Transformational Leadership in Health Care Today.

Management in nursing is in a state of revolution based on positive transformational changes. Effective leadership on individual nursing units directly affects nursing staff satisfaction. Employees are interested in managers who can lead in a positive and encouraging manner. Nurses who are content in their positions correlate to a reduction in staff turnover and improve retention. When the nursing staff are satisfied with their employment, patient satisfaction rises. Health care organizations can see this trickle-down effect through increases in patient satisfaction scores over time. The promotion of effective communication and positive attitudes enhances a healthy environment for all employees and staff. Health care organizations should evaluate individual nurse managers on units to promote transformational leadership qualities; this will directly result in staff satisfaction, staff retention, and patient satisfaction.

A guide to developing a culturally competent organization.

The journey to organizational cultural competence for a health care organization, educational setting, freestanding clinic, or long-term-care organization is a process that requires the collaborative efforts from people at all levels in every department as well as external consumers such as public policy officials, students, and community leaders. Broadly speaking, four main but overlapping areas must be considered in institute activities and strategies to accomplish a comprehensive culturally competent organization. These four areas are (a) administration and governance, (b) orientation and education, (c) language, and (d) staff competencies. This article presents key content areas and activities to consider on the journey to cultural competence. Tables with suggested departmental responsibilities for implementation are included. In some cases, the journey may best be facilitated by a consultant who is well versed in cultural competence and organizational dynamics.

The effect of routine rounding by nursing staff on patient satisfaction on a cardiac telemetry unit.

Patients' perception of their care is affected by the attention they receive while hospitalized. It has become a popular metric for improving the quality of care delivered. Rounding is believed to be the key to patients' perception of the care they receive. In this study, nursing administration wanted to increase patient's perception of how well their needs were being met. Regular scheduled rounding provided an opportunity for nursing to interact with patients on a regular schedule. All nursing care categories measured exceeded the goal of 90% in the first month after implementation, with the largest increase of averaged percentages being "attention to special or personal needs.

Does size matter to the health care professional?

Americans are very cautious of saying that differences matter and frequently advocate that differences, in fact, do not matter. In an effort to be nondiscriminatory, we are not supposed to think, let alone say, that race, sex, religion, and culture matter and, certainly, that size matters. We are supposed to accept differences and to love everything about ourselves. Thus, whether we are fat, short, flat chested; have thinning hair; have a receding hair line; or have bulges where we would rather not have them, we are supposed to be satisfied with ourselves, accept others as they are, and feel that everyone is equal. However, after only a brief exposure to television, travel magazines, or the Internet, we soon are faced with the truth that size is being used to sell and promote products and therefore must matter.

Opportunity cost: the impact of contextual risk factors on the cardiovascular health of low-income rural southern African-American women.

Low-income rural southern African-American women experience a high prevalence of morbidity and mortality from coronary heart disease (CHD) as well as other related cardiovascular (CV) diseases. Few models have taken into account the full impact of the contextual influences encountered on a daily basis by these women, and the effect of these influences on their CV health status. There are clearly demarcated examples of existing health disparities that occur in various ethnic/racial, underserved, and vulnerable populations. Yet, to date, there is no conceptual model that offers a plausible explanation as to why health disparities exist. Consequently, there is a lack of guidance as to where interventions should be focused for effective CV risk reduction. Because African-American women continue to die at a disproportionately higher rate, and at earlier ages than do White women, it is imperative that new theoretical models capable of driving empirically based interventions be developed, tested, and implemented. One possible choice is the conceptual model proposed in this article. The model is based on the interrelationships between contextual risk factors, rational choice theory (RCT), and opportunity cost. Conceivably, this model may serve as a foundation to ground conceptual thought and drive theory-based interventions to reduce the health disparities in the CV health of low-income rural southern African-American women. A model is presented in an attempt to provide guidance for advanced practice nurses who must struggle with addressing the critical need to reduce ethnic and race-associated CV health disparities.

Understanding ethnopharmacolgy: implications for cultural relativism.

It is commonly accepted that people differ culturally. In the Giger and Davidhizar Transcultural Assessment Model, cultural differences are evident in communication, spatial relationships and needs, social organizations (church, family, kinships, and clubs), time orientation, the ability or desire to control the environment, and biological variations (Giger & Davidhizar, 2008). While many individuals appreciate that there are differences between cultures, what is less well recognized is that people also vary according to biological variations depending on their racial and ethnic group. In the last 15 years, information about biological variations has rapidly expanded and that knowledge is essential in order to understand and provide care to individuals from another culture or another racial and ethnic group. Attention to biological variations related to race and ethnicity, the last component of the Giger and Davidhizar Transcultural Nursing Assessment Model, is a critical phenomenon that needs to be assessed in order to develop and implement a culturally sensitive plan of care in an effort to understand ethnopharmacolgy.

