Cultural care needs of Spanish speaking parents with limited English proficiency whose children are hospitalized: An ethnonursing study.

PURPOSE: Parents' inability to speak English proficiently is associated with communication barriers in the care process of their children, social determinants of health, and poor child health outcomes. Research exploring perspectives of Spanish speaking parents with limited English proficiency (SSP-LEP) whose children are hospitalized in the context of culture is lacking in the literature. The purpose of this study was to explore the cultural experiences, values, and beliefs of SSP-LEP, of Mexican origin, whose children were hospitalized and to understand nurses' roles in providing culturally congruent care. DESIGN AND METHODS: Leininger's qualitative, ethnonursing method was used for this study. The Theory of Culture Care Diversity and Universality provided a guiding framework. Eleven SSP-LEP, of Mexican origin, participated in interviews conducted in-person and via Zoom. Data was analyzed using Leininger's four phases of qualitative analysis. RESULTS: Three themes emerged: 1. role of the mother as an ever-present manager of care for the hospitalized child and family, 2. parents' difficult, fearful, stressful, and unknowing experiences in the presence of a language barrier, and 3. expected nursing care that was kind, respectful, compassionate, and attentive. CONCLUSIONS: Lack of knowledge creates hardships for parents who desire to be involved, informed caregivers. Communication in Spanish language is integral to parents' understanding and expected nursing care. SSP-LEP may have negative feelings; yet describe a positive care experience. PRACTICE IMPLICATIONS: Culturally congruent care should incorporate language services for information sharing that facilitates parent participation and decision-making; be kind, respectful, compassionate, and attentive; and promote maternal role maintenance.

Pediatric Nurses' Experiences in Caring for Non-English Speaking Patients and Families.

INTRODUCTION: Language barriers challenge patient- and family-centered care. Literature guiding pediatric nurses caring for patients and families with limited English proficiency in the inpatient setting is nonexistent. The purposes of this phenomenological study were to understand pediatric nurses' experiences in caring for patients and families with limited English proficiency and to explore how nurses navigate the communication gap. METHOD: A purposive sample of 15 pediatric Registered Nurses at a large urban children's medical center participated in face-to-face semistructured interviews. Verbatim transcribed interviews were analyzed line-by-line and categorized into themes. RESULTS: Themes included personal framework of care, consequences of caring, starting off right, nurse sensing, verbal/nonverbal methods, and interpreters. DISCUSSION: Nurses did not perceive differences in task-oriented care; they described compromised personal paradigms, held negative feelings, and utilized verbal/nonverbal communication methods. Future research is needed exploring patients' and families' perceptions regarding care by other language-speaking nurses.

A Call for Nurse Leader Action: Ethical Nursing Care of Latinx Unauthorized Immigrant Children and Families.

Latinx unauthorized immigrant children and children of unauthorized immigrant parents are at risk for care disparities and negative health outcomes. Unauthorized immigration from South and Central America to the United States has elevated to crisis level, exposing many children to poor health conditions, human rights violations, and risk of death. Unauthorized status greatly influences care access and delivery in the hospital setting. Restricted nursing care creates ethical dilemmas. Nurse leaders are in key positions to influence and advocate care. This article explores issues surrounding nursing care using the Theory of Bureaucratic Caring and identifies opportunities for nurse leader action.

Spanish Speaking, Limited English Proficient Parents whose Children are Hospitalized: An Integrative Review.

PROBLEM: Children of non-English speakers are at risk for health disparities. Little is known about the experiences of Spanish speaking parents with limited English proficiency (LEP) whose children are hospitalized. The purposes of this integrative review were to explore what is known and to identify gaps in the literature about the experiences of Spanish speaking parents with LEP whose children are hospitalized. ELIGIBILITY CRITERIA: Whittemore and Knafl's (2005) integrative review method guided the process. Studies addressed Spanish speaking parents of hospitalized children in the United States. SAMPLE: A final sample consisted of 36 quantitative and qualitative research studies published from 1994 to 2018; located through a search of CINAHL, Pubmed, and Scopus. RESULTS: Language services were inconsistent although mandated by standards and laws. Parents experienced mixed emotions related to care. Emergency departments in large, urban cities were the most common care settings. Differences in care outcomes and safety risks for children of Spanish speaking parents existed; however, findings were inconsistent. Only three of the 36 studies addressed nursing care. CONCLUSIONS: Research design and quality varied. Parents valued communication in their language. Nurses are the primary healthcare provider in the hospital setting but few studies explored parents' experiences associated with nursing care. No studies explored parents' experiences with their child's hospitalization in the context of culture. IMPLICATIONS: Future research is needed to explore the cultural values, beliefs, and experiences of Spanish speaking parents with LEP and the role of nurses and to inform culturally congruent nursing care, research, and policy.

