The effect of a cultural intervention on adherence to latent tuberculosis infection therapy in Latino immigrants.

OBJECTIVE: The purpose of this study was to examine the effect of a cultural intervention (CI) on increasing adherence to latent tuberculosis infection (LTBI) therapy among Latino immigrants. DESIGN AND SAMPLE: This clinical study used a preexperimental design. A nonprobability sample of 86 Latino immigrant clients who were starting LTBI therapy were enrolled in the intervention. The comparison group was an historical sample of 131 clients' records randomly selected from the previous year. INTERVENTION: The CI, designed by the principal investigator, was delivered by 2 Spanish-speaking interventionist nurses at each of 9 clinic visits. The intervention was based on Latino cultural values and included 5 components. MEASURES: The patients' adherence was measured by a self-report of the number of pills taken. RESULTS: The findings of this study were that clients in the CI group took a significantly greater number of doses of INH than those in the historical sample. CONCLUSIONS: Using a CI to increase adherence to LTBI therapy shows promise for public health nursing practice.

Community health nursing student experience in Nicaragua.

International clinical experiences can provide excellent opportunities for nursing students to practice community health nursing, enhance their global perspective, and increase their cultural awareness of vulnerable populations. Selected students from the Georgetown University nursing program spent part of their winter intercession in Nicaragua, working with a vulnerable population in an impoverished community. Students cared for families, worked in clinics, conducted health teaching sessions to large groups in the community, and held a health fair. A community assessment provided an experience in learning about the resources and demographics of the community. The program was feasible through the collaboration with the local Nicaraguan university nursing program.

Concepts of anemia among low income Nicaraguan women.

Anemia is a common health problem among women throughout the world, however, there has been minimal research on women's concepts of anemia. The purpose of this study was to examine concepts of anemia in low income Nicaraguan women. A qualitative design was used. Audio-taped open-ended interviews in Spanish with 14 women were used to obtain data. Tapes were transcribed and content analyzed. The findings indicate that few of the women had biomedically accurate concepts of anemia, such as that it was due to lack of iron from poor eating. Others held folk medical beliefs including home remedies, for example drinking the milk of a mare or beet juice and eating certain foods such as bean soup. Most of the women did not know any symptoms of anemia and a few reported that it can develop into leukemia. These concepts of anemia are instructive for nurses working with patients from Nicaragua and will be useful in developing nursing interventions to alleviate this public health problem.

Use of electronic monitoring in clinical nursing research.

In the past decade, the introduction of electronic monitoring systems for monitoring medication adherence has contributed to the dialog about what works and what does not work in monitoring adherence. The purpose of this article is to describe the use of the Medication Event Monitoring System (MEMS) in a study of patients receiving isoniazid for latent tuberculosis infection. Three case examples from the study illustrate the data that are obtained from the electronic device compared to self-reports and point to the disparities that may occur in electronic monitoring. The strengths and limitations of using the MEMS and ethical issues in utilizing this technology are discussed. Nurses need to be aware of these challenges when using electronic measuring devices to monitor medication adherence in clinical nursing practice and research.

Health and illness concepts among lower income Nicaraguan women.

Concepts of health and illness are culturally defined; however, few researchers have reported on these concepts among Latina women. A purposive sample of 14 lower income Nicaraguan women living in a squatter settlement is the focus of this qualitative study. The authors used in-depth, tape-recorded interviews in Spanish to gather data on the women's concepts of health and illness for adults and babies and of health maintenance activities. The authors analyzed the verbatim transcripts and analyzed them for themes. The women's concepts of health and illness included four themes: activities, disposition, eating, and appearance. Health maintenance activities included hygiene and sanitation, medical intervention, nutrition, and the appearance of cleanliness. Nurses and other health care providers will find these themes instructive in developing and providing health services for similar Latina women.

Beliefs about HIV in Low-Income Nicaraguan Women.

In Latin America, women account for more than 30% of all HIV cases. However, minimal research has been reported on women's beliefs about HIV in Latin America. The purpose of our qualitative study was to describe HIV beliefs in a sample of low-income Nicaraguan women living in a squatter settlement in Managua. Participants (N = 34) were women who participated in four focus groups. The mean age of the women was 40 years, and the mean education level was 5 years. Women reported a plurality of beliefs about HIV, some of which were biomedically accurate while others were not. Themes of stigma and rejection emerged across all focus group discussions. Younger women were more informed than older women. The findings are instructive for nurses working with Nicaraguan women and may be useful in developing HIV education interventions with similar populations in other Latin American countries or with immigrants from those countries.

Nursing research in Latin America: 1988-1998.

