Congruent Care Research Articles

Barriers and Facilitators to the Implementation of a Community Doula Program for Black and Pacific Islander Pregnant People in San Francisco: Findings from a Partnered Process Evaluation

IntroductionIncreasingly, community-based models of doula care are receiving attention as possible interventions to address racial inequities in maternal health care experiences and outcomes. In 2018, community-based organization SisterWeb launched to provide free culturally congruent community doula care to advance birth equity for Black and Pacific Islander pregnant people, with funding from the San Francisco Department of Public Health. We conducted a process evaluation of SisterWeb’s first 1.5 years of existence to identify multilevel barriers and facilitators to implementation of their programs.MethodsGuided by the Equitable Evaluation Framework™, we conducted 46 in-depth interviews with individuals from 5 groups: SisterWeb leadership, doulas, doula mentors, and clients, and external stakeholders.ResultsBarriers included having diverse clientele groups with unique needs, an ineffective payment model, and simultaneously building an organization and developing and implementing programs. Facilitators included the presence of established strategic partnerships, positive reception of services due to an unmet need for culturally and linguistically congruent pregnancy and birth support among SisterWeb’s clients, a clear organizational vision and mission, and a unique doula cohort model.DiscussionOur findings suggest developing community doula programs pay close attention to the difference between launching a program versus an organization, including the required resources of each, the sustainability of payment models for community doulas, and the provision of culturally relevant, needed services within priority communities. Furthermore, strategic partnerships with maternal health stakeholders in birthing sites, particularly hospitals, are vital to the success of a community doula program.

Transkulturalno sestrinstvo u Srbiji - važan faktor jednakosti u zdravlju

Awareness of culture and transculturally oriented care is becoming increasingly important as the world becomes closer, more complex and multicultural, so there is a need to bring into focus the interests and practical application of all health professionals. In order to improve the health-oriented behavior of members of different cultural groups, and thus prevent the occurrence of negative conflicts and destructive behavior there is a need to develop transcultural nursing around the world and also in Serbia. Global trends in terms of migratory change, imply the need to change the current practice in education and application of transcultural nursing among nurses in order to improve the quality of health care in Serbia and thus achieve equality in the provision of culturally congruent health care.

ATIVIDADE FÍSICA EM GRÁVIDAS ADOLESCENTES COM HIPERTENSÃO: UMA PERSPECTIVA TRANSCULTURAL

ABSTRACT Objective: to describe the generic care practices related to physical activity in pregnant adolescents with hypertension attending a health institution in Sincelejo - Sucre, Colombia. Method: a qualitative ethnographic study of pregnant adolescents with induced hypertension, cared for in a health institution in Sincelejo - Sucre, Colombia. Data were collected from December 2017 to April 2018, using semi-structured in-depth interviews, participant observation, and field notes in the homes of the participants; an ethnographic analysis was performed, and semantic relationships were established. Results: generic care practices emerged in the coastal culture related to the physical activity of pregnant adolescents with hypertension, as well as the following subtopics: generic care practices considered physical activity to prevent increased blood pressure (walking every day, putting ice on one's head, lying on one's left side, among others) and generic care practices considered risky physical activity for blood pressure (not walking, having sex at the end of pregnancy, among others). Conclusion: generic care practices related to physical activity of pregnant adolescents with hypertension show the relevance of the body of knowledge that adolescents and their families have in the coastal cultural environment, which becomes the basis for the nursing professional to provide culturally congruent care and to apply the nursing care process, both at home and in the hospital, to contribute to maternal and perinatal health.

Inequity in Health Among People Living With Alzheimer's Disease and Related Dementias in Adult Day Centers

In adult day centers (ADCs), 58% of clients identify as racial/ethnic minorities, and at least 30% have Alzheimer’s Disease and related dementias (ADRD). ADCs offer culturally and linguistically congruent care to clients, making them well-positioned to address potential health disparities affecting persons with ADRD. We used data from 53 California ADCs (n=3,053) to identify differences in clinical characteristics among ADC clients’ with ADRD based on demographics such as race and English proficiency. We found that, when compared to their respective counterparts, a significantly greater proportion of racial/ethnic minorities and non-English speakers (p<.001) had 5 or more chronic conditions in addition to ADRD. We noted considerable missing data on race, likely because ADCs in California are not mandated to report data on race/ethnicity. In order to identify inequities in care within this complex population, social determinants of health, including race, must be a standard component of client assessment.