Adults with sickle cell disease: an interdisciplinary approach to home care and self-care management with a case study.

The complexity of caring for adults with sickle cell disease (SCD) strains the confines of a care-segregated medical system. As treatment protocols have dramatically improved since 1990, many patients with SCD are now living well beyond their 6th decade of life. This improved survival rate presents opportunities and challenges for the home healthcare nurse in the management of adult patients with SCD. The home healthcare nurse is essential in the coordination of interdisciplinary health team members to reduce pain episodes and the potentially catastrophic complications of renal failure, pulmonary disease, and cardiovascular events. In addition, the home healthcare nurse serves as patient advocate for the transition from acute care to home, as well as advocate for healthcare maintenance of vision, musculoskeletal involvement, and social and psychological support. This article seeks to provide a viable network for home healthcare nurses to establish self-care management and support of the adult patient with SCD.

A surgical approach to the lateral compartment of the equine guttural pouch in the standing horse: modification of the forgotten "Garm technique".

The objective of this study was to evaluate the feasibility, efficacy and complications following lavage and drainage of the lateral compartment (LC) of the equine guttural pouch (GP) using a modified Garm's technique (MGT). In an ex vivo study (study 1), six cadaver heads were examined to assess the anatomical limits of the surgical approach and whether vital structures might be damaged. This was followed by an in vivo study (study 2) in which a lavage/drainage tube was placed for 3 days into each LC of four standing horses using the MGT. In both studies, the procedure offered direct access into the LC and indirect access into the medial compartments of the GP. In study 1, the MGT provided a rostroventral point of access allowing drainage of the LC, with no obvious iatrogenic damage. In study 2, the MGT permitted lavage of the entire GP in three healthy horses and one horse with mild GP empyema. The only major complication was development of emphysema of the lateral wall of one LC, with secondary collapse of the mucous membrane. The time for secondary wound healing was 12-14 days. The MGT can be performed safely in standing horses and may be of value in providing access for lavage and drainage in horses with mild GP empyema.

The impact of a blended learning approach on instructor and learner satisfaction with preceptor education.

To further enhance satisfaction and effectiveness, six pediatric hospitals created a blended learning approach to preceptor role preparation. In this blended approach, foundational content was delivered via online learning, allowing the classroom instructors to focus more on experiential learning activities. Both preceptor-learners and classroom instructors were asked to complete an evaluation of their experiences. This article describes the results and implications.

Hemangiosarcoma in 11 young horses.

Hemangiosarcoma is a rare neoplasm of horses and hemangiosarcoma in young horses might behave differently than in mature horses. The purpose of this study was to identify the characteristics of hemangiosarcoma occurring in horses < or = 3 years of age. Medical records from 1982 to 2004 were searched for horses < or = 3 years of age with a histopathologic diagnosis of hemangiosarcoma. Eleven records were identified. Thoroughbred and Thoroughbred crosses predominated. Age ranged from 9 days to 3 years. All horses presented with cutaneous or leg swellings or joint effusion. Physical examination findings included tachycardia, fever, and depression. Laboratory abnormalities included anemia (5/11), hyperfibrinogenemia (4/11), hypofibrinogenemia (3/11), thrombocytopenia (2/11), and neutrophilic leukocytosis (1/11). Ultrasonographic and radiographic evaluation was not diagnostic in any case. Antemortem histopathologic diagnosis was obtained in 10 cases. Six of 11 horses were euthanized. Surgical resection was performed in 5 horses, 2 of which were later euthanized. Diagnosis was confirmed histologically at postmortem examination in all euthanized horses. Two cases resolved spontaneously. Early histopathologic diagnosis may allow cure if the mass is localized and amenable to surgical resection. In cases where the horse is medically stable, and masses are not interfering with quality of life, a period of observation may be warranted.

Bolus location at the initiation of the pharyngeal stage of swallowing in healthy older adults.