The purpose of this article is to provide an overview of nursing research in Latin America during the decade from 1988 to 1998. Data from the bi-annual Pan American Colloquia in Nursing Research from 1988 to 1998 were subject to secondary analysis. Findings indicate that most of the research emanated from Brazil, the only country with a doctoral program in nursing in the 1990's. Research topics included: public health issues, clinical studies (usually of adults), nursing care studies of process, therapeutic communication, and administrative issues such as standards of care and quality. The most common design was descriptive quantitative, although there were several qualitative studies. The analysis provides directions for future research and indicates areas of concern, especially the need for theory based nursing research.

Herbal remedies in a Nicaraguan barrio.

To become more culturally competent, nurses need to increase their knowledge of the health practices of their immigrant clients. With the growing Latino immigrant community, it is imperative that nurses learn more about the cultures from which the immigrants come. This article examines the use of herbal remedies in treating common illnesses in a barrio in Managua, Nicaragua. Data were collected in a random sample of households in an impoverished community of more than 1,600 persons. The use of herbal remedies occurred in 78% of the households. Herbal remedies were used for a variety of symptoms. There was no difference in herbal remedy use based on age or education. The discussion focuses on the availability and functionality of these herbal remedies for this vulnerable population. Implications are addressed for incorporating this information into nursing practice with Central American immigrants, thereby increasing cultural competence.

International clinical experiences: long-term impact on students.

The realization that international learning experiences can provide an excellent opportunity for nursing students to practice nursing in a cultural system different from their own, gain an increased global perspective, and enhance their cultural competency, has led to the development of international nursing education programs across the globe. The authors explore the long-term impact on students of such an experience in Nicaragua. Graduates report how their knowledge, personal growth, and interpersonal connections were influenced by the experience

Contributions of qualitative research to evidence-based practice in nursing.

AIM: This article aims to identify the contributions of qualitative research to evidence-based practice in nursing. BACKGROUND: Qualitative research dates back to the 1920s and 1930s, when anthropologists and sociologists used qualitative research methods to study human phenomena in naturalistic settings and from a holistic viewpoint. Afterwards, other subject matters, including nursing, adopted qualitative methods to answer their research questions. The restructuring of health care over the past decade has brought about increased accountability in nursing research. One method for increasing this accountability is evidence-based practice. METHOD: The method used was a search in the Cumulative Index to Nursing and Allied Health Literature database from 1999-present. The search resulted in 61 citations for evidence-based practice in nursing research; however, only 5 citations focused on evidence-based practice and qualitative research. FINDINGS: The authors' findings revealed six contributions of qualitative research to evidence-based practice: generation of hypotheses; development and validation of instruments; provision of context for evaluation; development of nursing interventions; development of new research questions; and application of Qualitative Outcome Analysis. CONCLUSION: Qualitative research makes important contributions to the quality of evidence-based practice.

Predictors of adherence to latent tuberculosis infection therapy in Latino immigrants.

Adherence to Latent Tuberculosis Infection (LTBI) therapy is a continuing community problem. The purpose of this study was to examine the predictors of adherence to LTBI therapy in Latino immigrants at a public health clinic. A descriptive study was conducted to examine 153 randomly selected records from a population of Latino immigrant clients who had received a recommendation for 9 months of Isoniazid (INH) therapy. Most of the clients were women (64%), the mean age was 26.1, and the mean time in the U.S. was 4.58 years. The majority came from El Salvador, Bolivia, or Guatemala. Adherence dropped off in a linear fashion from month 1 (84%) to month 8 (34%). None of the demographic factors predicted adherence. Implications for community health nursing are discussed.

Adherence to latent tuberculosis infection therapy among latino immigrants.

BACKGROUND: One third of the world population is infected with Mycobacterium tuberculosis. In the United States, a key component for eliminating tuberculosis (TB) is treating latent TB infection (LTBI) in high-risk persons such as immigrants. OBJECTIVE: Examine the prevalence of adherence to LTBI therapy and the influence of basic conditioning factors on adherence among Latino immigrants, guided by Orem's Self-Care Deficit Theory. Adherence was treated as a health deviation self-care requisite; the self-care practice of taking daily medication for 9 months is essential to LTBI adherence. Conditioning factors include gender, age, sociocultural factors, environment, and health state. DESIGN: Exploratory, cross-sectional. SAMPLE: Nonprobability sample (n=53) of Latino immigrants attending an urban public health clinic in the Washington, DC metropolitan area. METHODS: Participants completed a brief questionnaire documenting selected conditioning factors, and 9-month adherence to LTBI therapy was determined from their medical records. RESULTS: Adherence dropped from 98% in month 2 to 72% at 9 months. The mean number of months adherent was 7.4. Adherence was not significantly associated with gender, country of origin, languages spoken, age, education, or years in the United States. Adherence was slightly lower (t=2.059, p=.059) in persons who knew someone with TB. CONCLUSIONS: Nurses should emphasize the importance of adherence for the full 9 months to this population.

