Undergraduate Nursing Student Reflections on Academic Service Learning Experiences - A Qualitative Study.

The provision of nursing care has shifted toward integrated primary care (provision of community health services by an interprofessional team), requiring that nurse educators take steps to ensure students have opportunities to learn and practice the leadership and professional skills required to function as members and leaders of interdisciplinary teams. We developed the Transforming RN Roles in Community Based Integrated Primary Care (TRIP) program for undergraduate nursing students to facilitate this learning. During clinical immersion, students participated in academic service learning (ASL) activities consisting of a minimum of 25 h of clinical agency service each semester. This descriptive qualitative design captures recurring themes in the ASL reflections of eight nursing students participating in the inaugural TRIP cohort. Three themes were identified (1) "Embracing the Nursing Profession" (2) "Utilizing the Professional Skills of Nursing" and (3) "I Am A Nurse". We urge our faculty colleagues to consider incorporating ASL experiences into their undergraduate activities. We believe the effort to initiate, develop and sustain these partnerships will pay handsome dividends in terms skill and confidence enhancements for our undergraduate nursing students.

Influences of Faith on Rural Appalachian Older Adult Health: An Ethnonursing Study.

INTRODUCTION: Rural Appalachian older adults (RAOAs) constitute a vulnerable population and experience significant health disparities. The combination of age, poverty, rural residence, health care provider shortages, and limited transportation increases risks for poor health outcomes. Spirituality enhances older adult health; however, little is known about spirituality-health linkages of RAOAs. Therefore, the purpose of this study was to discover the influences of spirituality on RAOA health. METHODOLOGY: Culture Care Theory and ethnonursing method guided analysis of 32 RAOA interviews in community settings in East Tennessee. RESULTS: "Faith" is an integral component of RAOA culture and health. Three themes were extrapolated: (a) Relationship with God is personal; (b) faith beliefs and practices influence health, illness, death, and dying; and [the need to] (c) "Open the door" for spiritual care. DISCUSSION: Faith assessment and spiritual care recommendations contribute to culturally congruent care for RAOAs and may be transferable to care for other older adults.

Community-Academic Partnership: Intervention to Prepare Community Members for the End-of-Life Journey.

Despite research findings that rural Appalachians prefer to die at home, few people access palliative and hospice care services, and many report limited knowledge about palliative/end-of-life care resources. A community-academic partnership was formed to address this need. Train-the-trainer workshop and materials were co-developed. This study tested the feasibility and cultural acceptability of the training intervention to increase community members' knowledge about palliative/end-of-life care resources for East Tennessee Appalachian people. Community-based participatory research design and culture care theory guided the project, intervention, and research. After engaging in end-of-life training, participants completed a retrospective pretest-posttest survey. Paired samples t tests were used to compare knowledge before and after training. Means and standard deviations were used to report training material usefulness and cultural acceptability. Short-answer qualitative data were analyzed using content analysis. Sixty-six adults completed the survey. Ratings for training materials and cultural/theological acceptability were high. Participant knowledge rankings showed significant improvement after training at the P <.001 level. Qualitative feedback was positive. The training intervention was feasible, culturally acceptable, and effective for increasing East Tennessee Appalachian persons' palliative/end-of-life care knowledge. Community member expertise/collaboration integrated into every stage of the project is the bedrock of cultural acceptability and feasibility.

"Turn It over to God": Faith Enhances Mental Health of Rural Appalachian Older Adults.

In Appalachia, rates of depression and suicidality are higher than national averages. Additional disparities of age, geographic isolation, economic distress, and mental healthcare provider shortages contribute to mental health challenges among rural Appalachian older adults (RAOAs). Based on ethnonursing research in East Tennessee, this article expands on findings about how RAOA faith beliefs and practices enhance mental health. Faith was found to decrease worry, improve coping, facilitate a sense of peace, and deepen thankfulness and joy. Implications for nursing practice and education indicate the importance of providing spiritual care to promote mental health and well-being for this vulnerable population.

Influence of Spiritual Engagement on Appalachian Older Adults' Health: A Systematic Review.

