Culturally Sensitive OCD Research: Lessons from the U.S.-Mexico Border.

This paper explores culturally-related concerns that arose during a multi-year study of obsessive-compulsive disorder (OCD) along the U.S.-Mexico border and describes adaptations made to better connect the research process to study participants. The purpose of this exploration is two-fold: (1) to offer suggestions for culturally sensitive borderland mental health research; and (2) to enhance dialog focused on culture, mental health research and the U.S.-Mexico border. Systematic coding of the written record of weekly research team meetings identified six recurring cultural concerns: emotionally charged and poorly understood terminology; differing meanings of ethnicity and acculturation; quality of life-regional variation and uncertainty; overlap of research and care; hopeful but hesitant; and fatalism. We conclude that diligence in the initial planning phase of a study is only part of the challenge in doing culturally sensitive research. Equally important is an ongoing process of evaluation to make explicit cultural concerns that arise during research, as well as a readiness to implement culturally sensitive research adaptations.

Nataniel, NAFTA, and Public Health at the U.S.-Mexico Border.

Advocating overall improvements in health for individuals and communities is a daunting but important task for nurses in particular, and for health care professionals in general. This is particularly true when focusing on the population along the 2,000-mile U.S.-Mexico border, a unique region in which distinct cultures, economies, and political systems meet. The purpose of this paper is to confront the assumption that trade and economic expansion automatically translate into improved public health, and to explore policy implications of the public health situation at the border. It uses a meta-narrative, an overarching story that draws on and illustrates collective stories from 300 participants in a study of mental health disparities, to argue for a more nuanced and complex understanding of health among the largely Hispanic population in this region.

The ecological future of the North American bison: conceiving long-term, large-scale conservation of wildlife.

Many wide-ranging mammal species have experienced significant declines over the last 200 years; restoring these species will require long-term, large-scale recovery efforts. We highlight 5 attributes of a recent range-wide vision-setting exercise for ecological recovery of the North American bison (Bison bison) that are broadly applicable to other species and restoration targets. The result of the exercise, the "Vermejo Statement" on bison restoration, is explicitly (1) large scale, (2) long term, (3) inclusive, (4) fulfilling of different values, and (5) ambitious. It reads, in part, "Over the next century, the ecological recovery of the North American bison will occur when multiple large herds move freely across extensive landscapes within all major habitats of their historic range, interacting in ecologically significant ways with the fullest possible set of other native species, and inspiring, sustaining and connecting human cultures." We refined the vision into a scorecard that illustrates how individual bison herds can contribute to the vision. We also developed a set of maps and analyzed the current and potential future distributions of bison on the basis of expert assessment. Although more than 500,000 bison exist in North America today, we estimated they occupy <1% of their historical range and in no place express the full range of ecological and social values of previous times. By formulating an inclusive, affirmative, and specific vision through consultation with a wide range of stakeholders, we hope to provide a foundation for conservation of bison, and other wide-ranging species, over the next 100 years.

Assessment of acutely mentally ill patient outcomes in an ethnically diverse population.

Hawaii's multi-ethnic population provides a special opportunity within the United States to examine relationships between ethnicity, mental illness, and psychiatric-mental health outcomes. Understanding such relationships is essential to facilitate the development of culturally sensitive intervention strategies. The aim of this study was to investigate if differences in patient outcomes exist between Caucasians, Asians and Pacific Islanders hospitalized for an acute psychiatric illness in Hawaii. A descriptive approach was used to examine the functional and mental health outcomes and perceptions of care of 138 subjects. The specific tools employed included the Brief Psychiatric Rating Scale (BPRS), Short Form 36 Health Survey Version 2 (SF-36v2), Perceptions of Care (POC), and the Psychiatric Records Abstract Instrument (PRAI). In terms of results, the BPRS scores showed an expected improvement at the time of discharge when compared to the admission assessment.

Stress in families with medically fragile children.

The literature related to the stress experienced by families who care for medically fragile children is analyzed. A model is generated from themes identified in the research literature. Four core themes were identified under which most of the stressors identified in the literature could be grouped. These are role conflict, financial burden, care burden, and independence. These are in turn arranged as a matrix in which the family, the child, the care professional, and health care system interact dynamically with the four core themes. The Family Stress/Task Matrix has the potential for facilitating research related to models that include a family-centered view among health professional and systems.

Buddhism, behavior change, and OCD.