Factors influencing osteoporosis knowledge: a community study.

According to the 2004 Surgeon General's report, more than 10 million people in the United States have osteoporosis, and another 34 million are at risk of developing this crippling disease that affects the quality of life. Efforts must be made to stem this disease that may be largely prevented with lifestyle changes. To engage in self-care to prevent osteoporosis, people need to have knowledge of risks and preventive behaviors. The purpose of this study was to examine factors influencing osteoporosis knowledge in 255 people in a university community. The Facts on Osteoporosis Quiz (Ailinger, Lasus, & Braun, 2003) was used to measure osteoporosis knowledge. Findings indicated that respondents had inadequate knowledge about osteoporosis. Age was positively correlated with knowledge (r = .27, p < .000), but education was not. There were marked differences in mean scores among ethnic groups. The findings suggest topics that community health nurses need to focus on in their osteoporosis educational interventions.

Americans' knowledge and perceived risk of tuberculosis.

Tuberculosis (TB) has resurged as a major public health problem in the United States, but there is minimal information on the public's knowledge of TB. The general population must become aware of the seriousness of the reemergence of TB. Using data from the National Health Interview Survey Supplement, this study examined knowledge and perceived risk of TB of 14,727 U.S. respondents. Results demonstrated some general knowledge of TB, several misconceptions, and low concern regarding their risk of contracting TB. Only 10.2% of the respondents perceived risk for themselves. Respondents reported perceived knowledge of TB at a high level, while their actual knowledge was lower. Gender, education, income, and ethnicity were associated with knowledge and perceived risk. Older people responded correctly to questions about TB knowledge more often than younger people. Conclusions were that public health nursing efforts need to be redirected toward health education regarding TB risk and spread, complementing existing screening and therapy programs.

Revision of the Facts on Osteoporosis Quiz.

BACKGROUND: Few instruments exist that measure knowledge of osteoporosis, a health risk for 28 million Americans. The original Facts on Osteoporosis Quiz (FOOQ), which was theoretically informed by Orem's (1995) Self-Care Theory, was published in 1998. In 2000, the National Institutes of Health (NIH) held a consensus conference on osteoporosis in which previous knowledge was modified based on current science. OBJECTIVES: The goal was to update the original instrument based on the latest scientific evidence and to determine its psychometric properties. METHOD: The quiz content was validated by osteoporosis experts and is theoretically informed by Orem's (2001) Self-Care Theory. An iterative process was used to design an instrument with an acceptable reading level. Reliability, item discrimination, and item difficulty were assessed in a convenience sample of 256 participants. RESULTS: The revised quiz, content-based on the 2000 NIH osteoporosis consensus conference, includes 20 questions. The quiz has a content validity index of.87, an internal consistency reliability of.76 and a 6th grade reading level. Item difficulty and item discrimination are also reported. CONCLUSIONS: The revised version of the FOOQ provides a valid, reliable, and theoretically informed instrument with acceptable psychometric properties.

Latino immigrants' knowledge of tuberculosis.

This study examined tuberculosis (TB) knowledge in Latino immigrants receiving latent TB infection (LTBI) therapy. The study design was descriptive correlational. Knowledge was measured using the LTBI Knowledge Instrument. The convenience sample included 82 Latino immigrants primarily from Central America and Bolivia who attended a public health clinic for their LTBI therapy. The mean TB knowledge score was 66%. Knowledge scores were correlated with years of education, but not with age or number of years in the United States. More than 80% of study participants correctly answered questions about the importance of keeping monthly appointments and how Isoniazid works to eradicate TB germs in the human body. Questions that pertained to the contagiousness of active TB and how the disease spreads received the most incorrect responses. Public health nursing interventions should focus on increasing Latino immigrants' knowledge of TB, both in public health clinics and in the community.

Concepts of anemia among low income Nicaraguan women / Conceptos de anemia entre mujeres nicaragüenses de baja renta / Conceitos de anemia entre mulheres nicaragüenses de baixa renda

Anemia is a common health problem among women throughout the world, however, there has been minimal research on women's concepts of anemia. The purpose of this study was to examine concepts of anemia in low income Nicaraguan women. A qualitative design was used. Audio-taped open-ended interviews in Spanish with 14 women were used to obtain data. Tapes were transcribed and content analyzed. The findings indicate that few of the women had biomedically accurate concepts of anemia, such as that it was due to lack of iron from poor eating. Others held folk medical beliefs including home remedies, for example drinking the milk of a mare or beet juice and eating certain foods such as bean soup. Most of the women did not know any symptoms of anemia and a few reported that it can develop into leukemia. These concepts of anemia are instructive for nurses working with patients from Nicaragua and will be useful in developing nursing interventions to alleviate this public health problem.