This study characterized the vertical position of the bolus head at the onset of the pharyngeal swallow in healthy older adults. Lateral-view videofluoroscopic (VF) images were obtained from ten healthy volunteers (age-71.6 +/- 7.5 years, mean+/- SD) as they swallowed 5-cc thin liquid barium aliquots. For each swallow, the bolus head and several anatomic landmarks were digitally recorded from the image in which pharyngeal swallow-related hyoid bone elevation began. Vertical distance between the bolus head and the intersection of the tongue base and mandibular ramus (TMI) was computed. Bolus head position at swallow onset ranged from 47.4-mm above to 34.9-mm below the TMI (2.2 +/- 14.4-mm, mean +/- SD). Although the bolus head was below the level of the TMI for the majority of swallows, neither penetration nor aspiration occurred. For individual subjects, mean bolus head position ranged from 25.8 +/- 5.0-mm above to 15.5 +/- 6.5-mm below the TMI. Whereas five of ten subjects initiated the pharyngeal swallow with the bolus head consistently above or consistently below the TMI, five subjects initiated swallowing with the bolus head either above or below the TMI across trials. Older adults commonly initiate thin-liquid swallows with the bolus head well below the TMI without associated penetration or aspiration. Thus, bolus position alone does not differentiate between normal and pathologic swallowing within the healthy elderly. Bolus position at pharyngeal swallow onset can vary substantially from trial to trial within an individual, suggesting that the triggering of swallowing depends on multiple influences.

Small intestinal volvulus in 115 horses: 1988-2000.

OBJECTIVE: To evaluate the historical data, signalment, clinical signs, results of laboratory analyses, treatment, and outcome of horses with small intestinal (SI) volvulus. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: One hundred and fifteen client-owned horses, aged 1 month to 21 years. METHODS: Clinical signs, laboratory data, surgical or necropsy findings, and outcome for horses with SI volvulus were obtained from medical records, identified by computer search and manual review. RESULTS: There was no statistical difference in signalment between cases and the hospital population. Seventy-four percent of horses were >/=3 years. There were considerable variations in clinical signs on admission; high heart rate and signs of severe pain were not consistent features. Examination per rectum identified distended small intestine in only 69% of horses. One hundred horses had surgery, and small intestine resection was performed in 25. Eighty-four horses were recovered from surgery, and 67 horses survived to hospital discharge (80% of horses recovered from surgery, 58% of 115 horses). Forty-eight percent that were ultimately discharged had a post-operative complication and these horses had a longer average stay than horses with no complication (11 days versus 8.9 days). CONCLUSIONS: We identified 115 horses with primary SI volvulus over a 12-year period. We found that the population of horses with this lesion was older than has previously been reported and that the prognosis for post-operative survival to hospital discharge is good (80%). Post-operative complications were common, and affected approximately half the horses that were ultimately discharged from the hospital. CLINICAL RELEVANCE: This information may aid diagnosis and prognosis and guide decision making for horses with this condition.

Factors associated with mortality and morbidity in small intestinal volvulus in horses.

OBJECTIVE: To determine historical, physical, and clinical factors that may affect morbidity and mortality in horses with small intestinal volvulus unrelated to other causes (e.g., incarceration, lipoma, etc.). STUDY DESIGN: Retrospective study. ANIMALS: Client-owned horses (115), aged 1 month to 21 years. METHODS: Data were obtained from medical records, identified by computer search and manual review. Continuous variables were compared between affected and non-affected horses with Mann-Whitney U-tests and non-continuous variables with Fisher's exact test (2 x 2 tables) or chi(2)-tests (larger tables). Stepwise logistic regression analysis was used to develop a multivariable model of the risk factors, taking account of confounding and interaction. RESULTS: Eighty percent of horses recovered from surgery survived to hospital discharge. Neither age, breed, nor sex was related to mortality. Survivors had a significantly lower heart rate, shorter capillary refill time, and better mucous membrane color. Variables associated with worsening cardiovascular status, increased hemoconcentration, and exudation of cells and protein into peritoneal fluid were significantly associated with non-survival. After recovery from surgery, the most serious complication was colic, which was significantly associated with non-survival (P=.028) as was a second celiotomy (P<.01). Both of these complications were associated with a jejunocecostomy during the first surgery. CONCLUSIONS: Significant differences in the clinical and clinicopathologic signs were identified between survivors and non-survivors. CLINICAL RELEVANCE: These findings can be used to make a scientific assessment of prognosis in the pre-operative, operative, and post-operative management of horses with small intestinal volvulus.

Risk factors and prevalence of injuries in horses during various types of steeplechase races.

