Congruent Care Research Articles

Indigenous nurses' practice realities of cultural safety and socioethical nursing.

Persistent healthcare emphasis on universal moral philosophy has not advantaged indigenous and marginalised groups. Centralising cultural components of care is vital to provide ethical healthcare services to indigenous people and cultural minorities internationally. Woods' theoretical explication of how nurses can integrate cultural safety into a socioethical approach signposts ethical practice that reflects culturally congruent relational care and systemic critique. To demonstrate the empirical utility of Woods' ethical elements of cultural safety within a socioethical model, through analysis of indigenous nurses' practice realities in Aotearoa New Zealand. The study used a qualitative indigenous narrative inquiry. Participants were recruited nationally. Twelve Māori registered nurses and nurse practitioners were interviewed. All participants provided direct care in either primary or secondary health services. Research approval was gained from the Human Ethics Committee of the lead author's tertiary institution. Participation was voluntary, and written informed consent was obtained. Analysis highlighted the following: (1) cultural needs, which for Māori were integral to care, were easily subsumed by clinical care being prioritised; (2) ethical care by non-indigenous nurses requires critical reflection about broader equity issues that impact Māori disengagement from healthcare; (3) retention of indigenous nurses was seen as essential because their advocacy and the cultural 'fit' for Māori contributed to positive healthcare outcomes; and (4) committed leadership ensured culturally safe care was not eroded through workplace efficiencies. The data provide rich representation of Woods' model. The data indicate that nurses must engage reflexively with a relational ethic of care and social justice dimensions in order to deliver culturally safe care. Woods' model provides a critical lens for nurses to examine their relational practice and systemic factors that enhance or detract from culturally safe care when caring for members of any indigenous group.

Around the Corner, Across the Globe

Nursing educators wrestle with preparing the future nursing workforce to meet the needs of underserved, vulnerable populations in marginalized communities who suffer significant health disparities and social injustices. This article illustrates the integration of engaged civic learning (ECL) within a social justice framework that prepares baccalaureate nurses as global citizens to provide culturally congruent health care around the corner in local communities and learning abroad programs across the globe.
 Multiple partnerships with local organizations were strengthened, with ECL integrated across the nursing curriculum and aligned with local needs of community housing, schools, churches, shelters, and fitness centers. The nursing faculty collaborated with language professors to develop a Spanish for Health Professions program to increase communication between students and the high percentage of Spanish-speaking populations served locally and globally.
 A mixed-methods design evaluated program outcomes using descriptive data, student reflections, and the Global Perspective Inventory (GPI) to assess students’ experiences and global learning related to learning abroad during their college experience. Results from pre-surveys to post-survey results showed significant improvement (p < .05) in global learning in 16 of 35 question items. As students journey from entrance into nursing school until graduation, ECL develops them into engaged global citizens.

The influence of the oncology-focused transgender-simulated patient simulation on nursing students' cultural competence development.

Disparities experienced by transgender patients, especially in cancer care, leads to poorer outcomes and overall health. Simulation, using transgender simulated patients (SPs) with a focus on cancer care can be an effective way to foster cultural competence nursing education. Guided by the National League for Nursing (NLN)/Jeffries Simulation Theory and Cultural Competence and Confidence Model, this grant funded pretest (n = 48) and posttest (n = 41) comparison group, quasi-experimental study aimed to understand changes in students' transcultural self-efficacy (TSE) following the transgender-simulated patient simulation (TSPS) focusing on an oncological emergency management. Developed by following recommended guidelines and standards, the TSPS had content validity review and pilot testing. It aimed to improve students' knowledge, skills, and attitudes with regard to providing culturally congruent nursing care. The statistical methods included paired sample t-tests, independent t-tests, and correlation analyses. Students who participated in the TSPS intervention had significantly higher posttest TSE scores (P < .05). SP methodology can be an effective way to foster cultural congruence in nursing care. The findings contribute to the importance of continuous efforts for the inclusion of lesbian, gay, bisexual, transgender, queer (LGBTQ) topic in nursing education to enhance culturally congruent care.

Understanding the Impact of Historical Trauma Due to Colonization on the Health and Well-Being of Indigenous Young Peoples: A Systematic Scoping Review.

