Caring for family members with Alzheimer's disease: perspectives from Chinese American caregivers

The purpose of this study was to examine the experiences of Chinese American caregivers who provide care for family members with Alzheimer's disease (AD). Individual interviews were conducted with four family caregivers. Results revealed ethnocultural and structural barriers that Chinese family caregivers experienced, including stigmatization of AD in the Chinese community, a lack of knowledge about AD, a lack of culturally and linguistically appropriate AD services, nega tive interactions with health-care providers, and difficulty with English. This study vides cultural knowledge and insights nurses who care for AD clients and their fam ilies. Overcoming barriers and working with Chinese American families and their community are needed to improve access and dementia services for Chinese American patients and their families.     

Care of LGBTQ older adults: What geriatric nurses must know

Geriatric nurses have a responsibility to promote the health of all older adults. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults are particularly vulnerable to poor health outcomes and are less likely to seek healthcare due to fear of discrimination. Despite elevated risk LGBTQ older adults are often ignored within geriatric nursing as there is little evidence to inform care. To adequately care for LGBTQ patients geriatric nurses should recognize the effects of bias, appreciate the importance of terminology, understand diversity within the LGBTQ community, advocate for the inclusion of sexual orientation and gender identity in admission assessments, share best practices, and advocate for increased visibility. Caring for this population may be challenging, as it will require geriatric nurses to expand their knowledge of LGBTQ health, explore their own biases, and challenge institutional norms. However, through coordinated efforts geriatric nurses can work toward improving care for LGBTQ older adults.     

Considering the Needs of Older Sexual and Gender Minority People

Sexual and gender minority older adults face unique challenges in health care and are at greater risk for poor health outcomes. The aging population is growing significantly. Nurse practitioners have an opportunity to address the specific challenges associated with family and social support, unique relationships, sexuality and its implications, the lack of community resources, housing including long-term care, end-of-life and palliative care disparities for these populations.     

Functional health illiteracy. Ethical concerns

Functional health illiteracy is a silent disability demanding the attention of healthcare professionals because it affects millions of people in the United States. Patients are reluctant to disclose this problem because they fear discrimination and stigmatization. Inadequate health literacy raises ethical questions because it is a barrier to healthcare and results in poor health outcomes. The purposes of this article are to provide an overview of functional health illiteracy, identify related ethical concerns, and discuss selected, relevant nursing implications. Nurses are in a unique position to serve as advocates, mediators, and translators for their patients who are functionally health illiterate.     

Integration of transgender health: A multi-modal approach

The lesbian, gay, bisexual, transgender, queer, and intersexed (LGBTQI+) community can benefit from access to evidence-based health care, social services, justice, and equality. A significant challenge that nurses and educators have is a lack of knowledge, enlightenment, and clinical experience necessary to provide equitable and evidenced based healthcare, specifically to transgender and gender diverse individuals. As this population continues to flourish, Associates Degree (ADN) prepared nurses will be called upon to render care frequently, so curricula must be adjusted. The objective of this quality improvement project was to emphasize how a multimodal education approach can expand knowledge and ease in caring for this community. The methodology included one in-class presentation and a Success Coaching Event that presented a didactic education module, a lived experience speaker, a film depicting bad versus good communication during a clinical encounter, and a post didactic discussion panel. The quasi-experimental design supported the success of the intervention, evaluated by comparing pre- and post-test survey scores as well as results from a final exam. This new curricular framework can be implemented in all ADN programs where nurses learn basics communication and assessment.     

Barreras en la asistencia sociosanitaria en personas transexuales: revisión sistemática de estudios cualitativos

Aim

To explore the barriers to requesting social and healthcare assistance perceived by transgender persons and professionals involved in the assistance.

