Screening for Distress in the Radiation Therapy Department: Distress Incidence by Sex,Treatment Intent,and Ethnicity

IntroductionHealth care is moving toward personalized (person-centered) holistic care. Screening for distress is a national initiative that promotes this and will allow for better interdisciplinary collaboration between health care providers. The use of distress screening allows our cancer centers to determine trends and correlations between patient demographics and patient distress. Distress leads to increased physical complications, increased patient anxiety, decreased compliancy with treatment, and an overall negative experience in the health care system. This tool helps health care providers to identify and manage patient distress in a timely manner.MethodsA screening for distress questionnaire was completed by 119 new patients entering the department of radiation therapy at the Saskatoon Cancer Center, Saskatoon, Saskatchewan, Canada. Results were segregated by sex, treatment intent, and ethnicity and then were subjected to a Wilcoxon rank sum test to determine statistical significance between test groups.ResultsResults indicated higher distress levels in female versus male patients, palliative care versus curative intent, and Aboriginal/Métis versus non-Aboriginal/non-Métis populations. The most commonly reported symptoms of distress included recurring fatigue, poor overall well-being, and high levels of anxiety. The fears/worries portion of the distress checklist was most commonly reported.ConclusionsThe screening for distress questionnaire has been proven to be a valuable tool in the facilitation of collaborative health care and holistic patient care. Because of higher than average distress scores, further investigation should be done with Aboriginal/Métis peoples in the health care system.     

Learning needs of nurses working in Canada's First Nations communities and hospitals

BACKGROUND: What are the learning needs of nurses providing services to Canada's First Nations Communities and Hospitals? First Nations (or Indian Band) are similar to communities except some comprise more than one geographic Native community. Aboriginal (or Native) individuals are members of the North American Indian, Inuit, or Métis peoples of Canada; those who reported being a Treaty or Registered Indian (with the Federal Government); or those who are members of an Indian Band/First Nation. METHOD: A Canada-wide survey was completed to determine the learning needs of nurses working with Canada's Aboriginal persons. RESULTS: Nurses indicated both broad and specific aspects of their clinical practice, which were important to their continuing education (CE) needs. Broad thematic areas for continuing education included the following: emergency/acute care and obstetrics/gynecology clinical skills, health and physical assessment, mental health, and prenatal and postnatal care. Specific areas nurses cited for CE included issues related to: victims of violence; non-compliant clients; substance abuse; and fetal alcohol syndrome. CONCLUSION: This study examined the learning needs of nurses working with Canada's Native people and provided a basis for comparing and contrasting CE issues of these nurses to other nurses working in remote locations around the world.     

Diabetes prevalence and care in the Metis population of Ontario, Canada

OBJECTIVE

The Métis are a distinct Aboriginal people in Canada with a unique history, culture, and language. This study examined diabetes prevalence and care in the Métis of Ontario.

RESEARCH DESIGN AND METHODS

The 14,480 people in the citizenship registry of the Métis Nation of Ontario were linked with provincial health care databases to determine diabetes prevalence and processes of care. Rates were compared between the Métis and the general Ontario population.

RESULTS

The age/sex standardized prevalence of diabetes for the Métis was 11.2%, nearly 25% higher than that of the general Ontario population. Métis were more likely to be hospitalized (12.7 vs. 10.7%) or require emergency room visits (36.1 vs. 27.7%).

CONCLUSIONS

Métis people have an increased burden of diabetes that puts them at risk for complications and morbidity. Ensuring adequate access to and quality of care for diabetes is essential to maintain the health of the Métis people.There has been relatively little previous research on diabetes among the Métis people, an Aboriginal group in Canada who are descendants of relationships forged between European men and First Nations women. The initial offspring of these unions were of mixed ancestry, and their subsequent intermarriages gave rise to a new Aboriginal people called the Métis with a unique history, culture, and language. The objective of this study was to examine diabetes prevalence and care for the Métis compared with the rest of the population of the province of Ontario.     

Nursing in First Nations and Inuit communities in Atlantic Canada

Effectively and holistically addressing the health-care needs of aboriginal people living in First Nations and nuit communities requires an understanding and a valuing of the cultural richness of the people. This article examines the programs and services provided in First Nations and Inuit health centres in Atlantic Canada and the support available for nurses working in First Nations and Inuit communities.     

Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians

Well-documented health disparities between Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) and non-Aboriginal Australians are underpinned by complex historical and social factors. The effects of colonisation including racism continue to impact negatively on Aboriginal health outcomes, despite being under-recognised and under-reported. Many Aboriginal people find hospitals unwelcoming and are reluctant to attend for diagnosis and treatment, particularly with few Aboriginal health professionals employed on these facilities. In this paper, scientific literature and reports on Aboriginal health-care, methodology and cross-cultural education are reviewed to inform a collaborative model of hospital-based organisational change. The paper proposes a collaborative model of care to improve health service delivery by building capacity in Aboriginal and non-Aboriginal personnel by recruiting more Aboriginal health professionals, increasing knowledge and skills to establish good relationships between non-Aboriginal care providers and Aboriginal patients and their families, delivering quality care that is respectful of culture and improving Aboriginal health outcomes. A key element of model design, implementation and evaluation is critical reflection on barriers and facilitators to providing respectful and culturally safe quality care at systemic, interpersonal and patient/family-centred levels. Nurses are central to addressing the current state of inequity and are pivotal change agents within the proposed model.     

Turning around the intergenerational impact of residential schools on Aboriginal people: implications for health policy and practice.

This paper reports on the first wave of results from a study exploring the views and experiences of community-based stakeholders on improving care for pregnant and parenting Aboriginal people in Canada. The issue of poor access to prenatal care by Aboriginal women and families is viewed through a post-colonial lens within a historical and social location.This case study was guided by participatory research principles. Data were collected through exploratory interviews and small-group discussions. The sample comprised purposively selected community leaders, providers, and community members affiliated with 2 Aboriginal health-care organizations in a mainly rural region. Participants from all 3 stakeholder groups expressed the view that care should be based on an understanding of the priorities and experiences of the pregnant and parenting Aboriginal women and families themselves. Therefore the research question What are Aboriginal parents' views of the importance of pregnancy and parenting? was added to highlight the views and life experiences of Aboriginal parents. "Turning around" the intergenerational impact of residential schools was identified as pivotal to care.The results suggest that pregnancy and parenting must be understood as reflecting both the unique individual and family experiences of Aboriginal people and the intergenerational impact of residential schools as an instrument of collective violence and as a key factor in Aboriginal Canadians' inequitable health status and access to health services.     

Validation of two postpartum depression screening scales with a sample of First Nations and Métis women.

The purposes of this study were to determine the prevalence of postpartum depression (PPD) and to examine the utility of the Postpartum Depression Screening Scale (PDSS) and the Edinburgh Postnatal Depression Scale (EPDS) in First Nations and Métis women in the Canadian province of Saskatchewan. A total of 103 women who had given birth in the preceding 1 to 12 months were recruited from the city of Regina and from First Nations health centres in Saskatchewan. Self-report screening instruments assessing PPD were administered along with a structured clinical interview for DSM-IV Axis I disorders (SCID) to confirm the diagnosis of PPD. Of the 103 women, 17% were diagnosed with PPD. The findings support the validity of the PDSS and the EPDS as measures of PPD in First Nations and Métis women. The author discusses the need for primary health care professionals, including nurses, to offer postnatal screening for women who may be at risk for PPD.     

CSCI Joe Doupe Lecture: End stage renal disease among Aboriginal people

Aboriginal people in Canada have an increased prevalence of ESRD, are more likely to initiate renal-replacement therapy on hemodialysis, and are much less likely to receive a kidney transplant compared to non-Aboriginals. Once established on dialysis quality of care and survival is similar for Aboriginal and non-Aboriginal people with ESRD. Understanding issues central to the health and outcomes of Aboriginal patients with ESRD, and documenting potential inequities in care, is essential to guide strategies to develop a new model for delivery of services for management of ESRD among Aboriginal people. Two areas in particular require further investigation for Aboriginal people with ESRD, namely the need to further investigate potential barriers to kidney transplantation, and reasons for lower rates of peritoneal dialysis as a form of renal replacement therapy. Research in this area will enable targeted interventions to be developed in partnership with the Aboriginal communities, with a goal to increase the health outcomes and quality of life for Aboriginal people with ESRD.     

Telling stories: nurses, politics and Aboriginal Australians, circa 1900-1980s

The focus of this paper is stories by, and about, (mainly non-Aboriginal) Registered Nurses working in hospitals and clinics in remote areas of Australia from the early 1900s to the 1980s as they came into contact with, or cared for, Aboriginal people. Government policies that controlled and regulated Aboriginal Australians provide the context for these stories. Memoirs and other contemporary sources reveal the ways in which government policies in different eras influenced nurse's attitudes and clinical practice in relation to Aboriginal people, and helped institutionalise racism in health care. Up until the 1970s, most nurses in this study unquestioningly accepted firstly segregation, then assimilation policies and their underlying paternalistic ideologies, and incorporated them into their practice. The quite marked politicisation of Aboriginal issues in the 1970s in Australia and the move towards self-determination for Aboriginal people politicised many - but not all - nurses. For the first time, many nurses engaged in a robust critique of government policies and what this meant for their practice and for Aboriginal health. Other nurses, however, continued as they had before - neither questioning prevailing policy nor its effects on their practice. It is argued that only by understanding and confronting the historical roots of institutional racism, and by speaking out against such practices, can discrimination and racism be abolished from nursing practice and health care. This is essential for nursing's current and future professional development and for better health for Aboriginal Australians.     

