Supporting minority nursing students: 'Opportunity for Success' for Ethiopian immigrants in Israel.

AIM: To report on an Israeli academic nursing project, aimed at supporting the integration of Ethiopian immigrants into nursing studies. BACKGROUND: The representation of ethnic minorities within nursing is crucial for the provision of efficient care in diverse societies. Nevertheless, successful integration of minority students in nursing programs is not a simple task and needs developing support systems that will attract and retain students from minorities. Ethiopian Jewish immigrants and their descendants in Israel form a community of 120,000 people. Their participation in the national workforce is low, as well as their average income. METHODS: The paper is based on formative evaluation, using action research, of an academic nursing program in Israel. FINDINGS: Four main strategies identify this project: (1) a policy of institutional commitment, (2) personal relations with staff, (3) personal tutoring, and (4) cultural safety education. The project has reached success in terms of attraction, retention and students' satisfactions. The project's two main challenges, which need further concern, are: (1) giving support without labelling and (2) supporting without creating dependency. CONCLUSIONS AND INTERNATIONAL POLICY IMPLICATIONS: Appropriate strategies can enable success of minority students. Nevertheless, the amount of support needed for such programs raises two major questions: (1) To what extent should individual nursing departments be expected to bear solutions to this widely experienced problem? (2) How does focusing on one minority affect cultural safety of the overall group?

Challenges on the path to cultural safety in nursing education.

AIM: The purpose of this study is to identify central challenges to be addressed in cultural safety education. BACKGROUND: In recent years, the idea of cultural safety has received increased attention as a way of dealing with diversity in the nursing profession, especially in divided societies. The idea of cultural safety goes beyond recognizing and appreciating difference, to an attempt to grappling with deeper issues like inequality, conflict and histories of oppression. METHODS: The paper is based on formative evaluation, using action research, of an academic nursing programme in Israel, involving Jewish and Arab students. Part of this research dealt with the integration of cultural safety education into the curriculum. FINDINGS: The study revealed four challenges in cultural safety education: making it safe for minorities to present their culture to the majority group ('the ambassador's dilemma'), dealing with tendency of groups to deny the existence of conflict ('the one big happy family fantasy'), making dynamics of oppression discussable ('the oppressed and the oppressor') and creating conditions in which people can freely choose their individual and group identities ('the threat of identity'). CONCLUSION: Cultural safety education may be experienced as unsafe for many participants. Better understanding of the challenges of cultural safety education is necessary for making it more effective.

Teaching nursing in a situation of conflict: encounters between Palestinian-Israeli and Jewish-Israeli nursing students.

PURPOSE: This research examines the ways Palestinian-Israeli and Jewish-Israeli nursing students, who study together in one group in an academic school of nursing situated in northern Israel, perceive each other and the relationships among them. DESIGN: The study is based on semi-structured interviews with undergraduate students. The cohort consists of 46 students, 20 of whom participated in the study. FINDINGS: The students perceive themselves as divided into two separate groups according to nationality. Cooperation between the groups related to their study duties is described as generally satisfying, but little expressive communication and scarce social relations occur across these two groups. Students provided their perceptions of 'the others' to explain this social distance. IMPLICATIONS: We discuss the challenges of the situation for nursing educators and some strategies for coping with these challenges.

The establishment of an academic nursing faculty: action research in Israel.

AIM: The aim of this paper is twofold: to conceptualize tensions related to the academization of nursing, and to analyse a case study, describing how such tensions were dealt with in the process of establishing a new nursing department. BACKGROUND: This paper represents the first stage of a case study of the transformation of a hospital-based nursing school into an academic programme, carried out as a joint venture between a local hospital school and a college in northern Israel. METHODS: This paper is based on action research. The participants were 19 members of the new academic faculty and 3 members of an action research center. FINDINGS: The three inter-related tensions surfaced in the research process are: (1) the status of nursing and nurses, (2) the role of research and critical thinking in nursing education and practice, and (3) the characteristics of students, who should enroll in and graduate from nursing programmes, or in other words, the character of the 'ideal nurse'. CONCLUSIONS: An action research process enables new teams to put tensions on the table so they can be openly addressed through ongoing reflection, inquiry, learning, evaluation and redesign.

Signal integration in lipopolysaccharide (LPS)-stimulated murine macrophages.

Using a panel of LPS-inducible genes, selected for the capacity of their products to contribute to endotoxicity, normal macrophages were compared to macrophages deficient in CD14, CD11b/CD18, or TLR4 to elicit gene expression in response to Escherichia coli LPS or the LPS mimetic, Taxol. All genes were TLR4-dependent. At low doses of LPS or Taxol, all genes were also CD14-dependent; however, IP-10 and ICSBP remained poorly inducible even at much higher concentrations. A distinct subset of genes (COX-2, IL-12 p40, and IL-12 p35) was CD11b/CD18-dependent. NF-B translocation and MAPK phosphorylation were dysregulated in receptor-deficient macrophages. In contrast to E. coli LPS, a Porphyromonas gingivalis LPS preparation was found to be TLR2-, rather than TLR4-dependent, and resulted in differential expression of genes within the panel. These data suggest that: (i) TLR4 is necessary, but not sufficient, to induce the full repertoire of genes examined; (ii) CD14 and CD11b/CD18 facilitate signaling for induction of select subsets of genes that are also TLR4-dependent; and (iii) signaling through TLR2 versus TLR4 differs quantitatively/qualitatively. These data support an LPS signaling complex on murine macrophages that minimally includes CD14, CD11b/CD18, and TLR4 to respond to E. coli LPS to elicit the full spectrum of gene expression.