Engaging the Transgender Community to Improve Medical Education and Prioritize Healthcare Initiatives

Phenomenon: Transgender patients experience discrimination, limited access to care, and inadequate provider knowledge in healthcare settings. Medical education to address transgender-specific disparities is lacking. Research that engages transgender community members may help address health disparities by empowering patients, increasing trust, and informing medical curricula to increase competence. Approach: A 2015 Community Forum on Transgender Health Care was hosted at the University of Louisville School of Medicine, which included healthcare professionals and transgender community members to facilitate dialogue among mixed-participant groups using a World Café model. Fifty-nine participants discussed the status of transgender healthcare and made recommendations for local improvements. A follow-up survey was administered to 100 individuals, including forum participants and their referrals. The forum discussion and survey responses were analyzed to determine common perceptions of transgender healthcare, priorities for improvement interventions, and themes to inform curriculum. Findings: The community forum discussion showed that local transgender care is overwhelmingly underdeveloped and unresponsive to the needs of the transgender community. The follow-up survey revealed that priorities to improve transgender care included a multidisciplinary clinic for lesbian, gay, bisexual, and transgender (LGBT) patients, an LGBT-friendly network of physicians, and more training for providers and support staff. This mutually constructive engagement experience influenced reform in undergraduate curricula and continuing education opportunities. Insights: Community engagement in healthcare disparities research can cultivate improbable discussions, yield innovative insight from marginalized populations, and build relationships with community members for future collaborations and interventions. Societal acceptance of transgender identities, which could be promoted through healthcare providers, could stimulate significant progress in transgender healthcare. Supplemental educational interventions for practicing physicians will improve the current conditions of transgender healthcare, but a comprehensive medical school curriculum specifically for transgender health that includes interactions between the transgender community and medical students could be particularly impactful.     

Emergency Care Considerations for the Transgender Patient: Complications of Gender-Affirming Treatments

The transgender population presents a unique challenge for the emergency nurse. There are types of surgeries, medications, complications, and differences in laboratory testing that are unique to transgender people. In addition, emergency nurses are increasingly encountering more transgender patients in the emergency department for care, referrals, and education. Yet, many emergency nurses lack the formal training to care for transgender patients and their families. A complete understanding of the terminology, gender-transforming surgeries, hormonal suppression and augmentation of sexual characteristics, adverse effects, complications of surgeries, and ongoing health risks owing to the altered hormonal milieu and potential risk for acquiring sexually transmitted diseases is important to provide the necessary emergency care for this emerging population.     

Bridging the Gap of Mental Health Inequalities in the Transgender Population: The Role of Nursing Education

The transgender population experience mental health disparities as a result of numerous environmental, sociocultural and personal factors. Health care-related discrimination plays an unfortunate role in these disparities. The institutional and informational erasure of transgender individuals in health care actively contributes to this discrimination. The lack of preparation of health care professionals to care for this population is a significant factor. There is an absence of education on transgender topics in nursing school and a lack of nursing research on this population. An awareness through education of culturally competent transgender terminology is crucial to ensure a transinclusive environment is created. The creation of a transinclusive environment in the mental health care setting will ultimately lead to improved patient outcomes.     

Clinical Care for the Aging LGBT Population

US Census estimates indicate that there are currently 1.75 to 4 million Americans who identify as lesbian, gay, bisexual, and transgender (LGBT), which will double by 2030. Life expectancy for the aging LGBT population is lower than that of the same age cohort due to health care disparities. Most nurse practitioners (NPs) and certified nurse midwives (CNMs) are not aware of needs of this population and clinical modifications required to improve access to care and health outcomes. This lack of information adds to the gap in health care services and deepens disparities. NPs and CNMs are in a unique position to improve care by addressing unique the health care needs of the aging LGBT population.     

Reducing the incidence of colorectal cancer in African Americans

African Americans have the greatest incidence of colorectal cancer than any other racial or ethnic group. This population's survival from colorectal cancer is lower than that in the White population. Increased incidence and mortality can be attributed to barriers such as lower screening rates, less use of diagnostic testing, decreased access to healthcare, cultural beliefs, and lack of education regarding healthcare practices and preventable disease. The first step in reducing morbidity and mortality is to educate healthcare providers concerning this population and their increased risk for colorectal cancer. Healthcare providers must promote screening, provide education, and incorporate simple screening tools into routine exams. Local health departments and community centers must reach out to the African American community and lend assistance with culturally appropriate education regarding this preventable cancer.     