Appalachia leads the country in mortality related to chronic comorbidities, such as heart disease, cancer, depression, and suicide. Appalachian older adults experience disproportionate risks for poor health outcomes. Spirituality is integral to Appalachian culture, and many older adults use spiritual engagement (SE) to cope with health challenges. Despite these connections, there is limited evidence about SE and well-being in this population. Therefore, the current systematic review addresses the literature gap of how SE influences health of Appalachian older adults. Using thematic synthesis, we analyzed 11 qualitative and three mixed methods studies. Major findings indicate that SE positively impacts holistic health through adaptive coping, guided partnerships with God, decreased loneliness, and enhanced sense of purpose. Future studies could examine SE practices among diverse populations, SE virtual experiences, and SE nursing assessments. Understanding how SE influences health of Appalachian older adults could prepare nurses to reduce disparities and improve health outcomes for this vulnerable population. [Journal of Psychosocial Nursing and Mental Health Services, 61(5), 45-52.].

Methods, Ethics, and Cross-Language Considerations in Research With Ethnic Minority Children.

BACKGROUND: Qualitative research seeking the perspectives of minority children on child health issues such as childhood obesity and healthy weight care is limited, especially in nursing research. OBJECTIVE: Our objective is to share methodological, ethical, and cross-language knowledge gained from conducting an ethnonursing research study. This study focused on providing a voice for ethnic minority children in childhood obesity literature. METHODS: The purpose of the study was to discover cultural influences on healthy weight care in children of Burmese refugees of Karen ethnicity. Researchers may exclude children of ethnic minorities from studies because of the distinct challenges in conducting cross-language research and research with children. We critically examine these challenges. The challenge of being a stranger was addressed by a period of immersion in the children's activities prior to data collection, in addition to volunteering as an English teacher with Karen adults. The immersion period was crucial for developing the trust needed in child-inclusive research and research in ethnic minority communities. The challenge of designing an inclusive study with families who experience language barriers was addressed with an interpreter who not only spoke Karen but was also a part of the Karen community. The interpreter provided the authentic sociocultural language equivalence needed for the study's rigor. Ensuring the child's voice was clearly heard was addressed with member checking. Methodological changes necessitated by a pandemic were a distinct challenge discussed in detail. RESULTS: We described methods useful for nurse researchers seeking transformative knowledge to reduce health disparities in childhood obesity. Nurse researchers may use these methods related to cross-language research and child research for designing research inclusive of minorities with language barriers. DISCUSSION: The perspectives of children from ethnic minorities are needed to inform culturally congruent healthy weight care for their communities. The goal in providing transparency of the difficulties, successes, and recommendations for methods in research with children of Burmese refugees is to encourage more nurse researchers to work with marginalized groups. Nurse researchers can inform evidence-based, culturally appropriate interventions to address health inequities of minority communities by including the voice of children from these communities.

Cultural Influences on Healthy Weight Care in Karen Children.

PURPOSE: Although the rates of childhood obesity are disproportionately higher in children of racial and ethnic minorities, research rarely addresses possible cultural factors. The purpose of this study was to discover cultural influences that contribute to or prevent childhood obesity from the perspectives of Burmese-American children and adolescents of Karen ethnicity in the southeast U.S. DESIGN AND METHODS: The ethnonursing research method was used to seek perspectives of healthy weight care from Karen children between 8 and 15 years-of-age (n = 10). Karen parents (n = 5) and non-Karen community members (n = 13) were also interviewed. Data sources - interviews, fieldnotes, and observation notes - were analyzed using the four phases of the ethnonursing method. RESULTS: Four themes important to healthy weight care in Karen children were discovered: views of a healthy child, food and food preparation, physical activity, and mutual support among family and community. These themes revealed both Karen and non-Karen influences. CONCLUSIONS: Most Karen cultural influences promote healthy weight care in Karen children and adolescents which may protect them from childhood obesity. Lack of after-school transportation, limited space to play/exercise, and the sedentary tendencies of girls could limit healthy weight care. PRACTICE IMPLICATIONS: Pediatric nurses may use knowledge gained from this study for promotion of healthy weight care in Karen families and to advocate for community changes which could benefit all children.

Transforming RN roles using an academic-practice partnership to improve healthcare access for underserved populations.

