Journal of Transcultural Nursing

The coronavirus pandemic has disproportionately negatively affected the ultraorthodox in Israel. Their unique characteristics and slow adoption of preventative health guidelines resulted in a significant increase in morbidity and mortality. To lower these rates, health and government authority figures employed methods to change the ultraorthodox community health behaviors.

This study utilizes the ACCESS model for transcultural nursing to analyze the response by authorities to high infection rates in the large ultraorthodox community in city of Beit Shemesh during the first wave of the outbreak (through early May).

The authorities employed all model components to varying degrees and found moderate success in changing health behaviors of the ultraorthodox.

Employing the ACCESS model as a response to the health care crisis among the ultraorthodox community in Beit Shemesh led to some success in increased compliance, thus lowering morbidity rates. However, not establishing strong respect and rapport hindered the process.

Foot ulcers cause women in Indonesia to lose opportunities to participate in religious and cultural activities due to the inability to wear certain footwear. This study examined body image as a mediator in the relationship between gender and quality of life (QoL) among patients with diabetic foot ulcer (DFU) in Indonesia.

A cross-sectional design with convenience sampling was used to recruit participants at the Surgical Outpatient Department and Wound Care Clinic in Bali, Indonesia. The Diabetic Foot Ulcer Scale–Short Form and the body image domain of the Body Investment Scale were administered.

We found gender differences in participants’ (n = 201) QoL and body image (p < .05). Body image fully mediated the effect of the relationship between gender and QoL (B = 6.68; 95% confidence interval [3.14, 10.52]) and explained 39.13% of the variance.

Health care providers should consider patients’ religious beliefs in DFU education and consider women’s body image issues. Diabetes foot ulcer may prevent women from performing religious rituals, thus, influencing their QoL. Protective strategies to prevent DFU among women in Indonesia warrant further development.

Hemodialysis patients in Korea increased 2.3 fold from 2008 to 2018 and continues to rise 7% to 10% annually. Long-term treatment to prevent complications requires understanding patients’ hemodialysis–life balance. Our purpose was to explore the process of life reorganization by hemodialysis patients from Korea.

Grounded theory methodology was utilized. Participants were hemodialysis patients recruited from four hemodialysis centers in Korea. Data were collected by in-depth individual interviews. Data were analyzed using constant comparative method with theoretical saturation.

Participants (n = 14) experienced four phases with transitions. A traditional Korean belief system, the view of blessing-focused destiny promoted a change in perspective from the focus on a life crisis, and thereby, played a role in buffering negative experience.

Nurses should assess the cultural individual needs of patients, which change according to each phase of life reorganization, and provide the right care at the right time to increase positive experiences.

We examined factors influencing anemia outcomes in rural children following implementation of a prevention program.

Mixed methods study of children, parents, and clinicians utilized statistical modeling and content/ethnographic analysis. Retrospective chart abstraction evaluated treatments administered and measured hemoglobin in children aged 6 to 59 months (n = 161). Prospective interviews/questionnaires examined parent (n = 51) and clinician (n = 19) perceptions.

Anemia prevalence decreased by 21.2%. Predictors of increased hemoglobin were clinic visit number and age at first visit. Once anemia improved, children were likely to remain improved (P = .65). Despite favorable program perceptions, stakeholders emphasized ecological barriers, including social disadvantage and local practices.

Socioeconomic factors prevented guideline concordant behaviors. Persistent attention to intrapersonal, interpersonal, and community social determinants is a sine qua non for successfully managing the epidemic. The first step to provide culturally congruent care is to explicitly acknowledge that guideline-concordant behaviors are often complex.

Despite expanding interest in cancer survivorship, little is known about urban Asian breast cancer survivors whose experience may differ from those in suburban and rural locations. This study explores survivors’ challenges to maximize outcomes and identify common and unique themes among urban Asian survivors. Information was obtained from the survivors and outreach workers from their community.

Descriptive qualitative methods including semistructured interview guides were used to plan, conduct, and analyze both individual interviews of Asian women (n = 6) and a focus group (n = 7) composed of community outreach workers.

The interview and focus group findings, endorsed themes of communication/language, trust, and privacy, with generational differences. Poor health literacy in both survivors and providers was identified.

Nurses are in a unique position to use the themes identified to both assist survivors expand their health literacy and lobby for resources for providers to promote culturally congruent care.

Language barriers challenge patient- and family-centered care. Literature guiding pediatric nurses caring for patients and families with limited English proficiency in the inpatient setting is nonexistent. The purposes of this phenomenological study were to understand pediatric nurses’ experiences in caring for patients and families with limited English proficiency and to explore how nurses navigate the communication gap.

