A scoping review of Islamic pilgrimage to Mecca: Mapping the health concerns and proposed solutions

OBJECTIVES

To map the current evidence about the health concerns and the potential solutions related to the Islamic pilgrimage to Mecca.

DESIGN

A scoping review was applied. Papers published in English between 2012 and 2023 were included but non-human research and sources without any related data were excluded. Data charting and extraction were used to map the current evidence.

RESULTS

The total of 36 papers were included with the total number of pilgrims of 17,075,887. The majority of studies were published in the Asia Pacific region (36.11%) as original articles (88.89%). The health concerns were grouped into five main aspects. There were 7603 deaths recorded or about 44 incidences of deaths per 100,000 pilgrims during the pilgrimage. There were recorded 11,018; 6178; 3393; and 17,810 cases for communicable diseases; non-communicable diseases; injuries and trauma; and health services (i.e., cardiac catheterization) and vaccination, respectively.

CONCLUSION

Relating to the five health concerns, this study identified the top seven issues in each category (i.e., hypertension, influenza vaccination), except for the death record. Moreover, there were three solutions (for general health, non- and communicable-diseases) presented. Stakeholders could use this evidence to improve healthcare quality particularly related to the annual Islamic pilgrimage to Mecca.

A concept of "cultural competence" among public health nurses in Japan

OBJECTIVES

To clarify the conceptual structure of "cultural competence (CC)" among Japanese public health nurses (PHNs), to enhance culturally appropriate support.

METHODS

A modified grounded theory approach (M-GTA) was used. A total of 11 municipal PHNs participated in this study. Data were collected through semistructured interviews. Interviews were audiotaped and transcribed. A comparative analysis was performed using M-GTA.

RESULT

Five categories were identified. Japanese PHNs supported foreign residents while (1) maintaining a sincere attitude with curiosity and humility toward others regarding CC; (2) deepening their realization of issues arising from awareness of one's own and other cultures; (3) developing their knowledge about clients' cultures and the surrounding environments; and (4) mastering the skills of building a relationship with clients while creating supportive systems surrounding them. As they gained more experience in supporting foreign residents, as indicated in the above categories, their cultural competence grew, allowing them to (5) gain experience while encountering individuals without holding stereotypes and prejudice.

CONCLUSIONS

The concepts of CC that emerged are based on cultural humility and are cultivated through supportive activities. The concepts identified in this study can serve as educational guidelines for health nurses and other care providers in Japan.

Experiences and Suggestions of Nurses Involved in Caring for Migrant Populations in Italy: A Qualitative Study

The aim of this research is to explore nurses' experiences in caring for migrants, regular and non-regular, within outpatient clinics in Italy.

MATERIALS AND METHODS

Thirteen nurses have been interviewed through online semi-structured interviews, conducted with the support of a questionnaire, made by researchers, consisting of open-ended questions on legislative issues, cultural issues, and regarding best practices. Purposive sampling has been used, along with phone and email recruitment. The audio recordings of the interviews were verbatim transcribed, then examined. This study is a qualitative descriptive fundamental research project.

RESULTS

Interviewees highlight migrants' difficulties in accessing care, critical points of legislation, transcultural skills crucial to nurses, and good practices. A total of 105 labels were developed and grouped into 23 categories under 7 themes (Italian legislation and migrants; structural difficulties in assistance; the influence of politics; the work of NGOs and associations; nursing care; winning strategies; and the role of the Family and Community Nurse).

CONCLUSION

The research highlights how access to care for migrants is hindered by legislative, structural, and cultural barriers, with consequences on the NHS (improper accesses to the emergency room, increased workload, and economic expenditure). For the full realization of the right to health, as enshrined by Art. 32 of the Constitution, changes are needed with respect to regulations and professionals' training.

The Development and Validation of an Intercultural Nursing Educator Profile Using the Delphi Method

INTRODUCTION

Educators require focused training to foster the development of intercultural competence in nurses. Training programs for educators need to be based on a comprehensive profile with a focus on intercultural learning. This study aims to define and validate a profile of the Intercultural Nursing Educator (INE).

METHOD

The Delphi method was used with an iterative, multi-stage process to transform opinions into group consensus. A total of 46 European, African, and American experts from the nursing and intercultural field participated. Inclusion criteria required English at a level of B2, expertise in the field of intercultural competence, experience in teaching intercultural competence in the nursing context, and publications focused on intercultural topics.

RESULTS

The INE profile was developed and all 126 competencies were validated.

DISCUSSION AND CONCLUSION

The profile is freely available on the project website and provides the basis for curricula, training programs and assessment of the required competences.

Does the cultural awareness of nurses affect brain drain and xenophobia?

AIM

Turkey is on the transit route of immigrants as it is located between countries where poverty and wars are intense and European countries. Therefore, there are countless immigrants from different countries in Turkey. Migrations affect every sector, especially the health sector. The aim of this study was to determine how cultural awareness of nurses, who are the cornerstone of the health system, affects brain drain and xenophobia. The problem of health care is not only on the agenda of immigrants, but also on the agenda of health service providers in their countries due to economic and working conditions.

DESIGN

This research was designed as descriptive and relationship-seeking.

METHODS

The data of the research were collected through Google Forms between December 5 and 26, 2022. A total of 231 nurses working in a public hospital in south-east Turkey participated in the study. Data were evaluated with descriptive statistics as well as reliability, t-test, ANOVA, Pearson correlation and linear regression analysis.

RESULTS

It was determined that the attitudes of the participants towards brain drain were moderate, their cultural awareness was low and their xenophobic attitudes were high. In addition, it was determined that 44% of the change in the total score obtained from the intercultural awareness scale was explained by the scores obtained from the xenophobia and brain drain scales.

CONCLUSIONS

In this context, it may be possible to reduce xenophobic attitudes by giving intercultural awareness trainings to nurses. In addition, it is important to provide working conditions and economic support by health policy makers to prevent the brain drain of nurses.

IMPACT

Nurses may need to provide care for individuals from different cultures due to the regions in which they live. For this reason increasing their cultural awareness and reducing xenophobia may ensure that they provide improved care to their patients.

The Art of Childbirth of the Midwives of Al-Andalus: Social Assessment and Legal Implication of Health Assistance in the Cultural Diversity of the 10th-14th Centuries

(1) Background: The role of Al-Andalus's women were the result of Arabization and Islamization in Spain. The 10th to the 14th centuries were a time of significant cultural diversity in the region. Female physicians and midwives were important for providing care to women. Despite existing studies, there is still a lack of focused research on the professionalization of these trades, including their requirements, intervention areas, and treatments. (2) Methods: To address this gap, we conducted a scoping review using the dialectical structural model of care (DSMC). Primary medical and legislative sources were used. (3) Results: two kinds of midwife, or qābila, were discovered, along with a woman physician, or ṭabība, who also acted as a midwife. These professions underwent diverse training and fulfilled duties as obstetricians and pediatricians. Midwives were esteemed members of society and were the sole female professionals who needed qualified training. Their performance in the courts was exemplary. Tools for facilitating childbirth and interventions related to female health were discovered in the study. (4) Conclusions: The patriarchal societies suffer from significant inequality in terms of academic training, knowledge transmission, and healthcare provision. Midwives functioned in segregated domestic and legal spaces and were responsible for providing public care to communities from the 10th to 14th centuries.