Experience of providing cultural safety in mental health to Aboriginal patients: A grounded theory study

The need for mental health clinicians to practice cultural safety is vital in ensuring meaningful care and in moving towards improving the mental health outcomes for Aboriginal people. The concept of cultural safety is particularly relevant to mental health professionals as it seeks to promote cultural integrity and the promotion of social justice, equity and respect. A substantive theory that explained the experience of providing cultural safety in mental health care to Aboriginal patients was developed using grounded theory methodology. Mental health professionals engaged in a social psychological process, called seeking solutions by navigating the labyrinth to overcome the experience of being unprepared. During this process participants moved from a state of being unprepared to one where they began to navigate the pathway of cultural safety. The findings of this research suggest health professionals have a limited understanding of the concept of cultural safety. The experience of providing cultural safety has not been adequately addressed by organizations, health services, governments, educational providers and policy makers. Health services, organizations and government agencies must work with Aboriginal people to progress strategies that inform and empower staff to practice cultural safety.     

Background,Offence Characteristics,and Criminal Outcomes of Aboriginal Youth Who Sexually Offend: A Closer Look at Aboriginal Youth Intervention Needs

Canada's Aboriginal peoples face a number of social and health issues. Research shows that Aboriginal youths are over-represented in the criminal justice system and youth forensic psychiatric programmes. Within the literature on sex offending youth, there appears to be no published data available to inform clinicians working with adjudicated Aboriginal youth. Therefore, the present study examines the background, offence characteristics, and criminal outcomes of Aboriginal (n = 102) and non-Aboriginal (n = 257) youths who engaged in sexual offending behaviour and were ordered to attend a sexual offender treatment programme in British Columbia between 1985 and 2004. Overall, Aboriginal youths were more likely than non-Aboriginal youths to have background histories of fetal alcohol spectrum disorders (FASD), substance abuse, childhood victimization, academic difficulties, and instability in the living environment. Both Aboriginal and non-Aboriginal youths had a tendency to target children under 12-years-old, females, and non-strangers. Aboriginal youths were more likely than non-Aboriginal youths to use substances at the time of their sexual index offence. Outcome data revealed that Aboriginal youths were more likely than their non-Aboriginal counterparts to recidivate sexually, violently, and non-violently during the 10-year follow-up period. Furthermore, the time between discharge and commission of all types of re-offences was significantly shorter for Aboriginal youths than for non-Aboriginal youths. Implications of these findings are discussed with regards to the needs of Aboriginal youth and intervention.     

Improving forensic mental health care for Aboriginal Australians: Challenges and opportunities

Mental illnesses constitute a major burden of disease in Aboriginal Australians and Torres Strait Islanders (hereafter Aboriginal Australians), who are also overrepresented in the prison system. A legacy of colonization compounds such prevalence, and is further exacerbated by the persistence of racial discrimination and insensitivity across many sectors, including health. This research completed in a Western Australian forensic mental health setting identifies non‐Aboriginal health professionals' support needs to deliver high‐quality, culturally‐safe care to Aboriginal patients. Data were collected from health professionals using an online survey and 10 semistructured interviews. Survey and interview results found that ongoing education was needed for staff to provide culturally‐safe care, where Aboriginal knowledge, beliefs, and values were respected. The findings also support previous research linking Aboriginal health providers to improved health outcomes for Aboriginal patients. In a colonized country, such as Australia, education programmes that critically reflect on power relations privileging white Anglo‐Australian cultural dominance and subjugating Aboriginal knowledge, beliefs, and values are important to identify factors promoting or compromising the care of Aboriginal patients and developing a deeper understanding of ‘cultural safety’ and its clinical application. Organizational commitment is needed to translate the findings to support non‐Aboriginal health professionals deliver high‐quality care to Aboriginal patients that is respectful of cultural differences.     

Aboriginal healing: regaining balance and culture.

This ethnographic study explored the question, How do urban-based First Nations peoples use healing traditions to address their health issues? The objectives were to examine how Aboriginal traditions addressed health issues and explore the link between such traditions and holism in nursing practice. Data collection consisted of individual interviews, participant observations, and field notes. Three major categories that emerged from the data analysis were: following a cultural path, gaining balance, and sharing in the circle of life. The global theme of healing holistically included following a cultural path by regaining culture through the use of healing traditions; gaining balance in the four realms of spiritual, emotional, mental, and physical health; and sharing in the circle of life by cultural interactions between Aboriginal peoples and non-Aboriginal health professionals. Implications for practice include incorporating the concepts of balance, holism, and cultural healing into the health care services for diverse Aboriginal peoples.     