For individuals with obsessive compulsive disorder (OCD), the difficulty of their situation comes as no surprise. But what might be less expected is how directly their situation is spoken to in Buddhist teachings. Still, in nearly all mainstream discussions of psychiatric disorders, including OCD, the rich philosophical and spiritual dimensions of these conditions and the related treatment and care tend to be either ignored or disguised in euphemisms and vague explanations. This article sheds light on this hidden aspect of psychiatry and psychiatric nursing through a philosophical analysis of one of the most popular approaches to treating OCD, Schwartz's four-step method from Brain Lock. In so doing, the argument is made that sharing the philosophical and spiritual foundations of treatment and care promises not only to deepen the insights and skills of clinicians but also to empower clients as participants in their own journeys toward wellness and beyond.

Spasm or transformation? Advanced practice psychiatric nursing education in the United States.

Psychiatric nursing graduate programs are in precipitous decline in the United States, leading many advanced practice psychiatric nurses to question the viability of their field. This article examines the current crisis in advanced practice psychiatric nursing education in the United States by identifying core concerns and exploring the reasons for these concerns. Suggestions for securing the future of this practice area are also discussed. These suggestions include identifying a more clearly focused role for advanced practice psychiatric nurses, development of realistic educational expectations, achievement of greater uniformity in curricula, and the establishment of a strong and rigorous process of accreditation.

Poems, patients, and psychosocial nursing.

1. Holism can prove just as elusive in psychosocial nursing as in any other specialty area. 2. Students in an undergraduate psychosocial nursing course used poetry to express the fullness of the situations in which they found themselves. 3. The poems touched a deeper and more complete sense of humanity than had been possible in other, more traditional, assignments.

Assessment of acutely mentally ill patients' satisfaction of care: there is a difference among ethnic groups.

The relationship between quality of care and patient satisfaction has been documented. The specific research aim related to this study is to determine if differences exist among Caucasians, Asians, and Pacific Islanders who are hospitalized for an acute mental illness with regard to their perceived satisfaction with the care. The results of the overall study have been reported elsewhere. The sample was composed of 138 patients, of whom 34.7% were Caucasian, 31.2% Pacific Islanders, and 34.8% Asians. Within 24 hours of discharge, patients completed the Perceptions of Care instrument. Caucasians were over-represented in our sample in comparison to their percentage in the general population of Hawaii. These patients were significantly more satisfied (p = .04) with their care than the other ethnic groups. No single variable was found to specifically indicate why they were more satisfied than Pacific Islanders and Asians.

From primetime to paradise: the lived experience of OCD in Hawaii.

The primary aim of this qualitative study was to describe the lived experiences of men and women in Hawaii who were diagnosed with obsessive-compulsive disorder, and in so doing to provide an avenue for exploring health disparities involving this illness. Ten in-depth interviews revealed distinguishable similarities and differences in experiences of obsessive-compulsive disorder and suggested ways of understanding these similarities and differences. This research emphasized that in order to address disparities between the diagnosis and treatment of obsessive-compulsive disorder, as compared to other neurobiological disorders, we must meet the critical need for education about this illness among clients, families, and clinicians.

Preliminary Study of OCD and Health Disparities at the U.S.-Mexico Border.

The widespread and devastating nature of obsessive compulsive disorder (OCD) sharply contrasts with the paucity of research involving Mexican Americans and Mexicans who suffer from this condition. This mixed-methods preliminary study was intended to provide initial data and to pilot the procedures for a larger investigation of the cultural identification, symptomatology, health concerns, coping mechanisms, and quality of life of Mexican Americans and Mexicans with OCD living in the U.S.-Mexico border region of El Paso, Texas and Ciudad Juarez, Mexico. For the sample of six participants, whose symptoms ranged from moderate to extreme, OCD was associated with marked impairment in quality of life, particularly in terms of social functioning, an area of central importance for many Mexican Americans and Mexicans. Areas of further study were identified, with the aim of developing culturally sensitive interventions to decrease health disparities involving OCD.

From clinician to client: the lived experience of mental illness.

Psychiatric researchers and clinicians are quick to pay homage to the idea that mental illness has no respect for occupational attainments, social status, or academic degrees. Yet there is a considerable gap between accepting this idea solely on the basis of one's involvement in research or caregiving, versus first-hand experience. In this paper, the author delves into his own experience of mental illness in order to deepen clinicians' understanding of the personal meaning of facing such a condition on a daily basis. Special attention is paid to the persistence of obstacles to effective treatment and care, obstacles due not so much to financial constraints as to a lack of enlightenment among those charged with improving the lives of persons with mental illness.