Seeking inclusion while navigating exclusion: Theorizing the experiences of disabled nursing faculty in academe.

Despite repeated calls for equity, diversity, and inclusion in nursing education and the significance of disability for the vocation of nursing, the voices and experiences of nursing faculty with disabilities are largely absent from our literature. In this paper, we present a critical grounded theory of the experiences of disabled nursing faculty in academe to begin to amend this gap. Using critical disability studies as a sensitizing framework and building on prior work on racism and other systems of oppression in nursing, we theorize that nursing academe is a normalized space produced by White, able-mindbodied, and cis-heteropatriarchal discourses that regulate the boundaries of inclusion via exclusionary social norms. Further, we describe the operations of normalcy in nursing academe, discuss implications for education and health care, and consider avenues for change.

Structural competency in mental health nursing: Understanding and applying key concepts.

Achieving mental health equity requires that nursing address structures that impede the ability of individuals and populations to achieve optimal mental health. Consistent with calls for structural change, this paper intends to promote structural competency in mental health nursing by applying this concept to the field. The first half of the paper discusses structural competency and key concepts vital for its development, namely, structure, social influencers of mental health, equity, structural justice, and historical understanding. In the second half we apply structural competency to mental health nursing at the educational, practice and system levels and conclude with recommendations for change.

"You have to fight to legitimize your existence all the time": The social context of depression in men with physical disabilities.

Little is known about the common experience of depression in men with physical disabilities. To help address this gap, we present findings from a qualitative study situated in the social determinants of health (SDH). Findings describe the detrimental effects of marginalization, economic precarity, restrictive masculine norms, stigma, and the need to resist ableist messages on men's health and well-being. It is our intention to raise awareness of the impact of the SDH on depression in men with physical disabilities and encourage clinicians and policy makers to address the social domain as they seek to improve mental health in this population.

A Conceptual Model to Promote the Retention of Women with Physical Disabilities in Research.

Inadequate participant recruitment and retention practices can affect sample representativeness and thus the generalizability of research findings. Retention of research participants has been examined within the literature to some extent; however, there is no consensus on best practice in achieving acceptable results. Furthermore, there is a gap in understanding how to engage and retain women with physical disabilities (WPDs) in research. To address these oversights, we review (1) the significance of retention as a methodological concern, (2) factors that influence the involvement and retention of participants in research, including individual, population, and health-illness considerations, and (3) particular circumstances impacting the inclusion and retention of WPDs in research. On the basis of a review of the literature and our experience with the Healing Pathways randomized controlled trial (RCT), we present a conceptual model to guide culturally sensitive health research implementation with WPDs, and promote the engagement and retention of this group in RCTs and other forms of interventional health research.

Palliative Care Practices and Knowledge of Home Care Nurses in Saudi Arabia: A Cross-Sectional Study.

Palliative Care (PC) is an interdisciplinary specialty focused on relieving symptoms and optimizing quality of life for people living with serious illnesses and their families. A great need for PC exists in Saudi Arabia due to its aging population and prevalence of cancer and other chronic diseases. Home healthcare can make PC more accessible to patients, but clinicians must be equipped with the PC knowledge and skills to perform their roles. This study was a descriptive, correlational examination of PC practices and knowledge of home care nurses recruited from military hospitals in Saudi Arabia. We surveyed participants using the Palliative Care Quiz for Nursing (PCQN) and the Modified Global Home Health Nursing Care Assessment Questionnaire. The mean PCQN score was 8.40, indicating low levels of PC knowledge. A nurses' demographic and physical, spiritual, religious, cultural, linguistic, ethical, and legal aspects of care revealed significant associations. Given the low levels of PC knowledge and skills, we recommend focusing on education, training, and research. Universities should review their curriculum to ensure PC content. Hospitals should provide training programs focused on all aspects of PC, specifically emotional and spiritual, without limiting training to physical aspects of care. Future research is also needed to inform policy in this area.

Having influence: faculty of color having influence in schools of nursing.

Faculty of color (FOC) play an important role in mentoring students and other FOC in schools of nursing. However, the unique nature of mentoring that FOC provide, which includes transmission of expert knowledge of the operations of racism in nursing academe, is not well understood. Furthermore, the influence FOC have on school cultures has not been well documented. To address this gap in knowledge we conducted a critical grounded theory study with 23 FOC in predominately Euro-American schools of nursing. Findings indicate that FOC Having Influence is a key process that explicates the influence FOC wield, exposing their work, which is often taken for granted, hidden, and, unacknowledged. FOC Having Influence occurred in two areas: 1) the survival and success of students and FOC and 2) shaping practices in schools of nursing and impacting health in communities. Implications for educational practice and future research are presented, based on study findings.

