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PubMed2001

Expanding conceptualizations of culturally competent care.

AIM: The aim of the study was to gain an understanding of cultural competence from the perspectives of non-mainstream nurse educators, specifically those of Latin heritage. BACKGROUND/RATIONALE: Although the theoretical concepts of 'cultural diversity' and 'culturally competent care' have been supported and promoted by the largest professional nursing organizations, the practical application of these concepts has often created difficulties for nurse researchers, educators, and clinicians. The lack of progress in teaching and evaluating cultural competence suggested the need to 'center the margins' and explore cultural competence from the margins of one particular non-mainstream nursing group, Latina nurse educators. DESIGN/METHODS: A grounded theory research design was employed. A group of 10 doctoral, prepared, self-identified, Latina nurse educators participated in face- to-face audiotaped interviews. Data collection, analysis, and theoretical sampling decisions occurred concurrently, strengthening theory generation. Institutional review board approval was received for all steps of the study. The major limitation of the study was the omission of student voices. RESULTS/FINDINGS: The analysis suggests that the Latina participants shared the common purpose of teaching students how to think about difference. The teaching practices of this group of Latina educators was based on a belief that 'difference' is not solely about specific cultural groups. For example, content about 'Hmongs' or 'Latinos'. Rather, Latina faculty focused on teaching students how to directly connect with anyone perceived as different from oneself. CONCLUSION: Latina faculty did not distinguish between competent care and culturally competent care; for them, competence necessarily includes cultural competence. They conceptualize the provision of competent care to all persons who are perceived as different, rather than focusing only on those who are perceived as 'culturally' different. These conceptualizations have the potential to shed new light on how nurses and nurse educators think about, develop, and integrate cultural competence into nursing education, practice, and research.

Cultural Diversity↗

PubMed2003

Health Visitors' experiences of Family Group Conferences in relation to child protection planning: a phenomenological study.

AIMS AND BACKGROUND: The purpose of this study was to explore Health Visitors' experiences of Family Group Conferences as part of Child Protection Planning in Hampshire, England. The aim was to identify good practice, recognizing the challenges of the approach and enabling recommendations for improved collaboration to be framed. The Family Group Conferences model is based on partnership, decision-making and family involvement and presents an alternative to case conferences. METHODS: A Husserlian phenomenological approach was adopted, using taped semi-structured interviews with four health visitors who had experience of Family Group Conferences. Colaizzi's seven stages of phenomenological analysis were used. FINDINGS: The four key categories related to the ability of the Family Group Conference model to empower families; the need for health visitors to receive appropriate education and training; organizational; and professional issues. Health visitors believed that Family Group Conferences could empower families, but they felt unprepared to attend. Concerns were identified regarding confidentiality and responsibility. Although the health visitors supported the principles underpinning Family Group Conferences, they were unsure about how to put theory into practice. The need for more education and training was strongly supported to enable the model to move from marginal to mainstream use. They also considered that Family Group Conferences could threaten interagency working, associated with issues relating to professional responsibility. CONCLUSIONS: The results identified training and procedural issues that need to be addressed if Family Group Conferences are to be introduced successfully within mainstream child protection practice. Insights from this study have led to inclusion of Family Group Conferences in the local child protection guidelines, with emphasis applied to interdisciplinary working, empowerment of families and professional staff, and education and training.

Attitude of Health Personnel↗

PubMed2000

Undergraduate projects - do they have to be within the conventional medical environment?

OBJECTIVES: Undergraduate medical curricula now include increasing amounts of project work aimed at developing skills related to lifelong learning. One course allows students to choose from a wide range of projects, including 'conventional' hospital specialties and also from topics outside the mainstream of medicine. DESIGN: 'Conventional' and 'external' projects were compared in terms of the prior academic abilities of the students undertaking them, the assessment results and student and supervisor feedback, in order to consider whether the unconventional projects were equally valid within the undergraduate medical curriculum. SETTING: School of Medicine, University of Leeds, UK. SUBJECTS: Medical students. RESULTS: No difference between the assessment results of the student groups was present, with over 85% of all students reaching a standard of 'excellent' or 'good' in their overall final grade. There was no difference in prior academic abilities between the student groups. Enjoyment of modules was comparable between student groups ('conventional' 89%, 'external' 93%) with good levels of satisfaction with the quality of supervision. There were no differences in students' self-appraisal of generic skill acquisition. Students who had undertaken 'external' projects felt they had gained less experience in data-handling and problem-solving skills. However, 'external' projects were rated higher by students in terms of having realistic and achievable objectives, and the supervisors of these projects were also more realistic about time commitments involved in project supervision. CONCLUSIONS: 'External' modules were very popular, with over 45% of students requesting places which were available for fewer than 20% of students per year. Concerns regarding the appropriateness of self-directed undergraduate medical student projects outside the mainstream of medical practice were unfounded.

