Giving health care to minority patients

Health care is usually thought of as a basic right of each individual. This so-called basic right is denied to many mainly because of their economic situation and the color of their skin. There is a need for more blacks, Indians, Mexican-Americans, Puerto Ricans, and Asians in the health care field. The numbers are low and the training process slow. Time is needed to prepare ethnic people of color. Since most of the deliveries of health care are white, these white workers must become sensitive to the traditions, values and attitudes of the ethnic groups of color. Schools of nursing are beginning to include cultural differences in nursing curriculums, but the majority of the nurses who practice are not aware of and are not sensitive to the needs of nonwhite patients. Nursing must help solve problems of the ethnic groups of color. Nurses must become personally involved in the injustices of health care. As Marie Branch states, there must be "personal reeducation." When this occurs, health care to the minority client will improve.     

An exploratory survey into primary care nurses and dementia care

This article introduces findings from the first phase of a randomized controlled trial of educational interventions in primary care. The focus of the article is the knowledge, attitudes and confidence of primary care nursing staff to the diagnosis and ongoing management of dementia. A total 78 nurses with a mean age of 46.4 years and a mean time since qualification of 23.0 years were recruited in 36 practices in central Scotland and in London. Disciplines represented by this sample were predominantly district nurses, health visitors, practice nurses and community staff nurses. Each practitioner was administered an extensive self-completion questionnaire before the educational interventions were introduced to measure baseline knowledge, confidence and perceived difficulties in dementia care management and attitudes. Results from the quiz indicate lower levels of knowledge about epidemiology and diagnosis, but slightly higher levels about management strategies. Self-reported ratings of confidence were also low and were directly related to ratings of difficulty in identifying dementia and dealing with coexisting behavioural and mental health problems. Lower scores on all domains were recorded for practice nurses than for district nurses or health visitors.     

Depressive symptomatology in three Latino groups

The purpose of this study was to examine depressive symptomatology in three Latino groups: Mexicans living in Mexico City, Latino immigrants living in the South Bay area of San Francisco, and Puerto Ricans living on the island of Puerto Rico. The Spanish version of the Center for Epidemiological Studies Depression Scale (CES-D) was used as part of a larger study on stress and coping. The levels of depressive symptomatology in all three Latino groups were significantly higher than those reported in other Latino samples and in White Americans. Mexican immigrants reported the highest levels of depressive symptomatology.     

Environmental Tobacco Smoke Exposure Among Hispanic Women of Reproductive Age

Abstract Exposure to environmental tobacco smoke is a potential health risk for women of reproductive age and their children. Household and workplace exposures were estimated for 4256 Hispanic women age 12 to 49 who participated in the Hispanic health and nutrition examination survey. Age-specific household exposure for nonsmokers was 31% to 62% for Mexican-Americans, 22% to 59% for Puerto Ricans, and 40% to 53% for Cuban-Americans. Exposure was significantly high for Puerto Rican and Mexican-American adolescents, 59% and 62%, respectively. Workplace exposure for nonsmokers was 22% to 35% for Mexican-Americans, 28% to 33% for Puerto Ricans, and 33% to 49% for Cuban-Americans. Young Mexican-American and Puerto Rican and all Cuban-American women reported high exposure to environmental tobacco smoke in the home or workplace. Assessment of family living and smoking patterns, understanding cultural values and norms, and household smoking control and cessation strategies that are mutually derived are useful for nurses and Hispanic and Latino populations to meet the environmental tobacco smoke health objectives for the nation.     

Ethnic,Gender, and Age Differences in Adolescent Nonfatal Suicidal Behaviors

This study examined ethnic differences in adolescent nonfatal suicidal behaviors as well as age and gender variation both across and within ethnic groups. Using a large (n = 14, 346) sample of adolescents in Grades 7 through 12, African Americans reported relatively high rates of suicidal thoughts and attempts and Southeast Asians reported high rates of suicidal thoughts. Hispanic Americans, European Americans, and Asian Americans were similar in their reports of nonfatal suicidal behaviors. Gender differences also varied across ethnicity as Southeast Asian boys (particularly older boys) reported more suicidal thoughts and attempts than Southeast Asian girls.     

