Contextual analysis of coping: implications for immigrants' mental health care

Providing high quality and effective health care services that are culturally acceptable and appropriate to clients has become an important issue for many health care providers. This paper explores problems associated with the traditional model that views coping according to hierarchical style and traits. While some scholars who have adopted this theoretical framework have made many contributions to the development of stress and coping theories, limitations are present. Using Vietnamese immigrants' experiences as examples, I argue that coping theories should emphasize the contextual nature of stress and coping, and that coping should be viewed as a dynamic process that varies under different social, cultural, political, economic, and historical conditions. Drawing from the work of others on coping, culture, imperialism, and colonialism, I explore the way that certain cultural conceptualizations determine how individuals cope. An understanding of the contextual nature of coping and of a Vietnamese immigrant's experience of coping with stressors and illness has implications for mental health care practice and research.     

THE INFLUENCE OF CULTURE ON IMMIGRANT WOMEN'S MENTAL HEALTH CARE EXPERIENCES FROM THE PERSPECTIVES OF HEALTH CARE PROVIDERS

It is well documented that serious mental health problems such as depression, schizophrenia, and post migration stress disorders exist among immigrant women. Informed by Kleinman's explanatory model, this qualitative exploratory study was conducted with seven health care providers who provided mental health services to immigrant women.

Analysis of the data revealed that (a) immigrant women face many difficulties when accessing mental health care services due to cultural differences, social stigma, and unfamiliarity with Western biomedicine, (b) spiritual beliefs and practices that influence immigrant women's mental health care practices, and (c) the health care provider-client relationship, which exerts great influence on how immigrant women seek mental health care. The study also revealed that cultural background exerts both positive and negative influences on how immigrant women seek mental health care. We suggest that although cultural knowledge and practices influence immigrant women's coping choices and strategies, awareness of social and economic differences among diverse groups of immigrant women is necessary to improve the accessibility of mental health care for immigrant women.     

Contextual and Cultural Influences on Caregivers of Hispanic Cancer Survivors

ObjectivesTo discuss contextual factors (barriers to accessing health care, immigration issues, minority stress, low education/income, challenging employment environments) and cultural values (familism, espíritu, confianza, marianismo, machismo) of Hispanic caregivers that may influence the caregiving experience.Data SourcesLiterature, research.ConclusionHispanic caregivers, like non-Hispanic caregivers, experience poor health during caregiving and have unmet needs for information and emotional support. Few evidence-based supportive care interventions are currently available, and more should be developed and tested for this growing population of Hispanic caregivers.Implications for Nursing PracticeNurses should assess both contextual factors and cultural values as part of treatment planning for quality cancer care.     

Psychosocial Predictors of Chronic Musculoskeletal Pain Outcomes and their Contextual Determinants Among Black Individuals: A Narrative Review

Black communities are disproportionally affected by Chronic Musculoskeletal Pain (CMP), but little is known about the psychological predictors of CMP outcomes and their contextual determinants among Black individuals. To address this gap, we conducted a narrative review of extant literature to (1) report the major conceptual models mentioned in prior work explaining the link between contextual determinants and psychological responses to pain among Black individuals with CMP; and (2) describe psychological factors related to CMP outcomes in this population that are highlighted in the literature. We searched 4 databases (APA PsycNet, PubMed/MEDLINE, Scopus, and Google Scholar) using the following search terms: musculoskeletal pain, chronic pain, mental health, psychological, coping, health disparities, contextual factors, conceptual models, psychosocial, Black, African American, pain, disability, and outcomes. We illustrate 3 relevant conceptual models – socioecological, cumulative stress, and biopsychosocial – related to contextual determinants and several psychological factors that influence CMP outcomes among Black individuals: (1) disproportionate burden of mental health and psychiatric diagnoses, (2) distinct coping strategies, (3) pain-related perceived injustice and perceived racial/ethnic discrimination, and (4) preferences and expectations related to seeking and receiving pain care. The detailed clinical and research implications could serve as a blueprint for the providers and clinical researchers to address health disparities and improve care for Black individuals with CMP.PerspectiveThis narrative review illustrates conceptual models explaining the link between contextual determinants and psychological responses to pain among Black individuals with chronic musculoskeletal pain. We discuss 3 relevant conceptual models – socioecological, cumulative stress, biopsychosocial –, and 4 psychological factors: disproportionate burden of mental health, distinct coping strategies, perceived injustice/discrimination, preferences/expectations.     

