Culturally Sensitive Care: Enlisting Community Partners to Meet Mexican American Caregiver Needs.

BACKGROUND: Culturally sensitive interventions are needed to assist Mexican American (MA) patients with cancer and their family members in managing their care, navigating the healthcare system, and decreasing disparities in healthcare outcomes for Hispanics with cancer. OBJECTIVES: The objectives of this study were to understand the meaning of culturally sensitive care for oncology clinic healthcare providers and to assess the usefulness and feasibility of the role of a promotora de salud to meet caregiver needs. METHODS: This study involved focus groups of 18 diverse providers who provided data for qualitative analyses. FINDINGS: The findings (themes) defined the facilitators of and barriers to culturally sensitive care and the perceived role of a promotora de salud to support the healthcare team and improve cancer care provided by MA caregivers. In addition, promotoras de salud can help reduce health costs by decreasing patient clinic visits.

The lived experience of new nurses: importance of the clinical preceptor.

BACKGROUND: New nurse internships or residency programs represent one evidence-based strategy to increase new nurse recruitment and readiness for practice. This qualitative study examined the phenomenon of being a new nurse in an internship program and explored ways that concernful practices (Diekelmann & Diekelmann, 2009) present themselves in that program. METHODS: Heideggerian phenomenology was used to structure the study of seven nurse interns. Transcripts were made from audiotaped conversations of each new nurse and the primary investigator. Hermeneutic analysis was used to identify study themes across narratives. Sequential transcript analysis was used to connect individual excerpts to create a converging conversation of new nurses' lived internship experiences. RESULTS: Three study themes defined the meaningfulness of the preceptor-new nurse relationship. A converging conversation of new nurse stories linked themes, concernful practices (patterns), and interpretation of the experience of being a new nurse in an internship program. CONCLUSION: This study amplifies the importance of the new nurse-preceptor relationship that supports new nurses' transition to practice.

Blending voices of Mexican American cancer caregivers and healthcare providers to improve care.

PURPOSE/OBJECTIVES: To identify and categorize healthcare provider perceptions of the meaning of cancer to Mexican American female family caregivers, including comparisons to caregiver themes in previous research. RESEARCH APPROACH: Descriptive, qualitative. SETTING: Three focus groups held in a publicly funded cancer clinic in the southwestern United States. PARTICIPANTS: 20 healthcare providers in diverse roles. METHODOLOGIC APPROACH: Tape recording of focus group discussions and transcription of content produced textual data for individual and team analysis. MAIN RESEARCH VARIABLES: Healthcare provider understanding, caregiver learning, and support needs. FINDINGS: Five major themes emerged related to the meaning of cancer to Mexican American caregivers: Caregivers fear the cancer diagnosis, interpret cancer as punishment, value maintenance of hope, believe in God and the doctor, and selectively disclose medical information. CONCLUSIONS: Healthcare providers identified most themes defined by Mexican American caregivers in an earlier study. However, provider identification of additional themes supports a blending of voices and partnerships between Mexican American cancer caregivers and providers to address caregiver literacy and support needs during the cancer cycle. INTERPRETATION: Understanding the cultural meaning of cancer to Mexican American caregivers provides a foundation for healthcare providers to define appropriate caregiver interventions in the cancer trajectory and to meet caregiver support and learning needs. Partnering of caregivers and providers also can ensure culturally sensitive care for Mexican American families experiencing cancer.

Perceived mood, health, and burden in female Mexican American family cancer caregivers.

Female family caregivers of various global cultures provide basic care in health, social, emotional, and financial domains for family members with cancer and may sacrifice their own health to do so. To learn about role-related mood, health status self-perceptions, and burden of one cultural group, we used qualitative and quantitative approaches to study 34 Mexican American (MA) women who provided care for an ill family member with cancer. We report quantitative data on study variables and make comparisons with caregiver qualitative reports. Implications for health planning, service delivery, and future research with underserved, minority female caregivers are presented.

Preparation and participation of undergraduate students to inform culturally sensitive research.

Most student work as research assistants occurs at the graduate level of nursing education, and little is known about the role of undergraduate students as research assistants (RAs) in major research projects. Based on our desire to study Mexican American (MA) cancer caregivers, we needed bilingual and bicultural RAs to serve as data collectors with women who spoke Spanish and possessed cultural beliefs that influenced their caregiving. Following successful recruitment, orientation, and mentoring based on Bandura's social learning theory [Bandura, A., 2001. Social learning theory: an agentic perspective. Annual Review of Psychology 52, 1-26] and accepted teaching-learning principles, RAs engaged in various behaviors that facilitated study outcomes. Faculty researchers, RAs, and study participants benefitted greatly from the undergraduate student involvement in this project. This article describes successful student inclusion approaches, ongoing faculty-RA interactions, and lessons learned from the research team experience. Guidelines discussed support the potential for making the undergraduate RA role a useful and unique learning experience.