肿瘤科护士对照顾终末期癌症患者的职责认同与负性感受研究

目的:了解肿瘤科护士对照顾终末期癌症患者的态度。方法:采用自行编制的"护士照顾终末期癌症患者的态度评估量表",对全国19家医院的463名肿瘤科护士进行调查,内容包括护士对照顾终末期癌症患者的职责认同程度以及工作中的负性感受两个维度,每个维度均包括症状控制、心理辅导以及家属支持3个方面的测量。结果:①护士对症状控制、心理辅导以及家属支持3方面的职责普遍认同,但在心理辅导方面,对帮助患者应对疾病状况和死亡的职责的认同分值不高,存在不确定性。②护士在3方面的实践中负性感受均较高,其中在帮助家属应对悲伤过程中的负性感受最强,对症状控制的无能为力感受次之。心理辅导方面,护士在帮助患者应对当前疾病状况和谈论死亡问题上感到困难。③护士在症状控制和心理辅导两方面的职责认同程度与工作中的负性感受呈负相关。结论:肿瘤姑息护理的继续教育仍需进一步加强,帮助更多的肿瘤科护士明确职责,更新理念,提高专科护理知识水平和能力,才能为终末期癌症患者提供更加专业、有效的护理,同时也有助于减轻工作中的负性感受和压力。     

Support for A&E nurses caring for patients with sickle cell disease

AIM: To investigate the supportive work carried out by a health psychologist working with nurses in an A&E department caring for patients with sickle cell disease, some of whom are known to present with difficult and challenging behaviour. METHOD: A sample of 21 female nurses who had all taken part in the support group completed questionnaires concerning perceptions of the usefulness of the sessions, attitude changes, degree of the perceived benefit derived, degree of perceived comfort in the group and views about whether the sessions should continue. RESULTS: Most nurses found the support group useful and, since attending the group, many reported more sympathetic attitudes towards sickle cell disease patients. The forum was observed to promote reflection in practice and offered a degree of social support, as well as giving the nurses more confidence in dealing with 'difficult' patients generally. Most nurses were happy with the format of the support group. CONCLUSION: The support group was found to provide the nurses with emotional support as well as boosting their confidence in dealing with this patient group. This will have an impact on the quality of patient care they are able to deliver.     

Preparation for cancer care: perceptions of newly qualified health care professionals.

The present paper is derived from a larger survey which examined the perceptions of recently qualified health care professionals' experience on evidence-based practice, team working and cancer care. This study reports solely on the findings relating to cancer care. The perceptions of recently qualified professionals in relation to their initial educational input on issues such as confidence, anxiety, communication skills and practice in cancer care as well as adequacy of support, professional supervision and use of reflection were gathered using a cross-sectional postal survey design. A total of 50 graduates from each professional category in nursing, occupational therapy, physiotherapy, and social work were sampled yielding a total sample of 200. Eighty-five questionnaires were returned yielding a response rate of 43%. Twenty-eight (33%) respondents stated that they were currently involved in working with people with cancer. These were as follows: 5 nurses, 8 physiotherapists, 9 occupational therapists and 6 social workers. Despite the low response rate, the findings suggest that health care professionals' educational input and experiences of working with people with cancer were overall positive; for example, in the respondents' confidence, communication skills, decrease in anxiety and application of knowledge gained in classroom to professional practice. Moreover, most respondents learnt about caring for cancer patients through practice rather than classroom teaching. A high percentage (i.e. 64%;18) across all groups felt supported when caring for people with cancer and reported receiving professional supervision as well as being able to actively reflect on their practice. The implications for education and practice were discussed particularly as there have been few studies conducted in relation to the specific needs and collaborative learning of these health care professional groups.     

Focus groups: examining a community-based group intervention for depressed Puerto Rican women

Puerto Ricans manifest high rates of depression but avoid seeking treatment. The purpose of this pilot was to learn directly from Puerto Rican women how culturally appropriate they would consider a proposed community-based intervention for treating depression. Interactive activities were reviewed by two focus groups of women (N = 16), all working in community-based health programs. All activities (e.g., writing, role playing, and music) except individual drawing were deemed appropriate. Categories that emerged were family/community values, mainland/non-mainland cultural variances, communication style, religion, education/occupational variances, health beliefs, Puerto Rican traditions/customs, emotions, and coping skills. Categories provided guidance for refining a community-based intervention for treating depression in Puerto Rican women.     

Prevalence of diabetes in Mexican Americans, Cubans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey, 1982-1984

The purpose of this study was to estimate the prevalence of diagnosed and undiagnosed diabetes among Mexican Americans, Cubans, and Puerto Ricans in the United States and compare these estimates to data from prior surveys for U.S. non-Hispanic whites and blacks. Data for this study are from the Hispanic Health and Nutrition Examination Survey, a multipurpose cross-sectional survey of three U.S. Hispanic populations conducted in 1982-1984. The interviewed sample of people aged 20-74 yr included 3935 Mexican Americans in the southwest, 1134 Cubans in Florida, and 1519 Puerto Ricans in the New York City area. The diabetes component consisted of interview questions on diabetes diagnosis and treatment and an oral glucose tolerance test administered to a subsample. The prevalence of diabetes was two to three times greater for Mexican Americans and Puerto Ricans than for non-Hispanic whites surveyed in 1976-1980. In Cubans, the prevalence was similar to that for non-Hispanic whites. In men and women 45-74 yr of age, the prevalence of diabetes was extremely high for both Mexican Americans (23.9%) and Puerto Ricans (26.1%) compared with Cubans (15.8%) or non-Hispanic whites (12%). The total prevalence of diabetes was not significantly different for Mexican Americans and Puerto Ricans but was significantly lower for Cubans. The relatively lower prevalence of diabetes among Cubans and the high prevalence in both Mexican Americans and Puerto Ricans may be related to socioeconomic, genetic, behavioral, or environmental factors.     