A Dialogue with Dr. Marilyn A. Ray: Nurse Scholar and USAF Veteran

Dr. Marilyn A. Ray, nurse scholar and retired United States Air Force (USAF) veteran and former flight nurse, began her nursing scholarship in Canada. She was influenced by the experiences and interprofessional scholarly ideas that she encountered along her career trajectory. Her early love of the air and space led her to the United States Air Force Nurse Corps, where she served as a flight nurse during the Vietnam war era, followed by leadership positions in nursing education, administration, practice, and research. Dr. Ray's contributions to nursing knowledge includes two nursing theories and a caring inquiry methodology. Dr. Ray is helping to create a new caring science certificate program at Florida Atlantic University, Christine E. Lynn College of Nursing. In this column, Dr. Ray shares the story of her scholarly influences and how they helped her care for her husband and gain insight into her contributions to nursing knowledge development.

Study of medication use and effects of medication among hospitalized older Buddhist monks: An embedded mixed-method study

AIM

The aim was to study medication use, effects of medication and perspective of participants involved in medication use among hospitalized older Buddhist monks.

DESIGN

An embedded mixed-method study.

METHODS

This study included 71 hospitalized older Buddhist monks and 23 participants involved in medication use. Quantitative data were collected from medical and medication records. Meanwhile, qualitative data were collected by using in-depth interviews. Data were analysed using descriptive statistics and content analysis. The study lasted from February to July 2021.

RESULTS

Over 77% of the monks had chronic diseases. The median of medicine use was seven medicines/person and 6 days of use. Effects of the medication were as expected (52.04%), not as expected (2.22%) and unmeasurable results (45.74%). Unexpected results were hypo-hyperglycaemia, nausea/vomiting, high blood pressure and confusion. From the interview, participants perceived and did not perceive unique practices and medication use in Buddhist monks. In addition, the Buddhist monks received medication following standards and Buddhist doctrine. Finally, recommendations for medication use were adhering to the standard, following Buddhist doctrine and being flexible as deemed necessary.

CONCLUSION

The results revealed medication use problems and medication effects among hospitalized older Buddhist monks.

IMPACT

Older adults and Buddhist monks have specific needs and practices related to culture and religion, affecting typical treatment, especially medication use. Cultural diversity and sensitivity should be a concern for healthcare staff. The results can be utilized to promote an understanding of cultural diversity and increase the safety of medication administration for hospitalized older Buddhist monks.

PATIENT AND PUBLIC CONTRIBUTION

Patient and public contributions were involved in this study. Participants involved in medication use were interviewed to answer the research objective. Moreover, a senior Buddhist monk at Wat Thai Washington D.C. reviewed content related to the Pali Canon for the final draft of the manuscript.

CLINICAL TRIAL REGISTRATION NUMBER

https://osf.io/b6p3e.

Transcultural Nursing in Italy: An Explorative Study

The health profile of foreigners in Italy is affected by multiple factors and events, including environmental, microbiological, cultural, and behavioral. To explore nurses' basic cross-cultural knowledge, and their perceptions of problems that arise in encounters with clients from outside the country, and to suggest solution strategies, we enrolled 327 nurses in an observational, cross-sectional, multicenter study. The findings suggested a need to improve sociocultural skills related to working in a multiethnic society, as early as the first level courses and possibly continue with appropriate master's degrees and research projects.

Examination of individualised care behaviours and ethnocentrism of nurses caring for refugees: A descriptive and exploratory study

BACKGROUND

Qualified individualised nursing care should be provided to all communities and ethnic groups with free of ethnocentrism.

AIMS

To evaluate nurses' individualised care behaviours and ethnocentric attitudes and predict the relationship between their individualised care behaviours and ethnocentric attitudes.

DESIGN

A descriptive and exploratory study.

METHODS

This study was conducted with 250 nurses working in a public and two private hospitals in a city, an area with many refugees. Data were collected using the Ethnocentrism Scale and Individualised Care Behaviours Scale. Structural equation model analysis to test hypothetical model and descriptive statistics were used.

RESULTS

Nurses working in the private hospitals had a higher individualised care decision control mean score. Those nurses who enjoyed spending time with people from different cultures had lower mean ethnocentrism scale scores, higher individualised care clinical status, personal life and decision control status subscales mean scores compared to other nurses. Mean scores of the individualised care personal life and decision control status subscales of the nurses who followed the literature on transcultural nursing was higher. A significant relationship between the ethnocentrism levels and individualised care behaviours was identified. Accordingly, the ethnocentric attitudes of the nurses negatively affected their individualised care behaviours, and the model established between the two concepts is statistically appropriate.

CONCLUSIONS

Nurses who work in private hospitals, receive intercultural nursing education and enjoy spending time with different cultures have higher individualised care behaviours and lower ethnocentrism levels. Ethnocentric attitudes of the nurses negatively affected their individualised care behaviours. Care strategies should be developed that consider the factors that will maximize individualised care practices that minimize ethnocentric behaviours among nurses.

IMPLICATIONS FOR THE PROFESSION

Increasing awareness on individualised care behaviours, ethnocentric attitudes and effected factors will contribute to improve of nursing care quality of nurses while giving care to individuals from different cultures.

Analysing Power Relations among Older Norwegian Patients and Spanish Migrant Nurses in Home Nursing Care: A Critical Discourse Analysis Approach from a Transcultural Perspective

Power relations in care are the link between patients and nurses regarding communication and the ability to act in this context. It can be affected when there is cultural interference between members, putting mutual understanding at risk in healthcare situations. This study analyses power relations in healthcare situations between older Norwegian patients and Spanish migrant nurses regarding active listening, shared decision-making, and patient participation. We performed a hermeneutical study endorsed in critical discourse studies framework from a transcultural perspective. A purposive sampling included older Norwegian patients living alone and Spanish migrant nurses working in Norway. Eleven face-to-face semi-structured interviews were conducted with older patients and four via videoconference with migrant nurses. The analysis followed hermeneutic considerations by Crist and Tanner, and linguistic analysis was performed. Shared decision-making and active listening situations sometimes showed a power imbalance that negatively influenced older Norwegian patients. However, Spanish migrant nurses were also conditioned by care organising institutions. This power triangle negatively affected the relationship between the older patients and migrant nurses, resulting in a lack of communication, personnel, time and trust. The migratory experience influenced the care provided by Spanish migrant nurses, shaping a series of cultural competencies acquired through the migratory process.

Integration of Population Health, Social Determinants, and Social Justice in Transcultural Nursing and Culturally Competent Care: White Paper by the Scholars Education Interest Group

INTRODUCTION

As part of its mission to advance Transcultural Nursing worldwide, the Transcultural Nursing Society Scholars upholds the central role of the discipline and cultural competence in advocacy, empowerment, and transformation of the life conditions of disadvantaged populations. This White Paper affirms the Scholars' core belief in the value of Transcultural Nursing and culturally competent care in addressing social determinants to promote health equity.

