A model for the delivery of culturally competent community care.

AIM: To describe the proposed Culturally Competent Community Care (CCCC) model, and the process of development and testing of the model. BACKGROUND: Community health nurses are challenged to provide culturally competent care in all types of communities. However, existing models have not provided community nurses with specific guidelines, and none attempt to explain the effects of culturally competent care on populations in community settings. Therefore, it is necessary to develop a model that is comprehensive in its description of the dimensions of culturally competent care in community-based settings and that also requires a focus on ethnic populations. The model is essential for reducing racial and ethnic health disparities. METHODS: Based on literature review and concept analysis, three constructs of the Culturally Competent Community Care Model were developed. Two of the constructs, the health care system and health outcomes, were developed based on a literature review. The main construct of the model, cultural competence, was developed after a concept analysis, following the development and testing of the Cultural Competence Scale (CCS). Interviews with eight community health nurses and a survey by five community nurse experts were conducted in order to refine and confirm the dimensions of cultural competence and its impact on health outcomes. CONCLUSIONS: The proposed dimensions of culturally competent care are caring, cultural sensitivity, cultural knowledge, and cultural skills. This model focuses on the relationship between cultural competence and health outcomes for culturally diverse populations. The framework provides specific guidelines for community nurses in developing and assessing cultural competence and meeting the health needs of diverse communities.

Patterns of violence in homeless women.

Fifty percent of all women in America have reported being battered at some point in time, and one in five report regular assaults. This exploratory qualitative study's purpose was to describe reported patterns of violence in sheltered battered women. Homelessness was the adaptive response to battering. A purposive sample of 7 women described violence patterns from childhood and their most recent relationships prior to seeking shelter. In-depth audiotaped interviews indicated extreme violence and terror. Thematic analysis revealed an understanding of abusive patterns with a male partner. A theory of freedom-seeking behavior emerged, with related themes including terror, murderous thoughts, awakening, and escape. The emerging theory has implications for outreach, case finding, and identification of intervention timing for abused women.

National Delphi study to determine competencies for nursing leadership in public health.

PURPOSE: To identify competencies needed by nurse leaders in public health programs. DESIGN: Five-round national Delphi. SAMPLE: Convenience sample of members of major public health nursing associations and nurse and non-nurse public health leaders in the USA. METHODS: Mailed survey in 1994-1995 using a modified snowball technique based on a modification of the Pew Foundation health professions' competencies for Round 1. Four additional rounds produced consensus. FINDINGS: Initially, 62 competencies were identified. Factor analysis resulted in four factors: political competencies, business acumen, program leadership, and management capabilities; 57 competencies were clustered in the four groupings and accounted for 91.4% of the variance. CONCLUSIONS: Graduate schools in nursing and public health must prepare students with broad-based competencies from a variety of disciplines. Findings of this national survey provide a database for curriculum development and evaluation of programs to prepare nurse leaders for roles in public health-based delivery systems.

Doctoral education in community health nursing: a national survey.

The purpose of this study was to identify content areas specific to community health nursing in doctoral programs throughout the United States. The research foci related to community health nursing were compared with previously identified research priorities in the field. Surveys were sent to 52 doctoral program directors; 23 questionnaires were completed. Telephone interviews were conducted with 16 program directors to clarify responses. Newer programs tended to be more generally focussed and without doctoral specialty courses of any kind. The four programs that identified community health nursing as a specialty within their curriculum were some of the oldest and largest programs in the country.

Health and life problems of homeless men and women in the southeast.

Homelessness in America is on the rise. Cities across the United States have been targeted in studies documenting the prevalence, health needs, and socioeconomic status of the "new" homeless. Southern cities have been noticeably underrepresented in these reports. The purpose of this exploratory, descriptive study was to identify the health needs and life situations of the homeless population in Columbia, South Carolina. Adult participants were interviewed at homeless shelters, public parks, and soup kitchens. Quantitative and qualitative methods were used to increase reliability and to portray a comprehensive picture of this diverse population. An interview guide was designed to help interviewers elicit the experience of homelessness including the needs of women and children. Outcomes paralleled findings of previous studies supporting the commonality of the homeless experience across geographic areas. Among the 157 respondents, 41 (26.1%) were women living in shelters or on the street. Minorities were well represented, with 67.5% of the sample composed of African Americans and .6% composed of Spanish Americans. Reasons for homelessness were expressed as a combination of factors such as loss of a job, family problems, or health problems. Of those who disclosed abuse histories (n = 59), 73.8% stated that this had occurred before becoming homeless. Implications for the development of innovative community nursing systems to meet the needs of this population are addressed.

Nursing theory-based practice in the home and community: the crux of professional nursing education.

Nursing has been viewed as a service for people wherever they may be--a service, grounded in scientific knowledge, that transcends setting. Yet nursing education has been overwhelmed by hospital institutions for the past 50 years, its attention diverted to medical entities and institutional trends, with fragmentation and depersonalization of general health care as well as nursing care as the result. Nursing theory-based practice is not feasible in institutions where medical orders overshadow all other disciplines. Community-based experiences in which nursing students learn about people and their health in the context of home and community offer the best promise for students to learn the complex human dynamics of real life and develop the holistic perspective required for independent nursing practice. The time has passed for nursing education to focus on the fraction of the population in hospitals while slighting knowledge about health as it is lived every day. Priority content for all nursing students should be a portable nursing theorybase that can be taken anywhere, focusing on health promotion, healthy environments, and quality of life.

Body weight: relationship to conversational distance and self-actualization.

Body weight is a major concern for women. This study investigated the relationship between body weight deviation, perceived effect of weight, conversational distance, and self-actualization in healthy caucasian college women (N = 109) between the ages of 18 and 50. The perception of body weight was measured with a structured questionnaire. Conversational distance was measured by having the participant approach the investigator, and self-actualization was determined using the Personal Orientation Inventory (POI). Significant correlations were found between the Time Competence (TC) subscale of the POI and Perceived Effect (PE) and between conversational distance and TC. Further analysis of the data revealed a relationship between body weight deviation, using the actual deviation from the norm, and the combined effect (magnitude and direction) of body weight (r = .54, p less than .001). Path analysis revealed the multidimensional nature of the issue of body weight for women. The usual assumptions about body fat for women are questioned and implications for future research are discussed.

Theoretical and measurement issues in the study of field phenomena.

A correlational design was used to explore relationships among indicators of the human field and self-actualization in healthy women (N = 130). Perceived body size (PBS) indicated the size of the energy field; conversational distance (CD) indicated field density; and body weight indicated field pattern. The findings revealed an inverse correlation between self-actualization and CD as hypothesized. The negative correlation between the size of the field and density was in the expected direction but did not achieve significance. Body weight was related to CD but not in the expected direction. There was no relationship between body weight and PBS.