Racial/Ethnic Differences in Early Detection and Screening for Chronic Kidney Disease Among Adults in Hawaii: A 10-Year Population Health Study.

INTRODUCTION: Native Hawaiian and Asian American populations are the most understudied racial/ethnic groups in chronic kidney disease (CKD) research. The objective of our study was to describe sociodemographic and comorbidity risk factors of chronic kidney disease among 2,944 community-dwelling Native Hawaiian, Filipino, Chinese, Japanese, and non-Hispanic white participants who attended the National Kidney Foundation of Hawaii Kidney Early Detection Screening program during 2006-2017. METHODS: We used multivariable logistic regression models to examine the association between age, sex, race/ethnicity, and the major risk factors for CKD (diabetes, hypertension, cardiovascular disease, hypercholesterolemia, overweight and obesity, and smoking) with elevated urine albumin to creatinine ratio (ACR) among adults aged 18 or older in 5 racial/ethnic groups in Hawaii: Native Hawaiian, Filipino, Chinese, Japanese, and non-Hispanic white. RESULTS: In the age- and sex-adjusted model, Native Hawaiian participants were significantly more likely than non-Hispanic white participants to have an ACR of 30.0 mg/g or more (odds ratio [OR] = 1.50; 95% CI, 1.15-1.95; P = .003). In the model that adjusted for CKD risk factors, the difference between Native Hawaiian and non-Hispanic white participants became nonsignificant (OR = 1.27; 95% CI, 0.96-1.69; P = .09]). The higher prevalence of chronic conditions among Native Hawaiians partially explained their higher risk of having an elevated ACR. Filipinos had significantly higher odds than non-Hispanic whites of elevated ACR in the age- and sex-adjusted model (OR = 1.44; 95% CI, 1.14-1.84; P = .003) and after adjustment for CKD risk factors (OR = 1.36; 95% CI, 1.06-1.74; P = .01). CONCLUSION: Culturally targeted interventions are needed to improve health outcomes among Native Hawaiians and Asian Americans, particularly Filipinos, with CKD. Such interventions should focus on early kidney disease management so that disease progression can be delayed.

Asian and native Hawaiian family caregiver satisfaction with palliative care services in nursing homes.

AIM: The aim of this study was to gauge Asian and native Hawaiian family satisfaction with palliative care services in two nursing homes in Hawaii, US. METHODS: This is a mixed-method study using a convergent design. Nine nursing home family caregivers who had received palliative care services took part. They completed a Famcare-2 satisfaction survey and participated in a 1-hour interview. Descriptive analyses and directed content analysis were completed and results were compared. RESULTS: The Famcare-2 results indicated that family caregivers were satisfied with palliative care services. The interviews provided in-depth information on the major areas discussed in the survey-management of patient physical symptoms and comfort, information, family support, and patient psychological care. CONCLUSIONS: There is a need to address family caregiver and interdisciplinary nursing home staff communication based on culturally appropriate approaches for palliative as well as end of-life care services among Asians and native Hawaiians.

Evidence-based practice strategies for faculty professional development in clinical translational research at Institutional Development Award (IDeA) state institutions in the Mountain West.

The Mountain West Clinical Translational Research - Infrastructure Network (MW CTR-IN), established in 2013, is a research network of 13 university partners located among seven Institutional Development Award (IDeA) states targeting health disparities. This is an enormous undertaking because of the size of the infrastructure network (encompassing a third of the US landmass and spanning four time zones in predominantly rural and underserved areas, with populations that have major health disparities issues). In this paper, we apply the barriers, strategies, and metrics to an adapted educational conceptual model by Fink (2013). Applying this model, we used four tailored approaches across this regional infrastructure network to: (1) assess individual faculty specific needs, (2) reach out and engage with faculty, (3) provide customized services to meet the situational needs of faculty, and (4) utilize a "closed communication feedback loop" between Professional Development (PD) core and MW CTR-IN faculty within the context of their home institutional environment. Summary statement results from participating faculty show that these approaches were positive. Grounded in best educational practice approaches, we have an opportunity to refine and build from this sound foundation with implications for future use in other CTR-IN networks and institutions in the IDeA states.

Benefits, barriers, and intentions/desires of nurses related to distance learning in rural island communities.

BACKGROUND: This study assessed distance learning needs among nurses on the Neighbor Islands in Hawaii. METHODS: An exploratory study was conducted using a descriptive qualitative design. Of the 37 nurses who completed the study, 7 were nurse administrators and 30 were staff nurses. There were 18 focus groups of nurses recruited from six public hospitals on the Neighbor Islands. RESULTS: Three major themes related to distance learning emerged in this study: benefits, barriers, and intentions/desires. Each major theme had several linkages to categories and subcategories. CONCLUSION: Overall findings were as follows: (1) cost was mentioned more often in three major thematic areas (benefit, barriers, and intentions/desires); (2) the need to revisit and address current curriculum approaches and practices in distance learning programs was identified; and (3) strong recommendations were made for programs and organizational support for distance learning in hospital settings. These findings have implications for nursing research, education, and practice.

