Cultural Distress: An Emerging Paradigm

How do the Social Determinants of Health Impact the Post-Acute Sequelae of COVID-19: A Critical Review

The review critically analyzes the social determinants of health (SDOH) variables in the current literature of patients with post-acute sequelae (PASC) of COVID-19 in the United States. Race, gender, and age were discussed as well as health outcomes, severity of illness, and phenotypes of long-COVID. Most research was retrospectively with samples that had access to health insurance, which did not capture populations with poor or no access to health care. More research is needed that directly addresses the impact on SDOH on PASC. The current literature is sparse and provides little actionable information.

Nursing students' experiences of communication in a multilingual and multicultural clinical environment: A qualitative study

AIM

The aim of this study was to investigate nursing students' experiences of communication in a multilingual and multicultural clinical environment.

BACKGROUND

Effective communication in a healthcare setting plays a crucial role in patient care. Yet, since universities, globally, have experienced an increase in the enrolment of both local and international students in various degree programmes, student populations have become increasingly multilingual and multicultural. This study was conducted in a multilingual country where many languages are not spoken by all citizens, which results in nursing students experiencing varied outcomes.

DESIGN

A qualitative, explorative, descriptive research design was used.

METHODS

Sixteen nursing students enrolled in either the Bachelor of Nursing Science (Clinical, Honours) or the Diploma in Nursing Science. Data were collected by means of in-depth, semi-structured interviews with a sample of 16 nursing students who were selected through convenience sampling. Data were analysed using thematic analysis.

RESULTS

The study revealed four themes: aspects that complicate communication; interesting aspects about communication; the need for communication assistance; and the need for policy intervention, which is key to addressing challenges in multilingual clinical environments.

A novel conceptual model of trauma-informed care for patients with post-acute sequelae of SARS-CoV-2 illness (PASC)

Aim

This paper proposes a novel, trauma‐informed, conceptual model of care for Post‐Acute Sequelae of COVID‐19 illness (PASC).

Design

This paper describes essential elements, linkages and dimensions of the model that affect PASC patient experiences and the potential impact of trauma‐informed care on outcomes.

Data sources

PASC is a consequence of the global pandemic, and a new disease of which little is known. Our model was derived from the limited available studies, expert clinical experience specific to PASC survivors and publicly available social media narratives authored by PASC survivors.

Implications for nursing

The model provides a critical and novel framework for the understanding and care of persons affected by PASC. This model is aimed at the provision of nursing care, with the intention of reducing the traumatic impacts of the uncertain course of this disease, a lack of defined treatment options and difficulties in seeking care. The use of a trauma‐informed care approach to PASC patients can enhance nurses' ability to remediate and ameliorate both the traumatic burden of and the symptoms and experience of the illness.

Conclusion

Applying a trauma‐informed perspective to care of PASC patients can help to reduce the overall burden of this complex condition. Owing to the fundamentally holistic perspective of the nursing profession, nurses are best positioned to implement care that addresses multiple facets of the PASC experience.

Impact

The proposed model specifically addresses the myriad ways in which PASC may affect physical as well as mental and psychosocial dimensions of health. The model particularly seeks to suggest means of supporting patients who have already experienced a life‐threatening illness and are now coping with its long‐term impact. Since the scope of this impact is not yet defined, trauma‐informed care for PASC patients is likely to reduce the overall health and systems burdens of this complex condition.

Trauma-Informed Approaches to Medicolegal Death Investigation: A Forensic Nursing Perspective

Forensic nurses engaged in medicolegal death investigations experience trauma-induced responses in responding to, investigating, and documenting sudden unexpected deaths. The trauma of these repeated experiences often results in diminished performance, job dissatisfaction, and burnout. The principles of trauma-informed care are not new but have not been incorporated into death investigation practices. When coupled with medicolegal death investigation procedures, application of these principles can help to alleviate distress for forensic nurses, colleagues, and decedents of concerned families. This case series illustrates how the principles of trauma-informed care can be implemented to enhance communication, deescalate emotional or threatening situations, and prevent retraumatization in the context of medicolegal death investigations.

Identifying Barriers to Effective Patient-Provider Communication About Food Insecurity Screenings in Outpatient Clinical Settings in Central Florida: A Mixed-Methods Study

OBJECTIVE

Screening for food insecurity in health care settings is inconsistently performed among health care providers. This study examined how patient-provider interactions influenced patient comfort discussing food insecurity, an important social determinant of health.

DESIGN

We conducted a convergent mixed-methods study and surveyed patients on their experiences with patient-centered care when communicating and interacting with their providers, and their comfort level being screened for food insecurity. Telephone interviews were also conducted to better understand the concepts in the survey.