OBJECTIVE: To identify the types of injuries sustained by horses that competed in steeplechase races and determine the prevalence of and risk factors for those injuries. DESIGN: Prospective study. ANIMALS: 2,680 horses that competed in various types of steeplechase races from 1996 through 2000. PROCEDURE: Data regarding races; environment; equipment problems; the number of horses that entered, started, and finished races; the number of riders that fell; and the number of horses that were slowed or stopped by the rider, ran off the course, fell, and sustained injuries or physical abnormalities during races were collected on a standard form by the official veterinarian who attended each meet. Data from all meets were not recorded; however, in recorded meets, data from every race were reported. RESULTS: Data for 197 hurdle, 65 timber, 76 flat, and 8 mixed races were recorded. Nine (3.4/1,000 horses that started in races) horses died or were euthanatized, and 7 of those were associated with catastrophic musculoskeletal injury. Seven fractures were recorded. Four fractures involved forelimbs, 1 involved a hind limb, and 2 involved the cervical portion of the vertebral column. All horses with fractures were euthanatized. Deep or hard course conditions were associated with an increased risk of breakdown injuries. CONCLUSIONS AND CLINICAL RELEVANCE: Successful development and implementation of strategies to prevent injuries and death in horses in steeplechase races depend on a clear understanding of the types and prevalence of injuries involved and risk factors associated with those injuries.

Salmonella bloodstream infections: report from the SENTRY Antimicrobial Surveillance Program (1997-2001).

Salmonella spp. are significant bloodstream pathogens and are routinely monitored for antimicrobial resistance by the SENTRY Antimicrobial Surveillance Program. Six hundred and one bloodstream infection (BSI) isolates of Salmonella spp., collected over a 5-year period (1997-2001) were tested for their susceptibility against 20 antimicrobial agents, comparing year and geographical region. Salmonella enterica serotype Typhi was the most frequently identified 'species' (43% of identified strains), although 'unspeciated' strains predominated overall (54.2%). The rank order for six selected drugs tested by their MIC(90) values and percentage susceptibility was: ceftriaxone (< or =0.25 mg/l; 99.5% susceptible)>ciprofloxacin (0.12 mg/l; 99.3%)> trimethoprim/sulphamethoxazole (< or =0.5 mg/l; 92.7%)>amoxycillin/clavulanate (16 mg/l; 89.7%)>ampicillin (>16 mg/l; 81.0%)>tetracycline (>8 mg/l; 79.4%). Most isolates remained highly susceptible to all 20 agents examined, with the exception of Salmonella Typhimurium (only 35.3% susceptible to tetracycline, 41.2% to ampicillin, and 61.8% to amoxycillin/clavulanate). DT104 resistance phenotypes were noted in 3.4 and nearly 60.0% of unspeciated Salmonella and S. Typhimurium, respectively. Unexpectedly, the highest overall susceptibility rates were recorded in Latin America. Fluoroquinolone resistance was observed and nalidixic acid screening MICs (< or =8 mg/l) predicted full susceptibility to ciprofloxacin. Five-year results from the SENTRY Program show no clear trend toward greater resistances in Salmonella spp. BSIs for the commonly used antimicrobial classes. With the exception of S. Typhimurium DT104, most Salmonella spp. remain highly susceptible to the tested antimicrobials that maybe utilized for Salmonella BSI.

Antimicrobial susceptibility profile among beta-haemolytic Streptococcus spp. collected in the SENTRY Antimicrobial Surveillance Program--North America, 2001.

The surveillance of antimicrobial resistance among beta-hemolytic Streptococcus spp. is an important health care concern due to the serious nature of the diseases that are caused by these pathogens and the emerging antimicrobial resistances. National and international studies have documented diverse rates of resistance to macrolide and lincosamide agents. The SENTRY Antimicrobial Surveillance Program evaluated the resistance rates of beta-hemolytic Streptococcus spp. to several drug classes including erythromycin and clindamycin during the 2001 study year. Twenty-five medical centers in North America contributed 787 isolates from serogroups A (SGA; 397 strains), B (SGB; 318 strains), G (SGG; 45 strains), C (SGC; 19 strains), and F (SGF; eight strains). Isolates were tested at a reference center by broth microdilution using NCCLS methods. A subset of isolates were characterized by molecular methods to determine the presence of erm and mef resistance mechanisms. All isolates were susceptible to beta-lactams, linezolid, vancomycin, chloramphenicol, quinupristin/dalfopristin, and fluoroquinolones. Garenoxacin (MIC(90,) 0.06 microg/ml) was the most potent fluoroquinolone tested. Tetracycline was inactive against SGB (14.8% susceptible) compared to SGC, SGG, SGF and SGA (48.9-85.6% susceptible). Resistance to erythromycin and clindamycin was highest among SGB isolates with M-phenotypes (mef) representing the majority (59.1%) of strains. Among isolates randomly selected for genotypic characterization, eight strains had mef (A), 16 had erm (A) [subclass erm (TR)], seven had erm (B) and one strain had erm (A) [subclass erm (TR)] and mef (A) present. These data when compared to previous SENTRY Program analysis showed macrolide resistance has remained stable over the last five years and M-phenotypes are the most prevalent expression of MLS(B) resistance in North America.