Effectiveness of breast cancer screening interventions in improving screening rates and preventive activities in Muslim refugee and immigrant women: A systematic review and meta-analysis.

PURPOSE: To systematically assess the effectiveness of breast cancer (BC) interventions in improving breast self-examination (BSE), clinical breast examination (CBE), mammogram screening rates, and preventive activities in Muslim refugee and immigrant women. DESIGN: Guided by the Health Belief Model, a mixed method systematic review and meta-analysis was performed using a sequential design. METHODS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA), the Critical Appraisal Skill Program Checklists, and the Joanna Briggs Institute (JBI) methodology for systematic review and meta-analysis. A systematic search of English-language peer-reviewed articles was undertaken in multiple health and social sciences databases from January 1, 2015, to March 31, 2022. Randomized clinical trials and quasi-experimental studies focused on the uptake of BSE, CBE, and mammograms were selected. RESULTS: Fourteen articles were included in the review. Most of the studies relied on quasi-experimental designs and were carried out in the United States of America. The qualitative analysis of BC screening interventions generated three themes: (1) education, (2) access-focused, and (3) cultural and faith-based. The meta-analysis included three randomized control trials and two quasi-experimental studies. The meta-analysis demonstrates the effectiveness of community-led cultural and faith-based interventions in facilitating the completion of CBE and mammography screening. Education on BC and patient navigator interventions are more effectively used in conjunction than standalone interventions, yet community-based cultural and faith-based interventions are the most effective. CONCLUSION: This systematic and meta-analysis review provides evidence on the effectiveness of access-focused and cultural and faith-based interventions in improving BC screening in Muslim refugee and immigrant women. Future research should focus on designing and measuring the effectiveness of cultural and faith-based interventions to increase Muslim refugee and immigrant women's BC screening knowledge and practices. CLINICAL RELEVANCE: This systematic and meta-analysis review demonstrates the need to explore Muslim refugee and immigrant women's cultural contexts for developing culturally sensitive BC screening interventions. Knowledge and practice of BC and religiosity intersect with financial, geographic, and linguistic barriers to decrease participation in screening and preventive activities in Muslim refugee and immigrant women.

Integrative review of the needs and challenges of indigenous palliative care in rural and remote settings.

AIMS: To appraise and synthesize the empirical literature on the needs and challenges of Indigenous peoples' accessibility to palliative care in rural and remote settings. DESIGN: Whittemore and Knafl's updated approach to integrative reviews, PRISMA guidelines and CASP (2020) checklists for narrative analysis were followed. DATA SOURCES: A systematic search of the published empirical literature from 1 January 2015 to 31 December 2021 was undertaken in five databases. REVIEW METHODS: Twenty-four studies met the research question and the inclusion criteria. RESULTS: Four themes describe the findings: Respect of Indigenous cultural beliefs on death and dying, connection to the land, needs for culturally responsive care and presence of institutional and systemic barriers. These themes indicate a pressing need to increase the accessibility and utilization of palliative care. Most of the studies were qualitative and conducted by teams of Indigenous and non-Indigenous researchers. CONCLUSION: Integrating Indigenous knowledge and providing culturally responsive palliative care are steps towards achieving the decolonization of palliative care and responding to Indigenous people's needs of palliative care services. Institutional and systemic racism affect Indigenous peoples' access and delivery of palliative services in Canada and globally. IMPACT: The review highlights the need for establishing partnerships and building local capacity with Indigenous communities to develop and implement culturally responsive palliative care programmes in remote locations.

An integrative review of Indigenous informal caregiving in the context of dementia care.

