An educational approach to develop intercultural nursing care for refugees from Ukraine: A qualitative study.

AIM: To describe how nurses and nursing students in Poland and the United States perceive the practice of intercultural care of refugees from Ukraine. BACKGROUND: Millions of Ukrainian citizens sought safety in other countries when Russia invaded Ukraine in February 2022. INTRODUCTION: Nurses in Poland and the United States are positioned to provide nursing care for refugees from Ukraine yet lack intercultural knowledge, skills, and attitudes to meet refugee needs. METHODS: This education-focused qualitative description study was conducted in Spring 2023. Eighteen MSN and BSN students from one university in Poland and one university in the United States completed an international virtual exchange course that concentrated on the health and well-being of refugees from Ukraine. Students' reflection papers generated the data for this study. Content analysis was used to systematically structure the data, and themes were inductively derived for an initial understanding of intercultural care for refugees. The COREQ guidelines were followed for reporting study findings. RESULTS: Major themes were troubled communication, overlooked trauma-informed care, and compromised vaccine status. Language differences, a gap in nursing knowledge, and cultural variations impeded intercultural care. DISCUSSION: To address intercultural care for refugees from Ukraine, macro- and microlevel factors should be considered. Healthcare facilities need certified interpreters or adequate language-access technology for nurses. Nursing programs might evaluate content on trauma-informed care and cultural competency to meet the needs of war-affected refugees. Leaders from Ukrainian refugee communities could partner with nurses to deliver culturally relevant information to increase vaccine uptake. IMPLICATIONS: Nurses should advocate for inclusion of the WHO competency standards of care for refugees in healthcare policies with emphasis on communication and evidence-informed practice. Placing Ukrainian community leaders on health councils could bridge the gap between refugees and mainstream society.

Changing Life Plans: When to Engage Caregivers of Older Adults With Cancer in Advance Care Planning.

Advance care planning (ACP) is a continuous process where individuals discuss and document their end-of-life preferences with trusted caregivers and health care providers. Caregivers are pivotal to include in ACP discussions because they assist loved ones to navigate serious medical illness. The purpose of this study was to examine caregivers' engagement in ACP decision making with their loved ones with cancer. A qualitative descriptive design was used, informed by Engel's biopsychosocial model, with a convenience sample of 14 caregivers in North Carolina. Virtual interviews were conducted using a semistructured interview guide. Using prevalence logic, the overarching theme of "Changing Life Plans" was explained by two subthemes, "Learning the Diagnosis" and "Keeping Them on Track." The timing and location of ACP conversations were important considerations. Over half of the participants (64%) had no knowledge or had misconceptions about ACP, and 5 had accurate knowledge. Nurses could develop partnerships with community leaders trained in palliative care principles to begin conversations early with community members. Advocacy groups might hold events, such as the Hello Game, in community settings to facilitate early ACP conversations.

Classes of medications prescribed to malnourished children and their relationship with time to recovery.

OBJECTIVE: There is conflicting evidence around prescription practices in the management of malnutrition; the study objective was to explore medication classifications prescribed and their relationship between time-to-recovery and specific demographic characteristics among children with malnutrition in Guatemala. DESIGN: Descriptive correlational study of data obtained in a retrospective record review. SAMPLE: Children aged 0-5 years with malnutrition treated in a Guatemalan Nutrition Rehabilitation Center between 2019 and 2020 (N = 155). MEASURES: Variables assessed were medication classification of prescribed medications, age, gender, time-to-recovery, malnutrition severity, and COVID cohort. RESULTS: The most frequently used medication classifications were vitamins (95%), respiratory (75%), antipyretic (68%), antibiotic (61%), and gastrointestinal agents (54%). Antibiotic, respiratory, corticosteroid, antipyretic, and gastrointestinal agents were prescribed significantly more in cases with a time-to-recovery of 6 weeks or greater. CONCLUSIONS: Medication classifications prescribed most often were related to common comorbidities of malnutrition and illnesses affecting children in Guatemala, such as respiratory and diarrheal diseases. The medication used in cases with a time-to-recovery of ≥6 weeks suggest these cases may have had more comorbidities, which could explain the longer recovery times. Caution is suggested in routine prophylactic antibiotic use in public health settings, given the lack of association with improved recovery times, the potential for antibiotic drug resistance, and the negative effects on renal function among children.

Original Research: Can a Palliative Care Lay Health Advisor-Nurse Partnership Improve Health Equity for Latinos with Cancer?

