Educating Nursing Students About Female Genital Cutting/Mutilation Using a Standardized Patient in a Virtual Dramatization Simulation.

INTRODUCTION: Female genital cutting/mutilation (FGC/M) is a ritual to remove any or all of the external female genitalia. Educational strategies regarding the teaching of FGC/M for nursing students are scarce. The focus of this article is to describe the development, implementation, and evaluation of a virtual, FGC/M-related dramatization simulation with a standardized patient (SP). METHODS: This educational intervention used an East African immigrant woman as the SP with 35 undergraduate nursing students in two nursing schools in the Midwest United States. RESULTS: Participants appraised the simulation as an effective way to teach and learn about FGC/M. Debriefing was a key part of the simulation. DISCUSSION: Students felt the simulation was novel and engaging for a highly sensitive topic. The SP thought the virtual setting made it more comfortable for her to reveal sensitive facts. The researchers confirmed that the simulation required extensive time commitment to develop, critique, and implement.

Peripartum Cardiomyopathy and Spouses' Experiences of Persistent Uncertainty.

PURPOSE: The purpose of this study was to explore the experiences of spouses whose wives had peripartum cardiomyopathy (PPCM). DESIGN METHODS: Participants were recruited for this phenomenological study through online sites Facebook and SavetheMommies. Fifteen men from four countries participated through semistructured phone interviews conducted between October 2019 and August 2020. Data were analyzed using a modified version of the constant comparison method. RESULTS: The overarching theme of spouses' experiences was Living with the 'what ifs' of persistent uncertainty. Four main themes were: Feeling the shock, Facing the challenge, Figuring out a new normal, and Finding meaning. Spouses had to deal with the fear of their wives' heart failure relapse or death, changed marital and parental roles, and unclear expectations of the future. CLINICAL IMPLICATIONS: PPCM is a rare complication of pregnancy with uncertain implications for the future that can have a profound impact on the woman's spouse and family. Our findings should alert nurses and other health care professionals to the need for emotional, spiritual, and informational support of spouses or partners of women who have PPCM. Nurses should include spouses and partners in care and communication to make sure they are as informed as possible, have their questions and concerns addressed as needed, and receive adequate follow-up support.

Nursing students' knowledge gained about female genital cutting/mutilation through dramatization simulation with a standardized patient: A quasi-experimental study.

BACKGROUND: Female genital cutting is a culture bound ritual involving excision of the female genitalia. Little is known about nursing students' knowledge and perceptions of female genital cutting and no studies using simulation to teach this topic exist. OBJECTIVE: The aim of this study was to examine the impact of a dramatization simulation on nursing students' knowledge about and perceptions of female genital cutting. DESIGN: A quasi-experimental pretest posttest study with a convenience sample. SETTING: Two Bachelor of Nursing schools in Northeast Ohio, United States. PARTICIPANTS: 35 third year undergraduate students. METHODS: Students were divided into an intervention group (n = 14) and a wait list control group (n = 21). The intervention group took a pre-test, did a reading assignment and then attended a virtual, dramatization simulation session with a standardized patient; a Muslim woman with a personal history of female genital cutting. They took the posttest within the next week. The control group took the pretest, did the reading assignment, and then took the posttest, followed by the simulation. The survey instrument used for pretest and posttest was the Knowledge, Perceptions, and Practice Questionnaire on Female Genital Cutting for Healthcare Professionals in the United States. Debriefing was a critical part of the simulation. RESULTS: The knowledge of female genital cutting of the nursing students in the intervention group increased more than that of the students in the control group (change score 3.57 and 2.05 respectively). Students' perceptions of female genital cutting were not significantly changed by intervention type. CONCLUSION: This study was the first of its kind to measure nursing students' knowledge and perceptions about female genital cutting before and after a dramatization simulation. A standardized patient dramatization simulation including focused debriefing may be an effective education strategy to teach nursing students about female genital cutting.

Psychological Distress, Post-Traumatic Stress, and Suicidal Ideation Among Resettled Nepali-Speaking Bhutanese Refugees in the United States: Rates and Predictors.