METHODS

The Scholars Education Interest Group proposes recommendations for changes in education, practice, and research undergirding the discipline and expand cultural competence to directly address social structural and historical forces that perpetuate health vulnerability in diverse populations.

RESULTS

Collaborative leadership between the TCNS Scholars, Board of Trustess and members should develop initiatives to foster implementation of the recommendations and promote global dissemination of exemplars in education, research and practice.

DISCUSSION

Collaborative implementation of recommendations will generate evidence of health equity outcomes through TCN and culturally competent care.

The lived experience of Chinese medical tourists receiving cancer care: A qualitative study

AIM

The purpose of this study was to describe and explore the lived experience of Chinese medical tourists receiving cancer care in clinical settings in the United States.

DESIGN

A qualitative phenomenological design.

METHODS

In this study, Hermeneutic phenomenology was used to interview 11 participants on WeChat, a popular social media platform of China. Hermeneutic phenomenology methods and hermeneutic circles were used to analyse data.

RESULTS

Five themes identified were: the application process involves various challenges; overcoming transportation and language barriers; feeling content with healthcare received in the United States; nearly perfect experience, except for long waiting times; and high cost of being a medical tourist.

CONCLUSION

Despite the cost and complexity of cancer treatment, Chinese medical tourists valued their experience in US clinical settings. Although, they experienced real challenges, they overcame obstacles with self-determination and varied resources. Therefore, culturally appropriate healthcare is highly recommended.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study are relevant for clinical practice, particularly cancer care to medical tourists in the United States. To better support the Chinese medical tourists with cancer, various strategies and techniques, as reported in this study, could be helpful. It is highly recommended to provide healthcare providers to enable them to understand and respect the diversity norms of other cultures.

Spanish adaptation and validation of the Cultural Competence Assessment Tool (CCATool) for undergraduate nursing students

AIM

To analyse and validate a contextually adapted version of the Papadopoulos' Cultural Competence Assessment Tool (CCATool) for Spanish undergraduate nursing students.

BACKGROUND

Globalization has driven and intensified international migration. Thus, nurses must treat patients of many different cultural origins. Accordingly, both cultural competence and an appropriate tool with which to evaluate it are required.

METHODS

The CCATool questionnaire was adapted for use in a Spanish context and was evaluated through a questionnaire completed by 262 undergraduate nursing students. Seven days later, the same students completed the questionnaire, without any intervention, and a subgroup of 144 students completed the questionnaire for a third time after taking a course in Transcultural Care. The reliability, sensitivity and stability of the questionnaire were assessed.

RESULTS

The reliability of the questionnaire obtained an adequate Cronbach's alpha of 0.81. Stability was assessed at seven days, using the intraclass correlation coefficient, which showed good/excellent results. Moreover, the questionnaire was able to detect the changes related to the nursing educative programme, thus highlighting a good sensitivity of the tool.

CONCLUSION

Cultural competence is an essential element of nurses' education, and instruction in this area should begin as soon as possible. In addition, an appropriate evaluation system is required. For this purpose, the present study describes and analyses a valid, reliable tool for use with undergraduate nursing students in Spain.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Health and education policies must be sensitive to the ethnic and cultural differences of the patients who are cared for, and address the situations that cause difficulties in care. Hospitals and health centres must offer good care to patients from diverse cultures, so one of the necessary situations is the training and evaluation of the cultural competence of health professionals.

Registered Nurse Anesthetists' Perceptions of Providing Care Within a Global Health Framework: A Qualitative Study

PURPOSE

The purpose of this study was to investigate how Registered Nurse Anesthetists (RNAs) who have been working for nongovernmental organizations in low- and middle-income countries perceive their role in global health.

DESIGN

A qualitative design was used in this study.

METHODS

Data were collected by means of semistructured interviews with 11 participants who met the inclusion criteria, and qualitative analysis of the interview content was performed.

FINDINGS

The analysis resulted in three categories and six subcategories. Of the categories, "Using skills" includes the respondents' varying levels of responsibility, tasks, and perceptions of how far they are applying their expertise. "Encountering new cultures" is about adapting to new cultural norms in nursing, education, and cooperation in the international team. "Promoting change through volunteerism" comprises personal and professional development, and impact - both local and potentially global.

CONCLUSIONS

This study highlights the relevance of RNAs in global health and emphasizes the cultural encounters, exchanges, and challenges associated with volunteer medical missions. RNAs' knowledge of, and humble approach to the host country's culture are essential for their ability to provide nursing care, engage in cooperation and training, and promote global health in a high-quality, sustainable and effective way.

Sources of Information and Communication About HPV Among Chinese Students Attending U.S. Colleges: Implications for Culturally Appropriate Strategies

INTRODUCTION

Little is known about human papillomavirus (HPV) information sources and communication among Chinese students attending U.S. colleges. We assessed information sources and communication about HPV and HPV vaccines among this population.

METHODOLOGY

A cross-sectional design with 449 participants was conducted by using a questionnaire and snowball sampling. Summary statistics and multiple logistic regression were used.

RESULTS

The most common sources of HPV information included the internet and friends. Communication about HPV occurred most frequently among friends, family, and health professionals. Those who had better HPV knowledge and attitudes and were vaccinated against HPV were more likely to use internet, friends, family, and health professionals as their information sources.

DISCUSSION

Because the internet, friends, and families are likely sources for HPV information and communication, future internet-based culturally appropriate education should offer information not only to Chinese students but also to their social circles. Cultural beliefs may affect HPV prevention and should be examined.

Transcultural health: attitudes, perceptions, knowledge of Italian nurses. An observational study

BACKGROUND AND AIM OF THE WORK

The Italian health profile of foreigners depends from several factors and events, such as: environmental, microbiological, cultural and / or behavioral. Healthcare professionals might to have greater and better basic and post-basic training in approaching foreign users. Listening and empathy, with complementary training can help to reduce distances and better understand the patient's socio-cultural background. The aim of the study is to explore the basic intercultural knowledge of the Italian nurses, the perception of the problems encountered during the interaction with foreign users and any solution strategies.

METHODS

From December 2020 to March 2021 a national observational study was conducted by involving 327 nurses.

RESULTS

85.5% among participants were females and most of them aged between 20 and 30 years (20.20%) and were employed in medical wards (22.60%). Among the hindering barriers explored, linguistic ones are highlighted (41.30%), specifically for the description of hospital rules (34.90%) and of social and health regulations (34.90%).

CONCLUSIONS

From the present findings, it emerges that the cultural competence of nurses could be developed by offering a multicultural education through basic and post-basic courses. (www.actabiomedica.it).

The Effect of Transcultural Nursing Course on Students' Moral Sensitivity: A Quasi-Experimental Study

INTRODUCTION

The moral sensitivity of nurses positively affects the quality of patient care. For this reason, nursing students are expected to gain moral sensitivity skills during their education. The aim of the study is to examine the impact of transcultural nursing course (TNC) on the moral sensitivity levels of students.

