"Something very taboo": a qualitative exploration of beliefs, barriers, and recommendations for improving mental health care and access for Hispanic adults in the Paso del Norte U.S.-Mexico border region.

Background: Hispanic adults with mental health conditions in the United States experience disproportionate access to and utilization of professional mental health treatment. This is believed to be in part due to systemic barriers and challenges, difficulty accessing care, cultural factors, and stigma. Studies to date have failed to examine these specific factors within the unique context of the Paso del Norte U.S.-Mexico border region. Methods: For this study, 25 Hispanic adults identifying primarily of Mexican descent participated in four focus groups exploring these topics. Three groups were facilitated in Spanish and one group in both English and Spanish. Focus groups followed a semi-structured format eliciting perspectives on mental health and mental illness, help-seeking, barriers and facilitators of help-seeking and treatment access, and recommendations for mental health agencies and providers. Results: Qualitative data analysis yielded the following themes: understanding of mental health and help-seeking; barriers to accessing care; mental health treatment facilitators; and recommendations for agencies, providers, and researchers. Conclusion: Findings from this study support the need for innovative mental health engagement strategies to reduce stigma, increase understanding of mental health, foster support systems, reduce individual and systemic barriers to seeking and accessing care, and to continue to engage communities in mental health outreach and research.

[Knowledge and application level of the Ramsay Scale by Mexican nurses specialized in intensive care]. / Conocimiento y nivel de aplicación de la escala de Ramsay por parte de enfermeras mexicanas especialistas en cuidados intensivos.

INTRODUCTION: Among the intensive care specialized nursing staff, knowing the sedation level of the patient under their responsibility is of crucial importance. The present study evaluated the knowledge that nurses specialized in intensive care (NSIC) have on the Ramsay Scale (RS) and the way in which they apply it. MATERIAL AND METHODS: Those personnel who were developing their activity in the intensive care units (ICU) of four public hospitals of the cities of Merida, Yucatan, Mexico were enrolled during May 2003. The information was obtained by applying an expressly designed questionnaire that contained both demographic endpoints (age, years of experience as NSIC and type of ICU) and those related with the RS (clinical components that it evaluates, operative definitions, frequency of use per week or day). 95% (95% CI) confidence intervals were applied and odds ratio (OR) was used to determined the likelihood of the event. RESULTS: Of the 60 nurses interviewed, 75% did not know the RS. Age was a significant factor associated with its knowledge, since 11 of 23 with an age equal to or less than 38 years (47.8%) and 4 of 37 over 38 years (10.8%) knew what it evaluated (OR of 4 for the group of lower age, 95% CI 1.5 to 12.3, p = 0.002). Of 15 NSIC who knew what it evaluated, 9 (60%) also knew its operative definitions, and stated that they applied it adequately per day. CONCLUSIONS: In this sample, there is an elevated percentage of NSIC who did not know the RS. Age was the factor associated with lack of knowledge.

Conocimiento y nivel de aplicación de la escala de Ramsay por parte de enfermeras mexicanas especialistas en cuidados intensivos / Knowledge and application level of the Ramsay scale by Mexican nurses specialized in intensive care

Introducción. Conocer el nivel de sedación del paciente a su cargo, entre el personal de enfermería especialista en cuidados intensivos, es de crucial importancia. El presente estudio evaluó el conocimiento que enfermeras especialistas en cuidados intensivos (EECI) tienen acerca de la escala de Ramsay (ER) y la forma en que la aplican. Material y métodos. Se incluyó personal que durante mayo de 2003 desarrolló su actividad en unidades de cuidados intensivos (UCI) de 4 hospitales públicos de la ciudad de Mérida (Yucatán, México). La información se obtuvo co la aplicación de un cuestionario diseñado ex profeso que contenía tanto variables demográficas (edad, años de experiencia como EECI y tipo de UCI) como relacionadas con la ER (componentes clínicos que evalúa, definiciones operativas, frecuencia de uso por semana y por día). Se aplicaron intervalos de confianza (IC) del 95% y se utilizó razón de momios (RM) para determinar la probabilidad del evento. Resultados. De 60 enfermeras entrevistadas, un 75% no conocía la ER. La edad fue un factor significativo asociado con su conocimiento, pues 11 de 23 (47,8%) con edad igual o menor de 38 años y 4 de 37 (10,8%) mayores de 38 años sabían qué evalúa (RM de 4 para el grupo de menor edad; IC del 95%, 1,5-12,3; p = 0,002). De 15 EECI que sabían qué evalúa, 9 (60%) también conocían sus definiciones operacionales, y refirieron que la aplicaban adecuadamente por día. Conclusiones. En esta muestra, un elevado porcentaje de EECI no conocía la ER. La edad fue el factor asociado con su desconocimiento

Introduction. Among the intensive care specialized nursing staff, knowing the sedation level of the patient under their responsibility is of crucial importance. The present study evaluated the knowledge that nurses specialized in intensive care (NSIC) have on the Ramsay Scale (RS) and the way in which they apply it. Material and methods. Those personnel who were developing their activity in the intensive care units (ICU) of four public hospitals of the cities of Merida, Yucatan, Mexico were enrolled during May 2003. The information was obtained by applying an expressly designed questionnaire that contained both demographic endpoints (age, years of experience as NSIC and type of ICU) and those related with the RS (clinical components that it evaluates, operative definitions, frequency of use per week or day). 95% (95% CI) confidence intervals were applied and odds ratio (OR) was used to determined the likelihood of the event. Results. Of the 60 nurses interviewed, 75% did not know the RS. Age was a significant factor associated with its knowledge, since 11 of 23 with an age equal to or less than 38 years (47.8%) and 4 of 37 over 38 years (10.8%) knew what it evaluated (OR of 4 for the group of lower age, 95% CI1.5 to 12.3, p = 0.002). Of 15 NSIC who knew what it evaluated, 9 (60%) also knew its operative definitions, and stated that they applied it adequately per day. Conclusions. In this sample, there is an elevated percentage of NSIC who did not know the RS. Age was the factor associated with lack of knowledge