Bridges and barriers: educational mobility of Hispanic nurses.

The lack of data on the educational mobility of the Hispanic nurse presents major barriers in designing effective strategies to diversify the nursing work force. However, such data are necessary to ensure parity of representation of Hispanics in nursing. The purpose of this project was to identify barriers and bridges to educational mobility experienced by Hispanic nurses. Focus groups were conducted in six sites throughout the country. Separate groups were conducted with Hispanic ADN nurses who had completed their BSN and with BSN nurses who had completed their MSN. Barriers encountered and identified by participants included financial burdens, institutional barriers, perceived discrimination by faculty and peers, and cultural values such as the importance of the family and prescribed gender roles. Conversely, bridges to completing degree requirements included family, peers, and faculty. Recommendations to facilitate educational mobility of Hispanic nurses are provided.

Borrowed theories, shared theories, and the advancement of nursing knowledge.

Despite the continued use of borrowed theories in nursing, little attention has been given to determining whether theories developed in another discipline are empirically adequate descriptions, explanations, or predictions of nursing phenomena. In this article, we demonstrate how a borrowed theory can be placed within a nursing context by linking it with two different conceptual models of nursing. We present our plans for research focused on condom use behavior and discuss how results from these studies will be used to determine whether the borrowed theory can be considered a shared theory.

Improving access to health care for children.

ISSUES AND PURPOSE: The number of uninsured children has been growing at an alarming rate. The most vulnerable children are those in lower-income families who are falling through the cracks between evolving government-sponsored health insurance programs. Recent policy initiatives may not be adequate to extend coverage to more children. CONCLUSIONS: Many low-income children actually are eligible for Medicaid but are not enrolled for a variety of reasons. The numbers of these children have risen due to welfare reform. Better outreach efforts are needed to ensure that new child health insurance programs and Medicaid expansions achieve their goals. IMPLICATIONS FOR PRACTICE: A comprehensive assessment of insurance status and referral to community agencies should be an integral part of patient care for all healthcare providers.

Practice what we preach? HIV knowledge, beliefs, and behaviors of adolescents and adolescent peer educators.

The purpose of this article is to (a) describe the knowledge, beliefs, and sexual behaviors of urban adolescents and adolescent peer educators, and (b) identify elements needed to design effective HIV/AIDS prevention programs for out-of-school youth. Thirty-three predominantly African American adolescents (female = 14; male = 19) between the ages of 14 and 24 in a large urban city including adolescent (n = 18) and adolescent peer educators (n = 15) participated. Paper-and-pencil questionnaire and focus-group interviewing methods were used. Adolescents and adolescent peer educators had a moderately high level of HIV knowledge, confidence in their ability to use condoms, and beliefs that condom use would not decrease sexual pleasure or imply infidelity. Both groups reported low perceptions of susceptibility of HIV infection. Engagement in sexual risk behavior was low, but was significantly higher among males. Although adolescent male peer educators engaged in a higher frequency of risk behaviors over time, they had a lower frequency of sexual risk behaviors in the past 2 months compared with male adolescents. Study findings showed that HIV prevention interventions need to include information about specific risk behaviors, such as using condoms for oral sex, and cleaning drug paraphernalia. Community-based and church programs, visible HIV prevention messages, specifically those aimed at increasing perceptions of HIV risk, and the development of condom-use skills were identified by adolescents and adolescent peer educators as relevant approaches to reduce HIV infection among this population.

Cultural influences on the sexual attitudes, beliefs, and norms of young Latina adolescents.

PURPOSE: To describe the influence of cultural values famillism, gender-role expectations, and religion on sexual attitudes, beliefs, and norms of young Latina adolescents. DESIGN: Ethnography, focus group interviews. SETTING: Community-based agencies in two urban cities. PARTICIPANTS: Puerto Rican and Mexican-American adolescents (10-15 years) and their mothers. MAIN OUTCOME MEASURES: Ethnographic interview guide. RESULTS: The importance of family and the role of the extended network, dimensions of famillism, were evident in such patterns as respect for self and family, protection of self, child, and family. The protectiveness of families toward girls, gender differences in rules, value of virginity, and the importance of having a family, were findings consistent with Latino gender roles. However, there were also some important deviations from these roles. For example, virginity, although important, was not associated with religious doctrine of practice. The necessity of preventing pregnancy was also considered important. CONCLUSION: Latino cultural values need to be incorporated in primary and secondary prevention efforts to decrease the risk associated with early and unprotected sexual activity.

Testing Orem's theory with Mexican Americans.

PURPOSE: To examine an ethnographic study using evaluation criteria for theory-testing through verification of personal experience. ORGANIZING FRAMEWORK: Ten theory-verification criteria developed by Silva and Sorrel (1992) for inductive methods of inquiry. SCOPE AND SOURCES: A 1995 ethnographic study conducted with Mexican Americans and conceptualized within Orem's Self-Care Deficit Theory of Nursing. Twenty Mexican American key informants were from 13 families. Primary data sources were focused observations and a series of ethnographic interviews. The study, purposes, methods, selected findings, confirmability and credibility of study findings, and relevance to Orem's theory are presented in the context of each criterion. FINDINGS: The purpose, design, analysis, and examination of results of the 1995 study sufficiently meet the 10 formative criteria. Because this study can be considered an example of theory verification research, findings are relevant to the development of Orem's theory. CONCLUSIONS: Through the use of theory-verification criteria, inductive methods of research can be used to test or verify theory. The testing of nursing theory with diverse populations is an important direction for continued theory development. Use of evaluation criteria can serve as a template for inclusion of diverse perspectives.