METHODS

This study had a quasi-experimental design. The sample consisted of 100 nursing students (intervention: 36 and control: 64). The intervention group was composed of students who had enrolled in the TNC. The data were collected through the Sociodemographic Information Form and the Moral Sensitivity Questionnaire. Independent samples t-test and analysis of variance were used in data analysis.

RESULTS

The moral sensitivity levels of the students who received the TNC were significantly higher than those who did not.

DISCUSSION

The TNC is an effective teaching method in increasing the moral sensitivity levels of nursing students.

Cultural Competence of Turkish Nurses and Nursing Students: An Integrative Literature Review

INTRODUCTION

Turkish population is characterized by its great cultural diversity, thus, Turkish nurses and nursing students often interact with patients of different cultural backgrounds from theirs. Cultural competence is needed to provide qualified contemporary nursing care. This study aimed to explore the literature on the cultural competence of Turkish nurses and nursing students.

METHODOLOGY

The Whittemore and Knafl review methodology was used to extract, summarize, and synthesize data of 15 primary research articles published between January 2011 and January 2021. The search was done in the Turkish Academic Network and Information Center-ULAKBIM (PubMed, TRDizin, DergiPark).

RESULTS

Three themes were identified: cultural competence, cultural-related problems, and importance of training on transcultural nursing.

DISCUSSION

Appropriate educational courses on transcultural nursing should be implemented in Turkish nursing schools as well as in continuing education programs for Turkish nurses.

"No Man Is an Island": Perspectives of CHamorus in Guam on COVID-19

OBJECTIVES

Guam is a United States territory situated in the western Pacific Ocean with a multiethnic population numbering approximately 168,000. The CHamorus, who are the Indigenous people of Guam, make up 37%. In this study, we sought to explore CHamorus' perspectives on and experiences of COVID-19.

DESIGN

Interviews were conducted with 10 CHamoru adults in June-July 2020 via telephone for a larger study on understanding how the collective history of the CHamoru people is perceived relative to contemporary health beliefs and practices. This study is a secondary data analysis of questions that focused on COVID-19. We used thematic analysis techniques to analyze the data.

RESULTS

Three themes were identified: self and other, or "no man is an island"; trust in government; and focusing on the positives. A cross-cutting theme was commitment to the common welfare of the community through interconnectedness and inafa'maolek (doing good for others).

CONCLUSION

Results indicated that CHamorus recognized a balance between community and individual, the need to protect the vulnerable while also considering personal choice, and the implications of enforced social distancing on community and economic stability.

Care and Rearing of Institutionalized Girls in Arequipa, Peru: An Ethnographic Approach

INTRODUCTION

Institutional care for children is a global phenomenon. Despite its advantages, common threats have been described. In Peru, more than 70% of institutionalized children/adolescents have living parents who cannot take care of them. The study aims to understand the care/rearing of institutionalized girls in Arequipa, Peru.

METHODOLOGY

Ethnographic design, with a sample integrated by 27 institutionalized girls. Data collected based on participant observation and semi-structured interviews. The analysis followed the Method of Constant Comparisons.

RESULTS

Five main themes were found: (a) The little house (foster home) is better than my house; (b) They take care of me-even when I am sick-; (c) But . . .; (d) What I have lived is what I am; (e) Happiness fits in this little house.

DISCUSSION

An ethnography of care/rearing practices could be helpful for a better understanding of the dimensions of the life of institutionalized girls living in developing countries.

Perception and Experience of Transcultural Care of Stakeholders and Health Service Users with a Migrant Background: A Qualitative Study

INTRODUCTION

While European health policies do frequently take into consideration the ideas and experiences of their users, the voices of minority and marginalized communities are not often heard. European healthcare services must address this issue as the number of healthcare users with an MM background increases.

AIM

To explore the perspectives of key stakeholders and healthcare users with an MM background on transcultural care in four European countries.

DESIGN

Qualitative phenomenological study.

METHODS

Semi-structured, individual interviews were conducted with stakeholders and MM users. Interviews were translated and transcribed verbatim and were carried out from February to May 2021. Descriptive statistics was used to describe the characteristics of the sample; qualitative data were analyzed thematically following Braun and Clarke's phases, resulting in 6 themes and 18 subthemes.

RESULTS

For stakeholders and MM users with long-established residence in their respective countries, cultural differences involve different family and community norms, religious beliefs, lifestyles, and habits. These components are perceived as in tension with healthcare norms and values, and they mediate in two key and related aspects of the relationship between MM users and healthcare providers: accessibility and communication.

CONCLUSIONS

Communication and access to healthcare are key to MM health service users, and they are the most frequent sources of misunderstanding and conflict between them and healthcare professionals.

IMPACT

It is important to extend the investigation of cultural issues in healthcare to stakeholders and MM users. There is no doubt that healthcare professionals should be trained in cultural competence; however, cultural competence training is not the only area for improvement. There should be a change in paradigm in healthcare services across Europe: from individual to organizational integration of culture and diversity.

Transcultural Nurse Views on Culture-Sensitive/Patient-Centered Assessment and Care Planning: A Descriptive Study

INTRODUCTION

Culture-sensitive (CS) and patient-centered (PC) care are considered essential to achieve high-quality equitable care. The purpose of this study was to determine how expert nurses incorporate CS/PC care into their assessment and care planning practices, especially for culturally diverse and marginalized patients.

METHODOLOGY

Using a qualitative, descriptive design, we conducted a focus group at the October 2019 Transcultural Nursing Society Conference. Participants (n = 9) discussed how they instilled cultural sensitivity and patient-centeredness into their assessment and care planning skills.

RESULTS

Participants revealed attitudes, knowledge, and skills associated with CS/PC assessment and care planning. They also identified specific strategies for translating CS/PC theory into assessment and care planning practices.

DISCUSSION

Three principles and many pragmatic strategies for incorporating CS/PC care into daily practice emerged from the data. Nurses may find these principles and strategies helpful in integrating CS/PC care into their daily care of patients in busy clinical settings.

Development and effectiveness of a global health competency promotion program for Korean undergraduate nursing students

Aim

This study aimed to assess the effectiveness of a programme designed to promote global health competency among nursing students.

Design

It used a randomized pre–post‐test comparison group design to compare the effects of a global health competency programme among nursing students.

Methods

Data collection for the pre‐test was carried out for 2 days (25–26 October 2018) and that of post‐test was conducted for 2 days (23–24 December 2018). A total of 38 fourth‐year nursing students participated in this study (14 in the international nursing group, 11 in the transcultural nursing group and 13 in the complementary and alternative medicine group). The participants were from the nursing department of a university in Cheongju.

Results

There were no statistically significant differences between the groups in the pre‐test homogeneity test. The international nursing group showed statistically significant improvements between the pre‐ and post‐tests in global health competency, cultural competency, global health confidence and cultural nursing confidence.

