Clinical nurses' perspectives on discharge practice changes from participating in a translational research study.

AIM: To describe clinical nurses' experiences with practice change associated with participation in a multi-site nursing translational research study implementing new protocols for hospital discharge readiness assessment. BACKGROUND: Nurses' participation in translational research studies provides an opportunity to evaluate how implementation of new nursing interventions affects care processes within a local context. These insights can provide information that leads to successful adoption and sustainability of the intervention. METHODS: Semi-structured focus groups from 30 of 33 participating study hospitals lead by team nurse researchers. RESULTS: Nurses reported improved and earlier awareness of patients' discharge needs, changes in discharge practices, greater patient/family involvement in discharge, synergy and enhanced discharge processes, and implementation challenges. Participating nurses related the benefits of participation in nursing research. CONCLUSION: Participation in a unit-level translational research project was a successful strategy for engaging nurses in practice change to improve hospital discharge. IMPLICATIONS FOR NURSING MANAGEMENT: Leading unit-based implementation of a structured discharge readiness assessment including nurse assessment and patient self-assessment encourages earlier awareness of patients' discharge needs, improved patient assessment and greater patient/family involvement in discharge preparation. Integrating discharge readiness assessments into existing discharge care promotes communication between health team members that facilitates a timely, coordinated discharge.

Qualitative evidence for Resilience, Stress, and Ethnicity (RiSE): A program to address race-based stress among Black women at risk for cardiovascular disease.

OBJECTIVE: Growing evidence demonstrates that perceived discrimination and racism are significant contributing factors to psychological distress, low-grade chronic inflammation, and cardiovascular health disparities among minorities, particularly among Black women. Despite this evidence, there are no evidence-based complementary therapy interventions available to ameliorate chronic stress associated with racism and discrimination. The purpose of this study was to examine the feasibility and effectiveness of a novel, 8-week, group-based stress reduction program, Resilience, Stress and Ethnicity (RiSE), designed to help Black women at risk for cardiovascular disease (CVD) develop effective coping skills for dealing with chronic stress uniquely associated with being a minority. METHODS: We conducted two semi-structured focus groups with Black women (N = 22) following their participation in the 8-week RiSE program. We analyzed the data using constant comparative qualitative methods. RESULTS: Attrition rate was low (13%) with all participants attending at least 6 of the 8 classes. Participants reported high levels of satisfaction with the program and the majority (81%) reported practicing the skills that they learned in real-life stressful situations. In describing the participants' response to the program, four key categories emerged from the data: (1) Increasing awareness of stressors associated with perceived discrimination and racism; (2) Coping with race-based stressors; (3) Coping with other sources of stress; and (4) Increasing sense of empowerment and emotion regulation. CONCLUSIONS: Findings suggest that RiSE is feasible and effective in helping Black women at risk for CVD cope with chronic stress associated with being a minority. Given evidence that perceived discrimination and racism are underlying factors in many inflammatory-based chronic diseases, this research may have broader implications for reducing health disparities across a wide-spectrum of chronic illnesses in which women minorities are disproportionately affected.

Making It All Work: Qualitative Descriptions of Hispanic Adults Managing Type 2 Diabetes With Limited Resources.

The greater prevalence of type 2 diabetes is a critical issue among the U.S. Hispanic population. This study examined the struggles of Hispanic adults managing type 2 diabetes with limited resources. Ten Hispanic adults (enrolled in a larger study to determine the effects of diabetes self-management intervention), 25 to 80 years of age and living in a rural West Texas county in the United States, were selected. Three categories of challenges emerged: (a) diabetes self-care behaviors and challenges, (b) challenges with limited resources, and (c) challenges with support mechanisms. "Making it all work" was the overarching theme that tied all the categories together. This study offers lessons for health care providers and policymakers on how to maximize the availability of resources for Hispanic individuals with type 2 diabetes living within the constraints of limited resources.

Exploring Spirituality Among African American Women: Implications for Promoting Breast Health Behaviors.

The purpose of this qualitative study was to gain understanding of the definition, meaning, and function of spirituality to African American women. Four categories emerged that add insight for nurses to develop innovative spiritual-based strategies to promote African American women's positive health behaviors. Implications for promoting breast health behaviors are described.

Sisters Saving Lives: Instituting a Protocol to Address Breast Cancer Disparities.

BACKGROUND: Caucasian women have a higher incidence of breast cancer compared to African American women; however, African American women are more likely to die from the disease than their Caucasian counterparts. Many efforts have been made to address this disparity, but it still exists. Data have shown factors contributing to this disparity, such as inequalities in health status, environment, access and use of care, socioeconomic status, knowledge, and cultural beliefs. Train-the-trainer programs have been widely used to address breast cancer disparities. OBJECTIVES: The aims of this article are to (a) identify and describe breast cancer disparities in an urban setting, (b) describe the Sisters Saving Lives program as an evidence-based intervention to address breast cancer disparities, (c) describe how self-efficacy theory was used to guide and evaluate the development of this pilot project, (d) identify key stakeholders involved, and (e) summarize outcomes observed. METHODS: Self-efficacy theory served as a guide to the development of the train-the-trainer program to help address breast cancer disparities among African American women residing in Chicago. FINDINGS: Training African American breast cancer survivors to deliver a culturally competent message on breast health education to African American women who do not have a breast cancer diagnosis raised awareness of the disease and potentially can address breast cancer disparities among African American women residing in Chicago.

Influence of sense of coherence, spirituality, social support and health perception on breast cancer screening motivation and behaviors in African American women.

Despite formidable barriers, some African American women (AAW) engage in breast cancer screening (BCS) behaviors. Understanding individual characteristics that allow AAW to overcome barriers to BCS is critical to reduce breast cancer mortality among AAW. A salutogenic model of health was used to evaluate the influence of sense of coherence, social support, spirituality and health perception on BCS motivation and behaviors in AAW, and to determine differences in these factors in AAW who participate in free BCS programs compared to AAW who do not. Findings revealed that greater levels of spirituality were significantly associated with greater motivation to practice BCS. Further, women who utilized free BCS programs reported significantly greater rates of both performing and of intent to perform breast self examinations (BSE) in the future, obtaining clinical breast exams and mammograms. Findings can inform the development of culturally specific programs to improve the utilization of BCS programs by AAW.

Breast cancer screening behaviors of African American women: a comprehensive review, analysis, and critique of nursing research.

Breast cancer is particularly burdensome on African American women (AAW) ranking second among the cause of cancer deaths in AAW. Although the incidence of breast cancer is highest in White women, AAW have a higher breast cancer mortality rate at every age and a lower survival rate than any other racial or ethnic group. Statistics indicate that the gap is widening. The results of several studies suggest that breast cancer mortality among AAW would be reduced if breast cancer screening recommendations were more effectively utilized. Results of research studies aimed at identifying variables relating to AAW acceptance of breast cancer screening activities have not had an impact on the disparity in mortality rates. The goals of this paper are to summarize the accumulated state of the nursing science and knowledge concerning breast cancer screening behavior of African American women, and to highlight important issues that research has left unresolved.