AIMS: To appraise the empirical literature on the needs of Indigenous informal caregivers caring for people living with dementia in Indigenous communities. DESIGN: Whittemore and Knafl's updated approach to integrative reviews, PRISMA guidelines, and CASP checklists for narrative analysis were followed. DATA SOURCES: A systematic search of published empirical literature from January 2010 to August 2020 was undertaken in six databases. REVIEW METHODS: Fifty-one studies met the research question and the inclusion criteria. RESULTS: Five themes describe the findings: Decolonizing Western perspectives on dementia, the centrality of cultural safety, caregivers' experiences, pre-dementia community education and family and community-centred care emerged from the thematic analysis. Most of the studies used quantitative methodologies, and few studies were conducted using community-based approaches. CONCLUSION: This review shows that Indigenous caregiving represents an emerging field in nursing and health sciences in a context of a global crisis. Researchers need to focus on Indigenous values and voices to adapt care and support informal caregivers. Our review emphasizes that working with Indigenous communities will likely translate into new care delivery models, policies and practices to support Indigenous informal caregivers and address the specific social determinants impacting caregivers' roles and tasks. IMPACT: This review highlights the necessity of having community and family-based discussions on enhancing the delivery of dementia care for Indigenous peoples in Canada and worldwide. Decolonizing Western perspectives of dementia translate into culturally safe approaches that aim to integrate Indigenous cultural perspectives of holism, reciprocity, wisdom, respect of older people and relationality into nursing practice. The support of Indigenous informal caregivers requires future studies to address the stigmatizing Western views of dementia.

An integrative review of empirical literature on indigenous cognitive impairment and dementia.

AIMS: To synthesize research findings about Indigenous perspectives on cognitive impairment and dementia. DESIGN: Whittemore and Knafl's updated approach to integrative review and PRISMA guidelines for narrative analysis was followed. DATA SOURCES: A systematic search of the published literature from 2010-June 2020 was undertaken in four databases and complemented by supplementary searches. REVIEW METHODS: Thirty-four studies met the research question and inclusion criteria. RESULTS: Four themes describe the findings. Most of the studies were conducted by non-Indigenous researchers and may reflect Western perspectives on dementia rather than Indigenous views. A majority of the studies report epidemiological data or the testing of clinical tools. CONCLUSION: The review indicates a dearth of knowledge about Indigenous perspectives on ageing and understanding of cognitive impairment and dementia. Researchers need to draw on Indigenous traditional knowledge, culture, and traditions through a meaningful engagement with Indigenous communities and Elders to indigenize and decolonize dementia care. IMPACT: This integrative review highlights the need for community-led discussions and community engagement around Indigenous perspectives, needs, and understandings of ageing, cognitive impairment, and dementia care.

Racialization in nursing: Rediscovering Antonio Gramsci's concepts of hegemony and subalternity.

Although Gramsci's notions of hegemony and subalternity may seem outdated in this 21st century, a critical examination of the literature shows that these concepts apply in this global pandemic and political context. Racialization is a form of structural violence. In this paper, I also explore Gramsci's' notion of engaged intellectuals to support the idea of social and political activism in nursing. Nurse scholars call for the decolonization of the discipline. Gramsci's philosophical approach to hegemony can be extended to racialization in nursing. Gramsci's notions of civil society and state can help nurses to see the structures that create racism in nursing and society.

A philosophical analysis of anti-intellectualism in nursing: Newman's view of a university education.

Canadian and international nursing educators are increasingly concerned with the quality of university nursing education. Contemporary nursing education is fraught by a growing anti-intellectualism coupled with the dominance of neoliberalism and corporate university business culture. Amid these challenges, nursing schools must prepare nurses to provide care in an era compounded by social and health inequities. The purpose of this paper was to explore the philosophical and contextual factors influencing anti-intellectualism in nursing education. We use John Henry Newman's view of the purpose of a university education as a heuristic perspective to examine anti-intellectualism in nursing. We contend that the ideological worship of technological advances, a culture of consumerism, quality improvement and risk management, the primacy of doing over thinking, competency-based curricula and business models rooted in neoliberal financial policies reinforce anti-intellectualism in nursing. Anti-intellectualism is a complex issue to address within the corporate university culture. We propose multiple strategies at the disciplinary, university and sociopolitical levels to decrease anti-intellectualism. Counteracting anti-intellectualism requires critical thinking, praxis and emancipation. Nurses should critically examine this anti-intellectual trend as it limits the advancement of the discipline and marginalizes its contributions within the academy. If nurses do not address this challenge, the survival of nursing as an academic discipline may be jeopardized.

