' knowledge of the roles and paths to pursuing different mental health careers. It also increased participants' belief that they could pursue a mental health career. The program improved some but not all measured attitudes toward mental health and mental health careers. In 2023, the program increased participants' likelihood of pursuing a mental health career. CONCLUSIONS: A pipeline program for underserved high school students delivered by an academic psychiatry department is feasible, and it was effective in changing attitudes and increasing the likelihood of pursuing a mental health career.

Cross-cultural serious neurological illness communication: qualitative analysis of multidisciplinary perspectives.

BACKGROUND: Cultural competence is important in approaching serious illness communication with diverse patients about goals of care. Culture colors patients' perspectives on many healthcare issues, including end-of-life care, and impacts how clinicians make decisions with patients. Communication about serious neurological illnesses can be additionally challenging due to disease impact on patients' cognition and decision-making abilities. We aim to understand provider experiences regarding cross-cultural serious neurological illness communication with diverse patients and families. METHODS: Using non-stratified purposive and snowball sampling, we conducted semi-structured interviews with 17 multidisciplinary participants, including neurosurgeons, neurologists, and social workers, who provide care for patients diagnosed with serious neurological disorders, at three hospital settings between 2021 and 2022. We used standard qualitative content analysis methods with dual review. RESULTS: Five themes reflected provider perspectives about serious neurological illness communication with diverse patients and families. Theme 1: providers recognize that patients' personal biases and lived experiences impact attitudes about healthcare and communication. Theme 2: challenges in communication can arise when providers miss chances to identify important cultural values. Theme 3: understanding how to engage with family members is important for effective communication about serious neurological illness. Theme 4: providers want to accommodate patients. Theme 5: cultivating trust builds a strong patient-provider partnership, even when racial or cultural discordance is present. CONCLUSIONS: Our study highlights elements of cross-cultural communication and opportunities for providers to approach diverse patients and families within a racial or culturally discordant context. Effective communication, fostered through respecting individual experiences and variation, eliciting cultural perspectives, engaging family, and cultivating trust reflects processes and learned skills required of high-quality teams caring for patients with serious neurological conditions.

Aboriginal young people's experiences of type 2 diabetes diagnosis, management and support: A qualitative study in the Kimberley region of Western Australia.

ISSUES ADDRESSED: In Australia, Aboriginal and Torres Strait Islander young people in remote settings are most-affected by young onset type 2 diabetes (T2D). It is necessary to understand young people's experiences, including factors impacting on self-management, to improve models of care. METHODS: A phenomenological methodology underpinned this qualitative study in Western Australia's Kimberley region. Two Aboriginal Community Controlled Health Services supported recruitment of seven Aboriginal young people aged 12-24 with T2D, who participated in interviews. A carer and health professional of one young person in each site were also interviewed and relevant medical record data reviewed to assist with triangulation of data. De-identified transcripts were inductively coded and a coding structure developed with oversight by a Kimberley Aboriginal researcher. RESULTS: Young people reported varied experiences and emotions relating to a T2D diagnosis. Most recounted this was upsetting and some reported current negative impact on emotional wellbeing. Challenges with understanding and managing diabetes were highlighted, particularly regarding healthy eating, physical activity and medication. Family are a prominent source of self-management support, with the intergenerational impact of diabetes being evident for each participant. Positive relationships with health professionals, entailing continuity of care, were valued. CONCLUSIONS: There are significant emotional and medical challenges for young people with T2D and their families. Recommendations from this work will contribute to the development of local resources and initiatives to improve diabetes-related support. SO WHAT?: Alongside broader efforts to support good health at the societal level, enhanced health education and family-oriented support structures including Aboriginal clinical staff for young people with T2D are needed.

Health Equities with Limited English Proficiency: A Review of the Literature.

Health equity exists when everyone has an equal opportunity to achieve their highest level of health. Effective communication is essential to ensure a therapeutic relationship. Patients with limited English proficiency (LEP) experience communication barriers, leading to poorer outcomes. Federal regulation requires hospitals to provide medically trained interpreters; however, this does not always occur. We identified 3 broad areas of research: communication barriers, outcomes, and costs. Findings highlight the challenges patients with LEP face in the health-care system, and the need for targeted interventions to enhance language access, improve cultural competence among health-care professionals, and ensure equitable outcomes for all.