Exclusion and control: patterns aimed at limiting the influence of faculty of color.

This article reports on findings from a grounded theory study of the experiences of faculty of color (FOC) in predominantly Euro-American schools of nursing. Findings indicate that a dominant group sometimes referred to as the "Good Old Girls" posed a major barrier to change. To maintain the status-quo, the Good Old Girls used their influence to subject FOC to Patterns of Exclusion and Control with the goal of controlling the influence of FOC. This occurred through parallel and interrelated exclusion and control subprocesses. Exclusion and control strategies threatened FOC's success in academe while simultaneously jeopardizing their well-being. The exclusion strategies FOC experienced included Invalidation of Sense of Self, Othering, and Unequal Standards and Access to Resources. The control strategies included Insincerity and Putting You in Your Place. We describe each of these processes in detail and end with a discussion of the implications of our findings for educational practice.

Promoting Inclusion of Disabled Nursing Faculty.

BACKGROUND: Disabled nursing faculty make important contributions, yet little information is available about this group. PROBLEM: Although information specifically about disabled nursing faculty is limited, available evidence and related literature point to a need for disability inclusive policy and practice in nursing academe. APPROACH: The authors gathered available information to inform development of 10 recommendations for change using universal design as a guiding framework. Universal design is development of an environment usable by all people to the greatest extent possible. OUTCOMES: The article includes 10 recommendations to promote inclusion of disabled faculty in nursing academe. Although disabled faculty are the focus, these recommendations have the potential to benefit all faculty. CONCLUSIONS: Implementing the recommendations may be challenging and will look different across schools. Nevertheless, such change is necessary to counteract exclusionary practices that impact disabled nursing faculty and promote inclusion of this important and underrepresented group.

Relationship, Choice, Health, and Typologies of Unpaid Care Labor for Older Adults.

Providing unpaid care labor to older adult friends and relatives is associated with deleterious health outcomes, especially among persons who feel they have no choice when taking on care responsibilities. We used hierarchical cluster analysis and structural equation modeling of data from the National Alliance for Caregiving's Caregiving in the U.S. 2015 Survey to explore choice-outcome relationships. We identified three distinct care typologies, hands-on, household, and managerial care. Perceived lack of choice predicted emotional stress directly and indirectly through household and managerial care; predicted physical strain directly and indirectly through all care typologies; but only predicted negative health impact indirectly through mediation. Lack of choice had greater direct effects on emotional stress and negative health impact for adult-descendants compared to participants with other relationships with recipients, for whom the effects of lack of choice on outcomes were mediated through household and managerial care.

Factors Associated With Depression in Breast Cancer Patients in Saudi Arabia.

BACKGROUND: Depressive symptoms in Arab women with breast cancer (AWBC) in Saudi Arabia can be influenced by spirituality, religiosity, social support, and breast cancer's stigma. Understanding the role of these factors can raise awareness and help create policies to improve care for breast cancer patients. Yet, there is limited research addressing the impact of these factors on depressive symptoms in AWBC. OBJECTIVE: The aim of this study was to investigate factors influencing depressive symptoms in AWBC in Saudi Arabia. METHODS: A cross-sectional design and convenience sampling were used to recruit 59 AWBC from oncology departments in Jeddah, Saudi Arabia, who were receiving active treatment to participate in this study. Participants completed an online survey or paper-based survey including questions on sociodemographics, social support, spirituality, religiosity, depressive symptoms, and breast cancer's stigma. Pearson correlation and multiple regression analysis were used to examine the influence of numerous factors on depressive symptoms in AWBC; Student t test statistic was used to distinguish the depressive symptom scores between online and paper-based survey. RESULTS: The average age of participants was 49 years (SD = 8.31). The mean (SD) of depressive symptoms was 20.52 (12.36). Pearson correlation analyses indicated that cancer patients with high levels of depressive symptoms were associated with low levels of spiritualty and religiosity, and high levels of breast cancer stigma. CONCLUSIONS: Religiosity and spirituality work as protective factors against depressive symptoms in AWBC. IMPLICATIONS FOR PRACTICE: Including religiosity and spirituality in the intervention plan should be considered when caring for AWBC.

