Forced migration: health and human rights issues among refugee populations.

Undocumented migration is a global phenomenon that is manifest in diverse contexts. In this article, we examine the situations that precipitate the movement of large numbers of people across several African countries, producing a unique type of undocumented migrant--the refugee. These refugee movements impact already fragile African health care systems and often involve human rights violations that are of particular concern, such as gender-based violence and child soldiers. We use examples from several countries in sub-Saharan Africa, including the Democratic Republic of the Congo, Rwanda, Liberia, Sierra Leone, and Mozambique. Drawing on key documents from the United Nations High Commissioner for Refugees, current research, and our personal international experiences, we provide an overview of forced migration and discuss implications and opportunities for nurses to impact research, practice, and policy related to refugee health.

Undocumented migration in the United States: an overview of historical and current policy contexts.

The aims of this overview are to provide a brief historical review of federal, state, and local immigration policies and to examine the historical origin and current constructions of the undocumented immigrant. We discuss how past and current policies promote, regulate, restrict, and deter immigration into the United States and access to health services and draw implications for the profession of nursing.

Undocumentedness and public policy: the impact on communities, individuals, and families along the Arizona/Sonora border.

The focus of this article is the health impact and implications of undocumentedness along the U.S.-Mexico border, particularly the Arizona/Sonora region. We describe the direct and indirect influences of immigration policies on the health of individuals, families, and communities. The Arizona border region maintains close social, cultural, and linguistic ties to Mexico, and the amplified efforts to secure the border have been dramatic on the region and on the people who live there. The 261-mile stretch across the Arizona-Sonora Desert is the most deadly corridor for immigrants crossing into the United States because they are at risk of being killed, kidnapped, and coerced into smuggling drugs or dying in the desert. Gang-related violence is pushing more Central Americans, including unaccompanied minors, to the United States. The impact on individual migrants and their families has been devastating. We examine the health implications of policy and applaud the actions of the Arizona Nurses Association and the American Academy of Nursing to address the health needs of border communities.

Cultural childbirth practices, beliefs, and traditions in postconflict Liberia.

In this qualitative study we used an interpretive, critical ethnographic approach to provide an understanding of childbirth and maternal illness and death in Liberia through the lens of women, families, and communities. We identified three major themes from the data: (a) secrecy surrounding pregnancy and childbirth; (b) power and authority; and (c) distrust of the health care system. The interpretive theory, Behind the House, generated from data analysis provides an understanding of the larger social and cultural context of childbirth in Liberia. Our findings provide a more complete understanding of the contextual factors that impact on the intractable problem of maternal mortality.

The Andrews/Boyle Transcultural Interprofessional Practice (TIP) Model.

The goals of the Andrews/Boyle Transcultural Interprofessional Practice (TIP) model are to provide a patient- or client-centered systematic, logical, orderly, scientific process for delivering safe, culturally congruent and competent, affordable, accessible, evidence-based, and quality care for people from diverse backgrounds across the life span. Key components of the TIP model include the context from which people's health-related values, attitudes, beliefs, and practices emerge; the interprofessional health care team; effective verbal and nonverbal communication among all team members; and a five-step systematic, scientific problem-solving process-assessment, mutual goal setting, and planning, implementing, and evaluating the effectiveness of therapeutic interventions and care. The model is applicable wherever nurses practice, teach, learn, lead, consult, and conduct research domestically and globally.

Self-care and mothering in African American women with HIV/AIDS.

African American women are the most rapidly growing group of people in the United States diagnosed with HIV/AIDS. The purpose of this study was to explore experiences of self-care and mothering among African American women with HIV/AIDS. It is important to recognize how culture affects illness management, childrearing, and daily living to design culturally appropriate nursing interventions for African American women. Critical ethnography was used to study 10 African American mothers from the rural Southeast who were HIV positive and mothered children who were HIV positive. Domains derived from the research were disabling relationships, strong mothering, and redefining self-care. The cultural theme was creating a life of meaning. African American mothers with HIV/AIDS in the rural Southeast used culturally specific self-care and mothering strategies reflective of cultural traditions. This study acknowledges strengths of African American women and generates theory that will enhance nursing care to this population.

New paradigms for transcultural nursing: frameworks for studying African American women.

African American women continue to experience disparities in health status when compared to their European American counterparts, yet, often their unique perspectives are not presented in the nursing literature. This article will discuss various theoretical frameworks arising from Black women's thought and reality that can be used to enhance and expand transcultural nursing knowledge. Historical, sociocultural, and literary perspectives will be used to illuminate the realities of African American women's lives. Selected frameworks arising from these realities will be discussed that recognize the impact of race, class, and gender on the lives of African American women and have the potential to guide nursing research and practice.

School-based asthma: a study in an African American elementary school.

ISSUES AND PURPOSE: Chronic illnesses, such as asthma experienced by children, are difficult for families and school professionals to manage. This study explored beliefs about asthma and asthma management among schoolchildren, parents, and teachers in an African American school. DESIGN AND METHODS: Focus groups were conducted with schoolchildren, parents, and teachers. Data were analyzed by content analysis; segments of information were categorized into groups that were later abstracted into themes illustrating beliefs and behaviors about asthma. RESULTS: The children reported fear of not being able to breathe and the limitations of living with asthma. The teachers were concerned that they did not have a sufficient understanding of asthma to manage children's asthma during the school day. Parents described complex lifestyles and the challenges of asthma management.

