Engaging Nursing Students in a Rural Native American Community to Facilitate Cultural Consciousness.

Integrating cultural consciousness into nursing curricula is important for preparing a global nursing workforce. This article evaluated the impact of a teaching strategy designed to facilitate nursing students' cultural consciousness beyond the classroom during a 1-week field experience within a rurally isolated Native American community. Cultural consciousness health care is a central element of health care delivery that integrates clinical knowledge, sensitivity, and cultural understanding. This study used an intrinsic single case study design bounded by 30 nursing students' perceptions of their week-long immersion experience within a rurally isolated American Indian community. The reality of the situations they encountered did not match their expressed expectations nor their tacit assumptions. Evidence taken in situ from clinical reflections demonstrated most of the students wrestled with this mismatch, although they improved their clinical assessment, technical nursing, and intercultural communication skills. Evidence from end of course reflections demonstrated that two-thirds of the students integrated their preconceptions and their immersion experiences with cultural consciousness emerging in their reflections.

Development of My Health Companion to enhance self-care management of chronic health conditions in rural dwellers.

Appropriate self-management support is needed to help individuals and their families meet the challenges of living with chronic health conditions. Such support is characterized by productive interactions between informed, active individuals, and their health care providers. The purposes of this paper are to describe the challenges to achieving self-management support and a tool, My Health Companion (MHC), which was developed to meet that challenge. The MHC is a paper personal health record designed to help rural women with chronic health conditions to better manage and understand their health information. The selection of content for the MHC was based on the literature, input from health care experts, and chronically ill individuals, and its development incorporated principles of personal health record and clear communication. The MHC was anecdotally shown to be useful to rural women with chronic health conditions in preparing for and enhancing their visits with health care providers. As a source of information, the MHC had potential for: being beneficial to providers in recommending appropriate treatment; contributing to more informed health decision making by ill individuals; and serving as a vehicle for the establishment of more productive interactions that contributed to the achievement of true client-provider partnerships in health care.

The pediatric nurse practitioner's role in reducing oral health disparities in homeless children.

Dental caries is the most common infectious disease of children. The majority of children in the United States who experience dental decay are from low-income, minority families. Many low- income, minority families are at risk for homelessness and, indeed, mothers with children are the fastest growing homeless group. Once homeless, families end up in shelters. Shelters are a unique source for the provision of health care; however, the provision of dental care to mothers and children in shelters is limited. At a shelter-based clinic, of a total number of children assessed in a 24-month period (n = 264), 22.7% (n = 60) had obvious gross dental cavities. The school-aged children (6-12 years) (n = 41) had the highest prevalence of dental cavities (34%). Consistent with the literature, dental caries was the most prevalent condition of homeless children and the most difficult for which to obtain treatment. Follow-up was difficult because of the transient nature of homeless families.

Developing a Cultural Immersion Service-Learning Experience for Undergraduate Nursing Students.

BACKGROUND: Cultural consciousness is a central element of purposeful and appropriate health care delivery. Research suggests that cultural consciousness is strengthened through self-reflection, dialogue about race, and experience within other cultures. METHOD: Two cohorts of senior-level nursing students participated in a 1-week cultural immersion service-learning (CISL) experience in an isolated, rural American Indian community. Student reflections and White Racial Identity Attitude Scale (WRIAS) data were collected and analyzed. RESULTS: The CISL experience facilitated culturally conscious care in two thirds of the participating nursing students. Differences in WRIAS scores were statistically significant (p < .0001) with an effect size of 1.9. CONCLUSION: Implementing CISL experiences into the undergraduate curriculum may help nursing students recognize societal privilege and improve cultural consciousness. Recommendations are provided to assist nurse educators to develop partnerships with indigenous nations, which make CISL experiences possible. [J Nurs Educ. 2019;58(2):117-120.].

Forging partnerships between rural women with chronic conditions and their health care providers.

Successful adaptation to chronic illness is enhanced by active client-health care provider partnerships. The purposes of this article are to (a) examine the health care partnership needs of western rural women with chronic illness who participated in a computer-based support and education project, (b) describe how the role of the women in the partnership can be maximized by the use of a personal health record and improving health literacy, and (c) discuss ways health care providers can enhance their role in the partnership by careful listening and creating environments conducive to forging productive client-provider partnerships.

Underserved patients' choice of kiosk-based preventive health information.

BACKGROUND AND OBJECTIVES: Compliance with health promotion recommendations falls short of expectations nearly every time it is studied. Some of the most successful programs, however, focus on the patient and incorporate computers. METHODS: Interactive kiosks in waiting rooms of clinics for the medically underserved were used to educate patients about alcohol consumption, exercise, smoking cessation, and weight control. RESULTS: Kiosks were accessed 11,401 times. Users averaged 40 years old, and most had at least a high school education and an average body mass index (BMI) of 29.8. Sixty percent were white, and 64% were women. Weight control garnered the most interest followed by smoking cessation. Those overweight and men with sleep disorders were more interested in weight control. Smokers and depressed women were most interested in smoking cessation. Men who were older, Latino, or had high blood pressure and women who were overweight were most interested in exercise. Those interested most in alcohol consumption were men who were white, drink alcohol, or married and women who were younger, single, black, Latino, or smoke. CONCLUSIONS: These results add to our understanding of underserved populations and individuals who might be more receptive to preventive health interventions so that educational efforts might be more likely to result in behavior change.

Nurse managed center: access to primary health care for urban Native Americans.

Urban Native Americans represent a small, diverse minority with unique health needs. The purposes of this descriptive retrospective study were to describe (a) the characteristics and primary health problems of urban Native Americans who receive primary health care at an urban nurse managed center (NMC) and (b) the nursing interventions provided at an urban NMC to urban Native Americans. A sample of 334 participants patient data were abstracted from a computerized clinical data set and coded based on the Omaha Classification System. The majority were over 40 years of age, were female, were single, completed high school, and were poor and uninsured, and many were unemployed. The most frequent health problems were related to pain, cardiovascular symptoms, dentition problems, and respiratory illnesses. The most frequent nursing interventions were for surveillance of physical signs and symptoms. The NMC was an accessible source of primary health care for urban Native Americans in northeastern Ohio.

Self-esteem: a hidden concern in oral health.

Little is known about the impact of oral health on self-esteem. The purpose of this descriptive study was to identify the frequency of low self-esteem in vulnerable persons who received oral health care at an academic nursing center. Participants (N = 86) completed the Index of Self-Esteem (Hudson, 1982b), answered open-ended questions concerning oral health care practices, and participated in an oral health examination. We found that 53% demonstrated low self-esteem, 67% (n = 58) had minor dental problems, and 33% (n = 28) had major dental problems. Oral health problems were ranked in importance along with cancer, diabetes, high blood pressure, and asthma. Oral hygiene included no tooth brushing, infrequent tooth brushing, flossing, chewing gum, and using mouth wash. This study emphasizes the roles of the community health nurse in assessing oral health (particularly among a vulnerable population), advocating for policy change, and providing education.

Nursing care delivered at academic community-based nurse-managed center.

The academic community-based nurse-managed center (CNC) in this study represents an innovative "nontraditional" model of primary healthcare that seeks to improve access for vulnerable uninsured urban populations. This article describes the nature of the services delivered by an academic CNC, the users of these services, and interventions provided by nurses in the CNC.