PURPOSE: A palliative care infrastructure is lacking for Latinos with life-threatening illness, especially in rural regions of the United States. The purpose of this study was to develop and evaluate a community-based palliative care lay health advisor (LHA) intervention for rural-dwelling Latino adults with cancer. METHODS: An exploratory mixed-methods participatory action research design was carried out by an interprofessional research team that included community and academic members. Fifteen Latino community leaders completed a 10-hour palliative care training program and then served as palliative care LHAs. Although 45 Latinos with cancer initially agreed to participate, four withdrew or died and six were not reachable by the LHAs, for a final total of 35 patient participants.The trained palliative care LHAs delivered information on home symptom management and advance care planning to assigned participants. Palliative care nurses led the training and were available to the LHAs for consultation throughout the study. The LHAs made an average of three telephone calls to each participant. The Edmonton Symptom Assessment System-Revised (ESAS-r) and the four-item Advance Care Planning Engagement Survey (ACPES-4) were administered pre- and postintervention to determine the intervention's effectiveness. Encounter forms were transcribed, coded, and analyzed using case comparison. RESULTS: The major finding was that significant improvements were shown for all four items of the ACPES-4 among both the LHAs (posttraining) and the participants (postintervention). Information on advance care planning was shared with 74.3% of the 35 participants. Participants showed clinical improvement in physical symptom scores and clinical deterioration in emotional symptom scores following the intervention, although these changes did not reach statistical significance. The advisors noted that participants were anxious about how to explain cancer to children, the uncertainty of their prognosis, and medical expenses. This sample was younger than those of other cancer studies; 51.4% were under age 50 and 73.1% had at least one child in the home. CONCLUSIONS: A community-based palliative care LHA-nurse partnership was shown to be a feasible way to engage in conversations and deliver information about advance care planning to rural-dwelling Latino adults with cancer. The positive results led to the regional cancer center's decision to select "cultural care" as its 2022 goal for maintaining its accreditation with the Commission on Cancer.

Understanding time-to-recovery among Guatemalan Children before and during COVID-19.

Purpose: To understand malnutrition recovery at a Guatemalan Nutrition Rehabilitation Center (NRC) before and during the COVID-19 pandemic. Design and methods: A retrospective chart review was conducted on-site in November 2022. The NRC is located on the outskirts of Antigua, Guatemala. They manage the care of 15-20 children at a time, providing food, medicine, and health assessments. A total of 156 records were included (126 prior to the onset of COVID; 30 after the onset of COVID). Descriptive variables collected were age, gender, severity of malnutrition, height, weight, amoxicillin, multivitamins, nebulizer/bronchodilator, and zinc. Principal results: There was no significant difference in time-to-recovery between COVID cohorts. Mean time-to-recovery was 5.65 weeks, or 39.57 days (SD = 25.62, 95% CI [35.5, 43.7]) among all recovered cases (n = 149). The cohort admitted after the onset of COVID-19 (March 1, 2020) had a significantly higher weight gain and discharge weight. In the total sample, amoxicillin was the only significant predictor variable for recovery time; with children receiving it being more likely to recover in >6 weeks. The few differences between cohorts was possibly attributed to the sample after the onset of COVID-19. These records had minimal sociocultural data. Major conclusions: Conducting a family needs assessment on admission could identify sociocultural factors that may facilitate nutritional recovery, such as housing conditions and potable water access. Further research is needed to more fully understand the complexities that the COVID-19 pandemic has had on childhood malnutrition recovery.

A Feasibility Study to Examine Clinical Variables of Childhood Malnutrition in Guatemala.

Introduction: Guatemala is the country with the highest rate of malnutrition in Latin America and fifth highest worldwide. The objective of this pilot study was to determine the feasibility of examining clinical variables of malnutrition among a subset of children at a Guatemalan Nutrition Rehabilitation Center (NRC). Methods: The study was conducted using a secondary dataset of children admitted and discharged at the NRC in 2018. A total of 42 cases were reviewed. The 12 clinical variables were age, gender, height, weight, nutrition status, referral, diet, secondary diagnoses, medications, supplements, discharge disposition, and time-to-discharge. Results: The two major findings were (a) the lack of access to height and weight at discharge and (b) the inability to verify time-to-recovery. Mean age of participants was 23 months (SD = 12.9). All children were discharged home; median time-to-discharge was 48 days. The Kaplan-Meier analyses indicated that children <2 had slower time-to-discharge (51 days), compared to those older than age 2 (32 days); though not statistically significant. Conclusion: Findings of this study provide valuable data to inform ways NRC leadership can better report child health outcomes. International community-academic partnership could contribute to understanding malnutrition and time-to-recovery.

Fluid Intake and Hydration Status Among North Carolina Farmworkers: A Mixed Methods Study.