There is a national call to improve healthcare access for underserved populations by preparing BSN students to practice at the full scope of their license in community-based, integrated primary care settings upon graduation. In response to this call, a robust academic-practice partnership-using interprofessional education and practice and primary care and leadership development- is preparing BSN students to practice in community-based integrated primary care settings where culturally diverse rural and urban underserved populations receive care. In this article, academic-practice partners describe the implementation, lessons learned, and initial outcomes of a grant-funded program that is transforming nursing education and practice. All partners viewed communication, collaboration, and flexibility as key to a successful partnership. Our work serves as a template to help others shift nursing culture to create a sustainable RN workforce prepared to improve the health and wellbeing of underserved populations.

Piloting the Transforming RN Roles in Community-Based Integrated Primary Care (TRIP): Student Responses.

In this manuscript, we report the pilot results of the Transforming RN Roles in Community Based Integrated Primary Care (TRIP) undergraduate nursing curriculum. Junior nursing students participated in TRIP didactic, simulation and clinical activities and completed a focus group at the midpoint and conclusion of year one. Focus group themes addressed recruitment, understanding or primary care, connections between clinical and didactic, and team based care. TRIP offers the first comprehensive community based integrated primary care training for students in our region. Overall, the TRIP curriculum enhanced student learning and promoted leadership.

Cultural Aspects of End-of-Life Advance Care Planning for African Americans: An Ethnonursing Study.

INTRODUCTION: Advance directive completion rates among the general population are low, with even lower completion rates among African Americans (AAs). This study's purpose was to identify culturally based meanings, expressions, and traditions of end-of-life (EOL) advance care planning (ACP) and decision making in order to promote culturally congruent nursing care among African Americans. METHODOLOGY: Leininger's Culture Care Theory and Ethnonursing Research Method guided the study. A convenience sample of 21 informants were interviewed in community settings. Data analysis was guided using Leininger's phases of ethnonursing data analysis for qualitative data. RESULTS: Three themes emerged that affect EOL decision making: (a) faith in God and belief in life after death, (b) a strong matriarchal family structure, and (c) fear of talking about death and mistrust of the U.S. health care system. DISCUSSION: AA culture, beliefs, and traditions influence EOL ACP and practices, and must be considered while providing culturally congruent care.

Families' Decision Making at End of Life in Rural Appalachia.

Caring for persons at the end of life has dramatically changed in the last 20 years. Improved chronic illness management and aggressive life-sustaining measures for once-fatal illnesses have significantly increased longevity. People with life-limiting illnesses and their families are asked to make complex and difficult decisions about end-of-life, palliative, and hospice care. The purpose of this study was to discover and describe the culture care expressions, patterns, and practices influencing rural Appalachian families making decisions at the end of life. The qualitative, ethnonursing research method was used to analyze data from 25 interviews. The 4 themes discovered provide insights that could help improve this underserved population's access to palliative and hospice care, which in turn could help them experience a dignified death. Recommendations for health care providers could help reduce rural Appalachians' health disparities and promote meaningful, culturally congruent end-of-life care.

Cultural Influences on Childhood Obesity in Ethnic Minorities: A Qualitative Systematic Review.

Introduction: Childhood obesity remains an unrelenting public health problem disproportionately affecting ethnic minorities. Although research has examined ethnicity as a factor of childhood obesity, few studies have examined cultural influences. The purpose of this systematic review was to examine the qualitative evidence of cultural influences on childhood obesity in ethnic minority groups. Methodology: Selective sampling of studies since 2008 yielded 251 articles. Twelve articles that addressed cultural influences on childhood obesity were identified for review. The Culture Care Theory Sunrise Enabler factors were used as an a priori framework for theme coding. Results: Nine themes emerged: child feeding, family, gender roles, food, healthy child appearance, physical activity, sedentary activity, food cost, and obesogenic environment. Discussion: Cultural care practices such as traditional foods and family meals are protective factors in childhood obesity and should be encouraged by nurses caring for and working with ethnic minority populations.

Culturally Acceptable Advance Care Planning and Advance Directives for Persons Experiencing Homelessness.

