What Native Americans want nurses to know: Attitudes and behaviors desired in client/nurse relationships.

OBJECTIVE: This study examined Native American perceptions of attitudes and behaviors desired in their client/nurse relationships for the purpose of informing cultural-competency education and practice. DESIGN: A descriptive-qualitative methodology was used and face-to-face interviews were conducted. SAMPLE: A targeted sampling approach was applied; the sample included Native Americans employed at a western reservation casino. ANALYTIC STRATEGY: Thematic analysis involved constant-comparison through the examination of similarities and differences, and relationships between concepts. RESULTS: Theme I, Native American Experiences with Nurses and Theme II, Native American Experiences with Other Native Americans. Subthemes offer participant perspectives of the dynamics within their client/nurse interactions. Participants offer advice to both nurses and other Native Americans that promotes mutual understanding and respect. CONCLUSIONS: Becoming a culturally competent nurse is a complex developmental journey. Four implications are offered. First, nurses can feel confident doing what they do best; valued nurse attributes and behaviors are being taught and practiced that are foundational for cultural competence. Second, within the context of a population-health focus, consider individual preferences and beliefs. Third, empower Native American self-advocacy. Lastly, disrupt racism at the relationship level by seeking cultural humility and practicing critical self-reflection and dialogue.

Intentionality in reducing health disparities: Caring as connection.

OBJECTIVE: Inadequate health care quality may contribute to Native American health disparities through racial/ethnic discrimination by health care professionals. Nursing approaches to relationships and caring offer a means to understand health disparities through an unconventional lens. The study objective was to examine health disparities within the context of patient/nurse relationships. DESIGN: A descriptive-qualitative method guided data collection and analysis. Eleven nurses who serve Native Americans were interviewed. They described attitudes, meaningful relationships, and nurse leadership. RESULTS: Nurses discussed their perceptions of and experiences with Native American patients. Four themes emerged: shared patient/nurse values, patient-centered care, external forces, and stereotype-driven care. CONCLUSIONS: Are we ready for the challenge to advocate for, build, and sustain organizational structures that support caring relationships? Implications for public health nursing include being intentional about recognizing implicit biases and ethnocentrism; examining nurses' complicit roles in perpetuating racism; and developing mechanisms to collectively advocate for improved Native American health.

Optimizing the Benefits of Self-Monitoring Among Patients With Cancer.

PURPOSE/OBJECTIVES: To investigate oncology professionals' perspectives about, experience with, and envisioned feasibility of incorporating patient self-monitoring as a patient-centered practice. 
. RESEARCH APPROACH: An interpretive, descriptive study.
. SETTING: Four health systems and five cancer centers in three states. 
. PARTICIPANTS: 38 nurses, nurse practitioners, oncologists, physician assistants, and radiation therapists.
. METHODOLOGIC APPROACH: Individual and focus group interviews.
. FINDINGS: Three themes were revealed. CONCLUSIONS: This study uncovers the potential contribution of patient self-monitoring as a means of providing patient-generated data that informs clinical decision making, going beyond self-monitoring for self-management only. Because the term self-monitoring is not used by clinicians, adoption of an agreed-upon term is recommended as the first step toward developing and implementing a self-monitoring strategy. Findings support the need to reenvision patient education to ensure self-monitoring is clinically useful while preventing an excessive focus on the negative, which may contribute to patient anxiety.
. INTERPRETATION: The full potential for self-monitoring by patients is not entirely reached. Because nurses are charged with providing patient education, they are strategically positioned to adopt the term self-monitoring and integrate a self-monitoring strategy into patient-centered practice.

Long-Term Learning in a Short-Term Study Abroad Program: "Are We Really Truly Helping the Community?".

OBJECTIVE: To discover long-term learning outcomes in a short-term study abroad program. Students worked directly with community members to identify health issues, implement educational workshops addressing those issues, and evaluate health outcomes. DESIGN AND SAMPLE: This is a qualitative, descriptive study. Thematic analysis was conducted using a written questionnaire completed one or more years postimmersion. The sample was 41 nursing students who participated in a 10-day immersion experience in remote Honduras. RESULTS: Four themes emerged revealing evidence of long-term learning. Three of these themes, Embracing Other, Gaining Cultural Competencies, and Experiencing an Ethnocentric Shift, are supported in the literature. The fourth theme, Negotiating Ethical Dilemmas, offers a new finding. CONCLUSION: Although educators have questioned ethical consequences of study abroad programs, there is a paucity of literature indicating that students are the ones doing the questioning. Implications for educators and community members alike include facilitating dialog about collective worldviews related to global health ethics when designing study abroad programs.

Tracking and journaling the cancer journey.

Clinicians sometimes suggest to patients that they keep track of illness-related issues. Self-monitoring is a helpful term to describe these at-home activities that yield essential information for self-management. The purpose of this article is to create greater awareness of the opportunities (and potential shortcomings) of patient self-monitoring for oncology nursing practice.

Transformative learning theory: facilitating mammography screening in rural women.