A purposive sample of 15 pediatric Registered Nurses at a large urban children’s medical center participated in face-to-face semistructured interviews. Verbatim transcribed interviews were analyzed line-by-line and categorized into themes.

Themes included personal framework of care, consequences of caring, starting off right, nurse sensing, verbal/nonverbal methods, and interpreters.

Nurses did not perceive differences in task-oriented care; they described compromised personal paradigms, held negative feelings, and utilized verbal/nonverbal communication methods. Future research is needed exploring patients’ and families’ perceptions regarding care by other language–speaking nurses.

Second-generation Arab Americans may be at risk for poor cardiovascular health behaviors, but these behaviors are poorly understood. The purpose of this study was to examine the effects of acculturative stress and psychological flexibility on cardiovascular health behaviors among second-generation Arab Americans.

In a cross-sectional study, survey data were collected in 2018 at local mosques, churches, and a university campus. Cardiovascular health behaviors were measured with a questionnaire based on the American Heart Association Life’s Simple 7. Acculturative stress and psychological flexibility were assessed using reliable and valid measures.

Participants (n = 325) with higher acculturative stress were significantly more likely to report intermediate overall cardiovascular health behaviors (p = .01) and poor to intermediate diet (p = .00). Psychological flexibility partially mediated poor/intermediate smoking (p = .02) and intermediate diet (p = .00) scores.

Nurses may consider the role of acculturation when designing culturally sensitive interventions to promote cardiovascular health in second-generation populations.

Latino populations, particularly those living in rural areas, experience a disproportionately high prevalence and poorer outcomes of type 2 diabetes mellitus (T2DM). The purpose of this study was to test the acceptability and perceived effectiveness of a group-based, facilitated digital storytelling intervention for T2DM self-management among rural Latino patients.

Twenty Latino adults with T2DM participated in facilitated storytelling discussions at two primary clinics. Participants viewed a 12-minute T2DM self-management digital storytelling intervention, followed by a facilitated group discussion. Surveys, observations, and focus groups were used to assess for acceptability and perceived effectiveness of the intervention through descriptive and qualitative analysis, informed by narrative and social cognitive theory.

All participants found the intervention interesting and useful and reported improvement in confidence, motivation, and behavioral intentions for T2DM self-management. Themes mapped closely with narrative theory models, further suggestive of the behavior change potential.

Facilitated discussions may add value to viewing of digital stories and represent a scalable approach to provide culturally congruent health care for Latino patients with diabetes in rural settings. Within the paradigm of group-based diabetes educational programs, this lends itself well to critical transcultural nursing care.

Guided by the intergenerational solidarity theory, this study examined how different dimension of intergenerational solidarity of adult children associated with their choice of being a primary caregiver for aging parents in the Chinese American families.

Secondary data from PIETY study were used. Logistic regressions were conducted to examine the relationships between each dimension of intergenerational solidarity and the likelihood of being a primary caregiver to mother or father.

Associational solidarity (odds ratio [OR] = 1.31, for father, OR = 1.27, for mother), normative solidarity (OR = 1.06, for both father and mother), and structural solidarity (OR = 0.95, for father, OR = 0.64, for mother) were significant associates of high chances of being primary caregivers for older parents.

Results from this study confirmed the importance of cultural construct of solidarity in caregiving choice. Practice implications for health care professionals, in particular the nurses were discussed.

Opioid crisis has disproportionately affected Alabamians with the highest opioid prescription rate, and it is subjected to affect Korean Americans (KA) negatively based on common predictors of opioid misuse that KA possess.

Cross-sectional data of KA in rural Alabama (N = 230) were analyzed. Opioid literacy was assessed by the Brief Opioid Overdose Knowledge survey. Six social determinants of health factors were considered: financial status, educational attainment, English proficiency, household food insecurity, health literacy, and social contact.

Participants had limited opioid literacy (M = 3.56, SD = 3.06). After adjusting for demographics and health covariates, higher levels of overall opioid literacy were associated with higher household income (B = .48, p < .01), higher levels of health literacy (B = .71, p < .01), and less frequent social contact (B = −.40, p < .01). Significant social determinants of health predictors varied across subdomains of opioid literacy.

The findings suggest that culturally competent and community-level interventions are needed to increase opioid literacy in KA in rural Alabama.

Withholding the malignant bone tumors disclosure from patients is common in China. The purpose of the study was to explore the perceptions of patients, families, doctors, and nurses regarding the disclosure of malignant bone tumors in China.

Semistructured interviews were conducted with 25 cases, consisting of 69 participants (14 patients, 25 family members, 17 doctors, and 13 nurses), and the transcripts were analysed using Colaizzi’s (1978) descriptive phenomenological analysis process.

