Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative

OBJECTIVE: To determine the effects of a culturally competent diabetes self-management intervention in Mexican Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS: A prospective, randomized, repeated measures study was conducted on the Texas-Mexico border in Starr County. A total of 256 randomly selected individuals with type 2 diabetes between 35 and 70 years of age, diagnosed with type 2 diabetes after 35 years of age, and accompanied by a family member or friend were included. The intervention consisted of 52 contact hours over 12 months and was provided by bilingual Mexican American nurses, dietitians, and community workers. The intervention involved 3 months of weekly instructional sessions on nutrition, self-monitoring of blood glucose, exercise, and other self-care topics and 6 months of biweekly support group sessions to promote behavior changes. The approach was culturally competent in terms of language, diet, social emphasis, family participation, and incorporation of cultural health beliefs. Outcomes included indicators of metabolic control (HbA(1c) and fasting blood glucose), diabetes knowledge, and diabetes-related health beliefs. RESULTS: Experimental groups showed significantly lower levels of HbA(1c) and fasting blood glucose at 6 and 12 months and higher diabetes knowledge scores. At 6 months, the mean HbA(1c) of the experimental subjects was 1.4% below the mean of the control group; however, the mean level of the experimental subjects was still high (>10%). CONCLUSIONS: This study confirms the effectiveness of culturally competent diabetes self-management education on improving health outcomes of Mexican Americans, particularly for those individuals with HbA(1c) levels >10%.     

The roles of contemporary Mexican American women in domestic health work

Domestic health work is defined as the day-to-day household activities, which are often invisible, that create the backbone of healthy environments and healthy individuals. This article describes the roles of a sample of contemporary Mexican American women in domestic health work. Using an ethnographic design, 13 moderately to highly acculturated women were interviewed to determine their roles in domestic health work. Women's roles fell into two broad categories: being a parent and caring for the family. The findings from this research highlight the burden and conflict of multiple roles in this sample and provide insight into the processes by which contemporary Mexican American women maintain culturally defined roles that they feel are important. It also addresses the burdens that they feel are culturally unnecessary. This research has significance for nurses working in the context of the community and the household in that it explicates women's roles in domestic health work and points to the need for community-based nurses to be aware of the many voices of Mexican American women.     

What has the literature taught us about culturally competent care of women and children

This article describes what is currently in the literature about culturally competent care for women and children. With the population of the United States growing increasingly diverse, there is a developing need for cultural competency among nurses and throughout healthcare organizations. Cultural competence includes both culture-specific and culture-generic knowledge, attitudes, and skills. While databased literature on cultural competency still requires further development, we do have evidence of positive outcomes of culturally competent care. The end result of the provision of culturally competent care by culturally competent nurses and healthcare organizations can be significant improvements in the health and well-being of women and children.     

Caring for the Transgender Patient

The perceived lack of interaction with transgender individuals fosters societal stigma and discrimination against this minority group. The lack of practitioners' ability to provide culturally competent care and knowledge of transgender health issues exacerbates severe health care disparities. Radiology and imaging nurses will routinely encounter transgender patients requiring radiological studies. This short communication provides an answer to a technical question posed about the estimate glomerular filtration rate for a transgender patient. Furthermore, the article provides nurses with several practical communication techniques that can have an immediate impact in improving transgender care by demonstrating dignity and respect toward this patient population.     

Nurses' concerns and practices with using interpreters in the care of Latino patients in the emergency department.

This phenomenological study aimed to describe nursing care of Latinos in the emergency department to determine how care is planned relative to the patient's ethnicity, including linguistic abilities. Unstructured interviews were conducted with 15 registered nurses from four hospitals in the Northwest. Interpreters play a pivotal role in nurses' practices. Nurses' skills with working with interpreters, interpreter availability, engagement, and accuracy enhance or impede effective care. Linguistic differences challenge effective care provision. Culturally competent care requires secure avenues of accurate communication. Administrators must provide nurses with resources that promote culturally competent care, including training with interpreters to facilitate effective communication.     

Integrating cultural values, beliefs, and customs into pregnancy and postpartum care: lessons learned from a Hawaiian public health nursing project

Determining the elements of culturally competent health care is an important goal for nurses. This goal is particularly integral in efforts to design better preventive health care strategies for pregnant and postpartum women from multiple cultural and ethnic backgrounds. Learning about the values, beliefs, and customs surrounding health among the targeted groups is essential, but integrating this knowledge into the actual health care services delivery system is more difficult. The success of a prenatal and postpartum program developed for native Hawaiian, Filipino, and Japanese women in Hawaii has been attributed to the attention on training, direct care giving, and program monitoring participation by local cultural and ethnic healers and neighborhood leaders living in the community, with coordination by public health nurses. This article profiles central design elements with examples of specific interventions used in the Malama Na Wahine or Caring for Pregnant Women program to illustrate a unique approach to the delivery of culturally competent care.     

"Nobody ever asked me before": understanding life experiences of African American elders.

With the unprecedented growth in the African American elderly population, there exists an urgent need to prepare nurses to deliver culturally competent care. The purpose of this study was to increase the knowledge available about the cultural heritage, worldviews, and life experiences of African American elders. Reminiscence interviews were conducted with African American elders living in a medium-sized northeast urban community. Data were analyzed using Spiegelberg's phenomenological Method. The following themes emerged: (a) nobody ever asked me before, (b) stories of discrimination, (c) coping with discrimination, (d) the hurt of discrimination, and (e) self-discoveries. Nurses, through the use of reminiscence, can gain insight into the cultural heritage, worldviews, and life experiences of African American elders and improve their ability to deliver culturally competent care to this population.     