Focus Groups: Examining a Community-Based Group Intervention for Depressed Puerto Rican Women

Puerto Ricans manifest high rates of depression but avoid seeking treatment. The purpose of this pilot was to learn directly from Puerto Rican women how culturally appropriate they would consider a proposed community-based intervention for treating depression. Interactive activities were reviewed by two focus groups of women (N = 16), all working in community-based health programs. All activities (e.g., writing, role playing, and music) except individual drawing were deemed appropriate. Categories that emerged were family/community values, mainland/non-mainland cultural variances, communication style, religion, education/occupational variances, health beliefs, Puerto Rican traditions/customs, emotions, and coping skills. Categories provided guidance for refining a community-based intervention for treating depression in Puerto Rican women.     

SARS流行期间护士职业伦理观的调查分析

目的 了解护士对护理SARS患者的态度及其伦理认识。方法 采用随机抽样的方法，选择了江门市收治SARS患者的2所三级医院200名护士进行调查，使用无记名问卷，内容包括一般情况，护士对SARS患者的接纳态度及其对SARS的伦理认识3部分。结果 回收167份问卷显示，护士对护理SARS患者的信心不足，存在回避心理，反应矛盾的伦理观，不同护龄护士对SARS的态度及其伦理认识在某些方面存在一定的差异。结论护理SARS患者对护士产生的积极影响大于消极影响，但仍需强化护士的职业伦理道德，以利于应对日后特发的公共卫生事件。     

Perceptions of the role of the hospital palliative care team

AIM: The aim of this study was to understand staff perceptions of the role of the hospital palliative care team and to identify knowledge and confidence levels of general staff caring for patients with palliative care needs. METHOD: A survey questionnaire tool was used with a response rate of 51 per cent. Participants included nurses, health care assistants and doctors. RESULTS: The study highlighted several misconceptions about the role of the palliative care team, but demonstrated that the clinical staff surveyed were confident in their palliative care skills, with the exception of discharge planning, despite the fact that only 26 per cent of nurses reported having undergone training in palliative care. It identified that HCAs felt confident in caring for dying patients yet had little confidence in dealing with distressed relatives or speaking to patients and families about death. It was also interesting to note that trained nurses felt confident in their symptom control skills, and they rated training in this area as one of the top priorities. CONCLUSION: The findings have considerable implications for palliative care services. Professional education should continue to focus primarily on symptom control and communication skills training, but stress management training should be considered. Staff need to be clear about how to obtain advice and what support is available for cancer patients. Further research is required to understand the needs of HCAs and potential models for education and support.     

Examining older adults' perceptions of health care providers: identifying important aspects of older adults' relationships with physicians and nurses

This article describes older adults' conversations about their relationships with health care providers. Focus group participants (N = 23) were from three ethnic groups (Black, White, and Hispanic) and ages 53 to 92. All but three of the participants were women. Content analysis revealed an overarching theme of genuine caring and three sub-themes: interest in patients' well-being, respectful dialogue, and sharing of information. Older adults' perceptions of genuine caring by physicians and nurses did not differ by ethnicity. Older adults want to engage in a caring, respectful, and educational relationship with their health care providers, which is consistent with fundamental professional values.     

The Hispanic Americans Baseline Alcohol Survey (HABLAS): Alcohol consumption and sociodemographic predictors across Hispanic national groups

Objective: To examine differences in alcohol consumption among Hispanic national groups in the United States [Puerto Ricans, Mexican, Cuban, and Dominican South Central (D/SC) Americans] and identify sociodemographic predictors of drinking and binge drinking (four drinks for women and five for men in a 2-hr period).

Method: The study used a household probability sample of adult Hispanics in five metropolitan areas in the United States. Comprehensive data on alcohol consumption were collected. Analyses included bivariate and multivariate regression techniques.

Results: Puerto Rican and Mexican American men reported higher drinking rates, weekly consumption, and binge drinking than D/SC and Cuban Americans. Women drank significantly less than men. Mexican American women reported the highest abstention rate (61%); Puerto Rican women drank more per week and binged more frequently compared with their counterparts in other groups. Puerto Rican origin, initiating drinking during high school years (<18), and male gender (US- or foreign-born) were significant predictors of weekly alcohol consumption. Being younger, being single, Puerto Rican or D/SC American origin, initiating drinking at <18 years, being a US- or foreign-born male and being a US-born female were significant predictors of binge drinking.