Five themes were identified: (1) doctors preferred to inform the family members first, (2) family members’ decisions depended on different situations, (3) the patients agreed that disclosure should be different for each person/personally, (4) care from nurses reduced the overreaction of patients, and (5) key points improve the informing quality.

Family participatory cancer disclosure and multidisciplinary teams could improve the quality of cancer disclosure. Culturally congruent health care and culturally sensitive interventions in cancer disclosure are suggested.

Arab American women (AAW) have significantly low mammography screening (MS) rates; religious and sociocultural factors may serve as facilitators or barriers to screening. Understanding associations with screening practices and attitudes is imperative. The purpose of this study was to examine associations of sociodemographic characteristics with perceived benefits and barriers to MS and explore relationships of MS with sociodemographics, and perceived benefits and barriers in Muslim and Christian AAW from three Arab countries, Jordan, Lebanon, and Egypt.

In this exploratory, cross sectional study, a convenience sample of 316 AAW completed a survey that combined sociodemographics and the Arab Specific-Culture Barriers instrument.

Religion was significantly associated with perceived benefits and country of birth had a significant association with perceived barriers. Significant relationships were found between some variables and MS.

This study provided insights into facilitators and barriers influencing behaviors and attitudes regarding MS in AAW. Additional efforts are to be made to overcome barriers within a religious and cultural context to empower these women.

People with sickle cell disease (SCD) often face stigmatization in Ghana and elsewhere in Africa. Research is needed to understand whether it is necessary to design an SCD stigma reduction program in the Ghanaian setting. The aim of this study was to explore the perception of stigmatization for adults with SCD in Kumasi, Ghana.

Using in-depth qualitative interviews, researchers conducted a phenomenological study to investigate the perception of stigmatization for people with SCD in Kumasi, Ghana. Snowball and purposive sampling was used to identify the participants.

Participants (n = 12) were mostly female, Akan, and Christian. Researchers categorized three main themes: (a) Feelings of social isolation, (b) Fear of disclosure, and (c) Bullying about physical appearance.

The findings highlight the need to develop effective strategies to counteract stigma. Transcultural health care providers can implement stigma reduction interventions that might be applicable throughout Africa where findings are likely to resonate with patients with SCD.

Despite the importance of compassionate leadership in health care, many of the existing publications do not account for the effect of culture. The aim of this study is to explore the views of nursing and midwifery managers from different countries in relation to the definition, advantages, and importance of compassion.

A cross-sectional, descriptive, exploratory online survey was conducted across 17 countries, containing both closed and open-ended questions. Data from N = 1,217 respondents were analyzed using a directed hybrid approach focusing only on qualitative questions related to compassion-giving.

Four overarching themes capture the study’s results: (1) definition of compassion, (2) advantages and importance of compassion for managers, (3) advantages and importance of compassion for staff and the workplace, and (4) culturally competent and compassionate leadership.

Innovative research agendas should pursue further local qualitative empirical research to inform models of culturally competent and compassionate leadership helping mangers navigate multiple pressures and be able to transculturally resonate with their staff and patients.

Nursing education is challenged to improve students’ cultural competence. Clinical simulation using standardized patients (SPs) may be an effective learning intervention. This systematic review was to identify current evidence on the use of simulations with SPs as learning interventions that have been developed to improve nursing students’ cultural competence and on the effectiveness of those interventions.

Using published guidelines, we conducted a systematic review of studies on simulation using SPs to teach cultural competence.

Ten studies met the inclusion criteria. Outcomes of simulation with SPs increased levels of nursing students’ cultural competence. Simulations with SPs were used in theoretical and practicum courses of nursing students’ cultural competence, often combined with case-study and video presentations. Other forms of cultural education also improved cultural competence.

This study supports that a combination of lecture, case-based learning, and simulation with SPs can increase nursing students’ cultural competence.

With a focus on building global citizens, a U.S. and Norwegian academic collaborative partnership fostered clinical learning experiences addressing cultural and health care comparisons. High-impact educational practices integrated into international clinical experiences, combined with virtual global learning classrooms, highlighted the Sustainable Development Goals.

Given nursing education’s requirements, devising innovative strategies expanded global learning in brief but transformative experiences while integrating nontraveling students, especially relevant considering current pandemic-related travel restrictions.

We developed an educational experience pairing U.S. students (17 in person; 64 through web conference) and Norwegian students (50 in person; 3 for web conference) in population health experiences, providing required clinical hours and a shared cultural exchange. Integration of nontraveling students in joint virtual global experiences broadened the global learning opportunity for all.

This work offers insight into how faculty used a virtual global learning experience as a synergistic tool with traditional study abroad.