Creating LGBTQIA+-Inclusive Health Care as a Supportive Care Strategy.

LGBTQIA+ (lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and others) people are threatened by stigma and discrimination, and experience an abundance of health-related disparities, inequities, an.

Sleep Health Ambassadors in Greater Detroit: A Model for Religio-Culturally Conscious Care in Places of Worship From Dearborn to Hamtramck.

An innovative healthcare delivery model in Greater Detroit is proposed to integrate religious and cultural identities with health strategies to address specific disparities, such as higher rates of diabetes and cardiovascular diseases linked to poor sleep, among minority communities, particularly among its diverse Muslim population. This model advocates for culturally conscious care, deeply appreciating the sociocultural determinants of health. It proposes utilizing mosques as community hubs to deploy sleep health ambassadors trained in sleep science and cultural sensitivity. These ambassadors would engage the community through trusted platforms, offering tailored health interventions aligned with religious practices and cultural norms. This approach not only promises improved health outcomes, such as enhancements in sleep quality, reductions in sleep-related health issues, and increased community health awareness, but also empowers the community by incorporating local religious leaders and stakeholders in program planning and implementation, for example, through the introduction of tailored sleep hygiene workshops that align with the timing of religious practices, such as Ramadan, and culturally sensitive screening for sleep apnea. Success will be measured by improvements in self-reported sleep quality, a reduction in daytime sleepiness, and community surveys assessing awareness and engagement. By demonstrating efficacy in managing sleep health, this model could scale to address broader health issues, ensuring interventions are culturally appropriate and effectively managed within community-specific contexts. This model holds the promise of significantly reducing health disparities by adapting health interventions to the cultural and religious contexts of communities, potentially transforming the landscape of community health management.

'I tried to get into their shoes and their culture'. Care worker experiences in cultural end-of-life care: Interpretative phenomenological analysis.

AIM: What are care workers' lived experiences caring for people of culturally and linguistically diverse backgrounds during end-of-life care? DESIGN: Interpretative phenomenological analysis METHODS: The lived experiences of 11 care workers within the Australian Capital Territory and region who have cared for someone of a culturally and linguistically diverse background during end-of-life care were captured. Each care worker was interviewed individually and answered a series of semi-structured open-ended questions. RESULTS: Using interpretative phenomenological analysis, three group experiential themes were derived: (i) navigating cultural shock and death, (ii) the hard work of communication and (iii) searching for deeper connections with client and self. Within these were key elements: Care workers worked hard to embrace cultural diversity, but struggled to meet cultural needs, particularly in relation to the unpredictable timeline of dying. Care workers relied on themselves and their improvisation, but experienced self-blame for inadequate care and unexpected challenges in communication. Blurred boundaries in relation to therapeutic relationships were apparent, and care workers felt alone with emotional burden, but also found belonging and joy in their work. CONCLUSION: Care workers' experiences are vital to understanding the barriers and challenges in providing culturally appropriate end-of-life care. Care workers repeatedly experienced an emotional burden and vicarious trauma throughout their work in this field. Care workers were self-reliant in all aspects of care including communication and consistently desired education, training, resources and support. There remains inadequate research on care workers and their role within the Australian healthcare context. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Care workers need access to support and resources including professional translators to provide culturally appropriate end-of-life care. Workplaces and registered nurses should facilitate training and provide guidance to care workers. A person-centred approach is required during all client encounters while maintaining appropriate therapeutic relationships including therapeutic use of self and professional boundaries. REPORTING METHOD: COREQ Checklist. PATIENT OR PUBLIC CONTRIBUTION: During this study, care workers were interviewed on their experiences caring for people of culturally and linguistically diverse backgrounds during end-of-life care. Patients were not directly involved within this study, but their views may have been expressed through the care workers' experience.

A beautiful bush space on Country: Indigenous women's perspectives on the cultural significance of a placenta garden.