INTRODUCTION: Bhutanese refugees may exhibit psychological distress (PD), post-traumatic stress (PTS), and suicidal ideation (SI), but little is known about predictors of these mental health problems. PURPOSE: To examine rates and predictors of PD, PTS, and SI among Bhutanese refugees. METHODS: Cross-sectional correlational study of 209 Bhutanese refugees in Midwestern United States. Data were collected using the Hopkins Symptom Checklist/Nepali version and Refugee Health Screener-15/PTS subscale and then analyzed using simultaneous multiple regression. RESULTS: Rates of PD, PTS, and SI were 18.7%, 8.1%, and 7.7%, respectively. Significant predictors of PD were a history of mental health treatment (p<.001) and fewer years of schooling (p = .032). Predictors of PTS were history of mental health treatment (p<.001), female gender (p = .016), fewer years of schooling (p = .012), and being single/previously married (p = .004). PTS predicted SI (ρ<.001). DISCUSSION: Health providers should routinely assess Bhutanese refugees' mental health status for timely further assessment and treatment.

Validation of the Hopkins Symptom Checklist-25/Nepali Version Among Bhutanese Refugees in the United States.

BACKGROUND: Bhutanese refugees' mental problems are relatively high. The Hopkins Symptom Checklist-25 (HSCL-25) has been used widely in examining refugees' mental health, but its psychometric properties in Nepali version is unknown. PURPOSE: To examine psychometric properties of the HSCL-25/Nepali version. METHODS: Bhutanese refugees (n = 209) responded to demographic questionnaire, the HSCL-25/Nepali, and the Refugee Health Survey-15. Exploratory factor analysis (EFA), convergent validity, and internal consistency were performed. RESULTS: After three rounds of EFA, item 14 was deleted resulting in HSCL-24/Nepali with good construct validity and excellent internal consistency (α = .94). CONCLUSIONS: The HSCL-24/Nepali version is reliable and valid and can be used to culturally, appropriately assess psychological distress of Bhutanese refugees as it omits item 14 that captures individual's sexual interest.

Searching for content on female genital cutting/mutilation in curriculums of U.S. Nursing Schools.

BACKGROUND: Over 500,000 women and girls in the U.S. are at risk for female genital cutting/mutilation, (FGC/M) because their cultural heritage is from countries where FGC/M is prevalent. Nurses lack knowledge about FGC/M, making them less likely to provide culturally congruent care. Little is known about FGC/M-related information in nursing school curriculums. METHODS: A total of 403 schools of nursing (SONs) responded to an anonymous online survey to identify the extent, placement, and educational approaches regarding FGC/M found in curricular content in nursing schools in the U.S. RESULTS: Fifty-seven percent of respondents did not know if nurses cared for FGC/M-affected women in the region where their nursing school was located. Only 27% of responding schools indicated FGC/M was taught in their curriculums, mostly in undergraduate programs, and primarily during classroom lectures, and rarely by simulation. SONs that were aware that nurses in their region provided care to women and girls at risk for FGC/M were more likely to have content on FGC/M in their curriculums. CONCLUSION: Though respondents indicated that this topic is important to global nursing education, it appears that few U.S. nursing students are learning to provide culturally congruent care to women and girls at risk for FGC/M. It is vital that nurse educators include this topic in appropriate places in the curriculum, so that students learn the unique healthcare needs of this population.

"I Hate the Word 'Liver'": A Photovoice Study of Burmese and Bhutanese Adolescent Health Care Brokers in Northeast Ohio.

INTRODUCTION: Adolescents health care brokers interpret for family and community members lacking English language proficiency in health care settings. The purpose of this study was to explore personal experiences of Burmese and Bhutanese teenagers who served as health care brokers in resettled refugee families in Northeast Ohio. METHOD: A mixed methods design using photovoice guided this study. Participants completed the Adolescent Language Brokering Survey, took photos, wrote in journals, and attended focus groups. RESULTS: Eight Burmese and Bhutanese teenagers participated. Three themes became apparent: health care brokering within sociocultural contexts, mediation during health care encounters, and representations of childhood. DISCUSSION: The adolescents were proud to be health care brokers yet found it disrupted their lives because they were living in both their traditional culture and the American culture. Photovoice empowered them through dissemination of findings during a photo exposition, community meeting, and health literacy class. Health care professionals must recognize benefits and prohibitions when working with adolescent health care brokers.