Racism, healthcare access and health equity for people seeking asylum

People seeking asylum are at risk of receiving poorer quality healthcare due, in part, to racist and discriminatory attitudes, behaviours and policies in the health system. Despite fleeing war and conflict; exposure to torture and traumatic events and living with uncertainty; people seeking asylum are at high-risk of experiencing long-term poor physical and mental health outcomes in their host country. This article aims to raise awareness and bring attention to some common issues people seeking asylum face when seeking healthcare in high-income countries where the health system is dominated by a Western biomedical view of health. Clinical case scenarios are used to highlight instances of racist healthcare policies and practices that create and maintain ongoing health disparities; limited access to culturally and linguistically appropriate health services, and lack of trauma-informed approaches to care. Nurses and midwives can play an important role in countering racism in healthcare settings; by identifying and calling out discriminatory practice and modelling tolerance, respect and empathy in daily practice. We present recommendations for individuals, organisations and governments that can inform changes to policies and practices that will reduce racism and improve health equity for people seeking asylum.

Pain Management of Amazon Indigenous Peoples: A Community-Based Study

Purpose

Indigenous peoples are vulnerable populations that live in remote areas of the Amazon forest with limited access to health-care services. Underreporting and undertreatment of pain is a common event in the general population but little is known about these issues in indigenous peoples. The aim of this study was to investigate the characteristics and cultural aspects of pain management in five ethnicities of the Brazilian Amazon.

Materials and Methods

Cross-sectional study carried out with adult indigenous individuals from five ethnicities of the Brazilian Amazon over two scientific expeditions (June–July/2017 and February–March/2019). Pain assessment included etiology, intensity, duration, aggravating and alleviating factors, body location, impact of pain on activities of daily living, and treatment.

Results

Ninety indigenous individuals with a mean age of 41.42 ± 19.59 years (range 19‒98 years) and median age of 37 years participated in the study. Sixty-four individuals (71.1%) reported experiencing pain at the time of interview with intermittent musculoskeletal pain of strong intensity being the more prevalent (back pain: 45.3%, joint pain: 43.7%) followed by headache (26.5%). The main alleviating factors reported were traditional indigenous medicine (21.0%) and rest (30.0%), and physical exertion was the main aggravating factor (69.0%). Most study participants reported that pain affected their mood, activities of daily living, and sleep and that they used both traditional indigenous medicine (78.0%) and conventional medicine (81.0%) for pain relief.

Conclusion

Musculoskeletal pain is prevalent among indigenous individuals, affects their quality of life, and is partly attributed to their lifestyle. Cultural aspects mediating the pain experience were observed. Traditional indigenous medicine for pain relief remains partially preserved among the ethnic groups investigated. The findings of this study can help improve the delivery care to these vulnerable populations.

The relationship between resilience, moral sensitivity, and cultural competence among nurses

This study aimed to examine the relationships between resilience, moral sensitivity, and cultural competence among nurses. A descriptive correlational design was employed. The study comprises 120 nurses. The resilience total scores and most of its domain scores were significantly and positively associated with the cultural competency total and domain scores. Additionally, the resilience total scores and some of its domain scores were significantly in relation to the moral sensitivity total and domain scores. Resilience total and domain scores were significantly and positively related to the moral sensitivity total and domain scores. The emergent correlations underscore the role that resilience plays in nurses' moral sensitivity and cultural competence. The emergent correlations underscore the role that resilience plays in nurses' moral sensitivity and cultural competence. The present findings suggest that nurse managers should develop delivery models that nurture resilience in nurses.

Two-Spirit Identity and Indigenous Conceptualization of Gender and Sexuality: Implications for Nursing Practice

The word Two-Spirit is an umbrella term that is used to describe Indigenous peoples who are diverse in terms of their sexual orientation and gender identity, though community-specific definitions and roles for gender and sexual orientation are more extensive and varied. While the terminology of Two-Spirit is recent in its development, Indigenous conceptualizations of diverse gender identities, roles, and sexual orientations have existed since time immemorial and provide important insights into how cultural safety can be incorporated into caring practices. The purpose of this article is to introduce readers to the term Two-Spirit and to provide a broad overview of Indigenous conceptualizations of gender, sexuality, and spirit, to address implications for the nursing profession, and to outline potential applications of this knowledge in practice.

Mixed-methods systematic review: Cultural attitudes, beliefs and practices of internationally educated nurses towards end-of-life care in the context of cancer

AIM

To identify and analyse the cultural attitudes, beliefs and practices of internationally educated nurses towards end-of-life care in the context of cancer.

BACKGROUND

Cultural heritage shape beliefs and practices about cancer and end of life, which complicates nursing care delivery. While previous studies centred on diverse patients' perspectives and cultural competence of healthcare professionals, little analysis available focusing on the cultural attitudes and beliefs of care providers from diverse backgrounds.

DESIGN

Mixed methods systematic review.

DATA SOURCES

CINAHL, MEDLINE, Embase, PsychINFO and Scopus were searched between January and March 2020. No date limit was applied.

REVIEW METHODS

Quality appraisal was conducted using the mixed-method appraisal tool. Convergent segregated synthesis was undertaken. Findings were thematically synthesised with the final synthesis presented narratively.

RESULTS

Seven studies were included: three qualitative, two quantitative and two mixed methods. None of the studies focused on the end-of-life care experiences of IENs in the context of cancer. One study reported views on cancer, with all studies analysing the cultural attitudes, beliefs and practices of internationally educated nurses towards end-of-life care. Three main themes were identified: the philosophy of care, approaches to care and perceptions of death and dying.

CONCLUSION

The distinct gap in research on understanding the cultural attitudes and beliefs of internationally educated nurses in end-of-life care in the context of cancer demands further research. Several aspects of end-of-life care were in conflict with internationally educated nurses' cultural attitudes, beliefs and practices. As these nurses are integral in achieving culturally competent care, further understanding of this phenomenon is required to advance the delivery of culturally sensitive care to patients.

IMPACT

Stakeholders, including the nursing workforce, need to play an active role in providing a culturally inclusive workplace. Support measures are necessary to reduce the impact of cultural conflicts experienced by internationally educated nurses.

Nursing Lecturers' Perception and Experience of Teaching Cultural Competence: A European Qualitative Study

Cultural competence is an essential component in providing effective and culturally responsive healthcare services, reducing health inequalities, challenging racism in health care and improving patient safety, satisfaction and health outcomes. It is thus reasonable that undergraduate nursing students can develop cultural competency through education and training. The aim of this paper was to investigate nursing lecturers' perception and experience of teaching cultural competence in four undergraduate nursing programs. A phenomenological approach was selected to illicit nursing lecturers' perception of culture and experience of teaching cultural competence. Semi-structured personal interviews were held with a sample of 24 lecturers from four European universities. The anonymized transcripts were analyzed qualitatively following Braun and Clark's phases for thematic analysis. Six themes and fifteen subthemes emerged from thematic analysis of the transcripts. Cultural competence was not explicitly integrated in the nursing curricula. Instead, the lecturers used mainly examples and case studies to illustrate the theory. The integration of cultural content in the modules was unplanned and not based on a specific model. Nursing programs should be examined to establish how cultural content is integrated in the curricula; clear guidelines and standards for a systematic integration of cultural content in the nursing curriculum should be developed.