WHO priorities for a common nursing research agenda.

In September 1997 a high-powered research team was brought to Geneva by ICN to set priorities and recommend strategies for ICN leadership roles (see INR, November-December 1997, page 161). An analysis of their findings is now being made. Meanwhile, extracts from country and regional reviews of nursing research presented at the expert group meeting are provided on the following pages, beginning with the WHO Nursing Unit analysis of research at nursing/midwifery collaborating centres and suggested future focus for nursing research.

Management and leadership by nurses.

Good management and leadership by nurses is essential for the achievement of health for all. Well-prepared nurses are required locally and nationally who can identify problems and needs, work on interdisciplinary teams to formulate development plans for human resources, improve working conditions, and raise the quality of care at reasonable cost.

PIP: A survey of medical/public health personnel in 76 countries aimed to achieve a greater understanding of nurses' management and leadership roles at various levels and of the content and design of nursing education programs. About 75% of countries had a chief nursing officer at the national level. Nurses in developing countries had a wide range of roles, such as drafting health programs, helping to develop legislation, and determining organizational structures. Yet, nurses at the national level in all countries tended to be just advisors and rarely involved in major policy efforts, suggesting that nurses are not adequately trained for senior management roles. Some leading problems for nurses in management were shortage of nurses (the most common problem in both developing and developed countries), shortage of well-educated nurse managers, limited participation in planning and policymaking, poor information systems, little interprofessional collaboration and teamwork, lack of supportive legislation, and lack of emphasis on primary care and epidemiology. Nurses should be educated in population-based nursing management. Key concepts of management and leadership should be part of basic nursing programs. Nurses should be skilled in promoting community participation, delegating, monitoring performance, motivating people, and coordinating activities. Postbasic and university education for middle-level nurses should be more expansive and involved, including but not limited to health assessment and organizational design. Senior management at the national level need to be thoroughly versed in nursing, health and disease, social analysis methods, and health systems and their management. They must participate skillfully in the development and evaluation of national health policies, plans and programs; develop information systems; and help with financial planning.

The World Health Organization's regions of the eastern Mediterranean and Europe: ageing of the population and nursing care.

This paper discusses the context and implications of nursing as a social force in regard to quality of care for the aged. The demographic transformations and its consequences in the WHO regions of the Eastern Mediterranean and Europe are discussed in their relation to socio-political, economic and educational developments and epidemiological changes. It is postulated that nursing has the choice of becoming a social force through raising its awareness of the new reality of a sizeable dependent population with chronic diseases. Nursing knowledge and research, the sharpening of political skills and the refinement of caring skills have the potential for influencing health care policy and long-term care services toward quality health care for the aged. Special attention is given to the use and misuse of concepts as self-care and appropriate technology. The final proof of nursing's willingness and ability to act as a social force will be in the allocation of efforts and resources in different countries. The value of nursing's contribution to the actual care of the aged will depend upon careful ethical considerations, as much as upon knowledge and influence.

Ethics and care for the elderly.

This article uses the case of presenile and senile dementia to discuss ethical concepts that have potential to guide nursing action. The concepts of 'sanctity of life' versus 'quality of life' or 'dignity' are both unsatisfactory for directing nursing intervention whenever proxy judgment is necessary. Guidelines for action must evolve from research, the search for clinical knowledge. As an underlying attitude and additional guide the author describes a Jewish ethical perspective which defines dependence and interdependence as an essential part of human existence and accepts the inevitability of living with moral uncertainty.

The continuation of home care to severely impaired children and aged in Israel: family attitudes.

There are a growing number of children and aged with severe chronic health problems in the community. Mothers become the prime caregivers to these children and aging spouses or middle-aged offspring the caregivers to these aged. The services offered to these families are determined by economic and social conditions, as well as changing fashions, rather than knowledge of the patients' and caregivers' needs. The purpose of this study was to assess the impact of homecare upon families caring for children versus those caring for aged and these families' attitudes toward continuation of home care versus institutionalization. The families included in the study were drawn randomly from the case load of community nurses in central Israel. In-depth interviews were conducted with 92 families of severely impaired children and 181 families of severely impaired adults and aged in their homes. While the majority of both populations carry a heavy burden of caregiving over years, they also receive gratification from their ability to care for their patient at home. There is little difference between those caring for children and those caring for adults in their attitudes toward continuation of home care. Mental rather than physical impairment, a deteriorating illness trajectory; depression, aggression and tension of the caregiver, the absence of sufficient social support and home care services correspond with negative feelings toward continued home care. The perceived impact of caregiving responsibilities upon the caregivers' lives, the ability to tolerate and manage symptoms and above all the quality of the patient-caregiver relationship influenced the caregivers' attitudes toward institutionalization in both populations. Family attitude toward continued homecare and institutionalization of children and adults are compared and the needs for services discussed.

Research in nursing gerontology.

Nursing gerontology is the scientific study of the nursing care of the elderly as individuals, family members and population groups. The author identifies and discusses the ethical issues which must be considered in relation to research in nursing gerontology: respect for persons, adequate knowledge base for decision-making, quality of life, quality of death and distribution of limited resources. Research priorities are then discussed.