Zika-Associated Birth Defects Reported in Pregnancies with Laboratory Evidence of Confirmed or Possible Zika Virus Infection - U.S. Zika Pregnancy and Infant Registry, December 1, 2015-March 31, 2018.

Zika virus infection during pregnancy can cause serious birth defects of the brain and eyes, including intracranial calcifications, cerebral or cortical atrophy, chorioretinal abnormalities, and optic nerve abnormalities (1,2). The frequency of these Zika-associated brain and eye defects, based on data from the U.S. Zika Pregnancy and Infant Registry (USZPIR), has been previously reported in aggregate (3,4). This report describes the frequency of individual Zika-associated brain and eye defects among infants from pregnancies with laboratory evidence of confirmed or possible Zika virus infection. Among 6,799 live-born infants in USZPIR born during December 1, 2015-March 31, 2018, 4.6% had any Zika-associated birth defect; in a subgroup of pregnancies with a positive nucleic acid amplification test (NAAT) for Zika virus infection, the percentage was 6.1% of live-born infants. The brain and eye defects most frequently reported included microcephaly, corpus callosum abnormalities, intracranial calcification, abnormal cortical gyral patterns, ventriculomegaly, cerebral or cortical atrophy, chorioretinal abnormalities, and optic nerve abnormalities. Among infants with any Zika-associated birth defect, one third had more than one defect reported. Certain brain and eye defects in an infant might prompt suspicion of prenatal Zika virus infection. These findings can help target surveillance efforts to the most common brain and eye defects associated with Zika virus infection during pregnancy should a Zika virus outbreak reemerge, and might provide a signal to the reemergence of Zika virus, particularly in geographic regions without ongoing comprehensive Zika virus surveillance.

Culturally competent practice in a pre-licensure baccalaureate nursing program in the United States: a mixed-methods study.

AIM: This study examined how one pre-licensure baccalaureate nursing program at a public university in the southeastern United States integrated concepts and issues of culture and culturally competent practice into its curriculum. BACKGROUND: Teaching and learning about culturally competent practice in pre-licensure nursing programs are essential to ensure a culturally competent health care workforce. METHOD: A mixed-methods case study approach was used. Data were collected from student surveys (n = 111), student focus groups (three groups, n = 9), faculty interviews (n = 14), and school of nursing documents, including the mission statement, faculty and student handbooks, and course syllabi. Data were analyzed using descriptive statistics and content analysis. RESULTS: Findings provide evidence of cultural competence, barriers to deeper engagement with cultural issues, and suggestions for improvement. CONCLUSION: These findings suggest teaching/learning strategies and curricular design issues that may lead to greater student and faculty member cultural understandings.

Client perceptions of cultural competence of community-based nurses.

Cultural competence is best understood by assessing provider and client perspectives. In this descriptive quantitative study, clients assessed dimensions of nurses' cultural competence including communication, decision-making, and interpersonal style. Nurses in 7 county health departments in North Carolina assessed their own cultural competence. Sixty-nine clients completed the Interpersonal Processes of Care and 71 nurses completed the Cultural Competence Assessment. Clients perceived their nursing care to contain key components of cultural competence. Nurses rated themselves as moderate to high cultural competence. Consistencies were noted between the clients' and nurse perceptions of cultural competence. These findings contribute to the enhancement of cultural competence among community nurses.

Self-reported cultural competence of public health nurses in a Southeastern U.S. Public health department.

OBJECTIVE: Delivery of culturally competent public health nursing that can address health disparities is dependent on competent practice by nurses. Examining public health nurses' (PHNs') cultural competence provides a basis for planning and developing interventions to ensure competent care. Examine the cultural competence of PHNs. DESIGN: Descriptive, exploratory study examining the measured cultural competence of PHNs and their perceptions of delivery of culturally competent care. SAMPLE: A convenience sample of 31 PHNs participated. MEASUREMENTS: Participants completed the Cultural Competence Assessment tool and documented personal experiences and perceptions of culturally competent health care through open-ended questions. RESULTS: Most participants reported a moderate level of cultural competence. Cultural awareness and sensitivity scores were higher than scores for culturally competent behaviors. Participation in specific types of cultural competence training was significantly related to higher scores on cultural competence. Participants documented culturally competent care for a diverse clientele and requested additional diversity educational opportunities and interpreter services. CONCLUSIONS: The nurses had culturally competent knowledge and attitudes but were unable to fully and consistently enact these in practice. The need for appropriate cultural competence education and interpreter services addressing health disparities, as mandated in the Culturally and Linguistically Appropriate Services in Health Care standards, is emphasized.