La anemia es un problema de salud común entre las mujeres alrededor del mundo, sin embargo, se han realizado pocas investigaciones sobre los conceptos de anemia entre las mujeres. El propósito de este estudio fue examinar los conceptos de anemia en mujeres Nicaragüenses de bajos ingresos económicos. La investigación fue de orden cualitativa. Para la recolección de datos, se realizaron entrevistas semiestructuradas, grabadas en castellano, con 14 mujeres. Las cintas grabadas fueron transcritas y se realizó un análisis de contenido. Los resultados indican que pocas mujeres poseen conocimientos biomédicos sobre anemia, por ejemplo, la ingestión de alimentos pobres en hierro. Otras expresaron creencias populares, como remedios caseros, ingestión de leche de yegua o jugo de remolacha y ciertos alimentos como sopa de judías. La mayoría de las mujeres no conocía ningún síntoma de anemia y pocas relataron que creían que esta enfermedad podría transformarse en leucemia. Estos conceptos de anemia son instructivos para las enfermeras que trabajan con pacientes en Nicaragua y será de mucha utilidad para desarrollar intervenciones de enfermería para aliviar este problema de salud pública.

A anemia e um problema de saúde comum entre as mulheres de todo a mundo inteiro, mas tem havido um mínimo de investigação sobre os conceitos de anemia entre as mulheres. O objetivo deste estudo foi o de analisar os conceitos de anemia em mulheres nicaragüenses com baixos rendimentos. Foi utilizado um desenho qualitativo. Para a coleta de dados, entrevistas semi-estruturadas foram conduzidas, áudio gravadas em espanhol para 14 mulheres. As fitas foram transcritas e tornou-se uma análise conteúdo. Os resultados indicam que poucas mulheres possuem conhecimento biomédico preciso sobre anemia, tal como ingestão de alimentos pobre em ferro. Outras mantiveram outras crenças populares incluindo remédios caseiros, ingestão de leite de égua ou suco de beterraba e certos alimentos como sopa de feijão. A maioria das mulheres não conhecia nenhum sintoma de anemia e poucas relataram que pode progredir para leucemia. Estes conceitos de anemia são esclarecedores para os enfermeiros que trabalham com doentes na Nicarágua e que será muito útil para desenvolver intervenções de enfermagem para minorar o problema de saúde pública.

Nursing research in Latin America: 1988-1998

El propósito de este artículo es ofrecer un panorama sobre la investigación en enfermería en América Latina durante la década de 1988 a 1998. La información reunida en los Coloquios Panamericanos de Investigación en Enfermería, que se celebran cada dos años, fue sometida a análisis secundario. Descubrimos que la mayor parte de las investigaciones emana del Brasil, el único país con un programa de doctorado en enfermería en los años noventa. Los tópicos de investigación incluyen asuntos de salud pública, estudios clínicos (normalmente de adultos), estudios del proceso de atención de enfermería, comunicación terapéutica y asuntos administrativos tales como normas de atención y calidad. El diseño más común fue el estudio cuantitativo descriptivo, aunque también encontramos varios estudios cualitativos. El análisis ofrece direcciones para futuras investigaciones e indica áreas de preocupación, especialmente la necesidad de una investigación en enfermería con base teórica.

Contributions of qualitative research to evidence-based practice in nursing

AIM: This article aims to identify the contributions of qualitative research to evidence-based practice in nursing. BACKGROUND: Qualitative research dates back to the 1920s and 1930s, when anthropologists and sociologists used qualitative research methods to study human phenomena in naturalistic settings and from a holistic viewpoint. Afterwards, other subject matters, including nursing, adopted qualitative methods to answer their research questions. The restructuring of health care over the past decade has brought about increased accountability in nursing research. One method for increasing this accountability is evidence-based practice. METHOD: The method used was a search in the Cumulative Index to Nursing and Allied Health Literature database from 1999-present. The search resulted in 61 citations for evidence-based practice in nursing research; however, only 5 citations focused on evidence-based practice and qualitative research. FINDINGS: The authors' findings revealed six contributions of qualitative research to evidence-based practice: generation of hypotheses; development and validation of instruments; provision of context for evaluation; development of nursing interventions; development of new research questions; and application of Qualitative Outcome Analysis. CONCLUSION: Qualitative research makes important contributions to the quality of evidence-based practice.