The intersection of food insecurity and health for rural Malawian women at the end of life.

BACKGROUND: One of the poorest countries in the world, Malawi's palliative care system is under-resourced, and one-third of the population is food-insecure. AIMS: This study describes the lived experience of female palliative care patients, and their caregivers, and aimed to: (1) analyse their physical, spiritual and mental health needs; and (2) analyse best palliative nursing practice for patients at the end of life. An unexpected finding was the impact of food insecurity on the women and their caregivers. METHODS: We conducted interviews with 26 women who at the end of life and 14 of their caregivers. All were participating in a community palliative care programme offered by an AIDS support organisation in Kasungu, Malawi. We used deductive qualitative analysis to organise identified themes using the four pillars of food security: availability, access, utilisation and stability. FINDINGS: All study participants experienced challenges with food security. CONCLUSIONS: We offer policy recommendations for palliative care nurses, and other allied health professionals.

Women's work at end of life: The intersecting gendered vulnerabilities of patients and caregivers in rural Malawi.

Gender inequality in the form of gender-based violence manifests throughout the course of women's lives but has a particularly unique impact at end of life. We sampled 26 patients and 14 caregivers for this qualitative critical ethnographic study. The study purpose was to describe the lived experience of female palliative care patients in rural Malawi and their caregivers. The specific aims were to (i) analyse physical, spiritual and mental health needs and (ii) guide best healthcare practice. The study was informed by feminist epistemology, which drew us to an analysis focused on how gender inequality and gender-based violence affect the care of those with terminal illness. In this article, based on our findings, we demonstrate how gender inequality manifests through the intersecting gendered vulnerabilities of patients and their caregivers in rural Malawi. The findings specifically provide insight into the gendered nature of care work and how the gendered life trajectories of both patients and caregivers intersect to impact the health and well-being of both groups. Our findings have implications on how palliative care can be scaled up in rural Malawi in support of women who are experiencing intimate partner violence at end of life, and the caregivers responsible for their well-being.

Enhancing cultural safety among undergraduate nursing students through watching documentaries.

The purpose of the study was to develop an understanding of how nursing students gained perspective on nursing care of diverse populations through watching documentaries in a cultural diversity course. The basis of this paper is our analyses of students' written responses and reactions to documentaries viewed in class. The guiding theoretical frameworks for the course content and the study included postcolonial feminism, Foucauldian thought, and cultural safety. Krathwohl's Taxonomy of the Affective Domain was used to identify themes and determine how undergraduate nursing students were progressing in achieving learning outcomes. Our findings suggest that while the use of documentaries serves as a tool for deepening students' understanding of the realities of various populations, this activity, in the absence of critical reflection, may inadvertently promote stereotypes and further marginalize different people groups. Even though nursing students reflected on the importance of cultural safety in nursing, our findings indicate that their actions may not reflect this, especially since these students are in the early stages of the nursing program. Students need to be provided with a space where they can explore implicit biases evoked by exposure to new information about different people groups as a way of enhancing culturally safe care.

An Emancipatory Approach to Cultural Competency: The Application of Critical Race, Postcolonial, and Intersectionality Theories.

Nurses teach, work, and conduct research in an increasingly hostile sociopolitical climate where health inequities persist among marginalized communities. Current approaches to cultural competency do not adequately equip nurses to address these complex factors and risk perpetuating stereotypes and discrimination. A theory-driven emancipatory approach to cultural competency will instead lead to lasting change and uphold the core nursing value of commitment to social justice. This article explicates key tenets of critical race, postcolonial feminist, and intersectionality theories and then applies them, using an emancipatory approach to cultural competency that can reshape nursing education, research, and practice.

Preparing culturally safe student nurses: An analysis of undergraduate cultural diversity course reflections.

This descriptive, qualitative study was conducted to gain insight into how pre-clinical nursing students' worldviews about people different from themselves are formed, changed, and expanded. 90 mid-term and 87 end- of-term reflection papers in a cultural diversity course were analyzed. Krathwohl's taxonomy of learning guided the evaluation of students' development. Our findings showed that the course content supported most students' in their affective development. It was also evident that students' perspectives, which were influenced by past experiences, changed as the course progressed. However, while a positive change in perspective towards providing culturally safe care was evident, this was not the case for all students. Our findings have implications for informing the development of undergraduate nursing courses that prepare future nurses for their professional role in providing culturally safe care.

Background and method of the Striving to be Strong study a RCT testing the efficacy of a m-health self-management intervention.

BACKGROUND: Osteoporosis is a prevalent and debilitating condition affecting >50% of post-menopausal women. Yet, a low percentage of women regularly engage in health promoting behaviors associated with osteoporosis prevention. Complex, multidimensional, m-Health interventions hold promise to effect engagement in health behavior change related to calcium and vitamin D intake, balance, core and leg strength, and physical activity. METHODS: Striving to be Strong study (R01NR013913-01) tests the efficacy of a research and theory based, patient centered, dynamically tailored intervention delivered via smart phone apps. Ecological Momentary Assessments (EMAs) enhance immediate feedback and complement traditional measures. The desired outcomes are the maintenance of osteoporosis self-management behaviors and a decrease in the loss of bone density over time. The Individual and Family Self-management Theory provided the conceptual foundation for the study. The sample consists of 290 healthy women between the ages of 40 and 60 with an anticipated attrition of 33%. This three group repeated measures Randomized Clinical Trial spans a 12-month time period. Data collected occurs via web site, smart-phone app, self-report, observation, and measures. Proximal (engagement in osteoporosis health behaviors) and distal (serum vitamin D, DXA, and body composition) outcomes are collected for testing of the efficacy of the intervention and theory evaluation. DISCUSSION: Active and rigorous quality management processes continually evaluate enrollment and retention goals, functionality of the automated intervention delivery and data collection systems, EMAs, and dispersion of incentives.

Raising Questions About Capitalist Globalization and Universalizing Views on Women: A Transnational Feminist Critique of the World Development Report: Gender Equality and Development.

Nursing in the United States has embraced global health primarily from a clinical perspective, with emphasis on care delivery to populations in underserved, resource-poor settings. Less attention has been devoted to developing expertise about social, economic, and political contexts that produce ill health around the world. The purpose of this article is to offer a transnational feminist critique of the World Development Report: Gender Equality and Development and to illuminate implications such reports may have in the lives of the world's most marginalized women and girls. We examine the political economy idealized in the report, raising questions about the capitalist framework underpinning its agenda. Second, we examine the assumptive language used in the report, suggesting that it discursively constructs a problematic representation of women in low-income countries. We contend that the report perpetuates a hegemonic discourse of patriarchy and inequality for women in the Global South through the use of an uncontested economic framework and universalist reasoning. We conclude the article with discussion about a transformative policy making that could be more inclusive of the wisdoms, values, and everyday experiences of women living in the Global South and about the vital role nurses can play in advancing gender equity through their active collaboration in policy critique and policy formulation.