Introduction: Indigenous Peoples are experiencing the ongoing effects of colonization. This phenomenon, historical trauma (HT), helps to address the current ill-health disparity. Aim of this scoping review was to identify sources of evidence available to understand the impact of HT on Indigenous young peoples. Method: A scoping review was conducted on available evidence-based literature. Article quality was assessed using validated quality appraisal tools. Synthesis was conducted with predefined levels of impact. Results: Consistent with the literature, the themes and levels of impact were interrelated. Despite this, studies predominately reported a singular focus with limited discussion of protective factors. Discussion: HT continues to have a profound impact on Indigenous young peoples across Canada, Australia, New Zealand, and the United States. Protective factors for HT were evident within Indigenous research designs. Future research should ensure a multilevel focus to explore intergenerational strength and how this influences culturally congruent health care.

Assessing Self-Reported Competence Among Registered Nurses Working as a Culturally Diverse Work Force in Public Hospitals in the Kingdom of Saudi Arabia.

Introduction: Nurses in the Kingdom of Saudi Arabia (KSA) represent a multicultural workforce who are educated in different countries from around the world. The purpose was to assess professional competence among a multicultural workforce of registered nurses in KSA in relation to individual and work-related factors. Method: The Nurse Professional Competence Scale was used in a cross-sectional design. Results: Registered nurses (N = 541) reported highest scores for "nursing care," and "value-based nursing care," and lowest scores for "care pedagogics," and "development, leadership, and organization of nursing care." All CAs achieved 0.80 or more Cronbach's alpha. Known-group validity was verified by comparing nurse managers and staff nurses competence in organization, administration, and leadership of nursing care (p = .000). Discussion: There is room for competence development in care pedagogics, and development, leadership, and organization of nursing care. Assessing registered nurses competence is of importance for planning and implementing cultural congruent nursing care.

Lifestyle and Cultural Factors Related to Longevity Among Older Adults in the Northeast of Thailand.

Introduction: Healthy longevity is important in older adults. The lifestyle and cultural background are likely related to longevity. This study explored lifestyles and Buddhist Thai culture relating to longevity, and evaluated activities of daily living (ADL), body mass index (BMI), and mental health. Method: A mixed method using concurrent embedded strategy was employed. Qualitative data collection included observation and in-depth interviews with 30 older adults aged 80 years and above from Northeastern Thailand. Quantitative data: Barthel ADL, BMI, and Thai Geriatric Mental Health Assessment (T-GMH-A) were assessed. Content analysis was applied using the Strauss and Corbin method. Results: Four major themes were, promoting physical activities, prevention and control of diseases, mental health management, and Buddhist socio-Thai culture. Means of Barthel ADL, BMI, and T-GMH-A were 19.0 (SD 1.1), 21.34 (SD 3.07), and 53.53 (SD 7.22), respectively. Discussion: These factors greatly influenced longevity and well-being. Culturally congruent care should be implemented to health care services.

Psychological concerns of Indian women with breast cancer in different national contexts: a systematic review and mixed-methods synthesis

BackgroundBreast cancer is becoming the most common cancer among women of Indian origin. However, little is known about the psychological impact of the disease and its treatment among this population.AimTo...

Care for LGBTQIA Communities When Advocacy Is All About Inclusion: A Conversation With Jackie Baras, MSN, MBA, RN.

Nurses have the obligation and duty to care for all people (American Nurses Association, 2015), and to treat them with dignity, respect, and compassion (Fowler, 2015). To address equitable care of LGBTQIA people in her community, Jackie Baras, MSN, MBA, RN, serves as LGBT Navigator at Robert Wood Johnson University Hospital/RWJBarnabas Health in New Brunswick, New Jersey. As a transgender woman, Jackie advocates as liaison and representative for all LGBTQIA patients and employees, focusing on health promotion and disease prevention, addressing knowledge gaps, and identifying community referrals, while working closely with hospital and clinical leadership to ensure that health-care services are coordinated seamlessly. Here, Jackie discusses her advocacy for equitable care for LGBTQIA communities, and ways nurses can provide culturally congruent care.

The Cultural Perceptions of Healthy Eating in Mexican American Children: A Focused Ethnography.