BACKGROUND: Australian Aboriginal and Torres Strait Islanders, hereafter respectfully referred to as First Nations women, often experience maternity care incongruent with their cultural needs. To date, there is limited research on First Nations women's perceptions of the role that placental burial and a placenta garden may play in promoting connection to culture for women and their babies. AIM: This study aimed to understand First Nations women's perceptions of placenta burial and a dedicated placenta garden in supporting connection to their culture. METHODS: In this qualitative descriptive study, decolonising methods were used to recruit eight First Nations women using message stick sampling via First Nations mentors. Stories were told through yarns using a semi-structured yarning guide. Reflexive thematic analysis led to theme generation. Member-checking of preliminary themes by participants and endorsement by First Nations mentors occurred before finalisation of themes. FINDINGS: Four themes captured the women's perspectives on the significance of placental burial and gardens. Recognising the Barriers explores factors impacting on culture and maternity care experiences. Enabling Continuity of Care describes a desire to work with a midwife towards a continuum throughout the perinatal period. Promoting Connection for Mum and Baby explores how the placenta garden can act as a conduit for connection. Finally, Creating Opportunity for Healing describes the essential healing that can be initiated through engaging in cultural placental burial. CONCLUSION: First Nations women described placental burial as essential to strengthening their connection to culture and perceived that continuity of care with a culturally knowledgeable midwife facilitated connection.

The Nursing Inter Shift Handover: A Moment of Care for Patients and Their Family Caregivers.

Precedents: The transfer between nursing shifts must guarantee the quality of care for patients and their families in the hospital. This study aimed to transform the handover between nursing shifts to strengthen the care capacity of patients and their family caregivers, and improve the care capacity of nursing staff, in a Latin American university hospital. Methods: This is a Nursing Methodology Research developed in the following phases: (a) identification of the best handover practices between nursing shifts to apply them within the institutional culture; (2) diagnosis of the transfer between shifts in the hospital; (3) design and validation of the transformation proposal; (4) measurement of transfer indicators; and (5) definition of a path to improve this transfer. Results: The proposal developed focuses on the patient and their family caregiver. The proposed protocol considered the perspective of the care recipients, the nursing staff, and the best available evidence. The overall transfer rating over 10 months went from 65% to 84%. Conclusions: The adjustment to the transfer process made it possible to strengthen the care capacity of patients and their family caregivers and improve the care capacity of the nursing staff.

Innovative cultural care training: the impact of flipped classroom methods on critical cultural competencies in psychiatric nursing: a quasi-experimental study.

INTRODUCTION: Healthcare systems are encountering a growing number of diverse and multicultural clients due to globalization and migration. To effectively address the challenges associated with cross-cultural interactions, nurses require a comprehensive framework of critical cultural competencies. One potential approach to enhancing these competencies in mental health care settings is to use innovative methods such as the flipped classroom in cultural care training programs. This study evaluated the effect of using the flipped classroom method in cultural care training on the critical cultural competencies of nurses working in a psychiatric hospital. METHODS: This quasi-experimental study involved 70 nurses working in a psychiatric hospital affiliated with the Kerman University of Medical Sciences in southeastern Iran. Through random sampling, the nurses were allocated into two groups of intervention (n = 35) and control (n = 35). The intervention group participated in a cultural care training program using the flipped classroom method, which consisted of four sessions conducted over a four-week period. To evaluate the nurses' critical cultural competence, the Almutairi's Critical Cultural Competence Scale was administered before the training and again one month later. RESULTS: The study findings indicated no significant differences in the scores of critical cultural competencies between the intervention group (4.53 ± 0.64) and the control group (4.73 ± 0.42) during the pre-test stage (t = 1.53, p = 0.13). Both groups had a similar perception of critical cultural competencies, which was not particularly positive. However, in the posttest stage, the intervention group (5.33 ± 0.49) demonstrated a significant increase in critical cultural competencies compared to the control group (4.75 ± 0.44) (t = 5.14, p = 0.001). CONCLUSION: The study results indicated that the use of the flipped classroom method in the cultural care training program effectively enhanced the critical cultural competencies of nurses. Given the importance of cultural care in both physical and psychiatric care settings for multicultural clients, it is crucial for nurses to receive ongoing in-service education that utilizes innovative and active methods such as the flipped classroom.

Factors that affect the health of immigrants: Qualitative meta synthesis.