[Validation of a questionnaire on health literacy among Francophones in situation of linguistic minority]. / Validation d'un questionnaire sur l'alphabétisme en santé des francophones en situation linguistique minoritaire.

OBJECTIVE: This study was designed to develop and test the qualitative validity of a French questionnaire. The questionnaire explored the mechanisms by which Francophone in situation of linguistic minority mobilize their social capital and cultural assets in terms of health literacy. METHODS: We used evidence derived from a previous qualitative study in which we elaborated the characteristics of social capital and cultural assets. Drawing on models of social capital and self-determination of language behaviour in Francophone in situation of linguistic minority, 21 items were developed and assessed to confirm content validity. For this purpose, cognitive interviews were conducted with 92 natural experts. These cognitive interviews tested the linguistic and content validity of the instrument. Consultations with research professionals were also conducted to increase content validity. RESULTS: Parsimony and simplicity were tested by application of the Flesch test. The results demonstrate that 19 questions (93%) corresponded to the general public, relatively simple, and everyday use categories. Natural experts confirmed the readability and simplicity of the questionnaire. CONCLUSION: This study addressed a lack of simple and readable questionnaire for collecting data among Francophone in situation of linguistic minority. The findings underscore the lack of evidence related to the familiar construction of health literacy among members of this population.

Empirical and pragmatic adequacy of grounded theory: Advancing nurse empowerment theory for nurses' practice.

AIMS AND OBJECTIVE: To draw on the findings of a grounded theory study aimed at exploring how power is exercised in nurse-manager relationships in the hospital setting, this paper examines the empirical and pragmatic adequacy of grounded theory as a methodology to advance the concept of empowerment in the area of nursing leadership and management. BACKGROUND: The evidence on staff nurse empowerment has highlighted the magnitude of individual and organisational outcomes, but has not fully explicated the micro-level processes underlying how power is exercised, shared or created within the nurse-manager relationship. Although grounded theory is a widely adopted nursing research methodology, it remains less used in nursing leadership because of the dominance of quantitative approaches to research. Grounded theory methodology provides the empirical and pragmatic relevance to inform nursing practice and policy. Grounded theory is a relevant qualitative approach to use in leadership research as it provides a fine and detailed analysis of the process underlying complexity and bureaucracy. DESIGN: Discursive paper. METHOD: A critical examination of the empirical and pragmatic relevance of grounded theory by (Corbin & Strauss, , ) as a method for analysing and solving problems in nurses' practice is provided. CONCLUSIONS: This paper provides evidence to support the empirical and pragmatic adequacy of grounded theory methodology. Although the application of the ontological, epistemological and methodological assumptions of grounded theory is challenging, this methodology is useful to address real-life problems in nursing practice by developing theoretical explanations of nurse empowerment, or lack thereof, in the workplace. RELEVANCE TO CLINICAL PRACTICE: Grounded theory represents a relevant methodology to inform nursing leadership research. Grounded theory is anchored in the reality of practice. The strength of grounded theory is to provide results that can be readily applied to clinical practice and policy as they arise from problems that affect practice and that are meaningful to nurses.

A Critical Perspective on Relations between Staff Nurses and their Nurse Manager: Advancing Nurse Empowerment Theory.

This study considers empowerment in nurse-manager relations by examining how conflict is handled on both sides and how the critical social perspective has influenced these relations. The authors use inductive analysis of empirical data to explain how (1) nursing work is organized, structured, and circumscribed by centrally determined policies and practices that downplay nurses' professional judgement about patient care; (2) power is held over nurses in their relationship with their manager; and (3) nurses' response to power is to engage in strategies of resistance. The authors illustrate how power influences relations between staff nurses and managers and provide a critical analysis of the strategies of resistance that result in personal, relational, and critical empowerment among staff nurses. Through resistance, staff nurses engage in alternative discourses to counteract the prevailing neoliberal organizational and managerial discourses of efficiency and cost-effectiveness.