Curriculum↗

PubMed2003

Putting your course on the Web: lessons from a case study and systematic literature review.

BACKGROUND: Education via the Internet offers enormous potential, but many online courses are pedagogically or technically weak and many good projects are never mainstreamed. METHOD: In drawing up our recommendations to address the issues around putting a course on the web, we drew on 3 main sources of data: an extensive in-depth course evaluation; a systematic review of the literature, and questions raised by participants on our training-the-trainers courses. RECOMMENDATIONS: For any web-based course to succeed, 10 overlapping and iterative areas of activity must be addressed. These are: the market for the course; course aims and intended learning outcomes; choice of software platform; staff training needs; writing high quality study materials; design features for active learning; technical and administrative challenges; evaluation and quality improvement; mainstreaming the course within the institution, and financial viability.

Computer-Assisted Instruction↗

PubMedDate not supplied

The history of breast cancer advocacy.

There have been four key steps in the advent of breast cancer advocacy: priming the market, engaging consumers, establishing political advocacy, and taking the advocacy mainstream. Breast cancer was surrounded by secrecy until the 1980s, when brave individuals such as former First Ladies Betty Ford and Nancy Reagan, and founder of the Susan G. Komen Foundation, Nancy Brinker (Susan Komen's sister), began speaking publicly about the personal impact of the disease, which increased awareness of breast cancer and made it more acceptable to talk about it openly. At the same time, statistics about breast cancer were presented in new ways that the public could understand. Public health advocates played a key role in the second step, engaging consumers, when they established guidelines in the 1980s that encouraged women to perform breast self-examinations (BSEs) and have screening mammograms and clinical breast examinations (CBEs). Other events that helped engage consumers were increased media coverage of breast cancer issues, the founding of the Komen Race for the Cure in 1983, and the establishment of other programs that both educated the public and raised funds. Funds from these efforts enabled advocates to hold educational forums and produce educational materials in different media and tailored to different audiences and to become active in the funding of research. The third step, political action, became possible when breast cancer advocates joined together in the 1980s and 1990s to work toward legislative, regulatory, and funding changes, such as passage of the Mammography Quality Standards Act and increased funding for the National Cancer Institute. These efforts contributed to a more than quadrupling of federal funding for breast cancer research in the 1990s. Going mainstream, the final step in the advocacy process, entailed establishing a solid base of support to ensure that the message about breast cancer stays strong and fresh. This has been achieved by engaging the business, government, and scientific communities as partners in advocacy.

Breast Neoplasms↗

PubMedDate not supplied

Mapping the future of environmental health and nursing: strategies for integrating national competencies into nursing practice.

:Nurses are increasingly the primary contact for clients concerned about health problems related to their environment. In response to the need for nursing expertise in the field of environmental health, the Institute of Medicine (IOM), Agency for Toxic Substances and Disease Registry (ATSDR), and National Institute of Nursing Research (NINR) have designed core competencies for the nursing profession. The IOM competencies focus on four areas: (1) knowledge and concepts; (2) assessment and referral; advocacy, ethics, and risk communication; and (4) legislation and regulation. The competencies establish a baseline of knowledge and awareness in order for nurses to prevent and minimize health problems associated with exposure to environmental agents. To address the known difficulties of incorporating new priorities into established practice, nurses attending an environmental health short course participated in a nominal group process focusing on the question, "What specific actions can we take to bring environmental health into the mainstream of nursing practice?" This exercise was designed to bring the concepts of the national initiatives (IOM, NINR, ATSDR) to the awareness of individual nurses involved in the direct delivery of care. Results include 38 action items nurses identified as improving awareness and utilization of environmental health principles. The top five ideas were: (1) get environmental health listed as a requirement or competency in undergraduate nursing education; (2) improve working relationships with interdepartmental persons-a team approach; (3) strategically place students in essential organizations such as NIOSH, ATSDR, or CDC; (4) educate nurse educators; and (5) create environmental health awards in nursing. The 38 original ideas were also reorganized into a five-tiered conceptual model. The concepts of this model include: (1) developing partnerships; (2) strengthening publications; (3) enhancing continuing education; (4) updating nursing practice; and (5) strengthening schools of nursing. The model serves as a road map for action in building environmental health capacity within mainstream nursing.

Clinical Competence↗

PubMed2001

Complementary and alternative medicine use in the Amish.