Introduction: Obesity in Mexican American children is reaching epidemic proportions. Improved understanding of children's healthy eating perceptions in culturally diverse populations is needed. The purpose was to describe the meanings and experiences associated with healthy eating from the perspective of Mexican American children. Methodology: The design was a focused ethnography. Midwestern children, aged 11 to 13 years, were interviewed in home and school settings. Leininger's four phases of qualitative data analysis was used to analyze data. Parental consent/child assent was obtained. Results: Twenty-one children were interviewed. Two themes emerged: (a) Mexican American children connect healthy eating with familiar foods in the context of their ethnic culture; and (b) foods that provide feelings of happiness and well-being are associated with healthy eating. Discussion: This study provides a clear understanding of the meaning and perceptions of healthy eating from the perspective of Mexican American children and offers data to promote culturally congruent care.

“I want to go home”: How location at death influences caregiver well-being in bereavement

Goal concordant or congruent care involves having expressed wishes upheld. Yet, the preferred location for end-of-life care may be unaddressed. Caregiver-patient congruence between preferred and actual locations of care may influence the quality of life in bereavement. The study aimed to explore how the congruence between caregiver-patient preferred and actual locations of death influenced well-being in bereavement. Mixed methods were employed. In-depth in-person interviews were conducted with 108 bereaved caregivers of a hospice patient about 4 months after the death. An interview guide was used to collect quantitative and qualitative data: demographics, decision-making, Core Bereavement Items (CBI), Health Related Quality of Life, and perspectives on the end-of-life experiences. Data were analyzed with a convergent mixed methods one-phase process. Patient preference-actual location congruence occurred for 53%; caregiver preference-actual location congruence occurred for 74%; caregiver-patient preference and location of death occurred for 48%. Participants who reported some type of incongruence demonstrated higher levels of distress, including more days of being physically and emotionally unwell and more intense bereavement symptoms. The Acute Separation subscale and CBI total scores demonstrated significant differences for participants who experienced incongruence compared with those who did not. Preference location congruence themes emerged: (1) caregiver-patient location congruence, (2) caregiver-patient location incongruence, and (3) location informed bereavement. Congruence between a dying person's preferred and actual locations at death has been considered good care. There has been little focus on the reciprocity between caregiver-patient wishes. Discussing preferences about the place of end-stage care may not make location congruence possible, but it can foster shared understanding and support for caregivers' sense of coherence and well-being in bereavement.

Muslims’ Affective and Cognitive Attitudes towards Formal Dementia Care in South Africa: Do They Vary according to Family Structure and the Experience of Familial Caregiving?

Background: The feelings and beliefs of some social groups sharing the same values about formal care institutions impacts their likelihood of using such services. Socialisation theory posits that there should not be any difference in attitudes towards formal care in the Muslim community, as they are influenced by the principles of Confucianism. However, demographic, epistemological, and socio-economic trends, as well as globalisation, may be impacting the efficacy of caring for people with dementia (PWD) at home. Objective: This study examines the affective and cognitive attitudes of South African Muslims towards formal care, and whether they vary according to family structure and experience with informal dementia care. Methods: We conducted a survey, administered in the form of an online questionnaire, of Muslim families across each of the 9 provinces of South Africa. The topics addressed included the demographics of the respondents, whether they had experience with informal dementia care, the structure of their family, and affective and cognitive attitudinal variables. Results: 422 responses were analysed, with the results demonstrating negative attitudes across family structures and experience with informal dementia care. This indicates that the changes brought about by economic development and globalisation are not impacting the social influence of the Islam religion towards caregiving. Conclusion: With up to 90% of PWD moving into formal care before they die in some countries, governments and other service providers of formal care need to provide culturally congruent care. There is also a need to build relationships with minority social groups that are not cared for by geriatric service organisations (governmental and non-governmental) in order to break down the negative attitudes that families have about formal care, and provide the families caring for PWD at home with coping strategies and support programmes to enhance the caregiving experience.

Culturally Congruent Care From the Perspectives of Judaism, Christianity, and Islam.

