Cultural Experiences, Patterns, and Practices of American Indian Women With Polycystic Ovary Syndrome: An Ethnonursing Study.

Introduction: Knowledge is needed about the cultural experiences, patterns, and practices of American Indian women with polycystic ovary syndrome (PCOS), so nurses can provide culturally congruent care. Method: A qualitative, ethnonursing study based on Leininger's theory of culture care diversity and universality. Data were collected from 13 key informants living on a reservation in the Western United States. Data were analyzed with Leininger's four phases of qualitative analysis. Results: Three universal themes were identified: (1) control of PCOS symptoms is important for the cultural well-being of tribal women, (2) culturally congruent PCOS education and health care are important with variations in approaches to treatment, and (3) tribal culture is important with variations in use of tribal practices. Discussion: Tribal culture affects the health care beliefs and practices of American Indian women with PCOS. The findings can be used to improve culturally congruent care for women with this chronic condition.

Using the Medicine Wheel Model to Study Polycystic Ovary Syndrome in American Indian Women.

Developing a nursing research project with American Indian tribes and navigating the institutional review board approval process can appear daunting to investigators because of tribal research requirements in addition to academic requirements. Nurse investigators conducted a research project exploring experiences of American Indian women with polycystic ovary syndrome. After successful implementation of the project, a model emerged to guide researchers working with tribal communities through project development and the institutional review board process. The model is based on the American Indian medicine wheel with each quadrant aligned with a season of the year: spring, summer, fall, and winter. The seasonal approach divides project development into sections that can be developed independently or simultaneously. The model emphasizes collaborative relationships between the research team and tribe. Researchers can adapt and customize the model for their projects based on their objectives and targeted populations. The purpose of this article is to describe the medicine wheel model and, as an exemplar, demonstrate application of the model in a project involving American Indian women with polycystic ovary syndrome. Additionally, potential implications of the model for nursing research, education, and practice are presented.

Rural Patients' and Primary Care Clinic Staffs' Perceptions of EHR Implementation: An Ethnographic Exploration.

This focused ethnographic research study explores patients' and clinic staffs' experience of electronic health record (EHR) implementation in a small, independent, rural primary care practice. On the basis of participant observation of clinic staff, staff focus group, and patient interviews, results demonstrate that both patients and clinic staff have distrust and disconnect from technology. Yet, patients and clinic staff embrace patient-centered approaches and value team-based care. Understanding patients' and staffs' experience can facilitate the EHR implementation in the rural primary care setting and facilitate online access, patient portals, and other technologically based patient-centered approaches.

Patients' experience and understanding of E-portals in rural general practice: an ethnographic exploration.

AIM This exploratory qualitative study provides insight into E-portal use in rural primary care. INTRODUCTION As of February 2017, almost 300,000 New Zealanders were using E-portals, offered in over 455 general practices. Patient portals are intended to give patients convenient and secure electronic access to their health information and increase their ability to manage their own health care. Early patient experience of E-portal use in New Zealand has not yet been studied. METHODS Thirty-three patients from three rural general practice sites were interviewed between December 2015 and June 2016. Eleven patients were not using a portal. Data were analysed using ethnograph and comparative analysis between two researchers. RESULTS Four major themes emerged from the data: (i) technology acceptance, (ii) activation to full engagement with E-portals, (iii) benefits and concerns, and (iv) the impact of rural contextual understandings for these 33 patients. DISCUSSION Portal use in New Zealand is in its infancy, but signs suggest that New Zealanders are ready and enthusiastic adopters of such technology. Engagement levels are variable and it is too soon to fully explore the impact of E-portals on the general practice culture, provider relationships and the degree to which portals increase personal self-efficacy in relation to health care.

Pharmacy and primary care perspectives on e-prescribing in a rural community: A focused ethnography.