An Ethnohistory of the Transcultural Nursing Scholars and Their Contributions to the Field

Introduction: The Transcultural Nursing Society (TCNS) recognizes transcultural nursing (TCN) scholars for creative leadership and advancing education, practice, research, and administration. The purpose of this study was to discover the historical context of scholars' professional growth and development and their contributions to and future vision for transcultural nursing. Method: Leininger's Ethnonursing Research Method was used to develop an ethnohistorical qualitative approach that included a semistructured, open-ended interview guide and data analysis plan. Data were analyzed using NVivo software and Leininger's Phases of Ethnonursing Data Analysis Enabler for Qualitative Data. Results: Analysis resulted in the discovery of five themes and 15 patterns related to the sources of scholars' interest in TCN; professional development strategies; contributions to TCN theory development, education, research, practice, service, and consultation; the responsibilities of being a TCN scholar; and their future vision for TCN. Discussion: These findings could inspire and guide TCN scholars as they pursue the study and practice of TCN.

School Nurses' Experiences of Health Promotion for School-Age Asylum Seekers

The number of school-age asylum seekers and refugees worldwide is increasing. Health promotion provided by school nurses can be crucial for the well-being of young asylum seekers, yet research on these nurses' experiences is limited. This qualitative study aims to describe school nurses' experiences of providing health promotion to school-age asylum seekers. Semistructured interviews were conducted with 12 school nurses, and inductive content analysis was then used. The results were grouped under the following themes: (1) difficulties in providing health services to school-age asylum seekers, (2) considering the vulnerable circumstances of asylum seekers, (3) the importance of family-centered health promotion, and (4) the importance of time management. School nurses face challenges that stem from individual asylum seekers' unique circumstances, nursing competency, and the school health care system. To deepen the existing knowledge, further research is needed from the perspective of asylum seekers.

Cultural Care of Pregnancy and Home Birth: An Application of the Sunrise Model

BACKGROUND AND PURPOSE

The role of older women close to the pregnant woman may be relevant when conveying information. The use of theories/models can guide the development of nursing practice.

PURPOSE

To explore beliefs and practices related to pregnancy and childbirth from the perspective of older women who gave birth at home, applying Leininger's Sunrise Model.

METHODS

Qualitative approach, using semi-structured interviews with 24 older women who gave birth at home (rural area, Spain). Manual content analysis of the data was used, and Sunrise Model guided to explore the role of culture and the factors affecting maternity care.

RESULTS

Two main categories emerged: beliefs/practices related to physiological aspects (subcategories: minimal intervention, hygiene, pain control, rest, feeding) and to psychosocial aspects (subcategories: spiritual well-being, company).

IMPLICATIONS FOR PRACTICE

The experiences of older women who gave birth at home helped us to understand some beliefs that survive in some pregnant women, similar in different cultures, and divided into physiological and psychosocial aspects. Older women have a relevant role as transmitters of information, and can provide some keys to plan health interventions, as companions or counselors. Applying the Sunrise Model, we verified the weight that culture has in maternal health care, and the multiple factors that interfere with the way of caring. The application of models helps us to improve nursing practice: not only should we focus on knowing the physical aspects, but also the social and cultural circumstances surrounding the pregnant woman.

Development of the Clients' Perceptions of Providers' Cultural Competency Instrument

INTRODUCTION

This study developed and validated the Clients' Perceptions of Providers' Cultural Competency instrument.

METHOD

A sequential exploratory mixed design identified three constructs derived from the studies of Leininger and others. Constructs were compared with publications on cultural competency. A panel of experts reviewed for content validity.

RESULTS

Three hundred and nine mostly Asians and Native Hawaiians completed the questionnaire. Twenty-two items with item-to-total correlation coefficients >.2 were retained. Overall instrument Cronbach's alpha was .89. Construct validity demonstrated the three constructs accounted for 49.6% of variance supported by distinct items with Cronbach's alphas of .82, .83, and .76, respectively. Preliminary criterion validity revealed no statistically significant differences in scores based on the location of services received or race/ethnicity.

DISCUSSION

The Clients' Perceptions of Providers' Cultural Competency instrument is congruent with nursing principles of equity and justice by measuring provider cultural competency from a client's perspective. Active client engagement in care contributes to transcultural nursing's goals to improve health equity.

Changing Home: Experiences of the Indigenous when Receiving Care in Hospital

OBJECTIVES

To understand the meaning of the experience of the indigenous when receiving care in a low-complexity hospital.

METHODS

Qualitative study with ethnographic approach conducted in a hospital of Antioquia, Colombia. The study had 12 indigenous participants who underwent semi-structured interviews. Observation was carried out in hospitalization wards, emergency, and outpatient services of the institution during 40 hours. The analysis process was performed descriptively. The methodological rigor was maintained by applying criteria of confirmability, credibility, transferability, and consistency. The study was approved by the Ethics Committee and authorized by the indigenous authorities to enter the field.

RESULTS

Five themes emerged: the context of caring for the indigenous, the need to consult the hospital, changes experienced by the indigenous in the hospital, experiences in relation with treatments, and relations established within the hospital. The meaning is constructed from a dichotomous perspective based on the favorable or unfavorable aspects of the situations and experiences, which for the indigenous is like "changing home".

CONCLUSIONS

The meaning of the experience of receiving care in hospital for the indigenous is constructed from the context in which they live and receive health services, the changes they live in the dimension of space by virtue of their traveling from their vital space to another space that, due to their physical characteristics, results strange and different, even not healing. Upon the difficulties, the indigenous develop strategies and actions to overcome limitations, whether through adaptation and learning.

Leadership among Women Working to Eradicate Female Genital Mutilation: The Impact of Environmental Change in Transcultural Moments

The study of cultural moments can identify the level of acceptance of female genital mutilation and the visibility of the involved health problems in a globalized world.

AIMS

To describe the transcultural process through which immigrant women who have experienced female genital mutilation become leaders against this practice.

METHOD

Descriptive research with cross-cultural principles and a qualitative approach. A semi-structured interview was the chosen technique for data collection. A total of 18 women participated in the preliminary observation and analysis unit, and only 8 women (38.8%) were ideologically against female genital mutilation (FGM).

INCLUSION CRITERIA

The selected women had undergone FGM and were fully prepared to discuss it.

RESULTS

Staying in a different country and the associated social relations reduce cultural pressure and promote critical thinking. Cultural moments reflect the different situations that affect the perception and practice of female genital mutilation. Health problems associated with female genital mutilation (sexual, reproductive, and psychological) become visible at transcultural moments.

CONCLUSIONS

Environmental country change affects the cultural pressure that sustains this practice in individual minds, institutions, structures, and bodies. These changes produce transcultural moments. The practice of female genital mutilation constitutes a significant segment of gender-based violence.

