Building an Indigenous mental health workforce is a strategy used to develop culturally responsive and effective mental health services in New Zealand. However, researchers know little about Indigenous (Maori) mental health nursing. We undertook a Maori-centered methodology and grounded theory using focus groups to collect data from 10 Maori mental health nurses. We then analyzed the data using constant comparative analysis and theoretical sampling until saturation of the core category and subcategories emerged. "Bridging two worlds," together with two subcategories, "going beyond" and "practicing differently," explains the process Maori mental health nurses used to resolve the tensions they encountered working in the worlds of mainstream and Maori health services. This research provides insight into the tensions Indigenous and minority nurses experience when attempting to integrate cultural perspectives and practices to meet the needs of their patients.
To explore the research lessons learned in the process of conducting qualitative research on cervical cancer screening perspectives among multiple ethnolinguistic groups of immigrant women and to provide guidance to family medicine researchers on methodologic and practical issues related to planning and conducting focus group research with multiple immigrant groups.
Observations based on a qualitative study of 11 focus groups.
Women from 1 of 5 ethnolinguistic immigrant groups and Canadian-born women of low socioeconomic status.
We conducted 11 focus groups using interactive activities and tools to learn about women's views of cervical cancer screening, and we used our research team reflections, deliberate identification of preconceptions or potential biases, early and ongoing feedback from culturally representative field workers, postinterview debriefings, and research team debriefings as sources of information to inform the process of such qualitative research.
Our learnings pertain to 5 areas: forming effective research teams and community partnerships; culturally appropriate ways of accessing communities and recruiting participants; obtaining written informed consent; using sensitive or innovative data collection approaches; and managing budget and time requirements. Important elements included early involvement, recruitment, and training of ethnolinguistic field workers in focus group methodologies, and they were key to participant selection, participation, and effective groups. Research methods (eg, recruitment approaches, inclusion criteria) needed to be modified to accommodate cultural norms. Recruitment was slower than anticipated. Acquiring signed consent might also require extra time. Novel approaches within focus groups increased the likelihood of more rich discussion about sensitive topics. High costs of professional translation might challenge methodologic rigour (eg, back-translation).
By employing flexible and innovative approaches and including members of the participating cultural groups in the research team, this project was successful in engaging multiple cultural groups in research. Our experiences can inform similar research by providing practical learning within the context of established qualitative methods.
Cites: BMJ. 2000 Jan 15;320(7228):178-8110634744
Cites: ANS Adv Nurs Sci. 2000 Jun;22(4):1-1510852665
Cites: Health Technol Assess. 2001;5(23):iii-15711785749
The aim of the study was to determine if a culturally sensitive smoking prevention program would have short-term impacts on smoking intentions among Aboriginal children. Two schools with high Aboriginal enrollment were selected for the study. A grade 4 classroom in one school was randomly assigned to receive the culturally sensitive smoking prevention program. A grade 4 classroom in the second school received a standard smoking prevention program delivered in this jurisdiction. Children in each classroom were tested pre- and post-intervention to measure attitude changes about smoking. There was a significant reduction in intentions to smoke among Aboriginal children who received the culturally sensitive smoking prevention program. The small overall sample size precluded a direct comparison of the efficacy of the culturally sensitive and standard programs. The present findings suggest a smoking prevention program that has been culturally adapted for Aboriginal children may reduce future smoking intentions among Aboriginal grade 4 students. Further research is needed to determine the extent to which school smoking prevention programs adapted to respect the long-standing use of tobacco in Aboriginal cultural traditions may be more effective than standard programs in reaching Aboriginal youth.
It can be challenging to provide generalist palliative care in hospitals, owing to difficulties in integrating disease-oriented treatment with palliative care and the influences of cultural and organisational conditions. However, knowledge on the interactions that occur is sparse.
To investigate the interactions between organisation and culture as conditions for integrated palliative care in hospital and, if possible, to suggest workable solutions for the provision of generalist palliative care.
A convergent parallel mixed-methods design was chosen using two independent studies: a quantitative study, in which three independent datasets were triangulated to study the organisation and evaluation of generalist palliative care, and a qualitative, ethnographic study exploring the culture of generalist palliative nursing care in medical departments.
A Danish regional hospital with 29 department managements and one hospital management.