Northern British Columbian Aboriginal mothers: raising adolescents with fetal alcohol spectrum disorder.

This interpretive ethnographic study describes the experiences of northern British Columbian Aboriginal mothers raising adolescents with fetal alcohol spectrum disorder (FASD) and provides an understanding of how the mothers interpreted and responded to their adolescents' FASD. The all-encompassing theoretical perspectives of postcolonialism provided the conceptual guide for this study. This ontological stance facilitates discourse on the social and historical context of this research focused on northern British Columbian Aboriginal mothers. Using semistructured interviews and participant observation, eight participants were interviewed three times over a period of several months. Data were analyzed using an interpretive analysis to generate an overarching cultural theme, Mothering from the Margins. The theme conveyed how study participants understood FASD and how they were raising their adolescents within the social and historical context unique to postcolonial societies.

Well-being in Dinka refugee women of southern Sudan.

The purpose of this study was to understand the health and well-being of Sudanese refugee women who were resettled with their children to the United States. The design was an interpretive ethnography using individual interviews and participant observation with extensive field notes. The findings describe personal factors as well as community and social conditions that influenced the health and well-being of the refugee women and their families. These influences are captured in the three themes that emerged from the study: (1) liminality--living between two cultures, (2) self-support--standing on our own two legs, and (3) hope for the future. These themes describe a process of how refugee women achieve well-being in the transition to a new country and culture. The study contributes to our theoretical understanding of how to develop culturally congruent interventions for resettled refugees.

Perspectives of nursing faculty about nursing in Iraq.

PURPOSE: Long standing problems are apparent in professional nursing in Iraq. This is a critical point in time and feedback and input from nurses will be important in advancing the profession. DESIGN: A questionnaire was used to explore the attitudes of faculty members about professional nursing, women's roles and nursing, and the Iraqi Nurses Association. The questionnaire was administered to 31 faculty members at the College of Nursing, University of Baghdad. FINDINGS: The respondents reported the poor image of Iraqi nursing and the relationship between physicians and nurses as the most immediate problems facing the profession. The respondents are not active in their professional association and believe that the association is not addressing current problems. Profound changes are needed in professional nursing before nurses can play significant roles in the Iraqi health care system.

Working with translators and interpreters in research: lessons learned.

The purpose of this special section is to describe culturally competent approaches for working with translators or interpreters who participate in transcultural studies. This article provides background for three exemplars of lessons learned in working with translators in transcultural studies: (a) the resettlement transition experiences of women from the Dinka tribe of Southern Sudan (Baird), (b) Samoans' risk for heart disease (Siaki), and (c) culturally Deaf adults' perceptions about depression (Sheppard).Capitalizing the word "Deaf" has gained wide acceptance to indicate a linguistic minority of people who have a hearing loss and use American Sign Language, a hallmark of Deaf culture. In each case, the individual researcher made adaptations to the usual processes of translation/back-translation when appropriate to the cultural context and the specific situations of the translators. Although these lessons were learned during research-related activities, they may apply to other circumstances when nurses work with bilingual/bicultural translators (e.g., translating consent forms or communicating with persons who have limited literacy in their native language).

The elephant in the room: critical reflections on militarism, war, and their health contingencies.

This philosophical analysis critically explores an archeology of militarism as an underpinning to multiple forms of violence, especially war. Deconstructing militarism and its discourses reveal it as a pervasive geographical, cultural, political, and psychological presence. New war technologies, related health and environmental problems, injuries, social suffering, and disproportionality in military spending as a threat to health are uncovered. Continuing the dialogue in formal nursing associations, critiquing media complicity in securing consent for war, and reconstructing a nonviolent, healthier world through nonviolent resistance are advocated.

Creating a virtual research community: the University of Arizona PhD program.

To address the critical shortage of doctorally prepared nursing faculty and nurse scientists, The University of Arizona College of Nursing designed and implemented, as a virtual research community, an online doctor of philosophy (PhD) program. We are now completing our third year of the Online PhD Program and will admit our fourth cohort of students in August. In this article, we reflect on our progress to date and discuss what we have learned with nursing colleagues who may be considering this kind of change in their own programs. After describing the context for change, we discuss how the change was managed, including the planning and implementation of the program. We conclude with an evaluation of the process and early outcomes of the Online PhD Program from the authors' unique vantage points as program director, associate dean for academic affairs, and dean.

Resistance, health, and latent tuberculosis infection: Mexican immigrants at the U.S.-Mexico border.

Mexican immigrants living in the U.S.-Mexico border region are confronted with different national explanations about latent tuberculosis infection (LTBI) and preventive treatment. The purpose of this study was to explore how a group of Mexican immigrant women (N = 8) at risk of LTBI treatment failure interpreted and ultimately resisted LTBI preventive treatment. A critical ethnographic methodology, grounded in asymmetrical power relations that are historically embedded within the U.S.-Mexico border culture, was used to examine the encounters between the participants and the health care provider. The study findings are discussed from the perspective of women who experienced oppression and resistance in the U.S.-Mexico border region, providing an account of how Mexican immigrant women become entangled in U.S.-Mexico TB health policies and through resistance manage to assert control over health care choices. In the context of the U.S.-Mexico border region, health care professionals must be skilled at minimizing asymmetrical power relations and use methods that elicit immigrant voices in reconciling differences in health beliefs and practices.