BACKGROUND: Migration has challenged society. Most people who move do so for economic reasons, but others move for more tragic reasons. The proportion of female migrants was slightly higher than that of male migrants, partly due to the longer life expectancy of women and the higher demand for female migrants in care-related Jobs. The process may affect migrants' health, particularly in countries where healthcare is associated with high economic costs or insurance availability. A global systematic review of qualitative studies with meta-synthesis was conducted. The results can be used to support health policy and clinical practice. OBJECTIVE: To describe how migrants perceive and experience the process of migrating and how it affects their health. SEARCH STRATEGY: Databases consulted were Medline, PsychInfo, Cuiden, Cinahl, WOS, Scopus, Social Science Database, and Epistemonikos. Thirty-four articles were selected for final meta-synthesis. INCLUSION CRITERIA: All qualitative primary studies were included that describe the experiences or perceptions of migrants and refugees over 18 years that talk about their migration process and the impact on their health; written in English or Spanish between 2016 and 2021. Articles referring to second generations and those dealing with pathologies that pre-date the migration process were excluded. DATA EXTRACTION AND SYNTHESIS: The COREQ and JBI templates were used as quality criteria. Studies mostly used a phenomenological methodology and in-depth interviews, both individual and group, were used for data collection and narrative synthesis. MAIN RESULTS: Uncertainty emerges as a main category. Three other interrelated themes have a direct impact on migrants' health: Language, Social Networks and Work. There are several conditions in each of these that have a positive or negative impact on health. The gender condition appears in both work and social networks, positively and negatively. DISCUSSION AND CONCLUSIONS: Health would be improved by having a stable job, which would facilitate access to health resources. Social networks and language are facilitators of access to a better job, but not the only condition. From a gender perspective, social networks can become a source of health problems, especially for women. The process of migration places women in a position of vulnerability due to the difficulties of reconciling family and work life. Job insecurity, workload, loss of family life or social isolation increase hopelessness and anxiety, leading to health problems. PUBLIC OR PATIENT CONTRIBUTION: As an academic review study, no patient contribution was required, and this study serves as a theoretical framework for more in-depth research that will work with migrant populations. As a public contribution, this work provides evidence of the need to improve access to health for some populations, in line with the Sustainable Development Goals (SDGs) set for 2030.

Evaluation of a pathway to address take own leave events for First Nations peoples presenting for emergency care: The Deadly RED project.

OBJECTIVE: The 'Deadly RED' project primarily aimed to improve culturally competent care to reduce the number of First Nations patients presenting to a Queensland ED who 'Take own leave' (TOL). The secondary aim was to evaluate the implementation project. METHODS: A pre/post-test quasi experimental study design using mixed methods was co-designed with adherence to Indigenous research considerations. Quantitative analysis of First Nations presentations before and after Deadly RED implementation was performed using SPSS. Qualitative analysis of transcribed research yarns in NVIVO was coded and themed for analysis. Staff experiences and perspectives were collated using electronically distributed surveys and process audits were performed. RESULTS: A total of 1096 First Nations presentations June to August 2021 and 1167 in the matched 2022 post-implementation period were analysed. Significantly more patients were recorded as TOL post-implementation (13.0% pre vs 21.3% post) and representations rates were unchanged. Forty-six staff surveyed identified improvements in all parameters including cultural appropriateness and quality of care. Qualitative analysis of 85 research yarns revealed themes migrated to increasingly acceptable, accessible, and usable care. Notably, 45% of the First Nation's patients recorded as TOL self-reported that their treatment was complete. The study was feasible as 80% of packs distributed and 73% follow-up screening after TOL. CONCLUSIONS: The Deadly RED evaluation revealed significant discrepancies in the reported data points of TOL and the 'story' of the First Nations persons experience of appropriate and completed care. Staff awareness and cultural capability improved significantly, and yarning allowed knowledge translation and improvements in communication which contributed to a better healthcare experience for First Nations patients attending our ED.

Interpreter-mediated neuropsychological assessment: Clinical considerations and recommendations from the European Consortium on Cross-Cultural Neuropsychology (ECCroN).