Conclusions: There are considerable differences in drinking behavior across Hispanic national groups as well as between men and women. Results underscore the need to recognize heterogeneity in drinking practices while designing effective prevention interventions in the community.     

Health status among US Hispanics: ethnic variation, nativity, and language moderation

BACKGROUND: The relationship between health status and Hispanic ethnicities, language, and nativity is poorly understood, due to the limitations and conflicting findings of previous studies. OBJECTIVES: To examine the effects of language and nativity on health status in Hispanic ethnic subgroups and non-Hispanic whites (whites). RESEARCH DESIGN: Cross-sectional analyses of data from the 1998-2004 National Health Interview Survey linked to the 1999-2005 Medical Expenditure Panel Survey. Health status was regressed on race/ethnicity, interview language, and nativity, with adjustment for demographic and socioeconomic variables. SUBJECTS: A total of 16,489 Hispanics (13,522 Mexicans, 778 Cubans, 1360 Puerto Ricans, and 829 Dominicans) and 45,422 whites. MEASURES: SF-12 mental (MCS-12) and physical (PCS-12) component summary scores. RESULTS: In adjusted analyses, Mexicans had significantly higher MCS-12 scores than other Hispanics and whites, with the largest advantage noted for Spanish-speaking Mexicans. Ethnic origin * nativity interaction effects were significant for both MCS-12 [adjusted Wald test, F (3236) = 7.27, P = 0.0001] and PCS-12 [F (3236) = 4.75, P = 0.0031]. Continental US-born Mexicans had worse mental and physical health status than non-US-born Mexicans. By contrast, continental US birth was associated with better mental health status for Cubans and Dominicans, and better physical health status for Puerto Ricans. CONCLUSIONS: Complex interactions exist among language, nativity, ethnicity, and health status among Hispanics. Mexicans have better health status than whites and other Hispanics, and the moderating effects of nativity and language differ for Mexicans compared with other Hispanics. Future research should approach Hispanics as a diverse grouping rather than a monolithic entity.     

Geriatric Care Boot Camp Series: Interprofessional education for a new training paradigm

Interprofessional education of health care professionals caring for older adults is critical to address the unique needs of geriatric patients. An interprofessional education program – the Geriatric Care Boot Camp Series (“Series”) – was designed for health care professionals to fill this education gap. The program consisted of three half-day, intensive boot camps conducted over a one-year period. A total of 112 learners participated; more than half were nurses. Data analysis revealed statistically significant increases following each boot camp in attendees’ reported knowledge about caring for older adults; statistically significant increases in comfort caring for older adults were also seen among participants in two boot camps. Attendees found the interprofessional nature of the program beneficial and said they would attend a similar program again. The Series is easily replicable, appealing to the target audience, and fulfills the need to better educate health care professionals on caring for older adults.     

军队保健护士危重病人照护与应急处置能力培训效果调查分析

[目的]调查军队保健护士危重病人照护与应急处置能力现况、存在的问题及培训效果,提升军队保健护士危重病人照护与应急处置能力。[方法]采用自制的军队保健护士危重病人照护与应急处置能力现状调查表,对247名军队保健护士危重病人照护与应急处置能力进行现况调查,根据存在的问题制订培训计划,设置相应课程,进行为期2个月的集中培训,培训结束后采用相同问卷再次调查,分析培训效果。[结果]培训前后军队保健护士对职业规划、危重病人基础护理技能、常见危重症救护、应急处置及现场救护能力4个维度得分比较差异有统计学意义（P 〈0.05）。[结论]经过为期两个月的培训,军队保健护士危重病人照护与应急能力水平显著提高。     

Sociocultural influences on disability status in Puerto Rican children.

BACKGROUND AND PURPOSE: This article describes culturally defined meanings of childhood function and disability in Puerto Rico to provide a context for the interpretation of test scores from the Spanish translation of the Pediatric Evaluation of Disability Inventory (PEDI). SUBJECTS AND METHODS: More than 600 Puerto Rican teachers, parents and caregivers of children with and without disabilities, and members of the general community participated in ethnographic interviews, which were designed to describe their beliefs, attitudes, and knowledge about childhood function and disability. RESULTS: Qualitative and quantitative data analysis confirmed that differences exist between Puerto Ricans and the norms established in the United States for the performance of functional skills by children, and the analysis also described Puerto Rican beliefs and attitudes toward disability. DISCUSSION AND CONCLUSION: Puerto Rican values of interdependence, a?o?ar (pampering or nurturing behaviors), and sobre protectiva (overprotectiveness) influence parental expectations for the capability of children with disabilities and should be considered when interpreting scores from the PEDI and establishing plans of care. Additional research is needed on the influence of contextual variables on child development and behavioral adaptations to disability.