Mexican cultural beliefs and breastfeeding: a model for assessment and intervention.

This article describes a model which organizes beliefs and practices of women of Mexican descent and describes counseling approaches for each. The four categories of beliefs and practices are beneficial, harmless, harmful and uncertain. Counseling ideas for each of the categories includes approaches to encourage, ignore, dissuade or observe to categorize the belief later. Situational examples correspond to each category to illustrate how the model can be incorporated into practice. The model provides a methodology for assessment and intervention which considers and respects the cultural elements that influence breastfeeding.

PIP: Part of an effort to improve breastfeeding counseling for women of Mexican descent, this article categorizes this cultural group's practices and beliefs that pertain to breastfeeding, and suggests appropriate counseling approaches. Beliefs and practices fall under the categories of beneficial, harmless, harmful, and uncertain. Respectively, counselors should encourage, ignore, dissuade, or observe for future classification each of the categories. Certain beliefs--like the idea that drinking atole, a cornmeal beverage -- neither jeopardize nor benefit the practice of breastfeeding. Therefore, a counselor can safely ignore this harmless belief. Other beliefs, however, do prove harmful for breastfeeding, such as the notion that a sudden shock or emotional upheaval (coraje or asusto) spoils the milk. While harmful beliefs need to be discouraged, the counselor should do so in a culturally sensitive manner. For example, instead of completely discounting the belief, counselors can avert the harmful effects of coraje or asusto by suggesting to the mother to discard the "old, bad" milk and resume breastfeeding the baby with "new" milk. Some beliefs, such as idea that a woman's shoulders must be covered to maintain an adequate milk supply, cannot yet be categorized. While body warmth helps milk production, the belief could become counterproductive if taken to the extreme -- if women believe that they can only breastfeed when their shoulders are covered. Beliefs under this category demand further observation. Lastly, counselors should encourage beneficial beliefs, such as the practice of cuarentena, where the 40 days following the baby's birth provide the mother, among other things, rest and a special diet. When dealing with any category, counselors should keep in mind that these beliefs are oftentimes centuries old, and should therefore approach them in a sensitive manner.

The clinical nurse specialist in the school setting: case management of migrant children with dental disease.

Dental disease is a major health problem for all school-age children in the nation; for migrant children the problem is most severe. This paper presents strategies for the clinical nurse specialist (CNS) in the school setting in case management of migrant children with dental disease. The barriers migrant families face in obtaining health care are addressed. Leininger's transcultural care theory serves as a conceptual framework. Examples of how the CNS functions in the roles of clinician, educator, consultant, and researcher are given. The federally funded Migrant Education Program is described, along with a model dental program developed by a CNS. Suggestions for documenting the effectiveness of the CNS's role in cost containment and in influencing positive outcome measures of school-age children are presented.