OBJECTIVE: With increasing international migration, societies have become increasingly diverse worldwide. Although neuropsychological assessment is influenced by several diversity characteristics, language barriers have repeatedly been identified as one of the main challenges to cross-cultural neuropsychological assessment in migrant populations. Importantly, neuropsychologists are often required to conduct interpreter-mediated neuropsychological assessments without any graduate training or continuing education on the topic. To address this gap, the objective of this paper is to provide guidelines for interpreter-mediated neuropsychological assessment. METHOD: A European Consortium on Cross-Cultural Neuropsychology (ECCroN) task force conducted a conceptual literature review and provided recommendations for good practice and working principles to inform the preparation and administration of interpreter-mediated assessments. RESULTS: ECCroN takes the position that it is the responsibility of neuropsychologists, as well as the institutions or organizations that employ them, to ensure effective communication between themselves and their patients. This may be accomplished by preparing for an interpreter-mediated assessment by engaging an appropriate interpreter, which in most circumstances will be a professional in-person interpreter speaking the same language(s) or dialect(s) as the patient, and considering practical, language, and cross-cultural issues. During the assessment, reasonable steps should be taken to proactively manage the proceedings and adopt a communication style that facilitates effective patient-directed communication, and when interpreting test data and determining formulations and diagnoses, the limitations of interpreter-mediated assessment should be carefully considered. CONCLUSION: Adhering to the provided recommendations and working principles may help neuropsychologists provide competent interpreter-mediated neuropsychological assessments to linguistically diverse patients.

Federal and State Policy Issues Affecting Lesbian, Gay, Bisexual, Transgender, and Queer Older Adults.

Anti-lesbian, gay, bisexual, transgender, and queer (LGBTQ) + discrimination is widespread, harming the health of LGBTQ + people and constituting a barrier to care. This contributes to higher rates of poverty among LGBTQ + people, especially among people of color, and lower insurance coverage rates. The Affordable Care Act's expansion of insurance access has reduced uninsurance rates among LGBT people and people living with human immunodeficienc virus (HIV). Systemic improvements in culturally responsive health care have occurred over the past decade, including increased collection and use of sexual orientation and gender identity data to improve quality of care. As older LGBTQ + people enter elder service systems, reforms are needed to ensure equitable access.

Effect of a Hispanic outreach program on referral and liver transplantation volume at a single center.

BACKGROUND: Although Hispanic patients have high rates of end-stage liver disease and liver cancer, for which liver transplantation (LT) offers the best long-term outcomes, they are less likely to receive LT. Studies of end-stage renal disease patients and kidney transplant candidates have shown that targeted, culturally relevant interventions can increase the likelihood of Hispanic patients receiving kidney transplant. However, similar interventions remain largely unstudied in potential LT candidates. METHODS: Referrals to a single center in Texas with a large Hispanic patient population were compared before (01/2018-12/2019) and after (7/2021-6/2023) the implementation of a targeted outreach program. Patient progress toward LT, reasons for ineligibility, and differences in insurance were examined between the two eras. RESULTS: A greater proportion of Hispanic patients were referred for LT after the implementation of the outreach program (23.2% vs 26.2%, p = 0.004). Comparing the pre-outreach era to the post-outreach era, more Hispanic patients achieved waitlisting status (61 vs 78, respectively) and received a LT (971 vs 82, respectively). However, the proportion of Hispanic patients undergoing LT dropped from 30.2% to 20.3%. In the post-outreach era, half of the Hispanic patients were unable to get LT for financial reasons (112, 50.5%). CONCLUSIONS: A targeted outreach program for Hispanic patients with end-stage liver disease effectively increased the total number of Hispanic LT referrals and recipients. However, many of the patients who were referred were ineligible for LT, most frequently for financial reasons. These results highlight the need for additional research into the most effective ways to ameliorate financial barriers to LT in this high-need community.

A scoping review into the service needs of people from culturally and linguistically diverse backgrounds living with disability to engage in meaningful occupations.