Native American Children and Adolescents: Cultural Distinctiveness and Mental Health Needs

Native American families have powerful reservoirs for resilience. Many families experience oppression, exploitation, and poverty that contribute to mental health disturbances. Cultural traditions associated with harmony can promote positive mental health for Native American children and adolescents. Health care providers will benefit from knowing risks, cultural expressions of coping, and a framework for contextual assessment and intervention. The purpose of this paper is to respond to the challenge of developing practices, programs, and policies that are culturally sensitive and helpful for people who need nursing care.     

HEALTH CARE PROVIDERS' PERSPECTIVE OF THE GENDER INFLUENCES ON IMMIGRANT WOMEN'S MENTAL HEALTH CARE EXPERIENCES

The number of immigrants coming to Canada has increased in the last three decades. It is well documented that many immigrant women suffer from serious mental health problems such as depression, schizophrenia, and post migration stress disorders. Evidence has shown that immigrant women experience difficulties in accessing and using mental health services. Informed by the post-colonial feminist perspective, this qualitative exploratory study was conducted with seven health care providers who provide mental health services to immigrant women. In-depth interviews were used to obtain information about immigrant women's mental health care experiences. The primary goal was to explore how contextual factors intersect with race, gender, and class to influence the ways in which immigrant women seek help and to increase awareness and understanding of what would be helpful in meeting the mental health care needs of the immigrant women. The study's results reveal that (a) immigrant women face many difficulties accessing mental health care due to insufficient language skills, unfamiliarity/unawareness of services, and low socioeconomic status; (b) participants identified structural barriers and gender roles as barriers to accessing the available mental health services; (c) the health care relationship between health care providers and women had profound effects on whether or not immigrant women seek help for mental health problems.     

The impact of empirical studies of spirituality and culture on nurse education

Aims and objectives. The aim of this paper is to share reflectively how my empirical studies on spirituality and culture have had an impact upon nurse education. Background. Spirituality and cultural dimensions of care are considered to be integral to holistic care. The healing potentials of spiritual and cultural care are well documented. The commitment to the research programme came due to the concern within early literature on nursing that the provision of spiritual care for patients is inadequate. Methods. The research programme used action research comprising largely qualitative approaches. As the holistic and multiperspective nature of spirituality and culture requires a multidisciplinary approach and flexibility of methodology, various research techniques were used. Results. The findings from the research programme led to the development of theories, models and conceptual literature on spiritual and cultural care. In particular, two models evolved from the studies: the ASSET for spiritual cares education and training and the ACCESS for transcultural care practice. The critical incident studies provide insights into nurses’ roles in spiritual care interventions. The phenomenological study highlights that chronically ill patients use spiritual strategies in coping with their illness. Conclusion. Overall, the paper offers a body of evidence that has an impact upon curriculum development in nurse education and nursing practice. Relevance to clinical practice. The ASSET model offers a framework for spiritual care education. The ACCESS model offers a framework for transcultural care practice. The critical incident studies map out nurses’ roles in spiritual and cultural care with scope for development of care intervention models for the future. The coping mechanisms study highlights how patients use spiritual coping strategies such as prayer and other resources to cope with their chronic illnesses.     

The influence of culture on immigrant women's mental health care experiences from the perspectives of health care providers

It is well documented that serious mental health problems such as depression, schizophrenia, and post migration stress disorders exist among immigrant women. Informed by Kleinman's explanatory model, this qualitative exploratory study was conducted with seven health care providers who provided mental health services to immigrant women. Analysis of the data revealed that (a) immigrant women face many difficulties when accessing mental health care services due to cultural differences, social stigma, and unfamiliarity with Western biomedicine, (b) spiritual beliefs and practices that influence immigrant women's mental health care practices, and (c) the health care provider-client relationship, which exerts great influence on how immigrant women seek mental health care. The study also revealed that cultural background exerts both positive and negative influences on how immigrant women seek mental health care. We suggest that although cultural knowledge and practices influence immigrant women's coping choices and strategies, awareness of social and economic differences among diverse groups of immigrant women is necessary to improve the accessibility of mental health care for immigrant women.     

The importance of social support for rural mental health

While the mentally ill are considered to be vulnerable as a group, those who are mentally ill and reside in rural communities are at a greater disadvantage due to limited access to health care, a scarcity of resources, and traditional cultural belief systems. Social support has been found to have a direct effect on the well-being of families and individuals. Specific strategies are presented which will assist rural health nurses in providing the support systems necessary to help rural residents in managing and coping with stress and mental health problems.     