Advance care planning among Asian Americans and Native Hawaiians receiving haemodialysis.

AIM: To explore the attitudes about death and dying, advance care planning (ACP), and completion of ACP among Asian Americans (AAs) and Native Hawaiians (NHs) receiving haemodialysis. This study was a descriptive, cross-sectional survey design. METHOD: A convenience sample of 50 participants aged 30-82 years was recruited from four outpatient dialysis centers in Honolulu, Hawaii and interviewed face-to-face using a 43-item end-of-life community survey. A majority of participants perceived dying as an important part of life and were comfortable talking about death, but expressed concerns and fears about end-of-life issues. Aspects of ACP, such as planning a funeral service, getting finances in order, and completing the will were important. While most participants' attitudes about ACP were positive, less than half (40%) had completed ACP. Most participants preferred initiating end-of-life conversations with family. CONCLUSIONS: The main conclusions drawn from this study are that there is a need for ACP and secondly that AAs and NHs would prefer to discuss ACP with family members rather than health or legal professionals. Findings from this preliminary study build on the need to use a theoretical framework in which to develop sound instruments and effective interventions to promote ACP completion among AAs and NHs receiving haemodialysis.

Filipino American grandparent caregivers' roles, acculturation, and perceived health status.

The purpose of this exploratory study was to describe the relationships between roles, acculturation, and perceived health status among 47 FA grandparent caregivers who were providing extensive caregiving to their grandchildren. Role satisfaction was significantly related to perceived health status. Role occupancy was significantly related to years lived in the U.S. and employment. Role integration and role stress were significantly related to gender and income. Acculturation was significantly related to role involvement, years lived in the U.S., language spoken, and education. The findings of this health disparities research study will lead to more contextual work in this area of study.

Nutrition and Diet as It Relates to Health and Well-Being of Native Hawaiian Kupuna (Elders): A Systematic Literature Review.

PURPOSE: The key to improving the health and well-being of Native Hawaiians is to understand the historical events that have caused change to their diet and nutrition, and identify the connection between food, life, and the land. The purpose of this article is to (a) present a review of the literature addressing nutrition and diet as it relates to health and well-being of Native Hawaiian kupuna (elders) and (b) identify limitations and gaps to promote future research. DESIGN: This systematic literature review focused on 29 studies. FINDINGS: Native Hawaiians have the highest body mass index levels, highest daily energy (kilocalorie) intake, and lowest multivitamin use. They have the highest prevalence of diabetes and hypertension compared with Whites. Traditional Hawaiian diet programs and family support were beneficial to improving health and well-being. CONCLUSION: Future research of traditional Hawaiian diet programs and revitalization of the culture may lead to improving the health and well-being of Native Hawaiians.

Culturally Competent Palliative and Hospice Care Training for Ethnically Diverse Staff in Long-Term Care Facilities.

Between 2013 and 2030, older adults 65 years and older of racial/ethnic populations in the U.S. is projected to increase by 123% in comparison to the Whites (Non-Hispanics). To meet this demand, training of ethnically diverse health staff in long-term care facilities in palliative and hospice care is imperative. The purpose of this study was to evaluate a palliative and hospice care training of staff in two nursing homes in Hawaii - (a) to evaluate knowledge and confidence over three time periods, and (b) to compare staff and family caregiver satisfaction at end of program. The educational frameworks were based on cultural and communication theories. Fifty-two ethnically diverse staff, a majority being Asian (89%), participated in a 10-week module training and one 4 hour communication skills workshop. Staff evaluation included knowledge and confidence surveys, pre- and post-test knowledge tests, and FAMCARE-2 satisfaction instrument. There were nine Asian (89%) and Pacific Islander (11%) family caregivers who completed the FAMCARE-2 satisfaction instrument. The overall staff knowledge and confidence results were promising. The staff rated overall satisfaction of palliative care services lower than the family caregivers. Implications for future research, practice, and education with palliative and hospice care training of ethnically diverse nursing home staff is to include patient and family caregiver satisfaction of palliative and hospice care services, evaluation of effectiveness of cross-cultural communication theories in palliative and hospice care staff training, and support from administration for mentorship and development of these services in long term care facilities.

Logic models used to enhance critical thinking.