Practical strategies for promoting full inclusion of individuals with disabilities in community-based participatory intervention research.

Community-based participatory research (CBPR) with disability communities is directed toward facilitating full inclusion of individuals with disabilities and disability community organizations in all aspects of the research process. Within the CBPR framework, academic-disability community partners may value and wish to use experimental designs to test interventions. Being aware of and proactively addressing barriers and challenges to inclusion in the areas of human resources, training, productivity, accommodation, and inadequate funding for disability community organizations are critical for success. Some of the strategies discussed in this article for addressing these challenges include creating redundant systems, providing benefits counseling and individualized payment options for employment, designing trainings to be disability friendly, and carefully considering selection of partners in light of available community resources.

Mistrust Reported by US Mexicans With Cancer at End of Life and Hospice Enrollment.

Hospice research with Hispanics mostly focuses on cultural barriers. Mindful of social justice and structural violence, we used critical grounded theory in a postcolonial theory framework to develop a grounded theory of hospice decision making in US Mexicans with terminal cancer. Findings suggest that hospice avoidance is predicted by mistrust, rather than culture, whereas hospice enrollers felt a sense of belonging. Cultural accommodation may do little to mitigate hospice avoidance rooted in discrimination-fueled mistrust. Future research with nondominant populations should employ research designs mitigating Eurocentric biases. Policy makers should consider concurrent therapy for nondominant populations with low trust in the health care system.

Development of the Breast Cancer Stigma Scale for Arab Patients.

OBJECTIVE: Health-related stigma is associated with depression, but there is a lack of studies examining the stigma of cancer in Arab patients. The purpose of this study was to establish the reliability and validity of a newly developed, culturally sensitive measure of stigma among Arab women with breast cancer. METHODS: The sample consisted of 59 Arab women with breast cancer who were Muslim, on active oncology treatment. The mean age of women was 49 years (standard deviation = 8.31). Content validity was assessed by calculating a Content Validity Index (CVI) based on ratings from seven oncology experts. Convergent validity was assessed by examining the association with a measure of depressive symptoms. Reliability was assessed by calculating Cronbach's alpha. RESULTS: The measure demonstrated strong content validity (item-CVIs ranged from 0.85 to 1.0 and the scale-CVI was 1.0) and good convergent validity (higher levels of stigma were significantly associated with higher levels of depressive symptoms). Finally, the reliability of the measure was also found to be adequate (alpha = 0.79). CONCLUSIONS: The initial examination of the Breast Cancer Stigma Scale for Arab Patients indicated that the scale is both valid and reliable to be used in Arab women with breast cancer.

Hispanic Hospice Utilization: Integrative Review and Meta-analysis.

Hospice is patient-centered end-of-life care. Hispanics are underrepresented among hospice patients (7.1%) relative to the U.S. population (17%). We conducted a systematic review of the literature and meta-analysis to understand this underrepresentation further. In palliative care, Hispanic hospice enrollment is comparable to that of non-Hispanic Whites (NHWs) (RR 1.02, 95% CI: 0.93-1.12; z=0.49; p = .627). However, in cases of heart failure (OR 0.49, 95% CI 0.37-0.66) and stroke (OR 0.77, 95% CI 0.63-0.94), Hispanics are much less likely to use hospice than NHWs. Cancer studies are mixed, but in meta-analysis were significant for lower relative hospice use in Hispanics (RR 0.96, 95% CI: 0.94-0.99; z=3.01; p=.003). It remains unclear whether using census and insurance data in statistical analysis provides valid results since the Hispanic population is younger, healthier, and less likely to be insured. Health equity in hospice may be better represented by hospice quality rather than hospice enrollment rates.

The influence of gender role stereotyping on women's experiences of female same-sex intimate partner violence.

Female same-sex intimate partner violence (FSSIPV) is a serious problem that affects the health and safety of lesbian and bisexual women. To begin to address the paucity of research, a mixed methods study was conducted to identify shared and unique risk and protective factors for FSSIPV. This article reports on qualitative findings related to the influence of gender role stereotyping on women's experiences of FSSIPV. Findings indicate that gender role stereotyping shapes women's experiences of FSSIPV by influencing individual, familial, community, and societal perceptions and responses to this phenomenon.

Does Racial Bias Affect NCI-Funded PIs' Willingness to Mentor Prospective Graduate Students?