INTRODUCTION: Although there is a large proportion of people from culturally and linguistically diverse backgrounds within Australia, their rate of access to disability services is disproportionately low. This review aims to understand the service needs of people from culturally and linguistically diverse backgrounds with disability to facilitate engagement in meaningful occupations. METHODS: Arksey and O'Malley's scoping review framework was employed. Ten databases were searched for Australian studies. A deductive content analysis framework was applied in the synthesis. RESULTS: Fourteen papers were included. Themes that emerged include language and cultural needs and considerations, which highlights the need for information sharing to take account of intergenerational, intercultural and sociolinguistic differences. It also identified the need for improved training and skills of existing interpreters. Culturally competent and responsive services was another theme identified, which emphasised the need to enhance the workforces' understanding of cultural practices. There is also a strong call for a more culturally diverse workforce to reduce the use of some interpreters and to build a more culturally competent workforce. The last theme was responsive service delivery, which requires the governance to support the development of a nurturing trusting therapeutic relationship. CONCLUSIONS: Service providers should be trained on the inequities and intersectionality of this population. Further research is required to explore current disability policy in Australia with an intersectionality lens to ensure recommendations can be made to address barriers and ensure this population receives services in a manner that enhances their ability to engage in occupations meaningfully.

'All Aboriginal and Torres Strait Islander children should have access to the ASQ-TRAK': Shared vision of an implementation support model for the ASQ-TRAK developmental screener.

ISSUE ADDRESSED: The ASQ-TRAK, a strengths-based approach to developmental screening, has high acceptability and utility across varied Aboriginal and Torres Strait Islander contexts. While substantive knowledge translation has seen many services utilise ASQ-TRAK, we now need to move beyond distribution and support evidence-based scale-up to ensure access. Through a co-design approach, we aimed to (1) understand community partners' perspectives of barriers and enablers to ASQ-TRAK implementation and (2) develop an ASQ-TRAK implementation support model to inform scale-up. METHODS: The co-design process had four phases: (i) partnership development with five community partners (two Aboriginal Community Controlled Organisations); (ii) workshop planning and recruitment; (iii) co-design workshops; and (iv) analysis, draft model and feedback workshops. RESULTS: Seven co-design meetings and two feedback workshops with 41 stakeholders (17 were Aboriginal and Torres Strait Islander), identified seven key barriers and enablers, and a shared vision - all Aboriginal and Torres Strait Islander children and their families have access to the ASQ-TRAK. Implementation support model components agreed on were: (i) ASQ-TRAK training, (ii) ASQ-TRAK support, (iii) local implementation support, (iv) engagement and communications, (v) continuous quality improvement and (vi) coordination and partnerships. CONCLUSIONS: This implementation support model can inform ongoing processes necessary for sustainable ASQ-TRAK implementation nationally. This will transform the way services provide developmental care to Aboriginal and Torres Strait Islander children, ensuring access to high quality, culturally safe developmental care. SO WHAT?: Well-implemented developmental screening leads to more Aboriginal and Torres Strait Islander children receiving timely early childhood intervention services, improving developmental trajectories and optimising long-term health and wellbeing.

Beyond translation: Transcreation of a clinicians' guide to structure discussions about health-related values with Latinx patients throughout cancer.

OBJECTIVE: This study aimed to ensure accurate translation and cultural appropriateness of a guide designed to help oncology clinicians provide person-centered care to Spanish-speaking Latinx patients with cancer. METHODS: Initial translation of a clinician-patient values discussion guide in open-ended question format ("Guide") was pretested in interviews with 27 Spanish-speaking individuals, followed by national expert panel review. At three sites, semi-structured, in-depth, audio-recorded interviews in the participant's preferred language (Spanish/English) were then conducted with Latinx patients receiving systemic treatment for a solid tumor malignancy and family joining them at clinic. RESULTS: Interviews of 43 patient/family participants representing diverse Latinx communities addressed the Guide's understandability, acceptability, relevance and responsiveness. Rapid analysis of interviews contributed to cultural adaptation/transcreation of the Guide for a pilot interventional trial. CONCLUSION: Moving beyond translation to transcreation can help promote inclusion, equity, and cultural sensitivity in oncologic care/communication. PRACTICE IMPLICATIONS: Clinicians now have a linguistically- and culturally-adapted guide including questions and prompts to help structure discussions in Spanish or English of health-related values with Latinx patients receiving oncologic care.