Authenticity: a concept analysis.

PURPOSE: This paper aims to analyze the concept of authenticity and propose a definition of authenticity that can be used to enhance the nurse-client relationship. SOURCES: Published research. CONCLUSIONS: Authenticity is a life-long process of self-discovery that includes realizing personal potential and acting on that potential. A part of this process is accepting the responsibility for and the consequences of life choices that are consciously or unconsciously made. This is sometimes achieved through suffering. This process culminates in a demonstration of congruency in ideals, values, and actions in relation to self and others.

Mental health service needs of a Latino population: a community-based participatory research project.

Community-based participatory research bridges the gap between academic researchers and the real-life issues of communities and offers promise for addressing racial and ethnic disparities in mental health care. The purpose of this community-based participatory research was to identify factors that affect access, use, and perception of mental health services by a Latino population at individual, organizational, and community levels. Individual level factors included health beliefs about mental illness and care, suspicions of providers, financial concerns, and culturally determined gender roles. Organizational factors included problems with access to care related to cost, lack of bilingual providers, and culturally competent care; and community level factors included distance between resources and the need for services to be provided in community sites. Immigration status and acculturation were identified as factors at all levels.

'Take my hand, help me out': mental health service recipients' experience of the therapeutic relationship.

The purpose of this study was to describe mental health service recipients' experience of the therapeutic relationship. The research question was 'what is therapeutic about the therapeutic relationship?' This study was a secondary analysis of qualitative interviews conducted with persons with mental illness as part of a study of the experience of being understood. This secondary analysis used data from 20 interviews with community-dwelling adults with mental illness, who were asked to talk about the experience of being understood by a health-care provider. Data were analysed using an existential phenomenological approach. Individuals experienced therapeutic relationships against a backdrop of challenges, including mental illness, domestic violence, substance abuse, and homelessness. They had therapeutic relationships with nurses (psychiatric/mental health nurses and dialysis nurses), physicians (psychiatrists and general practitioners), psychologists, social workers, and counsellors. Experiences of the therapeutic relationship were expressed in three figural themes, titled using participants' own words: 'relate to me', 'know me as a person', and 'get to the solution'. The ways in which these participants described therapeutic relationships challenge some long-held beliefs, such as the use of touch, self-disclosure, and blunt feedback. A therapeutic relationship for persons with mental illness requires in-depth personal knowledge, which is acquired only with time, understanding, and skill. Knowing the whole person, rather than knowing the person only as a service recipient, is key for practising nurses and nurse educators interested in enhancing the therapeutic potential of relationships.

Factors affecting use of the mental health system by rural children.

As many as 20% of children between the ages of 0 and 18 meet the criteria for one or more mental disorders at some point in their lives, with about one half of these being described as being seriously disturbed. Only about one-third of these children and adolescents receive help from the mental health system. Negative outcome expectations toward the mental health system can prevent use of services. This study examined rural parents' expectations about outcomes related to mental health treatment, the provider-client-parent relationships, social and cultural factors, and accessibility to mental health services. The parents' knowledge of the prevalence of mental health disorders in children and adolescents was also examined. Bandura's Social Cognitive Theory served as the conceptual framework for this study. Stigma toward the use of the mental health system was evident. More than half the parents were concerned that mental health professionals would not care for their child. Although negative relationship outcome expectations were revealed, positive treatment outcome expectations also emerged. Structural outcome expectations were not shown to be a major deterrent in receiving care. The belief and hope is that positive outcome expectations toward the mental health system will encourage use of services.