Experiences of self‐stigmatization and parenting in Chinese mothers with severe mental illness

Mental health stigma has serious ramifications on people with a severe mental illness (SMI). Stigma damages self‐esteem, recovery outcomes, family relationships, socialization abilities, access to housing, and career prospects. The cultural tendencies of Chinese people have been shown to be associated with particularly high levels of stigmatization. These cultural tenets can result in high levels of self‐stigma due to experiencing shame and a perceived need to keep mental illness a secret. Although there is a lack of existing evidence, it is possible that such experiences present unique challenges to Chinese mothers diagnosed with SMI when they parent their children. Therefore, this qualitative study explored the experiences of parenting and self‐stigmatization of Chinese mothers with SMI. Individual semi‐structured interviews were conducted with 15 mothers who were direct carers of their children aged under 18 and who were receiving community‐based care in Hong Kong. Manual inductive thematic analysis was used to analyse the interview data. Three main themes related to self‐stigmatization emerged from the interviews: (i) distancing and being distanced; (ii) doubting myself; and (iii) struggling for control. The experiences of self‐stigmatization appeared to damage these mothers’ self‐efficacy, which may negatively affect their parenting self‐esteem, tendency to seek professional help, and ability to manage their own mental health. Strategies to improve self‐efficacy, including psychoeducation, and additional childcare support/resources are required for mothers with SMI so they can better manage and balance the demands of motherhood and their mental healthcare needs.     

Health beliefs, practice, and priorities for health care of Arab Muslims in the United States.

The Arab Muslim population is one of the dramatically increasing minorities in the United States. In addition to other factors, religion and cultural background influence individuals' beliefs, behaviors, and attitudes toward health and illness. The author describes health beliefs and practices of the Arab Muslim population in the United States. That population is at an increased risk for several diseases and faces many barriers to accessing the American health care system. Some barriers, such as modesty, gender preference in healthcare providers, and illness causation misconceptions, arise out of their cultural beliefs and practices. Other barriers are related to the complexity of the health care system and the lack of culturally competent services within it. Nurses need to be aware of these religious and cultural factors to provide culturally competent health promotion services for this population. Nurses also need to integrate Islamic teachings into their interventions to provide appropriate care and to motivate healthy behaviors.     

Primary Care for Lesbian,Gay, Bisexual,Transgender, and Queer/Questioning (LGBTQ) Patients

The lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community is a vulnerable populace that accounts for 4.5% of the United States population. Unfortunately, this group of individuals faces discrimination. They need access to quality, prejudice-free health care. This article initiates the discussion of how nurse practitioners, primary care, and family practice providers can provide inclusive, unbiased, quality care to this community that is evidence based. Information is provided about common barriers preventing this population from receiving equitable care. Evidence-based methods are outlined for screening this population for common health conditions, paying particular attention to an established HIV risk assessment and its application in clinical settings to identify candidates for pre-exposure prophylaxis. Finally, pharmacologic information about preexposure prophylaxis and transgender hormone therapy is presented. The information presented prepares nurse practitioners to begin caring for this population.     

Community matrons: primary care professionals' views and experiences

Title.  Community matrons: primary care professionals' views and experiences.
Aim.  This article is a report of a study exploring how the role of the community matron is progressing and any barriers or facilitators to performing the role.
Background.  Long-term conditions are distressing for patients and costly for healthcare services. Government policy in western countries has increasingly focussed on more integrated and pro-active management of patients with multiple long-term conditions to maintain the ability of the aging population to function independently. The role of community matrons has been introduced in England in an attempt to address these issues.
Method.  A purposive sample of 31 health and social care professionals participated in five focus group discussions. Reported experiences of the community matron role by community matrons, district nurses, social workers and general practitioners were analysed according to the principles of grounded theory. Data were collected in 2007.
Findings.  The community matron role was seen as effective in meeting the medical and social needs of patients. This was achieved through patient education, developing patients' self-management of their health conditions and monitoring their social needs. Potential barriers to success of the role were associated with lack of role definition prior to its introduction.
Conclusion.  It is unclear whether the role is financially viable in its current form. Further research is required to examine differing models for implementing the role and judging its effectiveness in bridging the primary-secondary care interface.     