Introduction: Judaism, Christianity, and Islam are three world religions that occupy much of the world stage in health care, journalism, and media. Nurses frequently provide care for representatives of these groups. Culturally competent nurses recognize that there are differences and similarities within and between these religions. Methodology: This article incorporates findings from a scholarly review of the literature and transcultural nursing/health care principles and is guided by Leininger's Culture Care Diversity and Universality Theory. It discusses the roots from which these religions emerged, and the similarities and differences in religious beliefs and practices as pertained to health care. Conclusion: Nurses and other health care professionals may use knowledge presented in this article to conduct individualized cultural assessments and provide culturally congruent health care to Jewish, Christian, and Muslim populations. Leininger's three culture care modes of decisions and actions offer a creative approach to providing meaningful and helpful culturally sensitive care.

American Roma: A Cultural Care Case Study.

This case study depicts the cultural conflict that occurred when an American Roma (Gypsy) woman delivered her baby at a small hospital that had no knowledge or experience with the Roma culture. The case is analyzed based on the three modes of nursing actions and decisions for culturally congruent nursing care, an important tenet of Leininger's culture care theory. Culture care preservation and maintenance efforts included enabling family presence, respecting the culture's moral code, and acknowledging child-rearing norms. Cultural care accommodation and negotiation focused on the patient's hospital room accommodation, negotiating adherence to identification and security measures, and formulating the discharge plan. Cultural care repatterning and restructuring was not attempted. Recommendations for nursing practice are made based on this case, migration trends, and recent cultural changes.

The care provided by the family to the premature newborn: analysis under Leininger's Transcultural Theory.

To analyze the care practices of family members of premature infants admitted to a Neonatal Intensive Care Unit in the light of Leininger's transcultural theory. Qualitative, descriptive and exploratory study. Participant observation and semi-structured interviews were conducted with 16 family members of newborns, admitted to the neonatal unit of a public maternity hospital, during the months of May and June 2019. The software called Interface de R pour analyses Multidimensionnelles de Textes et de Questionnaire ® and the Bardin Content Analysis technique. Two thematic categories emerged: Family care in the neonatal unit; (in)effective support for shared care. The participation of families in the care of babies is still unstable, but it must be an inseparable element of culturally congruent care, thus collaborating with the full recovery of the premature.

English

The study was undertaken to explore the influence of cultural practices on birth experiences of first-generation Nigerian women (FGNW) living in London, with the objective of highlighting factors within emic and etic care that may influence birth outcomes for this population. The study entailed an exploratory, descriptive, contextual and qualitative methodology organised in two stages. Focus group discussions and semi-structured interviews were conducted with self-identifying FGNW with retrospective birth experiences, and eight non-Nigerian and four Nigerian midwives providing maternity care for this population. Second part entailed prospective study of FGNW at three intervals during a birth continuum. Combined epistemologies of culture care and trans-cultural theory were adopted. Thematic and ethno-nursing analytical approaches of identifying, analysing and reporting patterns and themes within the data ensued. Findings indicate that culture exerts a significant influence on birth and maternity care experiences of FGNW as care meanings are embedded in cultural values and beliefs, economics of family and other support networks, diaspora environment, culture of expectations, rituals and taboos, kinship of support, and immigration barriers in their negotiation of maternity care. Conflicts were uncovered between FGNW’s cultural and midwives professional care as aspects of FGNW’s cultural practices warrant preservation, negotiation; re-patterning to ensure continuing perinatal health and wellbeing. Culture Care Midwifery Model is espoused as a model to guide midwives in providing culturally congruent care that will meet the care needs of FGNW and optimise their health and wellbeing through birth continuum. Key words: Birth, culture, culture care, cultural congruence, emic care, ethno-nursing theory, etic care, family, kinship.

Top Ten Tips Palliative Care Clinicians Should Know About Psychosocial and Family Support.

Palliative care (PC) is perhaps the most inherently interdisciplinary specialty within health care. Comprehensive PC is delivered by a core team of physicians, nurses, social workers, spiritual care providers, pharmacists, and others who address the broad range of medical, psychosocial, and spiritual needs of those living with serious illness. While PC clinicians are typically skilled in screening for distress, the best path to follow when patients screen positive for psychosocial distress or exhibit mental health challenges may not always be clear. This article brings together the perspectives of experienced social workers practicing across PC and hospice settings. It seeks to identify opportunities and rationale for the integration of palliative social work (PSW) in the provision of quality, person-centered, family-focused, and culturally congruent care for the seriously ill. Increasing recognition of the impact of social determinants of health highlights the critical importance of including PSW if we are to better understand and ultimately address the broad range of factors that influence people's quality of life.