SETTING

Various clinical organizations in Central Florida, as well as food pantries affiliated with Second Harvest Food Bank.

PARTICIPANTS

Forty-six patients in Central Florida completed the survey, 12 of whom completed qualitative portions of the study (7 completing the qualitative survey questions and 5 completing a telephone interview).

MAIN OUTCOME MEASURE

Patient comfort discussing food insecurity with their health care providers.

RESULTS

Quantitative findings show that patient involvement in care planning and cultural sensitivity of health care providers were 2 important factors associated with patient comfort being screened for food insecurity. Qualitative findings suggest that providers' effective communication and empathy are other factors that can influence patient comfort.

CONCLUSION

To effectively address food insecurity of vulnerable patients and communities, it is important that providers conduct screenings within their practice. This study points to specific actions that providers may employ to increase patient comfort discussing this topic. Efficiently identifying food-insecure patients and connecting them to appropriate community resources would improve patient health and aid in efforts to eliminate health disparities.

Ready for Anything: A Holistic Approach to Training Sexual Assault Nurse Examiners

Although numerous training options exist for sexual assault nurse examiner certification, most focus on specific certification-related content rather than on creating a holistic preparation for sexual assault nurse examiner (SANE) practice. Holistic preparation may be preferable for SANE trainees who are early in their nursing careers or who have practiced in limited clinical environments. This article describes a holistic training approach implemented at a SANE training site funded by the Advanced Nursing Education initiative of the Health Resources and Services Administration. Training covers hands-on pelvic and anal examinations, community education, underserved communities, self-care, and other topics that support newly trained SANEs in establishing and maintaining practice. This content has prepared trainees for a wide variety of patient encounters as well as for engaging with the community. With this approach, our trainees have the opportunity to enhance their ability to provide SANE care and to provide additional resources within their primary practice environments.

Resisting the muddy notion of the 'Inclusionary Other': A re/turn to the philosophical underpinnings of Othering's construction

The notion of 'Inclusionary Othering,' in garnering uptake within diverse nursing spheres, muddies a critical understanding of Othering by obscuring the colonial production, exploitation and perpetuation of the Other for economic and political gain. The ongoing genocide of Indigenous women and girls in Canada is a direct manifestation of the Othering process and in response to the report's Calls for Justice, it is an apt time to re-enliven the conversation of the process of Othering's philosophical construction. The purpose of this article is to re/turn to the philosophical underpinnings of the process of Othering in hopes of enlivening a new wave of resistance within nursing and elsewhere to the means by which the Other is constructed as well as to the notion of Inclusionary Othering itself. Perhaps this re/turn to the philosophy of Edward Said and Sylvia Wynter can result in further thwarting the Othering construct by highlighting its colonial construction and usher in a pragmatic shift, increasing critical engagement with the construct as well as inspiring a re/newed resistance toward Othering in nursing practice.

'I don't talk about my distress to others; I feel that I have to suffer my problems...' Voices of Indian women with breast cancer: a qualitative interview study

Background

Breast cancer is the commonest form of cancer among women globally, including in India. The rising incidence in the developing world is thought to be due to increased life expectancy, urbanisation, and adoption of western lifestyles. A recent systematic review found that Indian women living in India or as immigrants in Canada experienced a range of psychological distresses both ameliorated and exacerbated by cultural issues personally, within the family, within their community, and in the context of faith, and only two of the five qualitative studies explored the experience of women with breast cancer living in India. Distress may also affect treatment compliance.

Aim

The aim of the study was to explore the psychological distresses experienced by Indian women with breast cancer living in Kerala, South India, during and after treatment and to understand better what helped to relieve or increase these distresses.

Methods

In-depth interviews were conducted with 20 consenting women undergoing treatment for breast cancer. Purposive sampling was used to obtain maximum variation in sociodemographic and clinical characteristics. Interviews were verbatim transcribed, translated into English, and back-translated to Malayalam to ensure that the meaning had not been lost. English data were analysed using thematic frame work analysis and synthesised to provide a deeper understanding of the individuals’ experience.

Results

Three major themes emerged from the data. The first major theme was ‘far-reaching psychological distress’. This included anxiety, guilt, anger, and depression in response to the disease and physical side effects of treatment and issues relating to body image, especially hair loss and sexuality. The second major theme was ‘getting on with life’. Women tried to make sense of the disease, by actively seeking information, the role of medical professionals, and their practical adaptations. Many found a new future and a new way to live normal. The third major theme was the ‘support system’ strongly based on family, friends, faith, and the community which affect them positively as well as negatively.