Social Pressure for Pregnancy Scale: Its Development, Psychometric Properties, and Potential Contributions to Infertility and Depression Research.

BACKGROUND: Women with infertility in different cultures, especially those in West African countries, are viewed as inferior. They tend to experience discrimination and have suboptimal mental health outcomes. However, recent evidence shows that social pressure for pregnancy, not infertility, is a significant predictor of depression. Yet, instruments that measure social pressure for pregnancy are scarce. Existing instruments to measure social pressure for pregnancy show no evidence of psychometric properties. PURPOSE: To assess the psychometric properties of a new tool, the Social Pressure for Pregnancy Scale (SPPS), among Malian women in West Africa. METHODS: Exploratory factor analysis, and analyses of convergent validity, discriminant validity (known-groups technique), and reliability. RESULTS AND CONCLUSION: The SPPS has good psychometric properties and can be used in future infertility studies especially in relation to depression.

Infertility, Psychological Distress, and Coping Strategies among Women in Mali, West Africa: A Mixed-Methods Study.

Relatively little is known about infertility and its consequences in Mali, West Africa where the context and culture are different from those of previously studied settings. This study therefore aimed to specifically examine infertility induced psychological distress and coping strategies among women in Mali. A convergent mixed-methods design-correlational cross-sectional and qualitative descriptive-guided the study. Fifty-eight infertile Malian women participated: 52 completed the Psychological Evaluation Test specific for infertility and a question on general health status, and 26 were interviewed in-depth. Over 20% scored above the cut-off point for psychological distress, and 48% described their general health as poor. There was no significant difference between women with primary vs. secondary infertility. The study found that infertile women lived with marital tensions, criticism from relatives, and stigmatization from the community. They experienced sadness, loneliness, and social deprivation. Coping strategies included traditional and biomedical treatments, religious faith and practices, and self-isolation. Health care professionals should provide holistic care for infertile women to meet their physical, spiritual, psychological, and social needs.

Welcome Day: A Community Interprofessional Model for Meeting the Needs of Migrant Workers.

Welcome Day, one specific day in the life of Hartville Migrant Ministry (HMM), a faith-based ministry in Ohio, illustrates the organization's vision, mission, and community collaboration. Migrant and seasonal farm workers, the Migrant Head Start program, HMM and Welcome Day, interprofessional collaboration, and Malone University School of Nursing faculty and students support are discussed. Programs and activities presented here could be reproduced in other communities.

Amish-Initiated Burn Care Project: Case Report and Lessons Learned in Participatory Research.

PURPOSE: This case report describes the phases of an Amish Burn Care Project and the lessons learned throughout the process. METHOD: Data sources to construct the case report included participant observation, interviews, archival documents, and a focus group. RESULTS: The narrative is organized into five phases of a participatory research approach: engagement, formalization, mobilization, maintenance, and expansion. LESSONS LEARNED: Community-initiated research led to legitimate change, working together for change took time, team members grew in mutual trust and respect for each other, cultural humility brought personal and professional growth, and capacity building took place through mutually supported efforts.

The effect of Burns & Wounds (B&W)/burdock leaf therapy on burn-injured Amish patients: a pilot study measuring pain levels, infection rates, and healing times.

PURPOSE: The purposes of this pilot study were to measure pain associated with dressing changes, assess the presence of infection, and document healing times of burn-injured Amish in central Ohio using an herbal therapy consisting of Burns and Wounds™ ointment (B&W) and burdock (Arctium ssp.) leaves. B&W contains honey, lanolin, olive oil, wheat germ oil, marshmallow root, Aloe vera gel, wormwood, comfrey root, white oak bark, lobelia inflata, vegetable glycerin, bees wax, and myrrh. DESIGN: A prospective, case series design guided the study within a community-based participatory research framework. METHODS: Amish burn dressers provided burn care. Registered nurses monitored each case and documented findings. Pain scores were noted and burns were inspected for infection during dressing changes; healing times were measured from day of burn to complete closure of the skin. All cases were photographed. RESULTS: Between October 2011 and May 2013, five Amish were enrolled. All had first- and second-degree burns. B&W/burdock leaf dressing changes caused minimal or no pain; none of the burns became infected, and healing times averaged less than 14 days. CONCLUSION AND IMPLICATIONS: The use of this herbal remedy appears to be an acceptable alternative to conventional burn care for these types of burns. The trauma of dressing changes was virtually nonexistent. Nurses working in communities with Amish residents should be aware of this herbal-based method of burn care and monitor its use when feasible.