Hegemonic Masculinity Attitudes Toward Female Genital Mutilation/Cutting Among a Sample of College Students in Northern and Southern Sierra Leone.

Introduction: Female genital mutilation or cutting (FGM/C) is a public health problem. Approximately three million women and girls undergo FGM/C every year, worldwide. The purpose of the study was to assess the influence of education on hegemonic masculinity attitudes between male and female students and whether parental education differentiated the groups. Method: A cross-section design was used. Data were collected through a survey response from 338 students in May 2017. The data were analyzed using chi-square and correlational tests. Results: Education did not change the attitudes of students toward FGM/C (χ2 = 3.64, p = .16); however, parental education had an influence on both male and female students' attitudes toward FGM/C. Discussion: The study suggests that education alone may not be sufficient to end FGM/C practice. A comprehensive community-led strategy incorporating culturally congruent health care to involve multiple parties of health professionals, religious leaders, government, and policy makers may be needed to address the problem.

Social Processes Affecting the Workforce Integration of First-Generation Immigrant Health Care Professionals in Aging Citizens in the Netherlands.

Introduction: Within a Dutch nursing home, the prevailing workforce culture was challenged by new personnel, which caused institutional change, which in turn, affected workforce integration. The purpose of this study was to examine social processes affecting workforce integration of first-generation immigrant health care professionals in aging citizens in a Dutch health institution in the Netherlands. Method: A purposive sample of 10 immigrants and 10 established nurses was recruited. Ethnography was used to guide this study. 105 hours of participant observation, 8 semistructured interviews with 4 immigrants and 4 established nurses, and 2 focus-group discussions with 8 immigrants and 6 established nurses. Results: The study identified various processes that affect culturally congruent care in the nursing home, like the imposing professional norms, the use of "weapons of the weak," mutual suspicions of indifference, and collective images of "us" versus "them." Both groups conceived the "others" as the source of their discomfort, however, both had pain of not mattering. Discussion: When recruiting international educated nurses "all nursing staff" face difficulties when going through the precarious process of mutual integration in daily care practices. We recommend that nurse leaders facilitate positive intergroup interactions that promotes reciprocity for all groups of nurses for better health care outcomes for all.

Survivorship Care Practices and Confidence of Oncology Nurses in Singapore: A Cross-Sectional Study

Introduction: Cancer survivorship care is challenging because little is known about delivering comprehensive and coordinated survivorship care practices (SCP) to patients. The purpose of this study is to examine oncology nurses' perceptions of responsibilities of SCP, confidence levels of SCP, and factors that influence provisions of SCP. Method: A descriptive cross-sectional study was conducted using the Cancer Professional Questionnaire. Analysis was conducted using independent t-test and analysis of variance to examine the differences between variables. Results: Nurses (n = 147) agreed that it was their responsibilities to provide SCP, but the majority lacked the confidence to do so. Significant differences were found in the confidence levels of nurses with different education attainments (p = .004). A lack of time and educational resources were factors impeding SCP. Discussion: Organizational interventions and education programs are needed to ensure that oncology nurses are confident in providing culturally congruent survivorship care in a multicultural country such as Singapore.

Using Community-Based Participatory Research to Explore Health Care Perceptions of a Select Group of Arab Americans.

Introduction: As the Arab American population grows in the United States, relatively little has been published about the health status of this population. The purpose of the research was to (1) discover health care perceptions of Arab Americans and (2) identify strategies to ensure the provision of culturally congruent health care. Method: Community-based participatory research methodology was used for this descriptive study. Interviews and focus groups were conducted with Arab Americans residing in northeast Pennsylvania. Results: Three themes were identified: (1) perceptions of health resulting in delays in seeking health care, (2) cultural values and practices resulting in need for culturally congruent provision of care, and (3) mistrust of the U.S. health care system resulting in underutilization of services. Discussion: Results indicate the need for nurses to implement culturally congruent community-based strategies and interventions for meeting health care needs of Arab Americans. By understanding the community's perceptions and attitudes, nurses will be better positioned to ultimately move toward the goal of reducing health disparities in this underserved population.