Over time, various methods have been used to stimulate critical thinking in undergraduate nursing students, and although many have been successful in helping students integrate the essential knowledge, experiences, and clinical reasoning that support practice, it is also useful to explore new methods. Faculty at the University of Hawaii at Manoa, School of Nursing and Dental Hygiene have taken an innovative approach of using logic models to further enhance critical thinking. This article presents an application of varying experiences and methods of using logic models to support the development of critical thinking and reasoning skills in nursing students. The processes in which logic models are used in the curriculum are described. The models are used to connect concepts from concrete to abstract levels in diverse and often nonlinear diagrams, guided discourse, and written assignments. The specific instructional methods used include concept mapping, concept papers, conceptual linking, and substruction.

Translational research education and training needs in Hawai'i.

The purpose of this needs assessment was to identify the translational research education and training needs of researchers and administrators working in Hawai'i's communities and to use the finding to develop an education and training plan. The assessment was led by a community advisory board with members from community health centers, social agencies, hospitals, and academia on O'ahu. The survey, developed with input of the community advisory board, was sent to 94 administrators and researchers involved or affiliated with research being conducted in Hawai'i. Forty-one respondents (43%) completed the survey. Respondents wanted education and training in research processes, specific research-related skills, and facilitating interactions between community and academic researchers. Sixty-one percent were interested in training related to community-engaged research and yearly seminars on "collaborative mentoring." Popular topics of interest were related to data monitoring, networking with different cultural groups, statistics, and human subjects review. A majority of respondents wanted to attend workshops, seminars, and presentations rather than take a class. Approximately 50% of the respondents wanted to gain information through on-line training. Findings guided the development of a translational research education and training plan for the University of Hawai'i National Institute of Health (NIH) Research Centers in Minority Institutions Multidisciplinary and Translational Research Infrastructure Expansion (RMATRIX) grant.

Barriers to preventive health care for young children.

PURPOSE: To review the literature on barriers to availability, access, and utilization of preventive health care for young children three to five years of age and their families and to discuss the role of nurse practitioners (NPs) in future research, education, and practice in this area. DATA SOURCES: A comprehensive literature search was conducted of online material and CINAHL and Medline (CD-ROM 1990 to present). In addition, experts in this area were asked to recommend extra reading materials. Additional references in textbooks and articles were examined. CONCLUSIONS: The literature review supports that there are major barriers to be addressed in the areas of availability, access, and utilization of preventive health care services for young children and their families. Major concerns include mandatory system for preventative health care, lack of health insurance coverage, cultural issues, and parental effects. IMPLICATIONS FOR PRACTICE: Health professionals in the community will need to work together to reevaluate current preventive health care practices for young children. Alternative methods for approaching and providing preventive health care services may become increasingly important if these services for young children are to be provided at current or increased levels.

Grandparent caregiving role in Filipino American families.

The purpose of this preliminary study was to explore the Filipino American grandparent caregiver role of grandchildren. This descriptive qualitative study utilized three data collection methods: demographic information sheet, focus group, and field notes. The Filipino American grandparents were recruited from a church in Honolulu, Hawaii. Thematic analysis was used to analyze narrative data. Filipino American grandparents view the grandparenting caregiving role as a normative process rather than a burden in which families take on responsibilities as part of cultural beliefs and norms such as pakikisama, utang na loob, and authoritarianism. Pakikisama is family unity and closeness and Utang na loob is mutual reciprocity "the give and take" and obligation in relationships.

Evaluation of the National Kidney Foundation of Hawai'i's Kidney Early Detection Screening program.

PURPOSE: Discussion of the formative program evaluation results of the National Kidney Foundation of Hawai'i (NKFH) Kidney Early Detection Screening (KEDS) program for Chronic Kidney Disease (CKD). The formative program evaluation had 921 participants who enrolled in the NKFH KEDS screening program between 2006-2009. The evaluation included 14 KEDS sites in Honolulu, Maui, and Hawai'i counties. MAIN FINDINGS: Based on the results of the formative evaluation, process changes were made to program recruitment, training, and procedure. A majority of participants were women, between 46 and 75 years old. The ethnic groups represented were: White, Japanese, Hawaiian/Part Hawaiian, Filipino, Chinese, Hispanic, and Other. The three most common risk factors identified were: (1) blood relative with diabetes, (2) blood relative with cardiovascular disease, and (3) self-reported high blood pressure. Participants in Hawai'i County had the highest mean for total risk factors. Ethnicity, gender, and age were significantly associated with selected vital signs, physiological measures, and lab tests. Fourteen percent of KEDS participants had an abnormal albumin:creatinine (A:C) ratio and 12% had an abnormal glomerular filtration rate (GFR), requiring follow-up by a health care professional. PRINCIPAL CONCLUSIONS: The KEDS formative program evaluation findings improved program planning and implementation. Summative program evaluation and implications for conducting research studies in this area will be the next step in the evaluation process.