Mental health nursing: a global perspective

OGUISSO T. (1995) Journal of Psychiatric and Mental Health Nursing 2 , 41–45: Mental health nursing: a global perspective. : This paper is based on a presentation by Dr Oguisso to the First Hamburg World Forum on Mental Health, 11 June 1994, for the Standing Committee of Presidents of International Non-Governmental Organizations Concerned with Mental Health Issues. Over recent years, the International Council of Nurses (ICN) has been concerned that health providers are sometimes not adequately prepared to give quality care and that resources are often well below those targeted for other sectors of the health care system. In 1991 the ICN chose 'Mental Health … Nurses in Action' as the theme for International Nurses Day on 12 May. With the help of the ICN-provided educational kits, national nurses' associations updated nurses on the problems and informed the public that nurses as a group can provide many of the mental health services to people and answer their families needs.     

Towards (re)conciliation: (re)constructing relationships between indigenous health workers and nurses

Towards (re)conciliation: (re)constructing relationships between indigenous health workers and nurses ¶ Currently in Australia, both Aboriginal and non-Aboriginal Australians are attempting to reconcile themselves with a history of colonization/invasion, which resulted in human rights violations against Australia's indigenous people. Australian nursing has to examine its past in relation to the treatment of Aboriginal Australians. Relationships between nurses and Aboriginal health workers are the most commonly occurring professional relationships between nurses and Aboriginal people and are of key importance to the successful delivery of health services to Aboriginal communities. This qualitative study, grounded in feminism, aimed to explore the professional relationships between Aboriginal health workers and nurses and to develop insights which could assist the Australian nursing profession through a process of reconciliation with Aboriginal Australians. Feminist analysis of narrative text revealed several key themes as being crucial to this process. These were: learning to know and understand; towards workplace equity; and skill sharing — learning from each other. Implications for nursing, in its journey toward reconciliation with Aboriginal Australians, are drawn from this study.     

The home environment of Métis, First Nations, and Caucasian adolescent mothers: an examination of quality and influences.

This longitudinal exploratory study compared maternal psychosocial, situational, and home-environment characteristics at 4 weeks and at 12-18 months postnatal for a convenience sample of 71 Métis, First Nations, and Caucasian adolescent mothers. The combined group of Métis/First Nations mothers had significantly higher infant-care emotionality scores than the Caucasian mothers at 4 weeks. The Caucasian mothers scored considerably higher on quality of the home environment; a refined multiple regression model containing infant-care emotionality, education level of the infant's maternal grandmother, ethnicity, and enacted social support explained 49% of the variance, with significant influences being infant-care emotionality and grandmother's education level.     

The importance of clinical experience in aboriginal communities

The importance of preparing nurses adequately to meet the health needs of Aboriginal people cannot be understated. Much of the reason for negative attitudes among nurses is a lack of knowledge and understanding of cultural differences. Clinical practice in an Aboriginal community can assist in the development of cross-cultural skills among student nurses. In recent times it has been accepted that nursing curricula in Australia must reflect an understanding and awareness of cultural perspectives, diversity and sensitivity. Exposing students to Aboriginal health workers has been found to result in a positive change in attitude among students (Hayes et al. 1994). Providing clinical experiences in Aboriginal communities can increase students' awareness of Aboriginal health status, the socio-cultural and historical influences involved, and the nurse's role in relation to Aboriginal health. Nurses are a major provider of health care within Aboriginal communities throughout Australia. Culturally diverse clinical placements challenge students to become aware of their own health beliefs, attitudes, and values, which can facilitate bridging cross-cultural gaps with clients and also facilitate the delivery of quality nursing care.     

Evaluation of services for people with HIV/AIDS in an inner-city health authority: perspectives of key service providers

This paper reports the findings of the first phase of a study designed to assess the needs of people with HIV and AIDS and the extent to which these needs are being met by services in Camberwell Health Authority in inner London The study involves collecting information and opinions from key service providers, clients with HIV/AIDS and their informal carers It is the service provider data which will be presented here Semi-structured interviews were conducted with 47 key service providers involved in the care and support of people with HIV/ AIDS in the Camberwell Health District Respondents were drawn from the local health services, local social services departments and a number of locally active voluntary organizations The aim was to gather respondents' views on their individual roles and the roles of the organizations they represented, the health and social needs of people with HIV/AIDS and the extent to which these were being met by current service provision and the co-ordination of services for people with HIV/AIDS The data showed that a broad range of services were utilized by people with HIV/AIDS, reflecting a wide variety of health and social care needs The majority of respondents felt that some of the needs of people with HIV/AIDS were similar to those of people living with other chronic illnesses (such as cancer) However, they also identified a number of problems which were either unique or more severe for people with the virus Services for people with HIV/AIDS were generally felt to be poorly coordinated and a number of areas of overlap and gaps in service provision were identified