Seroprevalence of hepatitis B surface antigen among pregnant women attending the Hospital for Women & Children in Koutiala, Mali.

OBJECTIVE: To establish the rate of seroprevalence of the hepatitis B surface antigen in pregnant women in south-eastern Mali, and to decrease mother-to-child transmission. METHODS: In a descriptive cross-sectional comparison study, 3 659 pregnant women attending a non-governmental hospital in Koutiala, Mali, during 2008 and 2009 were screened for the hepatitis B surface antigen during antenatal clinic attendance or when admitted for delivery. A chart review compared the hepatitis B virus (HBV)-positive women to HBV-negative women used as controls to identify potential risk factors for HBsAg positivity. The variables compared were age, parity, type of genital excision, birthweight of baby and HIV status. RESULTS: A total of 293 (8.0%) pregnant women tested positive for HBsAg. Their average age was 27.6 years, average parity of 2.8 births, 90% had Type 2 genital excision, 21% had low birthweight infants, and 14 (0.4%) women also tested positive for HIV. Infants born to HbsAg-positive women were immunised with the hepatitis B vaccine in the delivery room. Two hundred and eighty-four HBV-negative women were compared with the HBV-positive women. None of the differences of means or relationships was statistically insignificant. CONCLUSION: In view of the high endemicity and lack of easily identifiable risk factors, free maternal HBV screening should be provided to all women in Mali, and the infants born to HBsAg-positive women should be immunised within 12 hours of birth.

"I am not alone": a survey of women with peripartum cardiomyopathy and their participation in an online support group.

Peripartum cardiomyopathy is a devastating condition in which women without a previously identified heart condition experience heart failure in the ninth month of pregnancy or in the first 5 months after delivery of a baby. Online support groups are virtual communities for people affected by the same social or health issue. No literature exists on the benefits of women involved in an online support group for peripartum cardiomyopathy. The purpose of this descriptive study was to determine the benefits of participation in the online support group for peripartum cardiomyopathy based on a survey of active members of the group. All contacts between researchers and respondents were through e-mail. A survey of open-ended and Likert-type questions was used. Twelve women, aged 19 to 34 years, participated; all had a diagnosis of peripartum cardiomyopathy. This online support group is a vital resource for women with peripartum cardiomyopathy. Benefits to participation in the online support group included getting and sharing information, exchanging stories, being understood by other women, and gaining hope. Nurse practice implications include referring patients to reputable Web sites and support groups and serving as a professional facilitator in an online group.

Knowledge of female genital cutting and experience with women who are circumcised: a survey of nurse-midwives in the United States.

Thousands of women with a history of female genital cutting (FGC) have immigrated to the United States. The purpose of this study was to assess certified nurse-midwives' (CNMs') knowledge of FGC and to explore their experiences caring for African immigrant women with a history of genital cutting. A descriptive survey design was used. A random sample of 600 CNMs from the member list of the American College of Nurse-Midwives was surveyed. Two hundred forty-three CNMs completed a survey of FGC knowledge and provider experience. The respondents exhibited more correct medical knowledge about FGC than knowledge of cultural and legal issues. Differences in correct or incorrect knowledge were statistically significant based on provider experience. Almost 70% of respondents could identify infibulation. Less than 20% knew that both Muslim and Christian women are circumcised. Fifty-seven percent knew that it is illegal in the United States to circumcise women younger than 18 years of age. We found that discussions between CNMs and clients who were circumcised regarding FGC-related concerns and complications were minimal. Women with a history of FGC want female providers. Reinfibulation poses an ethical dilemma for some CNMs. Nurse-midwives in the United States need to learn more about FGC and the cultures of their clients in order to provide culturally competent care.

HIV/AIDS fatalism, beliefs and prevention indicators in Gabon:comparisons between Gabonese and Malians.