Competency mapping of primary healthcare nurses on the Brazil-Paraguay border / Mapeo de competencias de los enfermeros de atención primaria de salud em la frontera Brasil-Paraguay / Mapeamento de competências de enfermeiros da atenção primária de saúde na fronteira Brasil-Paraguai

ABSTRACT Objective: To map the competencies of Primary Health Care nurses in border regions of Brazil and Paraguay. Method: Exploratory qualitative studyconducted between February and July 2020, with 64 nurses from six Brazilian municipalities bordering Paraguay. It was conducted in three stages: 1. Documentary study: analysis of legal documents to identify the nurse's competencies. 2. Application of instrument to the study population .3. Mapping of competencies, through the competencies expressed by nurses analyzed using the collective subject discourse technique. Results: Twenty-eight general competencies were identified, categorized as assistance and management, and five specific competencies required to work in border regions: conducting a situational diagnosis of the border community; attending to foreign users with active and humanized listening; communicating appropriately with foreign users; identifying the epidemiological profile of the border; and, understanding the health policies of the neighboring country. The competencies required for the work from the participants' perspective were included in the mapping. The competence gap identified in the mapping refers to educational practices in communities. Final considerations: The study identified the necessary competencies for nurses to work in border regions, but pointed out gaps in the training and continuing education of these professionals.

RESUMEN Objetivo: Mapear las competencias de enfermeros de Atención Primaria de Salud en regiones fronterizas de Brasil y Paraguay. Método: investigación exploratoria descriptiva con enfoque cualitativo realizada entre febrero y julio de 2020, con 64 enfermeros de seis municipios brasileños fronterizos con Paraguay. Se realizó en tres etapas: 1. Estudio documental: análisis de documentos legales para identificar las competencias del enfermero. 2. Aplicación del instrumento a la población de estudio .3. Mapeo de competencias, a través de las competencias expresadas por enfermeros analizadas mediante la técnica del discurso del sujeto colectivo. Resultados: Se identificaron 28 competencias generales categorizadas en asistencia y gestión, y cinco competencias específicas requeridas para trabajar en regiones fronterizas: realizar un diagnóstico situacional de la comunidad fronteriza; atender a los usuarios extranjeros con una escucha activa y humanizada; comunicarse adecuadamente con el usuario extranjero; entender el perfil epidemiológico de la frontera; y, conocer las políticas sanitarias del país vecino. En el mapeo se incluyeron las habilidades requeridas para el trabajo desde la perspectiva de los participantes. La brecha de competencias identificada en el mapeo se refiere a las prácticas educativas en las comunidades. Consideraciones finales: El estudio identificó las habilidades necesarias para que las enfermeras trabajen en regiones fronterizas, pero señaló brechas en la formación y educación continua de estos profesionales.

RESUMO Objetivo: Mapear as competências dos enfermeiros da Atenção Primária à Saúde em regiões fronteiriças do Brasil e Paraguai. Método: Estudo exploratório de natureza qualitativa realizado entre fevereiro e julho de 2020, com 64 enfermeiros de seis municípios brasileiros fronteiriços com o Paraguai. Foi realizada em três etapas: 1. Estudo documental: análise de documentos legais para identificar as competências do enfermeiro. 2. Aplicação de instrumento para a população do estudo. 3. Mapeamento das competências, através das competências expressas pelos enfermeiros analisados pela técnica do discurso do sujeito coletivo. Resultados: Identificaram-se 28 competências gerais, categorizadas como assistenciais e gerenciais e cinco competências específicas requeridas atuar para regiões de fronteira: realizar o diagnóstico situacional da comunidade fronteiriça; atender o usuário estrangeiro com escuta ativa e humanizada; comunicar-se de forma adequada com o usuário estrangeiro; identificar o perfil epidemiológico da fronteira; e, conhecer as políticas de saúde do país vizinho. As competências requeridas para o trabalho na perspectiva dos participantes, foram contempladas no mapeamento. A lacuna de competência identificada no mapeamento se refere às práticas educativas nas comunidades. Considerações finais: O estudo identificou as competências necessárias para enfermeiros atuarem em região de fronteira, mas apontoulacunas na formação e educação permanente desses profissionais.