Will patients find diversity in the medical home?

Mexican Americans and blacks experience disparities in health outcomes relative to white populations. During the past five to 10 years, fewer blacks and Mexican Americans are going to medical school and entering primary care professions. To assure the availability of a patient-centered medical home for all Americans, policy makers must work to support a culturally competent and diverse primary care workforce.     

Caring for the patient who has undergone female circumcision

Home health and hospice nurses are increasingly called to care for patients the world over. The provision of culturally competent and culturally sensitive care is critical to patient care planning. Viewing the patient holistically and within the context of family and culture provides the basis of most effective care. While nurses may not be providing skilled care directly related to female circumcision, it is important to include all of the patient's concerns within the framework of a comprehensive plan of care.     

School nurses' self‐assessed cultural competence when encountering children of foreign origin: A cross‐sectional study

The purpose of this study was to investigate associations between school nurses' self‐assessed cultural competence in health visits with children of foreign origin and demographic variables, by using a cross‐sectional design. A Web‐based questionnaire assessing cultural competence and demographic variables was distributed to a nationally representative sample (n = 816) of school nurses in Sweden. Data were analyzed using regression analysis. School nurses assessed themselves as culturally aware and moderately culturally competent, but not as culturally knowledgeable, culturally skilled, or comfortable in cultural encounters. Cultural competence was related to education in cultural diversity, how often nurses encounter children of foreign origin, and nurses' country of origin. In total, these variables explained 23.6% of the variation in school nurses' cultural competence. Because school nurses regard themselves as moderately culturally competent, a foundation for promoting children's health on equal terms in school health care exists. However, education in cultural diversity combined with other additional strategies is needed to further strengthen school nurses' cultural knowledge, skills, and comfort level in encounters with children of foreign origin.     

Social relationships among family caregivers: a cross-cultural comparison between Mexican Americans and non-Hispanic White caregivers

Sometimes, clinicians assume caregivers in cultural groups believed to have large social networks and strong social support need little intervention from health professionals. This longitudinal study tests five hypotheses about the social relationships of Mexican American compared to non-Hispanic White caregivers and whether negative changes in social support affect perceived health. The sample includes 66 Mexican American and 92 non-Hispanic White caregivers. Findings show that social networks and social support are similar at baseline and similarly stable for 1 year. Negative changes in social support are correlated with poorer health perceptions. Findings underscore the importance of designing interventions that are culturally competent based on what the caregiver is experiencing rather than cultural stereotypes.     

Encounters between children's nurses and culturally diverse parents in primary health care

The objective of this study was to analyze the healthcare encounters between nurses and parents of different cultural backgrounds in primary health care. An ethnographic study was carried out using participant observations in health centers and interviews with nurses. Data were analyzed using thematic content analysis and constant comparative method. Four main themes were identified when nurses met parents of other cultural backgrounds: lack of mutual understanding, electronic records hamper the interaction, lack of professionals' cultural awareness and skills, and nurses establish superficial or distant relationships. The concepts of ethnocentrism and cultural imposition are behind these findings, hampering the provision of culturally competent care in primary health services. There were difficulties in obtaining and registering culturally related aspects that influence children's health and development. This was due to e‐records, language barriers, and the lack of cultural awareness and skills in health professionals making the encounters difficult for both nurses and parents. These findings show that there is a clear threat for health equity and safety in primary care if encounters between nurses and parents do not improve to enable nursing care to be tailored to any individual family needs.     

Culturally Congruent Care in Radiology Nursing

The United States' diversity is growing, making it difficult for nurses to meet the needs of patients from a wide range of cultures, belief systems, and groups. Nursing is not new to providing culturally competent care; however, the profession's demographic shift has made it a priority. Improving nurses' cultural competency can lead to increased access to health care and, as a result, better health outcomes. Nurses in all specialties work with people from all walks of life, which necessitates that they have the knowledge and skills necessary to care in a culturally appropriate manner. Radiology nurses, in particular, influence care in a variety of settings and provide care to people of all ages and acuities, making the commitment to fostering culturally congruent practice even more critical. Nurses can begin this process by critically reflecting on their own biases as well as the concepts of cultural humility, competence, and competemility.     

Occupational health nursing with Navajo workers. Providing culturally competent care.

1. Native Americans in the southwestern United States are considered a "vulnerable population." Native Americans have economic difficulties, poor health, and little access to health care. The Navajo nation is the largest Native American reservation in the United States. 2. Occupational health nurses who provide culturally competent care increase the likelihood for Navajo workers to obtain optimal benefits from workplace health services. 3. The nurse uses cultural assessment skills and critical thinking abilities to maximize therapeutic interactions and minimize barriers in communications with workers of other cultural backgrounds. 4. The nurse who is knowledgeable about the Navajo way can help achieve a balance between the traditional ways and Western ways of addressing serious health care issues facing the Navajo worker. This knowledge and cultural awareness also increases the effectiveness of health promotion and health education programs offered to workers, their families, and their communities.     

Listening to the quiet voices of Hispanic migrant children about health

There is a paucity of literature related to school-aged migrant children's perceptions of their own health. To best provide culturally competent care, more information is needed about migrant children's experiences. Focus-group methodology allowed the voices of migrant children to be heard by primary health care providers at a summer school program for children of migrant farm workers in south Georgia. Seventy-three children participated in 14 focus-group sessions. Six themes emerged from the data that were analyzed by using a qualitative software system. They are healthy behaviors, acculturation issues, environmental influences, health care actions, health behavior outcomes, and learning needs. Emerging patterns within each theme render insight about these migrant children. The findings suggest implications for pediatric nurses related to culturally competent care.