BACKGROUND: Electronic prescribing (ERx) is the ability for prescriber to send a digital prescription directly to a pharmacist through a dedicated secure network. A number of federally funded incentives such as the health information technology for economic and clinical health (HITECH) and Meaningful Use standards have led to ERx implementation. ERx is an integral part of primary care practice and today most community pharmacies are enabled to accept e-prescriptions. Little is known about the experience of rural pharmacists, primary care providers and patients regarding e-prescribing. This paper reports on the results of ERx from their perspectives. The findings are a portion of a larger qualitative descriptive study focused on the meaning of Meaningful Use in remote rural communities. One remote rural community in the Pacific Northwest was used for this research endeavor. OBJECTIVES: Explore understandings of e-prescribing from both pharmacist and primary care provider perspective. Explore patients' understandings and experiences of e-prescribing. METHODS: The conceptual model for this research was the Ecological Transactional Model. This model informed the research design, interview questions and analysis. A qualitative descriptive methodology - focused ethnography was used for this study. Six key informant interviews, 14 patient interviews and 15 hours of participant observation provided the data. Data analysis occurred collectively between a social pharmacy researcher, a primary care nurse practitioner-researcher and pharmacy graduate students. The research qualitatively identified contextual understandings and dimensions of ERx in this setting. RESULTS: Based on a focused ethnographic methodology, contextual understandings of rurality and role identity, both pharmacist and primary care provider, were explored. Perspectives on ERx of patients, clinic manager and RN staff were also elicited. Three dimensions of ERx were identified - technological, structural and communication. DISCUSSION: The structural, technological and communication dimensions are essential in understanding e-prescribing across settings and addressing digital divides in our health care system. Implications for interprofessional pharmacy education were addressed. Understanding the rural context and the need for role adaptability has implications for health care policy. Additional research is needed on the role of the rural pharmacist and how best to interact with primary care providers and patients.

RN Prescribing: An Expanded Role for Nursing.

PURPOSE: With the implementation of the Affordable Care Act, recommendations of the Future of Nursing Report, and recent regulatory changes by state boards of nursing, registered nurse (RN) roles are expanding. In this article, we advocate for RN prescribing as an expanded role in the United States. METHODS: We reviewed the literature on RN prescribing, the background in both high- and low-resource countries, levels of prescribing, specialized settings for RN prescribing, both RN and patients views/perceptions of prescribing, and evaluation research. From this review, we developed a proposal for RN prescribing. FINDINGS: Due to expansion of RNs into prescribing worldwide to meet unmet healthcare needs in both primary and specialty settings, we propose a role for RN prescribing within both primary care and outpatient specialty settings. The differences between RN and advanced practice RN prescribing are defined, and U.S.-based regulatory challenges are examined. CONCLUSION: Considering unmet healthcare needs and patients' need for medication and medication education, we advocate for RN prescribing as expanded scope and role change for experienced RNs to practice to the highest level of their education.

Shoulder Pain Assessment for the Occupational Health Nurse.

Shoulder pain is a common complaint in the workplace. A shoulder condition may arise from acute trauma or non-traumatic work-related activities. Shoulder pain falls into three categories: acute, chronic, and referred pain. The occupational health nurse can document detailed health histories and focused complaint-driven physical examinations. Nurses' expert assessments can guide injured workers to necessary treatment, case management, and return to full employment.

United States nurse practitioner students' attitudes, perceptions, and beliefs working with the uninsured.

To reduce health disparities, nurses are expected to provide compassionate and high quality care to all patients regardless of socioeconomic and insurance status. In the United States (US) nurse practitioner (NP) educators need to expose students to clinical practice settings, such as free clinics, where the vulnerable populations like the non-documented immigrants and uninsured receive care. The purpose of this mixed method study was to provide an immersion experience for (NP) students at free clinics. Then researchers evaluated the impact of a clinical immersion experience on NP students' attitudes, perceptions, and beliefs about the uninsured and determine whether the clinical experience impacted their willingness to consider working with vulnerable populations in the future. Qualitative and quantitative data suggests students challenged their own beliefs and attitudes regarding the vulnerable populations, gained insight into care provided at these free clinics, and expressed their intent to volunteer at these settings. In the era of health care reform both nationally and internationally and the need to improve primary care access globally, educational initiatives are needed to expose NP students to economically vulnerable populations. Future research needs to replicate and extend the findings of this study, focusing on teaching-learning experiences for nurse practitioners and other advanced practice nursing students.