Cultural competence of undergraduate student nurses: a multicenter study / Competencia cultural de estudiantes de pregrado en enfermería: estudio multicéntrico / Competência cultural de estudantes de graduação em enfermagem: um estudo multicêntrico

Objective: to evaluate the level of cultural competence of an undergraduate nursing students' population from four European higher education institutions. Method: a total of 168 nursing students from four different countries were included in our study. The study methodology involved a cross-sectional assessment of cultural competence among undergraduate nursing students from four European universities. Data collection included sociodemographic variables, as well as the following validated tools: the Intercultural Sensitivity Scale, the Cultural Competence Assessment Tool (student version) and the Cultural Awareness Scale. Results: our results indicated that students demonstrated a high level of intercultural sensitivity but a moderate level of cultural competence and cultural awareness. Variations existed among students from different countries, suggesting potential differences in educational approaches. Despite expectations that higher-level students would exhibit greater cultural competence, no significant differences were found by year of study, indicating a lack of effective integration of cultural competence into nursing curricula. Conclusion: nurse educators should consider the students' cultural competence before designing related study programmes. Training programmes related to cultural competence should include elements which have been associated with enhanced cultural competence, including language skills, cultural encounter, and opportunities for internationalisation.

Objetivo: evaluar el nivel de competencia cultural de una población de estudiantes de pregrado en enfermería de cuatro instituciones europeas de educación superior. Método: en nuestro estudio se incluyeron en total 168 estudiantes de enfermería de cuatro países diferentes. La metodología de estudio implicó una evaluación transversal de la competencia cultural de los estudiantes de pregrado en enfermería de cuatro universidades europeas. La recolección de datos incluyó variables sociodemográficas y las siguientes herramientas validadas: la Escala de Sensibilidad Intercultural, la Herramienta de Evaluación de la Competencia Cultural (versión para estudiantes) y la Escala de Conciencia Cultural. Resultados: los estudiantes demostraron un alto nivel de sensibilidad intercultural pero un nivel moderado de competencia y conciencia cultural. Hubo variaciones entre los estudiantes de diferentes países, lo que sugiere posibles diferencias en los enfoques educativos. A pesar de que se esperaba que los estudiantes de educación superior tuvieran mayor competencia cultural, no se encontraron diferencias significativas por año de estudio, lo que indica que la competencia cultural no se incluye de forma efectiva en los planes de estudio de las carreras de pregrado en enfermería. Conclusión: los educadores de enfermería deben considerar la competencia cultural de los estudiantes antes de diseñar programas de estudio relacionados con la misma. Los programas de formación relacionados con la competencia cultural deben incluir elementos que se hayan asociado con una mayor competencia cultural, eso incluye habilidades lingüísticas, encuentros culturales y oportunidades de internacionalización.

Objetivo: avaliar o nível de competência cultural de uma população de estudantes de graduação em enfermagem de quatro instituições europeias de ensino superior. Método: um total de 168 estudantes de enfermagem de quatro países diferentes foram incluídos em nosso estudo. A metodologia do estudo envolveu uma avaliação transversal da competência cultural entre estudantes de graduação em enfermagem de quatro universidades europeias. A coleta de dados incluiu variáveis sociodemográficas, bem como as seguintes ferramentas validadas: Escala de Sensibilidade Intercultural, Ferramenta de Avaliação de Competência Cultural (versão do aluno) e Escala de Consciência Cultural. Resultados: nossos resultados indicaram que os alunos demonstraram um alto nível de sensibilidade intercultural, mas um nível moderado de competência e consciência cultural. Houve variações entre os alunos de diferentes países, o que sugere possíveis diferenças nas abordagens educacionais. Apesar das expectativas de que os alunos de nível superior apresentariam maior competência cultural, não foram encontradas diferenças significativas por ano de estudo, indicando uma falta de integração eficaz da competência cultural nos currículos de enfermagem. Conclusão: os educadores de enfermagem devem considerar a competência cultural dos alunos antes de elaborar programas de estudo relacionados. Os programas de treinamento relacionados à competência cultural devem incluir elementos que tenham sido associados a uma maior competência cultural, incluindo habilidades linguísticas, encontros culturais e oportunidades de internacionalização.