PURPOSE/OBJECTIVES: To use transformative learning to investigate what experiences serve as catalysts for mammography screening, the cognitive and affective responses that result from the catalyst, and how screening behavior is impacted. RESEARCH APPROACH: A descriptive qualitative study. SETTING: Southeastern Wyoming. PARTICIPANTS: 25 low-income, rural women aged 40 years and older. METHODOLOGIC APPROACH: Four focus group interviews. FINDINGS: Cancer experiences triggered universal responses of fear by screeners and nonscreeners. The manner in which that fear response was interpreted was a critical factor in the facilitation of, or impedance to, screening. Dichotomous interpretations of fear responses provided the context for screening behavior. Immobilizing and isolating experiences were associated with nonscreening behavior, whereas motivation and self-efficacy were associated with screening behavior. CONCLUSIONS: Transformative learning theory is a useful framework from which to explain differences in mammography screening behavior. Creating opportunities that facilitate dialogue and critical reflection hold the potential to change immobilizing and isolating frames of reference in nonscreening women. INTERPRETATION: To help women transcend their fear and become self-efficacious, nurses can assess how cancer and the screening experience is viewed and, if indicated, move beyond standard education and offer opportunities for dialogue and critical reflection.

"How I kept track of it of course was my business": cancer patient self-monitoring as self-stylized work.

OBJECTIVES: Self-monitoring behaviors of cancer patients benefit patients, caregivers, and providers, and yet the phenomenon of self-monitoring from the cancer-patient perspective has not been studied. We examined cancer patients' self-monitoring preferences and practices, focusing on the meaning of self-monitoring within the cancer experience. METHODS: Semi-structured interviews were conducted among adult cancer patients who had been seen at least once at a rural United States cancer center. Questions sought out the meaning of self-monitoring and its practical aspects. Qualitative data were analyzed by adapting the four-stepped method by Giorgi for empirical phenomenological analysis. RESULTS: Twenty participants were interviewed (11 women and 9 men). Transcribed interviews revealed that cancer patient self-monitoring is self-stylized work that ranges from simple to complex, while being both idiosyncratic and routine. Participants reported using tools with systems for use that fit their distinctive lives for the purpose of understanding and using information they deemed to be important in their cancer care. Three conceptual categories were discerned from the data that help to elucidate this self-stylized work as fitting their individual priorities and preferences, reflecting their identities, and being born of their work lives. SIGNIFICANCE OF RESULTS: Findings highlight patients' unique self-monitoring preferences and practices, calling into question the assumption that the sole use of standardized tools are the most effective approach to engaging patients in this practice. Self-monitoring efforts can be validated when providers welcome or adapt to patients' self-stylized tools and systems. Doing so may present opportunity for improved communications and patient-centered care.

'Being a Part of Treatment': the meaning of self-monitoring for rural cancer patients.

BACKGROUND: The diagnosis and treatment of cancer entail managing vast amounts of information in order for patients to participate effectively in disease self-management. Information management includes patients' responses to acquire, manage, and use external and internal information, such as through self-monitoring practices. OBJECTIVE: The study objective was to examine the meaning of self-monitoring practices within the context of rural patients' responses to internal and external information. METHODS: An empirical phenomenological approach was used. Participants were adults 18 years or older, who were once diagnosed with cancer, who agreed to discuss health monitoring behavior in relation to their cancer experience, and who used services at a small, rural cancer center. Data were collected using semistructured interviews. RESULTS: Findings revealed a self-directed pursuit of self-monitoring that was shaped by 4 factors, that is, cognitive, affective, interpersonal, and symptomatic. Quotations from participants illustrate these factors. "I'd ask the questions …" represents the cognitive factor. "Are the horse stories about cancer treatments true?" represents the affective factor. The interpersonal factor is represented as "My nurse was there for me!" The symptomatic factor is represented as "Chemotherapy blocks out your memory." Informed by these factors, participants' self-monitoring practices fostered participants' sense of control and self-advocacy efforts. CONCLUSION: Nurses are in a strategic position to engage in supportive care practices through the facilitation of self-monitoring. IMPLICATIONS FOR PRACTICE: Assessment questions grounded in study findings are suggested for use by nurses to develop patient-centered education that facilitates self-monitoring practices.

Processes inherent in mammography-screening decisions of rarely or never-screened women.

Breast cancer is a significant cause of mortality and morbidity. A strong association exists between survival and early detection through regular mammography. Impoverished women underuse this life-saving screening, resulting in a disproportionate cancer burden. The study purpose is to discover the process of rarely or never-screened women's mammography-screening decisions. The sample consists of five rural, low-income, uninsured, and rarely or never-screened women. Grounded theory methodology is used to generate a new theoretical explanation of mammography-screening decision making. Findings include the central conceptual categories, intuitive dominance and intuitive certainty, which contribute toward an intuitive decision-making default. This intuitive thinking style weaves throughout two interrelated categories: (a) scarce, supportive, relational resources for learning and (b) dichotomous health care-seeking behaviors. Implications focus on a nontraditional client assessment whereby nurses can facilitate relational-based knowledge construction. Recommendations for future research include examination of the process of integrating intuition with reasoned thought for more fully informed decisions.