BACKGROUND: Agricultural workers are disproportionately at risk for heat-related morbidity and mortality. The purpose of this study was to explore how sociocultural and occupational factors, and environmental heat stress influenced fluid intake and hydration status among Latino farmworkers working in eastern North Carolina. METHODS: A community-informed, mixed methods research study was conducted in partnership with staff at a federally qualified health center. In summer 2020, we recruited Latino farmworkers at migrant camps. Twenty-eight male, migrant farmworkers participated in focus group discussions and 30 completed surveys and provided urine specimens. Wet bulb globe temperatures were measured in fields where workers labored. Content analysis and parametric analyses were performed. Data integration was completed using a meta-matrix. RESULTS: Prior to work, 46.7% of farmworkers' urine specific gravity measurements indicated dehydration, which increased to 100% after work. The farmworkers spent between 2 and 7.5 hours of their day working in conditions above the recommended limits for workplace heat exposure. Farmworkers described exposure to extreme heat and inconsistent occupational policy compliance. Farmworkers expressed the opportunity to drink water but accessibility and poor water quality limited hydration. The integrated data supported congruent findings of extreme heat, few work breaks, and substandard housing. CONCLUSION/APPLICATION TO PRACTICE: Farmworkers are dehydrated at work, placing them at higher risk for heat-related illness (HRI). By engaging with agricultural stakeholders, occupational health nurses can combine efforts and advocate for effective health and safety work policies to reduce HRIs and deaths among farmworkers. Legislation stipulating cooling and hydration practices would support safer work environments.

A community engagement strategy to sustain safe drinking water in Guatemala.

OBJECTIVE: We sought to examine a community engagement (CE) strategy, defined as a monetary contribution, on water filter usage DESIGN: A natural, quasi-experimental study was conducted in Guatemala following the distribution of water filters. Households in the 2014-2015 group (free water filter) were compared with households in the 2018-2019 group (CE strategy: US$5.50 for water filter) SAMPLE: One-year post-distribution, the comparison group (n = 56) and intervention group (n = 38) completed a survey on family health and water filter use RESULTS: Households in the CE group had almost five times higher odds (OR = 4.7, p = .022) of having a working water filter 1 year later. Using a multivariable logistic regression model, the single best predictor to explain working water filters was the CE strategy CONCLUSIONS: CE strategies that support ownership and dignity might sustain public health initiatives, in conjunction with collaborative international partnerships. Future research could include linking villages with local and international organizations that support safe drinking water initiatives.

Call the Rezadora: Aiding Latino Families at the End of Life.

INTRODUCTION: The rezadora, a lay spiritual leader, provides support to Latino families as they provide end-of-life (EOL) care for loved ones. The purpose of this study was to learn about the work of the rezadora in Guatemala as a resource for Latinos with serious illness in the United States. METHODS: An ethnographic exploratory case study was conducted during summer 2018 in rural Guatemala. We interviewed three rezadoras who resided in two villages. The study yielded two cases, the single case and the paired case, which allowed for a holistic view of how the rezadora serves the community. RESULTS: Content and thematic analysis led to two themes: Essence of being called and Power of prayerful song. Essence of being called was represented by the prominence of the rezadora and their perpetual faith work. Power of prayerful song was characterized through the mission, customs, and the presence of the rezadora. A good death was aided by the rezadora in this context. CONCLUSIONS: As the Latino population ages in place, the need for palliative and EOL care services will increase. Lay spiritual leaders could enhance the palliative care teams in these communities and improve the quality of life for Latinos with serious illness.

Four Kinds of Hard: An Understanding of Cancer and Death among Latino Community Leaders.

Early integration of palliative care after a diagnosis of cancer improves outcomes, yet such care for Latino populations is lacking in rural regions of the United States. We used a participatory action research design with Latino community leaders from emerging immigrant communities in North Carolina to explore sociocultural perspectives on cancer and death. Thematic analysis was conceptualized as Four Kinds of Hard represented by four themes: Receiving an Eviction Notice, Getting in the Good Book, Talking is (Sometimes) Taboo, and Seeing Their Pain Makes us Suffer. These themes captured fears of deportation, coping with cancer through faithfulness, ambivalence about advance care planning, and a desire to spare families from suffering. Findings suggest strategies to improve conversations about end-of-life wishes when facing advanced illness and death. This study demonstrates the importance of training Latino community leaders to improve palliative care and bridge service gaps for Latino families living in emerging rural communities.

Breastfeeding Decision-Making in an Addiction Trajectory: An Exploratory Grounded Theory Study.