Delivering Culturally Sensitive Care to LGBTQI Patients

Many health care providers are uncomfortable having conversations with patients about their sexual identity or sexual behaviors. Avoiding this discomfort is causing a serious threat to the mental and physical health of Americans, particularly those in the lesbian, gay, bisexual, transgender, questioning, or intersex (LGBTQI) community. The health-related disparities among LGBTQI patients range from bullying and physical assault to refusal of health care and housing. Many individuals choose not to seek health care due of fear of being judged, marginalized, or abused. This article focuses on the many disparities faced by the LGBTQI community and describes how simple changes in the practices of health care providers can potentially improve their health outcomes.     

Enroling and retaining human immunodeficiency virus (HIV) patients in their care: A metasynthesis of qualitative studies

ObjectivesTo report the findings of a metasynthesis review of qualitative studies on patient and provider experiences and perspectives on linkage and retention in HIV care.DesignThe review is an extraction, aggregation, interpretation and synthesis of qualitative findings based on the Sandelowski and Barroso method.Data sourcesA search of the literature was conducted in the databases Cumulative Index to Nursing and Allied Health, PubMed and PsycInfo for articles published from 2008 to 2013. Inclusion criteria were qualitative research articles published in English from across the world and in peer-reviewed journals. Literature reviews, conference abstracts and grey literature were excluded from this metasynthesis.Review methodsThe review consisted of a) comprehensive search, b) study classification, c) abstraction of findings, d) synthesis. Of the 4640 citations screened, 69 articles were included for this metasynthesis.Results69 unique articles from 44 countries were included. This metasynthesis takes into account the perspectives of at least 2263 HIV-positive participants (740 men, 1008 women, 78 transgender individuals and 437 unspecified sex) and 994 healthcare providers, family members and community members. The most salient barriers and facilitators to HIV linkage and retention in HIV care affirm ecological factors that are mostly beyond individual patients’ control. Triadic streams of influence concurrently affect care engagement that include a person’s psychological state upon diagnosis and their informational challenges (intrapersonal stream); one-on-one interactions with providers and their immediate community (social stream); and life demands, overall quality of care experiences and other structural barriers (cultural-attitudinal stream). Each stream’s influence on HIV care engagement varies at any given point to reflect an individual’s evolving and unique experiences with HIV infection throughout the illness trajectory.ConclusionThere is sufficient evidence that detail how to best link and retain patients in HIV care. Themes identified indicate going beyond individual-level factors and towards shifting attention and resources to systems that patients navigate. Forceful structural-level actions are needed to correct these long-identified barriers and enhance care engagement facilitators.     

Caring for Military Veterans in the Community: An Interprofessional Approach

Military veterans are at higher risk for poor health outcomes due to the myriad of physical and mental health problems that may occur during or after deployment to one or more military combat operations. To improve health outcomes for this vulnerable population, it is essential that healthcare providers employ an interprofessional approach when providing care. With increased numbers of veterans receiving healthcare in the civilian sector, community health nurses are in a unique position to implement and manage effective interprofessional collaboration that will ensure the provision of high-quality healthcare.     

Migrant farm workers and their families: Cultural patterns and delivery of care in the United States

Migrant farm workers and their families represented a critical labour pool in the planting and harvesting of agricultural products in the United States, yet their diminished health status parallel many non‐industrialized communities. The interaction of social, political, environmental and financial obstacles severely restrict access to health care among this community who often perceive insurmountable barriers to navigating the health‐care system. Through the provision of a culturally competent and sensitive assessment, community health nurses and other health providers can positively impact on health outcomes by incorporating the unique health beliefs and practices of this vulnerable population into a mutually defined plan of care.