HIV/AIDS fatalism may impact on individuals' health-seeking behaviour and HIV-prevention efforts. This descriptive study measured levels of HIV/AIDS fatalism and documented HIV/AIDS beliefs and practices among a sample of Gabonese and Malians living in Gabon, West Africa. The Powe Fatalism Inventory-HIV/AIDS version was used to measure levels of fatalism, while a short-answer survey was used to document personal beliefs and behaviours related to HIV and AIDS among 160 people in Gabon. The mean score of HIV/AIDS fatalism for the total sample was 6.8 on a 15-point scale. Malians had a more fatalistic outlook than Gabonese (mean scores 9.4 versus 5.3), Muslims were more fatalistic than persons of other religions (mean scores 9.2 versus 5.3), while healthcare providers were less fatalistic than non-providers (mean scores 3.8 versus 7.4). People that did not believe that HIV/AIDS is a punishment from God had a lower mean score of fatalism than those who did. Most of the sample believed that AIDS is a real disease, and most did not think that only immoral people discuss HIV and AIDS. The HIV-prevention indicators that related to lower scores of fatalism included knowing HIV-positive people, having had more years of formal education, a willingness to disclose one's HIV status (if known), and experience of HIV/AIDS education. Respondents who had tested for HIV were no less fatalistic than those who had never tested. The findings provide data from a part of the world where HIV/AIDS beliefs have rarely been documented. The results indicate a need for additional studies on correlations between HIV/ AIDS fatalism, HIV-prevention behaviours, and religious belief systems.

Fatalism and HIV/AIDS beliefs in rural Mali, West Africa.

PURPOSE: To examine beliefs about HIV/AIDS of rural Malians and to measure their level of fatalism in context of HIV/AIDS and prevention behaviors. DESIGN: Descriptive, correlational. METHODS: An AIDS Knowledge and Beliefs survey and the Powe Fatalism Inventory (PFI)-HIV/AIDS version were administered to a convenience sample of 84 people at three health center maternity clinics in southeastern Mali, West Africa. FINDINGS: The sample's HIV/AIDS fatalism mean was 9.2 on a 15-point scale, with an internal consistency of .89. Health workers and more educated participants had significantly lower fatalism scores. Fatalism also varied by the combination of gender and ethnicity. People who believed that AIDS was not real, was a punishment from God, was fabricated by the West, was a curse, and that it was taboo to talk about AIDS had higher fatalism means. None of the prevention indicators were significantly related to fatalism scores. CONCLUSIONS: These rural Malians had a high overall fatalism mean and their beliefs about AIDS based on traditional culture may affect prevention behaviors. More research is needed to understand the influence of fatalism on prevention behaviors.

Women's stories of abortion in southern Gabon, Africa.

The purpose of this study was to explore the reasons women in rural, southern Gabon, Africa, chose to terminate their pregnancies, the methods used to induce abortions, and postabortion effects experienced by these women. Abortion is illegal in this country. A descriptive qualitative design guided the methodology for this study. Five women with a history of induced abortion were interviewed in-depth for their abortion story. Reasons cited for an abortion included lack of financial and partner support. Abortion methods included oral, rectal, and vaginal concoctions of leaves, bark, and water and over-the-counter medications, including misoprostol. Affects were physical, spiritual, and relational. Health care professionals need to provide women with guidance for appropriate contraceptive usage. Abortion after-care of women with physical and spiritual needs is important. Future research is suggested on the use of misoprostol in Gabon to understand its affects on women's reproductive health.

Postabortion research: methodological and ethical issues.

The author conducted research on long-term postabortion experience guided by the principles of phenomenology, and she describes the ethical and methodological issues encountered during the study, in which she interviewed 17 women who were more than 5 years postabortion, in this article. Discussed here, in the context of abortion as a sensitive topic for researcher and participant, are personal bias; recruitment, protection, and interviewing of participants; data analysis; and communication of findings. During the research process, the author gave particular attention to the formulation of the consent form, contact with the participants, the interview technique, the choice of a transcriptionist, and the use of a second reader. She also acknowledged her personal position on abortion, the reality of role conflict, and the importance of debriefing.