BACKGROUND AND PURPOSE: Globally, five million women are affected by opioid use disorder (OUD). Women with OUD are less likely to breastfeed than the general population, increasing risk of neonatal withdrawal. Theoretical frameworks related to breastfeeding did not address women with OUD. The purpose of this study was to develop a conceptual model to better understand breastfeeding disparities among this vulnerable population. METHODS: A grounded theory study was conducted from August 2018 to March 2019 to investigate concepts likely to influence breastfeeding decisions in women with OUD. In-depth interviews were conducted in North Carolina with 10 women in recovery who breastfed, and their six identified support persons. Data were analyzed through iterative coding. This article focuses on maternal perspectives of breastfeeding informed by support persons. RESULTS: The overarching theme was breastfeeding decision-making in an addiction trajectory. Two antecedent pathways led to the recovery-relapse cycle. This cycle involved seeking, initiating, and maintaining recovery with episodic relapse. Perceived stigma linked the recovery-relapse cycle with breastworks. Breastworks, an emergent concept, was characterized by learning and knowing, good intentions, and health-care provider sensitivity. IMPLICATIONS FOR PRACTICE: This grounded theory model may inform clinicians in caring for women with OUD and support breastfeeding and newborn well-being. Strategies to address research and practice may include the development of a mobile application, having women in recovery on the health-care team, and incorporation of breastfeeding guidelines.

Planting the Seeds: The Role of Latino Lay Health Advisors in End-of-Life Care.

Latinos are less likely to have an advance care plan, use hospice or palliative care services, and have conversations about end of life than the general population. This article describes processes and outcomes of a Latino lay health advisor advance care planning training program in eastern North Carolina. An exploratory case study was used to understand the perspectives of Latino leaders. Two Latino leaders completed an advance care planning training in 2016. Data were generated from field notes, interviews, and observations. A description of the social and contextual conditions in the study setting facilitated data analysis. The primary finding, "planting the seeds," was the strategy that began the conversation of advance care planning. "Planting the seeds" meant introducing the topic carefully to ensure the person is ready to listen, the information will be accepted, and capacity will be gained to make informed decisions. Training Latino lay health advisors in advance care planning has the potential to eliminate health disparities.

In Sickness and Health: Views on Child Health From a Mayan Village.

INTRODUCTION: Guatemala is the only country in Central America with a majority indigenous population. Most indigenous Mayans prefer to seek health advice from family members. It is important to understand the beliefs of Mayan caregivers. The purpose of this study was to examine indigenous ways of explaining health and illness in the context of one Mayan village. METHOD: We applied a qualitative descriptive design in summer 2017. Interviews were conducted in Spanish with 10 Mayan caregivers, who were primarily female, between ages 19 and 50 years, in Guatemala. The sample was drawn from families who received a water filter the previous year. RESULTS: Health was explained by access to food, including local herbs, and clean water. Illness was explained by bodily symptoms and behavioral changes. DISCUSSION: Findings align with several United Nations 2030 Sustainable Development Goals and suggest a need to strategize with global partners.

At the Grave We Make Our Song: A Palliative Care Study in Rural Guatemala.

PURPOSE: We sought to understand decision making, family involvement, and cultural factors that influence palliative care for Guatemalans. DESIGN: A qualitative descriptive study was conducted in Guatemala to explore palliative care experiences among seven participants. FINDINGS: The overarching theme was Relief from Suffering, reinforced by three support systems: the family, community rezadora, and priest. The family made decisions and provided physical care. The rezadora sang prayers and prepared the home altar. The priest provided traditional sacraments. DISCUSSION: The role of the rezadora should be considered in providing palliative care to Guatemalans. Some Guatemalans are unfamiliar with or have difficulty understanding the role of the nurse in palliative and end-of-life care. IMPLICATIONS: We suggest training opportunities using international resources to enhance the role for Guatemalan nurses in end-of-life care. Palliative care nurses in the United States may benefit from incorporating the rezadora into strategies that extend these services to Guatemalans.

Team-Based Learning in a Community Health Nursing Course: Improving Academic Outcomes.

BACKGROUND: Population health concepts, such as upstream thinking, present challenging ideas to undergraduate nursing students grounded in an acute care orientation. The purpose of this study was to describe how team-based learning (TBL) influenced academic outcomes in a community health nursing course. METHOD: A descriptive correlational design examined the relationship among student scores on individual readiness assurance tests (iRATs), team readiness assurance tests (tRATs), and the final examination. The sample included 221 nursing students who had completed the course. RESULTS: A large positive correlation was found between iRAT and final examination scores. For all students, the mean tRAT score was higher than the mean iRAT score. A moderate positive correlation existed between tRAT and final examination scores. CONCLUSION: The study contributes to understanding the effects of TBL pedagogy on student academic outcomes in nursing education. TBL is a valuable teaching method in a course requiring the application of challenging concepts. [J Nurs Educ. 2017;56(7):425-429.].