Older patients' and their caregivers' understanding of advanced care planning.

The aim of this study was to review the recent literature (2019-2021) on older patients' and their caregivers' understanding of advance care planning. Recent studies highlight the continued gaps in knowledge about advance care planning for older adults with cancer and their caregivers both domestically and abroad. The recent literature also revealed that there is a lack of research methodology to assess knowledge of advance care planning reliably and validly in older adults with cancer and their caregivers given the lack of uniform scales to measure knowledge of advance care planning. Older adults with cancer are at an elevated risk of death from their illness, and it is essential they understand how advance care planning can improve their quality of life, facilitate goal congruent care and ultimately decrease medical expenditures at end of life. In order to engage in a process such as advance care planning, patients must know what it is and how it can be helpful to them. The lack of understanding about advance care planning presents a significant barrier to patients engaging in the process. Public health campaigns to increase advance care planning knowledge are needed to ensure that older adults with cancer and their caregivers understand how this service can be helpful to them as they approach end of life.

Providing culturally congruent care.

Providing culturally congruent care.

Juntos: A Model for Language Congruent Care to Better Serve Spanish-Speaking Patients with COVID-19.

Coronavirus disease 2019 (COVID-19) exacerbated pre-existing health disparities and disproportionately affected the Latino community. Clinicians identified communication barriers as a major challenge in care for COVID-19 Latino patients with limited English proficiency (LEP). To address these challenges, Juntos (Together) consult service was established to promote language-congruent care with cultural sensitivity, identify barriers to safe discharge, and facilitate referral to appropriate resources. Spanish speaking volunteer health care providers worked synergistically with medical teams caring for LEP Latino patients. Volunteers were trained on consultant responsibilities and discharge planning resources. The program was evaluated by a satisfaction survey distributed to providers who requested a Juntos consult and Juntos volunteers. Between May 5 and July 30, 2020, 19 individuals volunteered time to the Juntos consult service, 12 (63%) Latinos, 14 (74%) physicians, and 5 (26%) staff. The service supported 127 patients, 76 (60%) males, mean age 42 (±16), 83 (65%) uninsured, and 91 (72%) without primary care. The most common referral sources were medical units (52, 41%) and intensive care units (47, 37%). The most common services offered were family engagement (55, 43%), goals of care (35, 28%), and mental status assessment (26, 20%). The majority of providers who consulted Juntos were very satisfied (48/59, 81%) with the care delivered. The Juntos service offered critical support tailored to the patients' and primary teams' needs. The experience reinforced the need for cultural-based communication to provide optimal care to LEP patients. The Juntos consult service could be a model for providing language-congruent care even beyond COVID-19, but to do so will require institutional investment and rigorous outcomes evaluation.

Bariatric surgery in the Middle East and North Africa: narrative review with focus on culture-specific considerations.

There is an increasing volume of bariatric surgeries in the Middle East and North Africa (MENA), but the context of bariatric surgery in the region is not fully understood. Incorporating culture-specific considerations in the provision of care to patients who undergo bariatric surgery may help to optimize outcomes after surgery. We conducted a narrative review of published research studies on bariatric surgery in the MENA region, highlighting cultural and contextual aspects relevant to the care of bariatric surgery patients who undergo surgery in this geographic area. The authors searched the following online databases: PubMed, CINAHL, Embase, and Academic Search Elite from 2010-2020 for studies conducted in 18 countries in the MENA region. This narrative review identifies cultural-specific considerations that may affect bariatric care and outcomes in 6 domains: knowledge of bariatric surgery; mental health, body image, and quality of life; influence of family; religion and lifestyle; preoperative practices; and healthcare access. Provision of culturally congruent care may help patients to achieve the best possible outcomes after bariatric surgery. Results may inform efforts to provide safe and culture-specific care in the MENA region, as well as those who migrate or seek care in other countries. More research is warranted on this heterogeneous population to optimize postsurgery weight trajectory and psychosocial adjustment.

What Matters Most to Older Chinese Adults.