Cette étude se penche sur la question de l'autonomisation dans les relations entre infirmières et gestionnaires. Elle examine notamment la façon dont les conflits sont gérés par les deux camps et l'influence qu'exerce la perspective sociale critique sur ces relations. Les auteures ont recours à l'analyse inductive de données empiriques afin d'expliquer (1) la façon dont le travail infirmier est organisé, structuré et encadré par des politiques et des pratiques déterminées par des instances centrales et qui minimisent le jugement professionnel des infirmières en matière de soins aux patients; (2) le pouvoir des gestionnaires dans le cadre de leurs relations avec les infirmières; et (3) la réaction des infirmières face au pouvoir et les stratégies de résistance. Les auteures mettent en lumière l'influence qu'exerce le pouvoir sur les relations entre le personnel infirmier et les gestionnaires et présentent une analyse critique des stratégies de résistance qui mène à une autonomisation personnelle, relationnelle et critique au sein des effectifs infirmiers. Par la voie de la résistance, le personnel infirmier amorce un discours alternatif qui neutralise les discours organisationnels et gestionnaires néolibéraux dominants axés sur l'efficience et le rapport coût-efficacité.

A critical analysis of online nursing education: balancing optimistic and cautionary perspectives.

The landscape of nursing education has been transformed by increasing student demand for online programs coupled with strong institutional directives to deliver nursing courses through distributed learning. The authors present a qualitative research design informed by philosophical hermeneutics in which 30 undergraduate and graduate nursing students discuss their experiences of the influence of peer dynamics on online learning. The findings include issues related to time, demands of online participation, experiences of conflict, and the development of skills in the online environment. Theoretical matters of curriculum such as instrumentality and tensionality are examined, generating both optimistic and cautionary possibilities for online learning. Online nursing students could benefit from a period of face-to-face orientation with a focus on building intellectual and social communities, limited class size, and opportunities to connect learners.

Unmasking the predicament of cultural voyeurism: a postcolonial analysis of international nursing placements.

The growing interest in international nursing placements cannot be left unnoticed. After 11 years into this twenty-first century, violations of human rights and freedom of speech, environmental disasters, and armed conflicts still create dire living conditions for men and women around the world. Nurses have an ethical duty to address issues of social justice and global health as a means to fulfil nursing's social mandate. However, international placements raise some concerns. Drawing on the works of postcolonial theorists in nursing and social sciences, we examine the risk of replicating colonialist practices and discourses of health in international clinical placements. Referring to Bakhtin's notions of dialogism and unfinalizability, we envision a culturally safe nursing practice arising from dialogical encounters between the Self as an Other and with the Other as an Other. We suggest that exploring the intricacies of cultural and race relations in everyday nursing practice are the premises upon which nurses can understand the broader historic, racial, gendered, political and economic contexts of global health issues. Finally, we make suggestions for developing culturally safe learning opportunities at the international level without minimizing the impact of dialogical cultural encounters occurring at the local and community levels.

Developing and piloting an online graduate nursing course focused on experiential learning of qualitative research methods.

Despite the turmoil of a worldwide economic crisis, the health sector remains largely understaffed, and the nursing shortage represents a major issue that jeopardizes graduate nursing education. Access to education remains a challenge, particularly in rural and remote areas. This article reports the process of developing an asynchronous online qualitative research course. This online course was piloted among 16 interdisciplinary students. Participants agreed that experiential learning was useful to understand the intricacies of qualitative research. Within this constructivist approach, students were immersed in real-life experiences, which focused on the development of skills applicable to qualitative research. Based on the findings, we suggest that constructivism and the Four-Component Instructional Design (4C/ID) model (a four-part approach for fostering the development of complex skills) represent valuable ontological and pedagogical approaches that can be used in online courses. Triangulating these two approaches is also congruent with the student-centered philosophy that underpins nursing graduate programs.

Barriers and Facilitators Influencing Arab Muslim Immigrant and Refugee Women's Breast Cancer Screening: A Narrative Review.