Conclusion

Psychological concerns related to disease and treatment are common in Indian women with particular emphasis on body image issues associated with hair loss. Family and faith were key support systems for almost all the women, although it could also be the causes of distress.

Electronic supplementary material

The online version of this article (10.1007/s00520-020-05756-8) contains supplementary material, which is available to authorized users.

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

BACKGROUND

Breast 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.

AIM

To improve understanding of psychological symptoms among Indian women with breast cancer.

DESIGN

This is a systematic literature review and critical interpretive synthesis. Medical Subject Headings(MeSH) terms and keywords for breast cancer, psychological symptoms and treatment were used to search databases from inception to 7 May 2019. The reference lists of the included articles were examined. Search results were screened against the inclusion criteria, data were extracted, and quality was appraised by two independent researchers with recourse to a third. Narrative (quantitative) and thematic qualitative syntheses were applied, followed by critical interpretive synthesis.

DATA SOURCES

ProQuest, MEDLINE, Ovid EMBASE, EBSCO, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO.

RESULTS

18 of 763 studies from India or Canada were included (13 quantitative, 5 qualitative). Critical interpretive synthesis found psychological concerns similar to 'Western' women, but were framed by the common culture of Indian women in either country. Family structure, religion and community appear to protect against and cause distress in relation to the expected core role of being a wife and a mother and the male dominance in decision making. Stigma was amplified by poor knowledge about the nature of cancer. Migrant Indian women had additional problems due to language barriers.

CONCLUSIONS

Indian women with breast cancer living in India and Canada experience psychological morbidities which profoundly affect their role in their family and the wider community. Culturally congruent care, including accessible communication and information, may help prevent and alleviate distressing symptoms whether in India or in a migrant community.

“Things Are Different Now But”: Older LGBT Adults’ Experiences and Unmet Needs in Health Care

Background: Approximately 2.7 million U.S. older adults self-identify as lesbian, gay, bisexual, and transgender (LGBT). Many felt unsafe revealing their sexual orientation until relatively recently, and may still not be “out” to medical providers. The aim of this study was to increase understanding of the experiences and needs of older LGBT adults when accessing care. Method: Individual semistructured interviews were conducted with 10 individuals aged 65 years or older from a local LGBT community. Interviews were audio taped and transcribed verbatim. Transcripts were analyzed via thematic analysis. Results: Major themes were “Outness,” “Things are Different Now,” and “Additional Resources.” These describe participant comfort with being “out”; how treatment they received changed over time, and needed services or other options from the community. Conclusion: While many older LGBT adults are accustomed to navigating social mores to avoid negative experiences, nurses as well as other health care providers must be prepared to create trusting relationships with these individuals to provide truly comprehensive care.

'Contradictions in having care providers with a South Sami background who speak South Sami': older South Sami People in Sweden's expectations of home nursing care

The Sami are an indigenous population with multiple languages and dialects living in northern areas of Sweden, Norway, Finland, and the Kola Peninsula. The South Sami population lives in central regions of Sweden and Norway, and consist of about 2000 people. In this study, 56 older South Sami people from Sweden participated. Semi-structured interviews were conducted over the telephone and analysed through qualitative content analysis. The main findings show that older South Sami people's expectations of having care providers with a South Sami background speaking South Sami in home nursing care contain contradictions in and between participants. Participants had different preferences regarding having care providers with a South Sami background speaking South Sami in the future. When providing care to older South Sami people, individual adjustments are of importance, and our study showed that participants had different expectations despite having similar backgrounds.

Level of Cultural Self-Efficacy of Colombian Nursing Professionals and Related Factors

PURPOSE

To describe the level of cultural self-efficacy of Colombian nursing professionals and determine the main influencing factors.

METHOD

A descriptive, analytical cross-sectional study was conducted in 211 nursing professionals selected by systematic random sampling for a finite population, using the Colombian version of the Cultural Self-Efficacy Scale. After descriptive statistical analysis, nonparametric tests were applied to determine between-variable associations, followed by multiple linear regression analysis.

RESULTS

The mean Cultural Self-Efficacy Scale score was 2.58. An association with sex and age ( p < .05) was observed in regression analysis. The mean score for knowledge of cultural concepts was 3.20 and associated with age, years of experience, educational level, and cross-cultural experiences ( p < .05). The mean score for confidence in performing cultural nursing skills was 3.29.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The cultural self-efficacy level of this sample of nursing professionals, with their consequent capacity to provide culturally competent care, is moderate and is associated with sex and age. Confidence in knowledge of cultural concepts is affected by age, educational level, years of experience, and cross-cultural experiences. This evidence supports the implementation of changes to improve the cultural knowledge and therefore cultural self-efficacy of these professionals.