OBJECTIVE: To examine the rate of utilization of complementary and alternative medicine (CAM) in Amish women, a population that traditionally uses non-mainstream medicine. METHODS & RESULTS: Sixty-six Amish women completed a survey concerning their use of CAM. Thirty-six percent of the Amish women used at least one form of CAM, primarily reporting a use of diet and nutrition programs, herbal therapies, and chiropractic medicine. In addition, ten pregnant Amish women reported using echinacea, St. John's Wort, red clover, garlic and ginseng. CONCLUSION: This survey highlights the need to address potential adverse effects of herbal therapies in young women who are a member of a group that may use non-mainstream medicine.

Adult↗

PubMed1992

[Checking the precision of capnometers].

Capnometry, i.e. measurement of CO2 concentration (cCO2, vol%) and calculation of the respective CO2 partial pressure (pCO2, mmHg), is simple to apply, but the user must understand its principles of operation in order to appreciate its power and its limitations. However, sidestream capnometers use to dry the humidified respired gas (37 degrees C, pH2O 47 mmHg) for methodological reasons, thus increasing pCO2 by ca. 6% which, in turn, requires correction. With infrared spectroscopy, overestimation of pCO2 in presence of N2O and underreporting of pCO2 in presence of O2 also require to be corrected. These require either knowledge of the respective gas concentrations (mainstream analyzers) or adequate (i.e. correct) measurement (some sidestream capnometers). Changes in barometric pressure (pB) must be also either known or be measured automatically. Evaluation of the precision of capnometers must therefore focus on, (1) the possible pH2O correction, (2) the possible effects exercised by O2 and N2O, and (3) the possible dependence on barometric pressure. Two mainstream (Capnolog D/Dräger; Sirecust 404-1/Siemens) and eight sidestream capnometers (AGM 1304/Brüel & Kjaer; SARAcap A. G. and SARA-trans/Biomedical Systems/Hellige; Capnomac and Normocap 200/Datex/Hoyer; CO2 Monitor/Dräger; Nellcor N-1000/Nellcor/Dräger; Multinex/Datascope) were investigated. Dry and humidified gases (37 degrees C) of defined composition in respect of CO2, O2, N2, N2O, and H2O, were used for evaluation. The results prove reproducibility of ca. =/- 1 mmHg for the 10 capnometers within the 30-50 mmHg pCO2 range.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesiology↗

PubMed1997

A total system approach to sustainable pest management.

A fundamental shift to a total system approach for crop protection is urgently needed to resolve escalating economic and environmental consequences of combating agricultural pests. Pest management strategies have long been dominated by quests for "silver bullet" products to control pest outbreaks. However, managing undesired variables in ecosystems is similar to that for other systems, including the human body and social orders. Experience in these fields substantiates the fact that therapeutic interventions into any system are effective only for short term relief because these externalities are soon "neutralized" by countermoves within the system. Long term resolutions can be achieved only by restructuring and managing these systems in ways that maximize the array of "built-in" preventive strengths, with therapeutic tactics serving strictly as backups to these natural regulators. To date, we have failed to incorporate this basic principle into the mainstream of pest management science and continue to regress into a foot race with nature. In this report, we establish why a total system approach is essential as the guiding premise of pest management and provide arguments as to how earlier attempts for change and current mainstream initiatives generally fail to follow this principle. We then draw on emerging knowledge about multitrophic level interactions and other specific findings about management of ecosystems to propose a pivotal redirection of pest management strategies that would honor this principle and, thus, be sustainable. Finally, we discuss the potential immense benefits of such a central shift in pest management philosophy.

Animals↗

PubMedDate not supplied

A study on the mutagenicity of tobacco smoke from low-tar cigarettes.

A series of 16 low-tar cigarettes, yielding from 1 to 10 mg of tar, were smoked on a modified cigarette smoking machine that collected both mainstream (MS, inhaled) smoke and sidestream (SS, between puffs) smoke. The SS smoke is the major contributor to environmental tobacco smoke. The collected MS and SS smoke condensates were evaluated for mutagenicity by the Ames test and compared with MS and SS smoke condensates from a high-tar cigarette. Both MS and SS condensates of low-tar cigarettes (LTCs) were tested with the Salmonella strains TA1538 and TA100. Except for three cigarettes, the MS smoke mutagenicities of the LTC smoke condensates were significantly reduced (about 30%) when compared with a control, high-tar (23-mg) cigarette. Opposite results were obtained for the SS smoke condensates, which were more mutagenic (about 20%) than the SS smoke condensate of the high-tar cigarette. Thus, LTC mainstream smoke may be less hazardous to the LTC smoker, whereas LTC sidestream may emit more mutagenic compounds into environmental tobacco smoke, which, through passive inhalation, could affect both smokers and nonsmokers.