Acceptance and Impact of Point-of-Use Water Filtration Systems in Rural Guatemala.

PURPOSE: Infants and children in developing countries bear the burden of diarrheal disease. Diarrheal disease is linked to unsafe drinking water and can result in serious long-term consequences, such as impaired immune function and brain growth. There is evidence that point-of-use water filtration systems reduce the prevalence of diarrhea in developing countries. In the summer of 2014, following community forums and interactive workshops, water filters were distributed to 71 households in a rural Maya community in Guatemala. The purpose of this study was to evaluate the uptake of tabletop water filtration systems to reduce diarrheal diseases. DESIGN: A descriptive correlational study was used that employed community partnership and empowerment strategies. One year postintervention, in the summer of 2015, a bilingual, interdisciplinary research team conducted a house-to-house survey with families who received water filters. METHODS: Survey data were gathered from the head of household on family demographics, current family health, water filter usage, and type of flooring in the home. Interviews were conducted in Spanish and in partnership with a village leader. Each family received a food package of household staples for their participation. Descriptive statistics were calculated for all responses. Fisher's exact test and odds ratios were used to determine relationships between variables. FINDINGS: Seventy-nine percent (n = 56) of the 71 households that received a water filter in 2014 participated in the study. The majority of families (71.4%; n = 40) were using the water filters and 16 families (28.6%) had broken water filters. Of the families with working water filters, 15% reported diarrhea, while 31% of families with a broken water filter reported diarrhea. Only 55.4% of the homes had concrete flooring. More households with dirt flooring and broken water filters reported a current case of diarrhea. A record review of attendees at an outreach clinic in this village noted a decrease in intestinal infections from 2014 (53%) to 2015 (32%). CONCLUSIONS: A trend suggests that water filter usage was both practically and clinically significant in reducing the incidence of diarrheal disease in this sample. Some homes did not have flat surfaces for water filter storage. Housing conditions should be taken into consideration for future diarrheal disease prevention initiatives. CLINICAL RELEVANCE: Point-of-use water filters using a community-university partnership can reduce diarrheal disease in rural regions of Guatemala.

Testing the feasibility of ¡Cuídate! With Mexican and Central American youth in a rural region of a southern state.

Regions of the US with growing Latino populations are in need of culturally sensitive sexual risk reduction programs. A Latino community, a public school district, and a university in eastern North Carolina collaborated to test the feasibility of ¡Cuídate!, a culturally tailored, evidence-based sexual risk reduction program, with Mexican and Central American youth. Ten male and 10 female adolescents, ages 13-17 years, participated in the ¡Cuídate! program and post-program focus groups. Early adolescent boys and girls (ages 13-15) gained the most from this program. A safe environment facilitated healthy sexual communication, and condom skills-building provided a context for shared partner responsibility. Grade-level and gender differences were significant. Analysis of the focus group data identified three important messages: Everybody needs sex education, We like this program better because it is hands-on, and I'm going to make better decisions about sex. The findings of this study support the need for community-based interventions that ensure cultural respect, trust, and a safe environment in which to discuss sexual issues.

International cultural immersion: en vivo reflections in cultural competence.

A baccalaureate nursing program developed and implemented an international cultural immersion course in Guatemala to explore the impact of cultural immersion on student nurses' cultural competence. This qualitative descriptive study generated data through in-depth interviews and en vivo reflective journals. The three themes: Navigating daily life, Broadening the lens, and Making a difference, revealed an expanded context and worldview of culture. International service learning seemed to pervade all aspects of the students' experience. Exercises in participant-observation and reflective writing could enhance student self-awareness and their ability to benefit from a cultural immersion course.

Walking out of one culture into another: health concerns of early adolescent Latinos.

Adolescence is considered a critical life transition that can lead to heightened vulnerability. Acculturation takes on increased importance during this period. The purpose of this study was to explore the relationship between acculturation and perceived health concerns of early adolescent Latinos in rural North Carolina. A qualitative descriptive design using gender-specific focus groups was conducted in the summer of 2001. Twenty-six Latino adolescents, predominantly from Mexico, participated in one of four focus groups. Acculturation was assessed using the Short Acculturation Scale (Marin & Marin, 1991). The most prevalent health concern of the girls was unsolicited physical contact and aggressive male behavior. Boys expressed concerns about stress related to financial worries and drinking alcohol. A better understanding of where Latino adolescents are located in the acculturation process can assist school nurses in developing targeted school-based prevention programs that focus on building specific skills for Latino girls and boys.