Introduction:Although an abundance of gerontological research has focused on subjective well-being, quality of life, and life satisfaction, we know little about what matters most to older adults in sub-cultural groups. The purpose of this study was to explore what matters to older Chinese adults.Methods:The study used a qualitative interpretive design, drawing influences from phenomenology and constructed meaning through participants’ lived experiences.Results:After data analysis, a core theme of cultural foundations and categorical themes emerged. This study emphasized the importance of hearing the voices of Chinese older adults and how they viewed well-being, quality of life, life satisfaction, and health care.Discussion:The findings of this study have added to the body of existing knowledge of what matters most to older adults. These insights may advance nursing as it pertains to culturally congruent health care.

Identifying Gaps in LGBTQ Health Education in Baccalaureate Undergraduate Nursing Programs.

The lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) population historically has faced stigma and discrimination, including in health care. Although discrimination in health care generally has improved, barriers to culturally congruent care remain. Education for nurses and other health care workers is key to addressing these barriers; however, little is known about the status of LGBTQ health education in nursing schools. A survey on LGBTQ health education provided to undergraduate nursing students was sent to all Commission on Collegiate Nursing Education-accredited schools. Nearly two-thirds of responding schools indicated their graduates were not adequately prepared to care for this population, and 38% of schools agreed their faculty had the knowledge needed to adequately teach this content. Barriers included time constraints and lack of faculty knowledge. In addition to a need for expanded LGBTQ health education for students, there is a need for faculty education about LGBTQ content. [J Nurs Educ. 2021;60(10):552-558.].

Methods, Ethics, and Cross-Language Considerations in Research With Ethnic Minority Children.

Qualitative research seeking the perspectives of minority children on child health issues such as childhood obesity and healthy weight care is limited, especially in nursing research. Our objective is to share methodological, ethical, and cross-language knowledge gained from conducting an ethnonursing research study. This study focused on providing a voice for ethnic minority children in childhood obesity literature. The purpose of the study was to discover cultural influences on healthy weight care in children of Burmese refugees of Karen ethnicity. Researchers may exclude children of ethnic minorities from studies because of the distinct challenges in conducting cross-language research and research with children. We critically examine these challenges. The challenge of being a stranger was addressed by a period of immersion in the children's activities prior to data collection, in addition to volunteering as an English teacher with Karen adults. The immersion period was crucial for developing the trust needed in child-inclusive research and research in ethnic minority communities. The challenge of designing an inclusive study with families who experience language barriers was addressed with an interpreter who not only spoke Karen but was also a part of the Karen community. The interpreter provided the authentic sociocultural language equivalence needed for the study's rigor. Ensuring the child's voice was clearly heard was addressed with member checking. Methodological changes necessitated by a pandemic were a distinct challenge discussed in detail. We described methods useful for nurse researchers seeking transformative knowledge to reduce health disparities in childhood obesity. Nurse researchers may use these methods related to cross-language research and child research for designing research inclusive of minorities with language barriers. The perspectives of children from ethnic minorities are needed to inform culturally congruent healthy weight care for their communities. The goal in providing transparency of the difficulties, successes, and recommendations for methods in research with children of Burmese refugees is to encourage more nurse researchers to work with marginalized groups. Nurse researchers can inform evidence-based, culturally appropriate interventions to address health inequities of minority communities by including the voice of children from these communities.

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.

Marginalized patient identities and the patient-physician relationship in the cancer care context: a systematic scoping review.

We sought to examine and categorize the current evidence on patient-physician relationships amongmarginalized patient populations within the context of cancer careusing a systemic scoping review approach. Web-based discovery services (e.g., Google Scholar) and discipline-specific databases (e.g., PubMed) were queried for articles on the patient-physician relationship among marginalized cancer patients. The marginalized populations of interest included (1) race and ethnicity, (2) gender, (3) sexual orientationand gender identity, (4) age, (5) disability, (6) socioeconomic status, and (7) geography (rural/urban). Study screening and data extraction were facilitated through the Covidence software platform. Of the 397 screened studies, 37 met study criteria-most articles utilized quantitative methodologies (n = 28). The majority of studies focused on racial and ethnic cancer disparities (n = 27) with breast cancer (n = 20) as the most common cancer site. Trust and satisfaction with the provider were the most prevalent issues cited in the patient-physician relationship. Differences in patient-physician communication practices and quality were also frequently discussed. Overall, studies highlighted the need for increased culturally congruent care among providers. Results from this review suggest marginalized cancer patients face significant barriers in establishing culturally and linguistically congruent patient-physician relationships. Future studies should focus on the intersectionality of multiple marginalized identities andoptimization of the patient-physician relationship.