Humans↗

PubMed1993

On the perception of madness.

Since the beginning of recorded history, mental illness has been recognised as being primarily in the province of the healing profession. This view has continued, despite the fact that psychiatry left the mainstream of medicine with the development of asylums during the 19th century. With the advent of deinstitutionalization however, psychiatrists, particularly in Australia, have increasingly left public practice. As a result, the treatment of the severely and chronically mentally ill, especially those with behavioural disorder, has become neglected. It is argued that moves toward the mainstreaming of acute psychiatry to general hospitals offer a new opportunity for the profession to reassert itself in this essential but difficult area of psychiatric practice.

Australia↗

PubMed1991

On the advantages of cross-culture psychotherapy: the minority therapist/mainstream patient dyad.

The personal quality of the therapist is a key element in therapy. In the case of the minority therapist, the difference in language and cultural background offers the patient unique benefits. Value orientations amongst cultures are similar enough for the minority therapist to acculturate. Through acculturation, the therapist becomes aware of a new set of value orientations. This cultural objectivity better enables the therapist to help the mainstream patient to see alternatives in coping with stresses of life, and to fortify the patient's adaptive skills. Because Western psychiatry and psychotherapy are culture-bound, mainstream therapists may easily be "culturally addicted," whereas a minority therapist can maintain cultural neutrality. Advantages discussed include language independence, culture independence, positive transference and analogous experiences.

Cross-Cultural Comparison↗

PubMed1984

Hospice program integration: an issue for policymakers.

As the number of hospice programs in the United States expands, policymakers face a variety of issues concerning the care of the terminally ill. Do hospice programs offer a truly unique approach in caring for the dying? Are hospice services cost effective? Should hospice programs become integrated into the mainstream of medical care service delivery? Based on data from hospice programs in an industrialized Midwestern state, this paper explores the strategies employed by hospice programs to become integrated, the conflicts that have arisen among providers of hospice care, and the impact of hospice program integration on patient care. Results show that as hospice programs become more integrated, they have lost some of the idealism on which they were founded, have altered organizational structures, and have changed certain patient services. However, there is no evidence to suggest that integration of hospice programs into the medical mainstream has decreased the quality of patient care or patient satisfaction for hospice services.

Data Collection↗

PubMed2000

Analysis of potential transfer of continuous glass filament from Eclipse cigarettes.

This study was designed to determine if a prototype of the Eclipse cigarettes, which uses a special form of continuous glass filament (CGF) as an insulator around the carbon heat source, yielded CGFs via mainstream smoke. A method was developed that used electrostatic precipitation with a greater than 99% collection efficiency of mass to capture CGFs transferred to mainstream smoke. The cigarettes were smoked using an exaggerated puffing condition that was more than twice the Federal Trade Commission (FTC) standard. The cigarettes were subjected to handling procedures that simulated commercial shipping conditions prior to smoking. CGFs were intentionally added to a series of smoke condensate samples to determine CGF recovery efficiency. The recovery efficiency was determined for a series of four internal standards added to smoke condensate. The recovery efficiency was 86% for the Eclipse 5-014 prototype. The number of CGFs in smoke condensate collected from the Eclipse 5-014 prototype was approximately 0.06 +/- 0.02 CGFs per cigarette (+/- standard deviation), including the background counts of CGFs and 0.03 CGFs per cigarette, when corrected for background contributions. The number of CGFs found in smoke condensates for this prototype was not statistically distinguishable from zero or background in these experiments, which were capable of detecting transfer rates of greater than 0.2 CGFs per cigarette.

Glass↗

PubMed2000

Quantitative analysis of potential transfer of continuous glass filament from eclipse prototype 9-014 cigarettes.