Measuring Cultural Awareness Among Slovene Nursing Student: A Cross-Sectional Study

Background: Measurements of nursing students' cultural awareness are needed to evaluate education that intends to improve nurses' cultural competency skills. The purpose of this study was to assess the level of cultural awareness held by undergraduate nursing students. Method: A nonexperimental, cross-sectional design was applied to a purposive sample of 149 undergraduate nursing students. Data were collected based on the Cultural Awareness Scale (CAS). Results: The results show that the nursing students had a moderately high level of cultural awareness for all CAS subscales (M = 194.0). However, no statistically significant differences were seen between the students' demographic (gender and age) and other data (year of study and religion) related to the overall CAS score (p > .05). Discussion: Building on the satisfactory results obtained from this study, in the future, both the transcultural nursing contents as well as various strategies for teaching cultural competencies should be carefully evaluated.

Guaranteed Equal Opportunities? The Access to Nursing Training in Central Europe for People with a Turkish Migration Background

This paper examines the reason for the small percentage of professional nurses with a Turkish migration background and investigates possibilities to increase this low amount. Our society grows older, and the number of chronic diseases increases. Furthermore, nursing professionals tend to migrate, and the retirement of the baby boomer generation will also create a lack of professional nurses in Vorarlberg, Austria. People with a Turkish migration background, who are the second largest group without Austrian citizenship in Austria, could be an important resource for the upcoming lack of qualified nurses. The nursing profession could be a secure career opportunity for these people, and therefore it is of great importance to make access to professional nursing training easier for people with a Turkish migration background. This paper describes the effects of migration on society, institutions and individuals and gives an overview of concepts related to how to deal with this situation. This qualitative study investigates the access to nursing training for people with a Turkish migration background from three different points of view-those of experts, students and nurses with a Turkish migration background, and people with a Turkish migration background who have to pass a university entrance qualification-in the form of guided interviews. The results will illustrate structural and social barriers due to complex social dynamics and also highlight possibilities to reduce those barriers. Based on the results, prospects for professional nursing are deduced on the macro, meso and micro levels, which should generate an increasing number of nurses with a Turkish migration background.

Interpersonal Communication in Transcultural Nursing Care in India: A Descriptive Qualitative Study

Introduction: Good communication is crucial for safe and effective nursing care and is necessary in building interpersonal relationships with patients. The increase of global interactions in health care adds to the necessity of developing culturally competent communication in nursing. The purpose of the study was to gain a deeper understanding of interpersonal communication as experienced by nurses working in culturally diverse hospitals in India. Method: A descriptive qualitative method, analyzing 12 semistructured interviews conducted with nurses at two hospitals. Results: The study’s themes focus on tools and techniques for working with culturally diverse patients and how to sustain the quality of care in diverse hospital settings. Language resources, language tools, and cultural knowledge were useful aids for nurses when communicating with transcultural patients. It helped the nurses gain confidence and foresee patient needs. Discussion: Highlighting transcultural interpersonal communication techniques within nursing offers a safer and more productive practice of nursing care.

Ambivalent sexism of nursing students in Turkey and South Korea: A cross-cultural comparison study

Culture has become increasingly important concepts in nursing in the era of globalization. Nurses' cultural biases and prejudices are huge obstacles to their caring for patients from diverse cultural backgrounds. Therefore, this study examined sexism among nursing students from two patriarchal societies: Turkey influenced by Islam, and South Korea influenced by Confucianism. For this comparative study, we used the survey data from the sample of 560 nursing students, 309 from Turkey and 251 from South Korea. The findings showed that both samples showed high levels of sexism, both hostile and benevolent. When comparing the two samples, Turkish nursing students showed significantly higher sexism than did Korean students. Additionally, in both countries, male participants showed higher scores on sexism, especially hostile sexism. In terms of age, older students in Turkey showed lower levels of benevolent sexism. We hope the findings of this study can provide evidence to develop customized transcultural nursing education content in the context of different ethnicities and to help nurses and nursing students from specific cultural backgrounds in becoming aware of their own cultures.

Factors associated with premarital sexual behaviour of adolescents who lived in a former prostitution area

Premarital sexual behaviour is a common behaviour in adolescence. The environment around the prostitution area can adversely affect the behaviour and personality development of adolescents. The purpose of this study was to determine the factors associated with premarital sexual behaviour among adolescents who lived in former prostitution area based on transcultural nursing theory. A cross-sectional method was used for this study. The samples were 109 students who lived in the former prostitution area of Surabaya, chosen using the purposive sampling technique. The independent variables were knowledge, economic, lifestyle and cultural values, family and social support, religiosity, rules and policies, and technology. The dependent variable was premarital sexual behaviour. Data were collected by questionnaires and then statistically tested with Spearman's rho (ρ ≤ 0.05). The results showed that only religiosity had significant association with premarital sexual behaviour among adolescents (p = 0.004). While the other factors were not significantly associated with premarital sexual behaviour among adolescents. Religiosity is the most motivating factor to prevent deviant behaviour, including in terms of sexuality. These findings indicate the importance of religious teachings in educating children to behave properly.

Indigenous mothers' experiences of using acute care health services for their infants

AIMS AND OBJECTIVES

To develop an understanding of how Indigenous mothers experience selecting and using health services for their infants can assist nurses in improving their access to care. This understanding may ultimately lead to improved health outcomes for Indigenous infants and their families.

BACKGROUND

Access to acute care services is important to minimise morbidity and mortality from urgent health issues; however, Indigenous people describe difficulties accessing care. Indigenous infants are known to use the emergency department frequently, yet little is known about the facilitators and barriers their mothers experience when accessing these services.

DESIGN

This study undertook a qualitative, interpretive description design.

METHODS

This article adheres to the reporting guidelines of COREQ. Data collection methods included interviews and a discussion group with Indigenous mothers (n = 19). Data analysis was collaborative and incorporated both Indigenous and Western ways of knowing, through the application of Two-Eyed Seeing.

RESULTS

A thematic summary resulted in six themes: (a) problematic wait times; (b) the hidden costs of acute care; (c) paediatric care; (d) trusting relationships; (e) racism and discrimination; and (f) holistic care.

CONCLUSIONS

The experiences of Indigenous mothers using acute care services for their infants suggest a role for culturally safe and trauma and violence-informed care by health providers in the acute care context.

RELEVANCE TO CLINICAL PRACTICE

Nurses can improve access to acute care services for Indigenous mothers and infants through the provision of culturally safe and trauma and violence-informed approaches care, by building rapport with families, providing care that is respectful and nonjudgemental, eliminating fees associated with using acute care services and linking families with cultural resources both in hospital and within the community.

Using Transcultural Nursing Education to Increase Cultural Sensitivity and Cultural Assessment Documentation by Staff in an In-Home Chronic Disease Self-Management Program

BACKGROUND

Despite literature indicating that culturally sensitive care promotes a positive patient environment and may help improve outcomes, limited data exist on the documentation of patients' cultural concerns in electronic medical records (EMR).

OBJECTIVE

The project's objective was to use an educational intervention to increase clinic staff's cultural sensitivity and cultural assessment documentation.