Nurse Practitioner Students' Perceptions on Delivering Culturally Congruent Care to Vulnerable Mexican Immigrants: A Qualitative Study.

Increasingly, nurse practitioners serve as vanguards in providing primary health care to vulnerable Mexican immigrants. The aims of this study were to explore the lived experiences of nurse practitioner students in caring for Mexican immigrant patients and to capture their meaning of cultural influences deemed essential to the delivery of culturally congruent care. An exploratory descriptive design was employed. Purposive sampling was used to select 17 nurse practitioner students who volunteered to complete a semistructured face-to-face audio-taped interview and follow-up focus group discussion. Constant comparison was utilized to analyze data. From this process, four distinct themes emerged: Culturally congruent care extends beyond race and ethnicity, understands the importance of therapeutic communication, accepts complementary and alternative medical modalities, and recognizes the importance of eating patterns, food choices, and perceptions of ideal weight and health. These findings build on our understanding of key evidence-based cultural beliefs and practices that are important in delivering culturally congruent care to this subgroup.

The impact of cultural immersion service learning on BSN graduates: A quasi-experimental evaluation

Aim/ObjectiveThe cultural immersion service-learning model evaluated in this study sought to facilitate cultural consciousness of culturally congruent nursing care among predominantly White nursing students attending a university that was racially and culturally homogeneous. BackgroundEvidence supports the use of cultural immersion service learning during undergraduate nursing programs in developing the skills necessary for effective transcultural healthcare; yet, little is known about its impact beyond the semester of the experience. DesignThis project used a quasi-experimental design to determine if transcultural self-efficacy of BSN graduates among five campuses differed. MethodsOne campus of the five conducted a mandatory cultural immersion service-learning experience during the graduates’ junior year. From a population of 94 BSN graduates of which 30 (32%) graduates participated in the cultural immersion service-learning experience, 53 completed the Transcultural Self-Efficacy Tool. Eighteen (34%) of the graduates who participated in the cultural immersion service-learning experience participated in this study. ResultsThe transcultural self-efficacy was significantly greater in those graduates who participated in the cultural immersion service-learning experience; yet, no difference was found among graduates of the four campuses not offering the experience. ConclusionsThe cultural immersion service-learning experience seems to provide nursing students from racially and ethnically homogeneous communities with an experiential learning context which facilitates the development of transcultural self-efficacy.

Interventions to Improve Medication Adherence in Ethnically Diverse Patients: A Narrative Systematic Review.

Ethnically diverse patients often have lower medication adherence relative to Whites. Certain ethnic groups are also more susceptible to cardiovascular and related diseases. It is critical to develop culturally tailored interventions to improve medication adherence in these ethnically diverse patients. Thus, the aim of this systematic review was to identify what interventions have been developed and tested to improve medication adherence in ethnically diverse patients with cardiovascular-related diseases. A systematic search of peer-reviewed literature (MEDLINE, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane Central Register of Controlled Trials) was conducted to identify relevant articles. The narrative synthesis was performed based on elements offered by Popay et al. The mixed methods appraisal tool was used to appraise the quality of the included studies. A total of 11,294 records were retrieved, and 34 articles met the inclusion criteria for this systematic review. Synthesis of the literature revealed four overarching intervention strategies used to improve medication adherence: pharmacist-mediated, primarily nurse-led, community-based and community-health worker led, and text-message and phone-based. Several approaches can be used to improve medication adherence in ethnically diverse patients, although details on the approaches and conditions to produce optimal improvements for particular ethnic groups need to be determined in future studies. How does this affect culturally congruent health care?

Factors Influencing Transcultural Self-Efficacy Among Nurses With Foreign Patient Care Experience.

As the cultural diversity among patients increases, it becomes important for nurses to be prepared and efficient in providing culturally congruent care. The purpose of this study is to examine the factors influencing transcultural self-efficacy (TSE) among Korean nurses. A descriptive cross-sectional survey was used, and 131 nurses with foreign patient-care experience were recruited from a university tertiary hospital. The mean TSE score of participants was 5.27 out of 10 (SD = 1.50). The practical subscale of TSE was the lowest, while the affective subscale was the highest. A regression analysis revealed that education level, cultural competence, and intergroup anxiety are predictors explaining 58.8% of its variance (F = 27.5, p < .001). A low level of TSE causes avoidant behavior and ineffective communication in foreign patient care, resulting in unsatisfactory clinical performance. Effective education programs and administration guidelines may be critical for nurses to improve their TSE.