Mexican-American cultural meanings, expressions, self-care and dependent-care actions associated with experiences of pain.

The experience of pain within specific cultural groups has not been well studied. The purpose of this ethnographic study was to discover Mexican-American meanings, expressions, and care associated with pain. Data were obtained from 20 key and 14 general informants and analyzed using thematic and pattern analysis. Themes identified included: pain as encompassing experience of suffering; the obligation to bear pain and to endure it stoically; and the primacy of caring for others. Based on study findings, a beginning description of the cultural context is provided from which pain as experienced by Mexican-Americans can be understood and from which culturally competent nursing care can be designed.

Nursing research with African American and Hispanic people: guidelines for action.

In this article we have noted some of the conceptual and methodologic issues and challenges involved in conducting research with two ethnic/racial populations. In addition, we raised questions and gave recommendations to provide nurse researchers with guides as to how they might conceptualize and conduct and critique research with two groups. While this is not a strict blueprint, it is hoped that the guidelines and recommendations will serve as a focal point about which continued discourse and critical thinking about conducting research with members of ethnically/racially diverse groups may occur. The complex issues presented are not unique to nursing. Researchers from various disciplines have enumerated similar issues and, in turn, have been critical of research findings with samples of ethnic/racial groups. While a cadre of nurse researchers has begun to accept the challenge and to struggle with issues, more--much more--is needed. Conducting research with racial/ethnic minority populations in general, and African American and Hispanic peoples in particular, is necessary if nursing is to fulfill its societal mandate. Historically the scientific base for nursing practice has been described as being deficient in areas associated with cultural diversity. Few studies with deliberate cross-cultural or multicultural foci exist. According to Stevenson, laws of health and nursing must be constructed from research conducted with people of multiple cultures so that generalizations about health are valid representations of existing realities.(ABSTRACT TRUNCATED AT 250 WORDS)

The creation, validation, and continuing development of the Oucher: a measure of pain intensity in children.

This is the first article written by this group of authors/researchers who are collaborating on the development of the Oucher, an assessment tool to assist 3- to 12-year-olds describe the intensity of pain. The background and conceptual framework for its development, the research supporting the validation of the original Oucher, the research to create new ethnic versions, and the basic instructions for clinical use are described. In addition, several issues regarding the continued development and use of the Oucher are identified, including those relative to poster size and the gender and ethnicity of the photographed child. This article illustrates the precision and care needed to create clinically useful tools for obtaining information directly from young children.

Culture and pain: a Mesoamerican perspective.

Culture has been identified as a factor that influences a person's reaction to and expression of pain. Research in the area of pain and culture has not established a clear link between cultural meanings and attitudes associated with pain and pain behaviors. The purpose of this ethnohistoric study was to explore the beliefs related to the experience of pain within ancient Mesoamerica. The six themes that emerged from this study represent efforts related to the discovery of the epistemics of cultural meanings of pain in contemporary Mesoamerican cultures, specifically Mexican-Americans. These findings serve as a benchmark from which to understand Mexican-American meanings, expressions, and care associated with pain.

Pain assessment in children: theoretical and empirical validity.

Valid assessment of pain in children is foundational for both the nursing practice and research domains, yet few validated methods of pain measurement are currently available for young children. This article describes an innovative research approach used in the development of photographic instruments to measure pain intensity in young African-American and Hispanic children. The instruments were designed to enable children to participate actively in their own care and to do so in ways that are congruent with their developmental and cultural heritage. Conceptualization of the instruments, methodological development, and validation processes grounded in Orem's Self-Care Deficit Theory of Nursing are described. The authors discuss the ways in which the gaps between nursing theory, research, and practice are narrowed when development of instruments to measure clinical nursing phenomena are grounded in nursing theory, validated through research and utilized in practice settings.

Socialization and caring for hospitalized African- and Mexican-American children.

This article is based on the premise that African- and Mexican-American children's responses to health and illness are rooted in their socialization into group perspectives that have been shaped by particular social and economic realities. Nurses are expected to provide care to African- and Mexican-American children, even though nurses may not have been educated to understand the effect of socialized perspectives on their practices. The purposes of this article are to highlight how differences in perspectives and ideologies create misunderstanding and to provide nurses with some examples of how their behavior might be interpreted by African- and Mexican-American children. The major practice implications center around the points that the motivations for African- and Mexican-American children's behavior may be different from those of European-American children, even though the observable behaviors may be similar and the children of these two groups may bring additional socialized fears and anxieties to the hospital setting. Examples of actual practice situations are used to illustrate the major points.

Nursing actions to prevent and alleviate pain in hospitalized children.

Nurses are confronted daily with the responsibility to care for hospitalized children in pain, yet the substantive knowledge base about that care and how effective it is remains extremely limited. Although there is initial evidence of effectiveness of several pharmacologic and nonpharmacologic pain relief approaches, little evidence of use or effectiveness in clinical nursing practice exists. To begin to address this knowledge deficit, two studies conceptualized within Orem's (1991) general theory of nursing were undertaken: one involving ethnographic interviews to determine what pain relief actions are taken by nurses with recognized expertise in caring for children in pain and another, follow-up survey to examine the frequency with which these actions are used by general nursing staff. Data about perceived effectiveness of the actions were also obtained. The results of these two studies of nursing actions to prevent and alleviate pain in hospitalized children document that nurses use a wide variety of creative methods to relieve pain. From interviews with the nurse experts both specific actions and action patterns and themes were identified. Furthermore, these patterns were congruent with methods of helping used by nurses as described by Orem. Results of this research currently serve as the basis for development and testing of nursing action protocols for alleviation of pain in hospitalized children.