THE IMPORTANCE OF SOCIAL SUPPORT FOR RURAL MENTAL HEALTH

While the mentally ill are considered to be vulnerable as a group, those who are mentally ill and reside in rural communities are at a greater disadvantage due to limited access to health care, a scarcity of resources, and traditional cultural belief systems. Social support has been found to have a direct effect on the well-being of families and individuals. Specific strategies are presented which will assist rural health nurses in providing the support systems necessary to help rural residents in managing and coping with stress and mental health problems.     

Coping with predictable crises of diabetes

Although the role of emotional and psychosocial factors in diabetes is generally appreciated, most health care professionals, diabetic patients, and families of patients have no clear model that clarifies the nature of psychosocial variables and provides defined principles for effective treatment and preventative interventions. A multivariate clinical model for coping with predictable crises of diabetes is presented. The model is based on the constructs of crisis, coping, and social support as well as a developmental and life course perspective. The psychosocial tasks to be addressed in coping with crises, in general, as well as strategies of coping are defined and discussed. The specific predictable crises of diabetes are described with reference to the demands and sources of stress inherent in the critical situations and the associated strategies for coping with them. Special attention is given to coping with the initial diagnosis and onset of the disease, the role of health care professionals, and developmental issues in coping with diabetes.     

Preceptorship: Using an Ethical Lens to Reflect on the Unsafe Student

Patient safety has become a worldwide health concern, and health care professionals have a moral and ethical responsibility to promote patient safety. The clinical education of many health care professionals often involves a preceptorship or field experience wherein students are assigned to work one-to-one with a preceptor or field educator so that they can be socialized into the profession and receive a reality-oriented experience. Health care professionals who accept the responsibility of being a preceptor face additional workload and stress, especially when the students to whom they are assigned are not meeting the expectations of safe, professional practice. Taking a stand against unsafe students is an important way for preceptors to promote patient safety. Given the nature of the stress and the inherent ethical issues associated with precepting an unsafe student, it is useful to examine this experience through an ethical lens. Included in this article is a brief overview of preceptorship as a model of clinical education, together with a discussion of the nature of the ethical decisions that preceptors face when precepting an unsafe student. Ethical theories, namely, virtue ethics and utilitarianism, are also explored and serve to provide the ethical lens through which preceptors can reflect upon their experiences with unsafe students.     

Caring for a parent with Alzheimer's disease: process of daughter caregiver stress

This study aimed to explore the process of caregiver stress associated with the care of a parent with Alzheimer's disease, the perception of the relationship with the parent, the image of the caregiver role, and the contextual aspects of coping and social support relationships The grounded theory method was used to analyse the daughter caregiving process for 17 women Findings included substantive theory and 13 hypotheses This study provides an expanded awareness of the interrelationship between caregiver stress and the contextual aspects of social support, coping, and the nature of the prior filial relationship     

宫颈癌患者配偶照顾疲劳感及影响因素的研究

目的 探讨宫颈癌患者配偶的照顾疲劳感并分析其影响因素。方法 采用疲劳量表、照顾者压力量表、简易应对方式问卷对240名宫颈癌患者配偶进行调查。结果 宫颈癌患者配偶照顾疲劳总分为（8.92±1.64）分,85.00%的宫颈癌患者配偶处于中度、重度疲劳;与癌症患者配偶相比,躯体疲劳、心理疲劳及疲劳总分均高于癌症患者配偶且有统计学意义。其疲劳感受照顾时间、应对方式、身体心理健康状况及社交经济状况的影响。结论 宫颈癌患者配偶照顾疲劳感发生率高,临床医护人员应针对配偶照顾疲劳感的影响因素,对其实施有针对性的健康教育指导和干预措施,以减轻宫颈癌患者配偶照顾疲劳感,提高其生活质量及身心健康,进而提高对患者的照顾质量,促进患者疾病的康复。     

Stress and coping among families of patients with traumatic brain injury: a review of the literature

Aims and objectives. This literature review aims to structure the available information on the psychological reactions of family members confronted with traumatic brain injury. The stress–coping theory and the systems theory provide the theoretical framework for this review. Method. Literature review. Results. The level of stress experienced by the family members of patients who have traumatic brain injury is such that professional intervention is appropriate, even after 10–15 years. Not the severity of the injury but the nature of the injuries determines the level of stress. Partners experience more stress than parents. Children have specific difficulties. Young families with little social support, financial, psychiatric and/or medical problems are the most vulnerable. Coping with traumatic brain injury can be described in phases. The better family members can cope with the situation, the better the patient's recovery. There are functional and non‐functional coping mechanisms and coping is influenced by such factors as gender, social and professional support and the possibility to have reciprocal communication or an affective relation with the patient. Relevance to clinical practice. Support from professionals reduces the stress being experienced and encourages people to cope effectively. Conflicts with professional carers should be avoided. Every attempt should be made to develop models of long‐term support and care that alleviate sources of burden on relatives. Further research is necessary to develop such models.     