Improving end of life care with advance care planning in a rural cancer center.

e18637 Background: We discovered four out of five Medical Oncology patients admitted to the hospital December 2019 and January 2020 were discharged to hospice and died within a week. None of those patients had advance directives. In November and December 2019, all oncology patient charts were reviewed and only 7% (12/174) had advance directives. We believe an established advance directive could have helped avoid unnecessary hospitalization, improved end of life care and reduced wasteful health care costs. This led to the question: Would process changes in a rural cancer center lead to an increase in completion and documentation of Advance Directives, thereby providing more patient goal congruent care? Methods: Data collection and process mapping was performed revealing current processes and overall barriers. This was analyzed and countermeasures were developed leading to process changes and interventions. The interventions included assigning dedicated staff to “own” the advance directives education, follow up and completion, training and certification of staff, and education of the entire Cancer Center on the new process and interventions. The new process included a standardized order set to cue a referral to the dedicated staff, standardized patient education and follow up and documentation consistencies. Results: The initial data collection revealed an advance directive completion rate of 7% in new oncology patients. Process inconsistencies and communication deficiencies, with redundant screening and no follow up, created significant barriers to advance directives. Repeat data collection after creating a position for dedicated staff to educate patients and help with advance directive completion revealed a completion and documentation rate of 6% and thus, was insufficient to lead to change. When a consistent process with formal communication to the dedicated staff was implemented, improvements were noted. Our most recent data collection revealed a 36% completion and documentation rate in advance directives. Conclusions: Lack of effective advance directive programs potentially lead to end of life care incongruent with patients’ wishes and wasteful of health care resources. An advance directive ensures that if a patient is unable to clearly communicate their wishes, these wishes are still honored. In addition, the advance directive can help avoid unnecessary hospitalizations, improve end of life care and reduce wasteful health care costs. As a rural cancer center with a limited service area, we are challenged with a small sample size. Practice will be needed to ensure consistency and efficacy of the current interventions in order to support continued improvement in completion and documentation rates of advance directives. This project will be expanded to address advance directives for all patients.

The Perceptions of Patients, Families, Doctors, and Nurses Regarding Malignant Bone Tumor Disclosure in China: A Qualitative Study.

IntroductionWithholding the malignant bone tumors disclosure from patients is common in China. The purpose of the study was to explore the perceptions of patients, families, doctors, and nurses regarding the disclosure of malignant bone tumors in China.MethodSemistructured interviews were conducted with 25 cases, consisting of 69 participants (14 patients, 25 family members, 17 doctors, and 13 nurses), and the transcripts were analysed using Colaizzi’s (1978) descriptive phenomenological analysis process.ResultsFive themes were identified: (1) doctors preferred to inform the family members first, (2) family members’ decisions depended on different situations, (3) the patients agreed that disclosure should be different for each person/personally, (4) care from nurses reduced the overreaction of patients, and (5) key points improve the informing quality.DiscussionFamily participatory cancer disclosure and multidisciplinary teams could improve the quality of cancer disclosure. Culturally congruent health care and culturally sensitive interventions in cancer disclosure are suggested.

A Concept Analysis on Culturally Congruent Care

Background: Culturally Congruent is providing quality care that promote cultural competency. This include extreme humility and extreme openness and acceptance of different culture in beliefs, values, and discipline.Purpose: This study aims to provide quality patient care despite the challenges in the healthcare plans like misinformation, mistrust and misinterpretation. The nurse should provide quality health care that suit to patient culture.Methods: The method use is a case analysis. The eight steps of this method are: 1) Selecting a concept; 2) Determining the aims or purposes of analysis; 3) Identifying all uses of the concept; 4) Determining the defining attributes of the concept; 5) Constructing a model case; 6) Constructing borderline, contrary, invented, and illegitimate cases; 7) Identifying antecedents and consequences; and 8) Defining empirical references.Results: The theory of culture care emphasizes in the uniqueness of nursing as a means to know and help the culture in the field of clinical practice. Culturally based care factors are recognized as major influence upon human expressions related to health and illness. The theory also serves as guide to nurses’ thinking, practice and in research development.Conclusion: Integrating cultural competence models will promote effectiveness in nursing practice.