Voices of Mexican American caregivers for family members with cancer: on becoming stronger.

This grounded theory study report describes the experience of 34 Mexican American (MA) female caregivers who provided care to a family member with cancer. Caregivers identified a process of "Becoming Stronger" as a result of their caregiver role. The emerging theoretical model of female MA cancer caregiving offers evidence to change current cancer care approaches from patient-focused to family-focused care for this ethnic group. Findings suggest that changes most responsive to cultural values and likely to provide accessible and quality cancer care for MA families are those that involve active partnering with MA caregivers to prioritize the patient's cancer care.

Using imaginative literature to foster cultural sensitivity.

Readings from two novels, Sandra Cisneros' The House on Mango Street and Toni Morrison's The Bluest Eye, were included in maternal-child clinical courses as part of a pilot project to identify potentially effective strategies for increasing student cultural sensitivity and reflective thinking skills. The authors analyzed student journals to determine student values and beliefs during maternal-child clinical experiences. The study sample consisted of 40 young women enrolled in a baccalaureate nursing program in a private, liberal arts university. These young women consistently interpreted ;the other' in their own image. They responded most strongly to themes of belonging, including the struggles of immigrants to ;fit in,' the ways of being acceptable and valued in U.S. society, and the process through which students as nurses learn to accept and care for others who are different.

Student understanding of culturally and ethically responsive care: implications for nursing curricula.

Nursing education programs have a responsibility to develop strategies that improve future nurses' multicultural competence and ethical approaches to caring for populations different than their own. This article describes results of a final exam evaluative process used in an undergraduate class focused on culture and ethics. Ideas for nurse educators who desire increased student responsiveness and accountability for meeting the cultural and ethical needs of clients are offered.

Age and ageism: inhabiting the lives of healthy older adults through video narratives.

When applied humanities is used as a framework, the educational innovation described in this article provides a more balanced view of aging than occurs in most nursing programs. Five video narratives and focused discussion questions, intended to mitigate the "otherness" of old age, are described. Rationales and sample student responses are provided.

"They care but don't understand": family support of African American women with type 2 diabetes.

PURPOSE: This study evaluated the relationship between perceived social support among African American women with type 2 diabetes and diabetes self-management. METHODS: The sample included 12 African American female patients at a diabetes clinic in the southeastern United States. Focus group participants responded to questions related to social support and its influence on diabetes management. RESULTS: Support comes particularly from family, but also friends and/or healthcare providers. The dual challenges of diabetes management and multicaregiving were an expected theme from the sessions. A unique emerging theme, however, was the women's perception of a lack of understanding of their needs by members of their social networks. Participants believed that those who provide support claim they care and try to be helpful but provide minimal physical assistance or emotional understanding of their needs, which could vary daily. Those who provide informational support seem to care but misunderstand the type of information actually needed and how best to deliver it. CONCLUSIONS: Healthcare providers can help improve communication with these women by actively seeking to meet their support needs and educating families so that provisional support is more meaningful and diabetes management more attainable.

Mid-life African-American women with type 2 diabetes: influence on work and the multicaregiver role.

PURPOSE: Few studies have examined the multicaregiver role, including the work role, of African-American women and the influence of that role on diabetes self-management and the ability to cope with type 2 diabetes. Therefore, the purpose of this study was to explore the perceptions of work and the multicaregiver role of a group of such women to more clearly identify the influence of these factors on diabetic self-management and personal coping. METHODS: Focus group methodology was used to collect data from 12 mid-life African-American women. After data inspection, the research team extracted themes related to work and the multicaregiver role. Identification of relationships among and between themes helped delineate explanations of data and refine questions for future research. FINDINGS: Focus group analysis of participant responses elicited 4 themes. Family as core represented the participant's role as leader of her household. Work as survival defined the stresses of work and the physical and psychosocial responses to not working due to the social and economic costs of diabetes. Participants also identified pressures of balancing work and family responsibilities due to diabetes, a theme of impaired role function. The final theme, inner-strengthening, defined participants' methods of self-preservation through introspection and spiritual behaviors. CONCLUSIONS: Despite their identification of physical and psychosocial struggles with diabetes, participants did not think of diabetes as a life-long illness because it affected their ability to remain at "the head of the table," to continue engaging in paid work outside the home, and to provide for their families. Historical, social, political, and economic factors supported the themes of the study and provide a foundation for further research and healthcare delivery system changes focused on improving the lives of these women and their families, who are facing the challenges of chronic illness.