Postpartum depression in immigrant Hispanic women: a comparative community sample.

PURPOSE: To determine whether a high rate of postpartum depression (PPD), previously found in immigrant Hispanic women at a community clinic, would also be found in a community sample. DATA SOURCES: Sixty women from local community settings were given the PPDS-S instrument and the General Acculturation Index to screen for PPD symptoms. Data were then compared with previously published community clinic data. CONCLUSION: Sixty percent of the immigrant Hispanic women showed significant PPD. The only statistically significant positive predictive factor for increased PPD symptoms was having a previous history of depression. In addition, 54% had an elevated symptom content profile score for suicidal thinking. IMPLICATIONS FOR PRACTICE: Health practitioners should be aware of a potentially high rate of PPD in this population, especially in light of previously studied increased rates of suicide attempts in Latinas. If a prior history of depression is predictive of PPD, it is possible that many of the mothers in our sample suffered from depression prior to the postpartum period, but were not appropriately diagnosed or treated. Recommendations for outreach and further research are discussed. In particular, further research regarding the prenatal prevalence of depression in immigrant Hispanic women is recommended in order to further understand the high incidence of PPD.

The last frontier: rural emergency nurses' perceptions of end-of-life care obstacles.

INTRODUCTION: Caring for dying patients is part of working in a rural emergency department. Rural emergency nurses are prepared to provide life-saving treatments but find there are barriers or obstacles to providing end-of-life (EOL) care. This study was completed to discover the size, frequency, and magnitude of obstacles in providing EOL care in rural emergency departments as perceived by rural emergency nurses. METHODS: A 57-item questionnaire was sent to 52 rural hospitals in Idaho, Wyoming, Utah, Nevada, and Alaska. Respondents were asked to rate items on size and frequency of perceived obstacles to providing EOL care in rural emergency departments. Results were compared with results from 2 previous emergency nurses' studies to determine if rural nurses had different obstacles to providing EOL care. RESULTS: The top 3 perceived obstacles by rural emergency nurses were: (1) family and friends who continually call the nurse for an update on the patient's condition rather than calling the designated family member; (2) knowing the patient or family members personally; and (3) the poor design of emergency departments that does not allow for privacy of dying patients or grieving family members. The results of this study differed from the other 2 previous studies of emergency nurses' perceptions of EOL care. DISCUSSION: Nurses in rural emergency settings often work in an environment without many support personnel. Answering numerous phone calls removes the nurse from the bedside of the dying patient and is seen as a large and frequent obstacle. Personally knowing either the patient or members of the family is a common obstacle to providing EOL care in rural communities. Rural nurses often describe their patients as family members or friends. Caring for a dying friend or family member can be intensely rewarding but also can be very distressing. CONCLUSION: Rural emergency nurses live and work on the frontier. Little EOL research has been conducted using the perceptions of rural emergency nurses possibly because of the difficulty in accurately accessing this special population of nurses. Rural emergency nurses report experiencing both similar and different obstacles compared with their counterparts working in predominately non-rural emergency departments. By understanding the obstacles faced by emergency nurses in the rural setting, changes can be implemented to help decrease the largest obstacles to EOL care, which will improve care of the dying patient in rural emergency departments. Further research is needed in the area of rural emergency nursing and in EOL care for rural patients.

Emergency nurses' suggestions for improving end-of-life care obstacles.

INTRODUCTION: More than 123 million ED visits are reported annually. Many patients who arrive for care to help extend their lives instead die while in the emergency department. Emergency departments were designed to save lives rather than to provide optimal end-of-life (EOL) care. Emergency nurses care for these dying patients and their families. The purpose of this study was to determine what suggestions emergency nurses have for improving EOL care. METHODS: Emergency nurses were asked which aspects of EOL care they would like to see changed to improve how patients die in emergency departments. Of the 1000 nurses surveyed, 230 provided a total of 295 suggestions for improving EOL care. Content analysis was used to identify categories of qualitative responses. Responses were coded individually by research team members and then compared with ED EOL literature. Clusters of data were formulated to form themes with sufficient data returned to reach saturation. RESULTS: Five major themes and four minor themes were identified. The major themes were increasing the amount of time ED nurses have to care for dying patients, allowing family presence during resuscitation, providing comfortable patient rooms, providing privacy, and providing family grief rooms. CONCLUSION: Large numbers of patients seek care in emergency departments. Emergency nurses are often called on to care for dying patients and their families in this highly technical environment, which was designed to save lives. Emergency nurses witness the obstacles surrounding EOL care in emergency departments, and their recommendations for improving EOL care should be implemented when possible.

Integrating advanced writing content into a scholarly inquiry in nursing course.