INTRODUCTION: This narrative review identifies barriers and facilitators influencing breast cancer screening among Arab Muslim immigrants and refugees. Low participation rates create health inequities in breast cancer screening among this population. METHOD: A systematic search of peer-reviewed empirical articles was performed. PRISMA, CASP, and MMAT checklists were used to appraise the studies. RESULTS: Results include 3 themes: individual, health care system and health providers, and cultural factors. DISCUSSION: Lack of fluency in the new country's language, lack of knowledge, and poor exposure to breast cancer screening may contribute to the Arab Muslim women's vulnerability to undiagnosed or delayed breast cancer diagnosis.

Examination of Breast Cancer Screening Knowledge, Attitudes, and Beliefs among Syrian Refugee Women in a Western Canadian Province.

BACKGROUND: Women living in the Arab world present low breast cancer screening rates, delayed diagnosis, and higher mortality rates. PURPOSE: To further explore the Muslim Syrian refugee women's breast self-examination (BSE), utilization of clinical breast examination (CBE) and mammography. METHODS: A cross-sectional descriptive exploratory study design was used. The sample consisted of 75 refugee women. Data were collected using Champion's Health Belief Model Scale, the Cancer Stigma Scale, and the Arab Culture-Specific Barriers to Breast Cancer Questionnaire. Descriptive, Pearson correlation and logistic regression analyses were used to analyze the data. RESULTS: A minority of women had BSE (32%), CBE (12%) and mammograms (6.7%) anytime during their lifetime. Women's breast cancer screening (BCS) knowledge ranked at a medium level (M = 10.57, SD = 0.40). Low knowledge score, BSE information, policy opposition, responsibility, barriers to BSE, and seriousness were found to be statistically significant in women's BSE practice. BSE benefits and religious beliefs significantly predict CBE Age, education, knowledge, responsibility, susceptibility, social barriers, and religious beliefs were statistically significant in women's mammography use (p < .01). CONCLUSIONS: Participants' breast cancer screening practices were low. Health beliefs, Arab culture and stigma about cancer affected women's BCS practices. Faith-based interventions may improve knowledge and practices.

Enhancing decolonization and knowledge transfer in nursing research with non-western populations: examining the congruence between primary healthcare and postcolonial feminist approaches.

This article is a call for reflection from two distinct programs of research which converge on common interests pertaining to issues of health, social justice, and globalization. One of the authors has developed a research program related to the health and well-being of non-western populations, while the other author has expanded the field of Aboriginal and international research in Canada and abroad. Based on examples drawn from our respective programs of research, we suggest conciliating the philosophy of primary healthcare to postcolonial feminism for decolonizing research and enhancing knowledge transfer with non-western populations. We contend that applying the theoretical and methodological strengths of these two approaches is a means to decolonize nursing research and to avoid western neocolonization. In conciliating primary health care and postcolonial feminism, the goal is to enhance the pragmatic relevance of postcolonial feminism to generate resistance through transformative research for achieving social justice. In tapping into the synergistic and complementary epistemological assumptions of the philosophy of primary health care and postcolonial 'feminisms', nurse researchers reinforce the anti-oppresive goals of postcolonial feminist research. Consequently, this approach may enhance both decolonization and knowledge transfer through strategies like photovoice.

A qualitative examination of othering processes within international nursing placements.

BACKGROUND: International placements represent a popular choice to develop cultural competency and safety in nursing. The question as to whether study abroad programs enable the development of cultural competency and safety skills or provide exotic travel experiences needs further clarifications. OBJECTIVE: The study explores the usefulness of international placements in developing cultural safety among undergraduate nursing students. DESIGN: An exploratory qualitative design was used to answer these research questions: 1) How do undergraduate students make sense of their study abroad experiences? And 2) How international placements facilitate the acquisition of cultural safety and consciousness-raising about racial and social privileges? PARTICIPANTS: A sample of 7 participants who completed a 4th-year community and acute care stages in Global South countries were recruited. METHODS: A postcolonial feminist theoretical approach was used to guide the study. DATA COLLECTION: Semi-structured interviews explored participants' perceptions of cultural differences, ways of adapting to cultural diversity, and the benefits and challenges of their global experiences. Thematic content analysis was used to analyze the data. RESULTS: Thematic analysis revealed three themes: 1) Self-knowledge, 2) othering, and 3) consciousness of neocolonialism. DISCUSSION: Results raise some concerns about the usefulness of international stages in developing cultural competency and cultural safety in undergraduate nursing students. Results indicate that international placements can be useful to raise consciousness about racial and social privileges. Yet, international placements involve some risks to the receiving Global South countries. This study unmasks Othering's processes, where participants reproduce harmful neocolonial relations. CONCLUSIONS: International placements involve cultural risks that translate into Othering processes where Global South nurses and students are represented as powerless. Postcolonial feminist theories are relevant to study international placements as they enable the critical examination of race, gender, and social class and how they play out in international placements in Global South countries.