Two overall themes emerged: (1) 'generalist palliative care as a priority at the hospital', suggesting contrasting issues regarding prioritisation of palliative care at different organisational levels, and (2) 'knowledge and use of generalist palliative care clinical guideline', suggesting that the guideline had not reached all levels of the organisation.
Contrasting issues in the hospital's provision of generalist palliative care at different organisational levels seem to hamper the interactions between organisation and culture - interactions that appear to be necessary for the provision of integrated palliative care in the hospital. The implementation of palliative care is also hindered by the main focus being on disease-oriented treatment, which is reflected at all the organisational levels.
Dr. Crowshoe: Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada. Dr. Han: Department of Family Medicine, Queen's University, Kingston, Ontario, Canada. Dr. Calam: Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada. Dr. Henderson: Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada. Dr. Jacklin: University of Minnesota Medical School, Duluth, Minnesota. Ms. Walker: School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Dr. Green: Departments of Family Medicine and Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
Health education about Indigenous populations in Canada (First Nations, Inuit, and Métis people) is one approach to enable health services to mitigate health disparities faced by Indigenous peoples related to a history of colonization and ongoing social inequities. This evaluation of a continuing medical education workshop, to enhance family physicians' clinical approach by including social and cultural dimensions within diabetes management, was conducted to determine whether participation in the workshop improved self-reported knowledge, skills, and confidence in working with Indigenous patients with type 2 diabetes.
The workshop, developed from rigorous national research with Indigenous patients, diabetes care physicians, and Indigenous health medical educators, was attended by 32 family physicians serving Indigenous populations on three sites in Northern Ontario. A same-day evaluation survey assessed participants' satisfaction with workshop content and delivery. Preworkshop and postworkshop surveys consisting of 5-point Likert and open-ended questions were administered 1 week before and 3 month after the workshop. Descriptive statistics and t test were performed to analyze Likert scale questions; thematic analysis was used to elicit and cluster themes from open-ended responses.
Participants reported high satisfaction with all aspects of the workshop. Reporting improved understanding of socioeconomic (P = .002), psychosocial, and cultural factors (P = .001), participants also described adapting their clinical approach to more actively incorporating social and cultural factors and focusing on patient-centered care.
The workshop was effective in shifting physician's self-reported knowledge, attitudes, and skills resulting in clinical approach modifications within social, psychosocial, and cultural domains for their Indigenous patients with diabetes.
Inuit interpreters are key players in end-of-life (EOL) care for Nunavik patients and families. This emotionally intensive work requires expertise in French, English and Inuit dialects to negotiate linguistic and cultural challenges. Cultural differences among medical institutions and Inuit communities can lead to value conflicts and moral dilemmas as interpreters navigate how best to transmit messages of care at EOL.
Our goal was to understand the experience of Inuit interpreters in the context of EOL care in Nunavik in order to identify training needs.
In the context of a larger ethnographic project on EOL care in Nunavik, we met with 24 current and former interpreters from local health centres and Montreal tertiary care contexts. Data included informal and formal interviews focusing on linguistic resources, experiences concerning EOL care, and suggestions for the development of interpretation training.
Inuit working as interpreters in Nunavik are hired to provide multiple services of which interpretation plays only a part. Many have no formal training and have few resources (e.g. visual aids, dictionaries) to draw upon during medical consultations. Given the small size of communities, many interpreters personally know their clients and often feel overwhelmed by moral dilemmas when translating EOL information for patients and families. The concept of moral distress is a helpful lens to make sense of their experience, including personal and professional repercussions.
Inuit interpreters in Nunavik are working with little training yet in context with multiple linguistic and cultural challenges. Linguistic and cultural resources and focused training on moral dilemmas unique to circumpolar contexts could contribute to improved work conditions and ultimately to patient care.????.
Cites: BMJ Support Palliat Care. 2013 Mar;3(1):61-8 PMID 23585926
Cites: Milbank Q. 2006;84(1):111-33 PMID 16529570
Cites: Am J Health Behav. 2007 Sep-Oct;31 Suppl 1:S122-33 PMID 17931131
The nursing community in the Nordic countries has become multicultural because of migration from European, Asian and African countries. In Norway, minority health care providers are recruited in to nursing homes which have become multicultural workplaces. They overcome challenges such as language and strangeness but as a group they are vulnerable and exposed to many challenges.