Ideas for the development of the interprofessional field

Gerontology and geriatrics are inherently multidisciplinary fields, incorporating a variety of perspectives, yet little systematic thought has been devoted to exploring the implications of this diversity for educational programs that are interdisciplinary in nature. This paper suggests a standard nomenclature for the use of the terms 'multidisciplinary', 'interdisciplinary', 'interprofessional' and 'team-based' to describe programs; considers the different structural or institutional levels within which these programs may be developed; explores the implications of various contextual settings such as acute care, long term care, community-based, and health promotion programs; summarises the kinds of changes in cognitive and value-related dimensions of professional practice that are the hallmarks of interdisciplinary programs; and, finally, suggests a set of criteria for achieving truly interdisciplinary education.     

Historic and Future Health Promotion Contexts for Nursing

Purpose: Health promotion in the United States has been narrowly defined focusing primarily on individual behaviors, risk factors, and lifestyle. This article traces the historic and conceptual roots of health promotion care in the United States and critically examines the direction nurses have taken in health promotion.
Scope: Health promotion care in Western ideology emphasizes the value of individuals and the importance of personal responsibility for success or failure.
Conclusions: Health promotion nursing interventions, based on the tenets of individual choice and knowledge, restrict the range of interventions. The complex nature of health promotion requires that nurses consider the economic, sociopolitical, and cultural context in which health care takes place. Recommendations are made for an expanded nursing role in health promotion, one that is consistent with nursing's underlying contextual focus and concern with environments.     

Knowledge of low birth weight care as a source of coping strategies for mothers: Cross sectional study in perinatology WARD'S

The lack of information on infant care can cause stress, contributing to poor coping strategies of mothers of low birth weight (LBW) infants. This study aimed to examine the relationship between knowledge on LBW infant care and mothers' coping strategies. Sixty mothers of LBW infants admitted to the perinatology ward, selected through a quota sampling method, participated in this study. The inclusion criteria were all mothers who have LBW infants with the following condition without congenital defects, not using respiratory aids, and able to drink orally. Data were collected through interviews using a three-part questionnaire: parental demographics and infant characteristics, the Maternal Knowledge Score, and the Coping Strategy Scale. A multiple linear regression analysis was employed using SPSS software version 20. The final model of analysis showed that after controlling for the stress level, a significant correlation existed between maternal knowledge on LBW infant care and coping strategies, implying that increased knowledge and decreased stress levels will improve mothers' coping. Therefore, it is recommended that nurses provide mothers and families with active and proactive learning opportunities through health education programs on infant care, which can increase the mothers’ confidence and improve their coping strategies.     

Cultural discovery in nursing practice with Vietnamese clients

BACKGROUND: Although there is a developing body of literature dealing with cultural care issues there is a continuing need for research based knowledge of how nurses work within a multicultural population in providing culturally competent care. Nurses' experiences with Vietnamese clients can contribute to the knowledge of how to provide cultural care. PURPOSE: The purpose of this 1997 study was to investigate what North American nurses learned from their work with Vietnamese clients. METHOD: A grounded theory approach was employed. A purposive sample of 27 Registered Nurses, who work with Vietnamese clients in North America, in acute care, community, and clinic settings were interviewed using a semi-structured format. Following ethical approval, an explanation of the study, and data collection, data were analysed using dimensional analysis. Verifiability, adequacy of the findings, and empirical grounding of the theory was established through use of the constant comparative method as well as review of the research method and the study results by selected participants in the study and a nursing expert. FINDINGS: The action process of cultural discovery was found as the most fruitful explanation of nurses' experiences. Properties of cultural discovery were learning to see them, seeing a common humanity, and learning to see how they see health. The condition of cultural discovery was making a connection with the consequences of learning how to provide sensitive care and a changed nurse. CONCLUSIONS: Nurses can learn to become more culturally competent in their care for Vietnamese clients. Nurses learned to be more aware of the differences among people of different cultures as well as recognizing common elements among different groups. They learned to broaden and redevelop their concept of health and to respect the social adjustments that the Vietnamese were making.