Communication and the electronic health record training: a comparison of three healthcare systems.

BACKGROUND: The electronic health record (EHR) used in the examination room, is becoming the primary method of medical data storage in primary care practice in the USA. One of the challenges in using EHRs is maintaining effective patient-provider communication. Many studies have focused on communication in the examination room. PURPOSE: Scant research exists on the best methods in educating nurse practitioners and other primary care providers (clinicians). The purpose of this study was to explore various health record training programmes for clinicians. METHODS: One researcher participated in and observed three health systems' EHR training programmes for ambulatory care providers in the Pacific Northwest. A focused ethnographic approach was used, emphasising patient-provider communication. RESULTS: Only one system had formalised communication training in their class, the other two systems emphasised only the software and data aspects of the EHR. CONCLUSIONS: The fact that clinicians are expected to use EHRs in the examination room necessitates the inclusion of communication training in EHR training programmes and/or as a part of primary care nurse practitioner education programmes.

Putting a face on medical errors: a patient perspective.

Knowledge of the patient's perspective on medical error is limited. Research efforts have centered on how best to disclose error and how patients desire to have medical error disclosed. On the basis of a qualitative descriptive component of a mixed method study, a purposive sample of 30 community members told their stories of medical error. Their experiences focused on lack of communication, missed communication, or provider's poor interpersonal style of communication, greatly contrasting with the formal definition of error as failure to follow a set standard of care. For these participants, being a patient was more important than error or how an error is disclosed. The patient's understanding of error must be a key aspect of any quality improvement strategy.

Physicians, patients, and the electronic health record: an ethnographic analysis.

PURPOSE: Little is known about the effects of the electronic health record (EHR) on physician-patient encounters. The objectives of this study were to identify the factors that influence the manner by which physicians use the EHR with patients. METHODS: This ethnographic study included 4 qualitative components: 80 hours of participant observation in 4 primary care offices in the Pacific Northwest; individual interviews with 52 patients, 12 office staff members, 23 physicians, and 1 nurse-practitioner; videotaped reviews of 29 clinical encounters; and 5 focus-group interviews with physicians and computer advocates. The main outcome measures were factors that influence how physicians use the EHR. Researchers qualitatively derived these factors through serial reviews of data. RESULTS: This study identified 14 factors that influence how EHRs are used and perceived in medical practice today. These factors were categorized into 4 thematic domains: (1) spatial--effect of the physical presence and location of EHRs on interactions between physicians and patients; (2) relational--perceptions of physicians and patients about the EHR and how those perceptions affected its use; (3) educational--issues of developing physicians' proficiency with and improving patients' understandings about EHR use; and (4) structural--institutional and technological forces that influence how physicians perceived their use of EHR. CONCLUSIONS: This study found that the introduction of EHRs into practice influences multiple cognitive and social dimensions of the clinical encounter. It brings into focus important questions that through further inquiry can determine how to make best use of the EHR to enhance therapeutic relationships.

Clinician style and examination room computers: a video ethnography.

BACKGROUND AND OBJECTIVES: The use of computers in medical examination rooms is growing. Advocates of this technology suggest that all family physicians should have and use examination room computers (ERCs) within the near future. This study explored how family physicians incorporate the use of ERCs in their interactions with patients. METHODS: This qualitative study involved five family physicians, one family nurse practitioner, and a convenience sample of 29 patients. Data included videotaped visits, clinician interviews, and videotape reviews. The setting was an urban family practice with a 7-year history of viewing electronic medical records. The main outcome measures were themes emergent from videotaped data. RESULTS: We identified three distinct practice styles that shaped the use of the ERC: informational, interpersonal, and managerial styles. Clinicians with an informational style are guided by their attention to gathering data as prompted by the computer screen. Clinicians with an interpersonal style focus their attention and body language on patients. Clinicians with a managerial style bridge informational and interpersonal styles by alternating their attention in defined intervals between patients and the computer. CONCLUSIONS: Family physicians have varying practice styles that affect the way they use examination room computers during visits with patients.