Audit studies suggest that racial discrimination disadvantages black individuals in educational/professional advancement. We hypothesized that prospective black male doctoral students would experience greater disparity in responses when seeking access to National Cancer Institute (NCI)-funded principal investigators (PI) compared with prospective white males. Primary aim was to explore response and acceptance rates for black versus white men seeking cancer research mentorship. Identical e-mails were sent to 1,028 randomly selected PIs affiliated with 65 NCI-designated cancer centers from "Lamar Washington" (black; n = 515) or "Brad Anderson" (white; n = 513). Primary outcomes: (i) responses within one week; and (ii) type of response. We used logistic regression to examine effects of condition (black/white) on primary outcomes. Approximately 48.3% and 50.0% of the sample responded to "Lamar" and "Brad," respectively. For responders, 40.9% and 43.7% and "agreed" to meet with Lamar and Brad, respectively. This design did not detect bias by PIs against black prospective male students. Cancer Res; 78(17); 4809-11. ©2018 AACR.

Integrative Review of the Literature on Hispanics and Hospice.

The provision of optimal end-of-life care to Hispanics receiving hospice care requires familiarity with hospice-specific variables. For example, a preference for nondisclosure of terminal prognosis in some Hispanics is incongruous with traditional hospice practice. In addition, the Spanish word for hospice, "hospicio," has negative connotations about abandonment of loved ones. Added to cultural considerations are socioeconomic considerations. Many marginalized Hispanic individuals may experience distinct challenges when enrolling in hospice due to socioeconomic hardships relating to poverty, citizenship, and lack of insurance. This systematic integrative review examines the research literature on Hispanics and hospice to report on the state of the science for this topic. Reviewed articles were identified systematically using computer research databases and inclusion and exclusion criteria. Of the 21 reviewed articles, many are survey and low-inference qualitative designs with limited validity and trustworthiness. Most survey instruments were not validated for Spanish language or Hispanic culture. None of the qualitative studies included theoretical sampling or follow-up interviews. Few study designs considered heterogeneity within the Hispanic population. Interpreting results cautiously, there is evidence that some Hispanics find some satisfaction with hospice care in spite of cultural incongruities and socioeconomic challenges. Future research calls for intervention studies and high-inference qualitative designs to gain insight into hospice experiences and what constitutes quality hospice care from the perspectives of Hispanic subgroups. Assessing quality and designing interventions for these end-of-life cultural and socioeconomic issues will improve end-of-life care and facilitate the hospice philosophy of promoting emotional growth at end of life.

Health Care Providers' Perspectives on Barriers and Facilitators to Cervical Cancer Screening in Vietnamese American Women.

INTRODUCTION: Vietnamese American women (VAW) are diagnosed and die at twice the rate than White non-Hispanic American women (16.8/100,000 vs. 8.1/100,000 and 4.4/100,000 vs. 2.4/100,000, respectively). Despite efforts to increase cervical cancer (CC) screening among VAW, the participation rates are persistently low (69% to 81%). The purpose of this study was to explore health care providers' (HCPs) perspectives on barriers and facilitators to CC screening in VAW. METHOD: This qualitative descriptive pilot study, used open-ended semistructured interviews with 10 HCPs. RESULTS: The HCPs had two to 23 years treating VAW. Major barriers and facilitators identified by the HCPs were as follows: VAW's decision making about CC screening; sexual health divide; language discordance, relying on interpreters; breaking suspicion; VAW's exposure to health sources of CC screening; sustainable trust; and motivated health care practices. DISCUSSION: HCPs perceived the reasons for VAW not being screened or delaying CC screening were due to their lack of knowledge, cultural barriers, language, and issues related to trust.

Anti-racist pedagogy: challenges faced by faculty of color in predominantly white schools of nursing.

Despite the significant effects of systems of oppression on health, nursing education tends not to include anti-racist pedagogy in its curricula, preferring instead to focus more narrowly on culture. This narrow focus allows nurses to depoliticize discussions of race and other social differences, largely ignoring the influence that systems of oppression, imperialism, and historical trauma have had on health in marginalized populations. In contrast, anti-racist pedagogy educates students in ways that make racialized power relations explicit, deconstruct the social construction of race, and analyze interlocking systems of oppression that serve to marginalize and exclude some groups while privileging others. This article describes anti-racist pedagogy from the perspective of a faculty member of color, drawing on personal experience and a review of the anti-racist pedagogical literature. Specifically, this article highlights some of the personal and professional challenges faced by faculty of color when engaged in anti-racist pedagogy in predominantly white schools of nursing.