Since there are few data examining methods to help students learn to write in a scholarly manner, the purposes of this project were to (1) evaluate students' learning of writing content integrated into a Scholarly Inquiry in Nursing course by examining differences in scores on a writing assessment taken at the beginning and end of the course; and (2) examine student confidence ratings relative to writing to see if it improved during the course. After obtaining IRB approval and informed consent, the CLIPS pre and post assessment mean scores of 82 students in a Scholarly Inquiry in Nursing course were compared using the Wilcoxon signed-rank test. Confidence ratings in formal and informal writing were also obtained from a subsample of 47 students. Mean scores improved in 12 out of 26 assessment categories related to punctuation, correct usage of words, and sentence construction. Student mean confidence ratings increased each month.

Reasons parents exempt children from receiving immunizations.

School nurses are on the front lines of educational efforts to promote childhood vaccinations. However, some parents still choose to exempt their children from receiving vaccinations for personal reasons. Studying the beliefs of parents who exempt vaccinations allows health care workers, including school nurses, to better understand parental concerns which may, in turn, help prepare school nurses for effective communication with these parents. The objective of the study was to explore personal beliefs of parents living in Utah, who exempted their children from receiving vaccinations. A cross-sectional, descriptive design was implemented. Data were collected from a convenience sample of 287 parents responding to an open-ended question about why they exempted their children from receiving at least one vaccination. The qualitative data included parental comments, concerns, or suggestions regarding childhood vaccinations. Five categories were identified regarding reasons for personal exemptions: parental perceptions, health care systems issues, chronic disease concerns, immune system concerns, adverse reaction concerns and other reasons not classified. The number of parents refusing childhood vaccinations remains relatively low; however, despite public health efforts, the percentage increases each year.

Perceptions of health and well-being held by Native Hawaiian migrants.

BACKGROUND AND PURPOSE: Migration is often a challenging process. Native Hawaiians migrate from Hawaii to Las Vegas at an impressive rate, but no research has explored how migration affects their health and well-being. The purpose was to describe how Native Hawaiians in Las Vegas perceive their health and well-being and any changes therein since migrating. DESIGN: Using a qualitative descriptive design, 27 participants took part in semistructured interviews. FINDINGS: Most participants perceived no changes in health and minor changes in well-being. Many maintained their well-being by adapting valued activities to their new circumstances. However, 5 participants were deeply burdened by life in Las Vegas or longing for Hawaii, and their well-being suffered. They tended to identify barriers to well-being rather than ways to foster it. CONCLUSION: Health care providers can help Native Hawaiian migrants by encouraging early access to the health care system in their new location and facilitating participation in helpful, adaptive behaviors.

Successfully incorporating Writing Across the Curriculum with advanced writing in nursing.

The purpose of this article is to explain the concepts of Writing Across the Curriculum, Writing in the Disciplines, and Writing to Learn, and to describe the incorporation of advanced writing into a baccalaureate nursing program and provide suggestions for accessing resources and promoting success. The goals of incorporating Writing Across the Curriculum, Writing in the Disciplines, and Writing to Learn concepts into nursing curriculum are to assist nursing students to achieve competence in clinically relevant writing assignments; to demonstrate critical thinking and communication skills, both oral and written; to execute useful literature searches; to read and understand research reports; and to encourage the incorporation of evidence into clinical practice. With a strong and established writing foundation, nursing students will be more successful in written and oral communication during their nursing program and throughout their nursing career.

The impact of migration on the health of voluntary migrants in western societies.

The authors reviewed literature on the health of voluntary migrants to Western societies and factors affecting their health. Health indicators include mortality rates and life expectancy, birth outcomes, risk of illness, patterns of deteriorating health, cardiovascular disease, body mass index, hypertension, and depression. Multiple factors explain variability, including length of residence and acculturation, disease exposure, life style and living conditions, risky behaviors, healthy habits, social support networks, cultural and linguistic barriers, experiences with racism, and levels of awareness of cultural health practices among health care providers. Evidence exists for superior health among many migrants to Western countries relative to native-born persons, but the differential disappears over time. Migration is a dynamic, extended process with effects occurring years after physical relocation. Systemic change is required, including health policies that ensure equity for migrants, culturally appropriate health promotion, and routine assessment of migration history, cultural health practices, and disease exposure.

Patient-centered care and adherence: definitions and applications to improve outcomes.

PURPOSE: The implementation of patient-centered care (PCC) has been hampered by the lack of a clear definition and method of measurement. The purpose of this review is to identify the fundamental characteristics of PCC to clarify its definition, propose a method for measurement of PCC, and recommend effective PCC practices. DATA SOURCES: Review of literature related to PCC, adherence and communication from Cinahl, PubMed Academic Search Premier, and Cochrane Library databases. CONCLUSIONS: Research has shown that patient-centered interactions promote adherence and lead to improved health outcomes. The fundamental characteristics of PCC were identified as (a) patient involvement in care and (b) the individualization of patient care. The use of a numeric rating scale to measure the presence of these characteristics allows quantification from the patient perspective. Effective PCC practices were related to communication, shared decision making, and patient education. IMPLICATIONS FOR PRACTICE: PCC is a measure of the quality of health care. Understanding the characteristics of PCC facilitates its implementation and measurement. Promoting PCC activities will improve adherence and encourage patient responsibility for health status.