METHODS

Researchers conducted this 3-month project at a Midwestern clinic's in-home, self-care chronic disease management program. The voluntary sample of clinical staff (n = 8) received an educational intervention on transcultural nursing practices. Researchers administered the Transcultural Self-Efficacy Tool for the Multidisciplinary Healthcare Provider (TSET-MHP) to participants before and after the intervention. A pre- and postintervention EMR audit was completed on 128 charts to evaluate cultural assessment documentation.

RESULTS

TSET-MHP cognitive and practical subscales scores increased postintervention. Affective subscales scores decreased slightly. Electronic cultural assessment documentation increased by 10%. An assessment questionnaire showed an increase in participants' cultural self-awareness and comfort with cultural assessment.

CONCLUSIONS

An educational intervention demonstrated an increase in providers' cultural awareness and cultural assessment documentation.

IMPLICATIONS FOR NURSING

Transcultural nursing education may help increase providers' perceived cultural self-efficacy, which may improve cultural assessments and culturally competent care.

Sexual Relationship Power and Safe Sex Communication Among Partnered Women in the Dominican Republic

Introduction: Research is needed to identify influences on safe sex communication among specific culture groups. This study aimed to (1) describe sexual behaviors and indicators of sexual power among partnered Dominican women and (2) identify which of these indicators are significantly associated with safe sex communication. Methodology: Cross-sectional surveys, grounded in the theory of gender and power, were conducted with 100 partnered women at a clinic in southeastern Dominican Republic. Linear regression modeling was used to identify significant associations. Results: Self-efficacy (β = 0.48), total personal monthly income (β = 0.21), and history of sexually transmitted infection (β = 0.19) were significantly associated with higher level of partner safe sex communication. Discussion: Nurse clinicians, educators, and researchers should consider self-efficacy, personal income, and history of sexually transmitted infection when addressing communication in HIV prevention efforts among Dominican women.

Care from the Cultural Perspective in Women with Physiological Pregnancy: a Meta-Ethnography

OBJECTIVES

This work sought to conduct an interpretative synthesis of qualitative studies on the phenomenon of care from the cultural perspective in women with physiological pregnancy.

METHODS

The Meta-ethnography method was used with the seven traditional phases by Noblit and Hare to describe the knowledge derived from the results of qualitative studies with relation to the study phenomenon. A bibliographic search was carried out in seven databases. Twenty-nine qualitative studies were pre-selected of which 23 complied with the quality criteria of the Critical Appraisal Skills Program.

RESULTS

Upon synthesizing the studies selected, 12 thematic categories emerged: pregnancy: a natural phenomenon in the woman's life; spirituality and family support; the midwife; positive and negative feelings; physical exercise; comfort and rest; feeding; avoid consumption of non-beneficial substances; intrauterine stimulation; heat and cold; sexuality during pregnancy; and traditional beliefs and myths.

CONCLUSIONS

Synthesis of the studies permitted developing a line of argument, which reveals that the care practices of pregnant women have a cultural legacy of beliefs, values, myths, and customs that are aimed at guaranteeing the protection of the mother and of her unborn child.

Psychiatric nursing care experiences of immigrant patients: A Focused ethnographic study

This study aimed to describe the psychiatric nursing care experiences of immigrant patients. The incidence of mental health problems is higher and the use of mental health services is lower among immigrants, especially refugees, compared with the majority of the population. The study uses a qualitative research approach, with an emphasis on focused ethnography research methods. The participants were immigrant patients (N = 14) residing in adult psychiatric wards of certain hospitals (N = 3) selected for the study. A majority of the participants were refugees or asylum seekers. A total of 21 in-depth interviews were conducted. The experiences of these immigrant patients, both in their home countries and in their country of residence, had had an adverse effect on their mental health, with past traumatic experiences being the most central factor. Their symptoms included depression, anxiety, somatization, and psychosis. The findings show that the categories of factors that helped promote recovery among immigrant patients were nursing, medical treatment, care environment, and the patients' own methods. Based on the findings, a systematic evaluation of traumatic experiences is recommended for immigrants from countries with a history of war and/or political violence. Healthcare providers should also consider the importance of cultural desire in psychiatric nursing for the recovery of patients.

Enhancing cultural safety among undergraduate nursing students through watching documentaries

The purpose of the study was to develop an understanding of how nursing students gained perspective on nursing care of diverse populations through watching documentaries in a cultural diversity course. The basis of this paper is our analyses of students' written responses and reactions to documentaries viewed in class. The guiding theoretical frameworks for the course content and the study included postcolonial feminism, Foucauldian thought, and cultural safety. Krathwohl's Taxonomy of the Affective Domain was used to identify themes and determine how undergraduate nursing students were progressing in achieving learning outcomes. Our findings suggest that while the use of documentaries serves as a tool for deepening students' understanding of the realities of various populations, this activity, in the absence of critical reflection, may inadvertently promote stereotypes and further marginalize different people groups. Even though nursing students reflected on the importance of cultural safety in nursing, our findings indicate that their actions may not reflect this, especially since these students are in the early stages of the nursing program. Students need to be provided with a space where they can explore implicit biases evoked by exposure to new information about different people groups as a way of enhancing culturally safe care.

Linguistic and Psychometric Validation of the Thai Version of Simplified Diabetes Knowledge Scale: A Measure of Knowledge of Diabetes in a Thai Population

Purpose

To develop a linguistically and psychometrically validated Thai version of the Simplified Diabetes Knowledge Scale (T-SDKS) for adults with Type 2 diabetes mellitus (T2DM).

Design

A cross-sectional study was carried out among people with T2DM.

Methods

Consecutive sampling was undertaken to recruit participants at the outpatient diabetes clinic of a hospital in Northern Thailand.

Results

A total of 502 patients with T2DM were recruited. The mean age of the participants was 60.2 years, and 60.5% were female. The T-SDKS attained a reliability coefficient of .79. The item-total correlation value was greater than 0.20 for each item, and the inter-item correlation ranged between 0.03 and 0.49. Respondents attained a mean percentage knowledge score of 42.39% ± 15.45 on T-SDKS.

Discussion/conclusions

The T-SDKS has demonstrated to be a brief and simple diabetes knowledge assessment tool to use in a busy clinical setting.

Implication for practice

The findings can be used to improve health education interventions.

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.

Establishing a culturally specific nursing home for Finnish-speaking older persons in Sweden: A case study

Aim

The study aims to describe the establishment of a culturally specific nursing home for Finnish-speaking older persons in Sweden.

Design

A descriptive qualitative study.

Methods

A descriptive case study based on a review of 14 public documents and individual interviews with two experts in the area, analysed with qualitative content analysis.

Results

This study found that shared language, preservation of customs and habits and collaboration between the representatives of the municipality, Finnish-speaking migrant associations and staff at the nursing home influenced the development of the culturally specific nursing home for older Finnish-speaking people intended to avoid loneliness, isolation and misunderstandings among older Finnish-speaking. Collaboration between healthcare service for older persons and minority people resulted in an optimal culturally specific nursing home, simultaneously encountering the majority culture. Nursing and healthcare services need to be aware of positive effects of collaboration with stakeholders to achieve optimal culturally specific nursing homes.