An Exploratory Study of Bone Health Among Native Hawaiian Women in Rural Hawai'i.

INTRODUCTION: The purpose of this study was to obtain baseline data on bone mass density for Native Hawaiian women and to better understand the socio-cultural context for assessing bone health and risk of osteoporosis for this underserved population. METHOD: A sequential mixed-method design guided by Leininger's Culture Care Theory of Diversity and Universality consisted of two phases: (a) an initial exploratory focus group and (b) dual-energy X-ray absorptiometry (DEXA) scans and individual interviews. Data were analyzed using descriptive statistics and thematic analysis. RESULTS: Phase a (n = 12) suggested that Native Hawaiian women have limited knowledge of bone health, but recognize traditional and cultural ways of health. Phase b (n = 50) showed that Native Hawaiian women have healthy bones, according to the T-score results. The interviews suggested that perspectives of bone health are culturally anchored. DISCUSSION: Understanding cultural values and practices are vital for care. Preliminary recommendations for health professionals are included.

Integration of Population Health, Social Determinants, and Social Justice in Transcultural Nursing and Culturally Competent Care: White Paper by the Scholars Education Interest Group.

INTRODUCTION: As part of its mission to advance Transcultural Nursing worldwide, the Transcultural Nursing Society Scholars upholds the central role of the discipline and cultural competence in advocacy, empowerment, and transformation of the life conditions of disadvantaged populations. This White Paper affirms the Scholars' core belief in the value of Transcultural Nursing and culturally competent care in addressing social determinants to promote health equity. METHODS: The Scholars Education Interest Group proposes recommendations for changes in education, practice, and research undergirding the discipline and expand cultural competence to directly address social structural and historical forces that perpetuate health vulnerability in diverse populations. RESULTS: Collaborative leadership between the TCNS Scholars, Board of Trustess and members should develop initiatives to foster implementation of the recommendations and promote global dissemination of exemplars in education, research and practice. DISCUSSION: Collaborative implementation of recommendations will generate evidence of health equity outcomes through TCN and culturally competent care.

Development of the Clients' Perceptions of Providers' Cultural Competency Instrument.

INTRODUCTION: This study developed and validated the Clients' Perceptions of Providers' Cultural Competency instrument. METHOD: A sequential exploratory mixed design identified three constructs derived from the studies of Leininger and others. Constructs were compared with publications on cultural competency. A panel of experts reviewed for content validity. RESULTS: Three hundred and nine mostly Asians and Native Hawaiians completed the questionnaire. Twenty-two items with item-to-total correlation coefficients >.2 were retained. Overall instrument Cronbach's alpha was .89. Construct validity demonstrated the three constructs accounted for 49.6% of variance supported by distinct items with Cronbach's alphas of .82, .83, and .76, respectively. Preliminary criterion validity revealed no statistically significant differences in scores based on the location of services received or race/ethnicity. DISCUSSION: The Clients' Perceptions of Providers' Cultural Competency instrument is congruent with nursing principles of equity and justice by measuring provider cultural competency from a client's perspective. Active client engagement in care contributes to transcultural nursing's goals to improve health equity.

The Use of Mobile Health to Assist Self-management and Access to Services in a Rural Community.

The purpose of this study was to explore the barriers to and needs for using mobile health technology to assist low-income Asian American and Pacific Islander participants living in rural Hawaii in their healthcare. Three focus groups consisting of patients, family support/significant others, and providers (N = 19) were conducted to assess the unique needs of low-income Asian American and Pacific Islander patients in rural Hawaii. The electronic health literacy scale was also used among participants in the patients and family support/significant other groups. The total electronic health literacy means were 23.57 (SD = 9.71) among participants in the patient group, 34.50 (SD = 7.78) in the family support/significant others group, and 35.67 (SD = 4.56) in the providers group. The qualitative analysis yielded categories with three main themes: value of mobile health, stumbling blocks to mobile health, and mobile health wish list and subthemes. Practice implications include uses of these findings to integrate future versions of mobile health that will promote effective communication and information specifically to diverse low-income populations.

Pheochromocytoma: challenges in diagnosis and nursing care.

Pheochromocytomas are catecholamine-secreting tumors arising from chromaffin cells of the sympathoadrenal system, which includes the adrenal medulla and sympathetic ganglionic tissue. The effects of catecholamine excess cause potentially fatal symptomologies and end-organ damage if not diagnosed and treated. If diagnosed and removed surgically, most of these patients can be cures. Pheochromocytomas are rare and affect from two to eight per million people. There are 800 deaths in the United States annually as a result of complications. Of patients who have pheochromocytomas diagnosed at autopsy, 75% died suddenly from myocardial infarction or cerebral vascular catastrophe. Challenges in diagnosis, tumor location, and treatment are considerable.