The aim is to explore minority healthcare providers, trained nurses and nurses' assistants, and their experiences of challenges when working in a multicultural team in a Norwegian context.
The study has a qualitative design, using narrative interviews, and a phenomenological-hermeneutic analysis method to explore the experiences of challenges in dementia care.
The study was approved by The Norwegian Regional Ethics Committee, and the Norwegian Social Science Data Services.
Five informants from different African, Asian and European countries participated in the study. The study was conducted in a Norwegian nursing home, in a dementia care unit.
The results show that minority health care providers experience and find meaning in being a member of a team, they overcome challenges, characterized by the interdependency in the team, appreciating new cultural experiences and striving to belong. They must overcome challenges such as language problems and the feeling of strangeness.
The findings are discussed considering Løgstrup's ethic of proximity, the ethical demand of trust, and interdependency. The ethical demand is an answer to a common, transparent, unspoken agreement to be met, seen, and understood.
The study shows that cooperation in a multi-professional and multi-ethnic team is important, and secures the quality of care to persons with dementia. Further research is necessary to examine the relation between a multi-ethnic staff and the patients experiencing dementia. Further research is necessary to examine ethnicity, the relation between a multi-ethnic staff, the patients experiencing dementia and next of kin.
As demonstrated in three cases, this paper illustrates how psychoanalytically informed multimodal care was an essential element of effective medical treatment of children traumatized by the Chechen war. Multimodal psychoanalytically informed aid work involves holding a variety of psychoanalytic viewpoints, including but not restricted to those represented by the Freudian, Interpersonal, and Relational orientations; its purpose is to allow for greater clarity in conceptualizing the traumatized child's response to war in order to provide the necessary care during the therapeutic process. Among the issues addressed are how traumatic memory can initially be expressed nonverbally, and therefore the use of embodied life-metaphors and witnessing are central to the survivors' ability to remember and symbolize. In addition, the significance of cultural awareness and sensitivity are explored as key components to the children's care. In the first case, the author illustrates how a traumatic life-metaphor can be resolved at an embodied, rather than an exclusively verbal, level. In the second case, cultural tradition and relativism have a significant impact on addressing medical and quality of life issues for the child. The third case illustrates how the analyst functions as recognizing witness to a parent's trauma; the "being with" of the relationship becomes the agent of the parent's change.
There is a lack of knowledge about psychosocial resources that may sustain post-resettlement psychological adjustment among unaccompanied minor asylum-seekers. The aim of this study is to investigate the impact of social support from family abroad and friends on acculturation, discrimination, and mental health among these vulnerable children and youth. Questionnaire data were collected from a population-based multi-ethnic sample involving 895 unaccompanied minors resettled in municipalities in all regions of the country. They met in groups in their local communities. The informants were on average 18.6 years, and had an average length of stay in Norway of 3.5 years. The findings showed that the participants suffered from high levels of ongoing war related intrusive symptoms and depression. Still, at the same time they engaged in adaptation processes that are normative to youth with immigrant backgrounds, in terms of constructing supportive networks and developing culture competence. In accordance with the main effect hypothesis, social support had direct effects on depression and indirect effects by increasing culture competence that may aid the young refugees in dealing with discrimination. However, there were no effects of social support on symptoms of PTSD. The findings give direction to areas of interventions, beyond dealing with the sequel of the traumas the unaccompanied minors have been exposed to, not only for clinicians, but also social workers and school personnel.
The purpose of this study was to investigate associations between school nurses' self-assessed cultural competence in health visits with children of foreign origin and demographic variables, by using a cross-sectional design. A Web-based questionnaire assessing cultural competence and demographic variables was distributed to a nationally representative sample (n = 816) of school nurses in Sweden. Data were analyzed using regression analysis. School nurses assessed themselves as culturally aware and moderately culturally competent, but not as culturally knowledgeable, culturally skilled, or comfortable in cultural encounters. Cultural competence was related to education in cultural diversity, how often nurses encounter children of foreign origin, and nurses' country of origin. In total, these variables explained 23.6% of the variation in school nurses' cultural competence. Because school nurses regard themselves as moderately culturally competent, a foundation for promoting children's health on equal terms in school health care exists. However, education in cultural diversity combined with other additional strategies is needed to further strengthen school nurses' cultural knowledge, skills, and comfort level in encounters with children of foreign origin.