Although the process of dying is a universal human experience, it often magnifies individuals' unique cultural differences. Persons experiencing homelessness (PEHs) have unique barriers, challenges, and wishes for end-of-life care. There is insufficient evidence about how to provide culturally congruent advance care planning (ACP) through advance directive (AD) completion for PEHs. This study addressed this knowledge gap, and its findings serve as the basis for developing additional strategies to promote a satisfying ACP experience for this population when they complete an AD. The purpose of this study was to discover if an AD form recreated for PEHs would positively affect their completion of the AD as well as their overall experience with ACP. Guided by the culture care theory and qualitative ethnonursing methodology, 38 individuals (30 PEHs and 8 student nurses) were interviewed. Data were analyzed using the 4 phases of ethnonursing analysis. The 3 themes abstracted were (1) "it needs to be done," (2) the presence or absence of trusted family support, and (3) ACP for PEHs is facilitated by an AD workshop. Nursing interventions based on study findings can be used to help promote a dignified, meaningful ACP experience for vulnerable populations.

Transforming RN Roles in Community-Based Integrated Primary Care (TRIP): Background and Content.

Given the large body of evidence linking physical and mental health and the impetus provided by health care reform and the Affordable Care Act, the time is ripe to engage nurses in community based, integrated primary care teams to holistically address psychiatric, mental health and substance abuse needs. There is a compelling need for curricular redesign and clinical innovation to prepare an RN workforce for practice in community based integrated primary care teams. To that end, a faculty team of primary care, interprofessional education and content experts developed the Transforming RN Roles in Community Based Integrated Primary Care (TRIP) program for BSN students in a large university in the southeastern United States. The primary goals of the TRIP program are to build/implement an innovative BSN curriculum and expand our academic practice partnership by enhancing student clinical experiences with the goal of preparing an RN workforce for practice in community based integrated care teams. The TRIP program incorporates didactic, simulation and clinical components. Our first student cohort began the TRIP program in the fall of 2018 and will complete the program in spring 2020. In this paper, we provide details about the background, content and activities of this 4-semester (2 year) program.

Cultural Aspects of End-of-Life Care Planning for African Americans: An Integrative Review of Literature.

Advance directive completion rates among the general population are low. Studies report even lower completion rates among African Americans are affected by demographic variables, cultural distinctives related to patient autonomy, mistrust of the health care system, low health literacy, strong spiritual beliefs, desire for aggressive interventions, importance of family-communal decision making, and presence of comorbidities. An integrative review was conducted to synthesize nursing knowledge regarding cultural perspectives of end-of-life and advance care planning among African Americans. Twenty-four articles were reviewed. Nurses educate patients and families about end-of-life planning as mandated by the Patient Self-Determination Act of 1991. Implementation of advance directives promote patient and family centered care, and should be encouraged. Clinicians must be sensitive and respectful of values and practices of patients of diverse cultures, and initiate conversations with open-ended questions facilitating patient trust and sharing within the context of complex beliefs, traditions, and lifeways.

Using an iPad for Basic Communication Between Spanish-Speaking Families and Nurses in Pediatric Acute Care: A Feasibility Pilot Study.

The growing number of Spanish speakers in the United States poses communication challenges for healthcare providers. Language barriers in pediatric acute care have been associated with an increased risk for adverse events, longer hospital stays, and decreased quality of care. In addition, clinicians' usage of interpreter services is inconsistent. In fact, nurses often lack interpreter support during daily bedside care. Nursing staff at a pediatric children's hospital in the southeastern United States identified bedside communication with Spanish-speaking patients and families as a clinical challenge. To address this challenge, a basic communication interface, UTalk version 1.0 (the author is the owner and proprietor), supported by an Apple iPad, was developed by the researcher with input from nursing staff, a certified medical interpreter, and Spanish-speaking community members. A feasibility pilot study of the interface's usability and engagement was conducted on the hospital's pediatric medical-surgical unit through qualitative interviews with nurse-family dyads. Three themes emerged from the data: UTalk-facilitated communication, UTalk needs improvement, and interpreter miscommunication. These findings indicate that a mobile digital device interface is a feasible method for augmenting bedside communication with Spanish-speaking patients and families. These results also may serve as a reference for the development of similar mobile device interfaces. Further research with a larger sample size is needed.

Home care for children with multiple complex chronic conditions at the end of life: The choice of hospice versus home health.

Families desire to bring their children home at end of life, and this creates a variety of unique care needs at home. This study analyzed the child and family factors associated with hospice versus home health care use in the last year of life among children with multiple complex chronic conditions. Using the Andersen Behavioral Healthcare Utilization Model, the predisposing, enabling, and need factors of the child and family were shown to be significant predictors of hospice and home health care use. Hospice and home health care have advantages, and families may wish to use the service that best fits their needs.