This study was designed to determine if the Eclipse prototype 9-014 cigarettes, which use a special form of continuous glass filament (CGF) as an insulator around the carbon heat source, yield CGFs via mainstream smoke. A previously developed method (Higuchi et al., 2000) that employed electrostatic precipitation-with a greater than 99% collection efficiency of mass-was used to capture CGFs transferred to mainstream smoke. The cigarettes were smoked using an exaggerated puffing condition more than twice the Federal Trade Commission (FTC) standard. Prior to smoking, cigarettes were subjected to handling procedures that simulated commercial shipping conditions. Using a modified standard addition method, and utilizing a mixture of water and glycerol as a mock condensate, CGFs were intentionally added to a series of (mock condensate) samples to develop knowledge of CGF recovery efficiency. The linear regression model of the recovered CGFs demonstrated a recovery efficiency of 86%. This efficiency rate was applied to the number of CGFs recovered from samples of smoke condensate and associated background samples. The number of CGFs in smoke condensate collected from the Eclipse 9-014 prototype was approximately 0.32 +/- 0.17 CGFs per cigarette (+/- standard deviation), including the background counts of CGFs, and 0.16 CGFs per cigarette when corrected for background contributions. The number of CGFs found in the smoke condensates for this prototype was statistically (p =.00031) distinguishable from zero and background in these experiments. The low number of CGFs seen in the transfer data from this prototype studied, the unique physical characteristics of the filaments (e.g., controlled physical dimensions), and the absence of biological activity of similar glass filaments/fibers indicate that biologically significant exposure to the Eclipse smoker does not occur.

Humans↗

PubMed2004

Comparative subchronic inhalation study of smoke from the 1R4F and 2R4F reference cigarettes.

A subchronic, nose-only inhalation study compared the effects of mainstream smoke from a 1R4F research cigarette to that of a 2R4F research cigarette. Male and female rats were exposed for 1 h/day, 5 days/wk, for 13 wk to mainstream smoke at 0, 0.06, 0.20, or 0.80 mg wet total particulate matter per liter of air. Clinical signs, body and organ weights, clinical chemistry, hematology, carboxyhemoglobin, serum nicotine, pulmonary plethysmography, gross pathology, and histopathology were determined. When histological changes resulting from exposure to smoke from the two types of cigarettes were compared, no biologically significant differences were observed. At the end of the exposure period, subsets of rats from each group were maintained without smoke exposures for an additional 13 wk (recovery period). At the end of the recovery period, there were no statistically significant differences in histopathological findings observed between the 1R4F and the 2R4F cigarettes. The complete toxicological assessment in this comparative inhalation study of 1R4F and 2R4F cigarettes suggests no overall biologically significant differences between the rats exposed to the two cigarettes.

Animals↗

PubMed2006

Numerical simulation of the effects of dilution level, depth of inhalation, and smoke composition on nicotine vapor deposition during cigarette smoking.

A numerical model of an aerosol containing vaporizable nicotine depositing to the walls of a tube was developed and applied to simulate the vapor deposition of nicotine in a denuder tube and under conditions approximating those in the respiratory tract during mainstream cigarette smoke inhalation. The numerical model was validated by comparison to data for denuder tube collection of nicotine from the smoke of three types of cigarette differing in smoke acidity and nicotine volatility. Simulations predict that the absorption of water by aerosol particles inhibits nicotine vapor deposition to tube walls, and that increased temperature, decreased tube diameter, and increased dilution enhance nicotine vapor deposition rate. The combined effect of changing these four parameters to approximate the transition from conducting to gas exchange regions of the respiratory tract was a significant net increase in predicted nicotine vapor deposition rate. Comparisons of nicotine deposition rates between conditions in the conducting airways and those in the gas exchange region were informative with regard to reported nicotine retention measurements during human smoking. Reports that vaporizable nicotine can penetrate past the conducting airways, that nicotine can be retained at near 100% efficiency from mainstream smoke, and that cigarettes with differing acidity and nicotine volatility have similar nicotine uptake rates are all shown to be consistent with the results of the model simulations.

Computer Simulation↗

PubMed1997

Australia's public health response to HIV and HCV: a role for 'affected' communities.

This paper identifies a number of the key elements that underpinned the success of Australia's public health response to minimizing the spread of HIV. It is argued that one major factor was the high level of collaboration between health care professionals and "affected" communities, such as injecting drug users, sex industry workers and gay men. This collaboration allowed for the negotiation, development and implementation of the range of innovative HIV initiatives that were ultimately responsible for keeping HIV in the injecting drug use and sex industry to low levels. Despite the central role played by injecting drug users and their peer based organizations, the significance of their activities has gone largely unacknowledged by senior health bureaucrats and politicians. As a consequence, advice from injecting drug users and their peer-based organizations on the current hepatitis C epidemic has been largely ignored. Instead of learning from Australia's HIV experience and involving these groups in consultation and advisory roles, the Federal Government has reverted to accepting advice from only established mainstream organizations. It is argued that the success of infection control outside mainstream communities, such as among injecting drug users, can most effectively be achieved through the involvement of these "affected" communities. There is a need at the local, national and international levels to ensure both the involvement of "affected" communities and that recognition is given to them for the significant and essential role they play in infection control.

Journal Article↗