Evaluation of bacterial contamination and control methods in soluble metalworking fluids.

In the United States, 1.2 million workers are exposed to metalworking fluids. During operations, aerosols are produced and airborne contaminants can be inhaled. Although biocides are used to control the bacterial content of metalworking fluids, they can create health-related problems, and their efficiency remains to be proved. The objectives of this project were (1) to verify whether rigorous cleaning according to a standard protocol could reduce microbial contamination and (2) whether the use of biocides with different spectra could reduce the bacterial population. Four similar machines producing similar components were evaluated; a specific treatment was applied to each machine. The machine used as a control (1) was thoroughly cleaned prior to sampling, (2) did not undergo any major cleaning afterward, and (3) was operated without the use of any biocide. A major cleaning is a protocol described and recommended by the fluid manufacturer and was performed on the three other machines, two of which were subsequently treated with biocides weekly. Fluid samples from the four lathes were collected weekly during a 6-month period, and total bacterial and cultivable Gram-negative bacteria were analyzed for each sample. Major cleaning of the machines (120-4) did not significantly reduce the concentration of bacteria in the cutting fluids when compared with the control machine (120-3), which had not undergone major cleaning. The concentrations of total bacteria were in the 10(6) CFU/mL range for these two lathes; however, a reduction in the total number of fluid changes was observed for this machine. Bacterial flora in the cutting fluids was significantly controlled with the use of biocides. Bacteria concentrations were in the 10(3)-10(5) CFU/mL range for the lathes with the use of biocides. Since thorough cleaning is insufficient and biocides are recognized as being responsible for some worker health problems, other avenues for controlling bacterial flora in cutting fluids should be evaluated to reduce worker exposure to their bacterial contaminants.

Examining the conflation of multiculturalism, sexism, and religious fundamentalism through Taylor and Bakhtin: expanding post-colonial feminist epistemology.

In this post-9/11 era marked by religious and ethnic conflicts and the rise of cultural intolerance, ambiguities arising from the conflation of multiculturalism, sexism, and religious fundamentalism jeopardize the delivery of culturally safe nursing care to non-Western populations. This new social reality requires nurses to develop a heightened awareness of health issues pertaining to racism and ethnocentrism to provide culturally safe care to non-Western immigrants or refugees. Through the lens of post-colonial feminism, this paper explores the challenge of providing culturally safe nursing care in the context of the post-9/11 in Canadian healthcare settings. A critical appraisal of the literature demonstrates that post-colonial feminism, despite some limitations, remains a valuable theoretical perspective to apply in cultural nursing research and develop culturally safe nursing practice. Post-colonial feminism offers the analytical lens to understand how health, social and cultural context, race and gender intersect to impact on non-Western populations' health. However, an uncritical application of post-colonial feminism may not serve racialized men's and women's interests because of its essentialist risk. Post-colonial feminism must expand its epistemological assumptions to integrate Taylor's concept of identity and recognition and Bakhtin's concepts of dialogism and unfinalizability to explore non-Western populations' health issues and the context of nursing practice. This would strengthen the theoretical adequacy of post-colonial feminist approaches in unveiling the process of racialization that arises from the conflation of multiculturalism, sexism, and religious fundamentalism in Western healthcare settings.