Helping at-risk nursing students succeed on the National Council Licensure Examination-Registered Nurse.

As the nursing student population becomes increasingly diverse, more and more students have diverse learning needs and present risk of passing the National Council Licensure Examination-Registered Nurse. Nursing faculty need to be more aware of strategies to assist students prepare and be successful in the National Council Licensure Examination and succeed in the nursing program. This article describes the development of a course to help students take tests and improve study skills. The course NUR 090, Strategies for Nursing Success, has proven successful in facilitating success in nursing school.

Church and spirituality in the lives of the African American community.

The African American church is held in the highest esteem by most African Americans. Although the influence of the African American church has been underestimated by physicians and nurses, it could be pivotal in optimizing health status among African Americans. Because of this influence, health care practitioners, including nurses, are now recognizing the important role that the African American church plays in improving the health status of individuals in the African American community. This article illuminates the health and health care concerns of the African American community by considering the traditional lack of equal access for this population and the role that the church can play in not only offering church-based health care services but also improving the health status of church congregations. Future roles of the African American church for improved health status are also suggested.

Attitude: impact on pain assessment.

Nurses have many attitudes and beliefs about the means with which to navigate the road to pain relief for their patients. The use of an efficient and effective method to "light the path" has been extremely subjective in the past. There are reliable instruments than can be used effectively to measure and treat pain if they are used in the context of cultural appropriateness, a consistent healthcare team effort, and as part of a multidimensional approach. The utilization of the guidelines in this paper can provide direction for nurses to improve best practices and documentation in pain management, so that we may never have to say again "pain assessment instruments don't work.

When your patient cannot hear you.

Communication is vitally important in relationships and a hearing loss can have a profound impact on a person's desire to interact with others. Embarrassment and frustration can cause a person to withdraw and avoid social situations leading to isolation and depression. Persons who recognize they have a hearing problem, seek treatment, and have benefited from available therapies are able to have better relationships with friends and family, feel better about themselves, have improved mental health, and feel greater security and independence. It is in the best interest of the patient that the nurse actively assess for any kind of hearing difficulty and provide appropriate education and referral.

Transformational leadership in health care today.

Management in nursing is in a state of revolution based on positive transformational changes. Effective leadership on individual nursing units directly affects nursing staff satisfaction. Employees are interested in managers who can lead in a positive and encouraging manner. Nurses who are content in their positions correlate to a reduction in staff turnover and improve retention. When the nursing staff are satisfied with their employment, patient satisfaction rises. Health care organizations can see this trickle-down effect through increases in patient satisfaction scores over time. The promotion of effective communication and positive attitudes enhances a healthy environment for all employees and staff. Health care organizations should evaluate individual nurse managers on units to promote transformational leadership qualities; this will directly result in staff satisfaction, staff retention, and patient satisfaction.

Eliminating health disparities: understanding this important phenomenon.

Since the formation of the United States in early times, diversity has always been a reality. With the immigration of diverse whites from Europe, the importation of black slaves from Africa, and the presence of the preexisting Native American populations, diversity has long been a fact of life in this country. However, one of the long-standing priorities of the United States has been "good health" for all the people. The broad diversity of the population has presented a tremendous challenge to health care. This article addresses this important topic by looking at the concept of health disparity from a biopsychosocial perspective and further by describing disparities that are present in the United States among the 2 major ethnic minority groups, African Americans and Mexican Americans. Many other health disparities could be considered in other groups, but space limits of article allow only the 2 major ethnic minority groups to be addressed.

Promoting culturally appropriate interventions among vulnerable populations.

Evidence-based practice is critical for the improvement of interventions for culturally diverse and disadvantaged groups in the community. Nurses are strategically located in the line of patient care and must be grounded in knowledge related to the delivery of culturally appropriate intervention strategies. Although many of the health care disciplines have failed to conduct or disseminate culturally competent interventions among vulnerable populations, it is important to note that nursing has long been engaged in such activities. Clearly, all health care professionals must be provided with the tools that they need to give appropriate and effective care to patients and to conduct and disseminate relevant research about vulnerable populations. This chapter focuses on culturally competent interventions for ethnic and racial minority groups, women, and the mentally ill.

American Academy of Nursing Expert Panel report: developing cultural competence to eliminate health disparities in ethnic minorities and other vulnerable populations.

The members of the Expert Panel on Cultural Competence of the American Academy of Nursing (AAN) envisioned this article to serve as a catalyst to action by the Academy to take the lead in ensuring that measurable outcomes be achieved that reduce or eliminate health disparities commonly found among racial, ethnic, uninsured, underserved, and underrepresented populations residing throughout the United States. The purposes of this article are to (a) assess current issues related to closing the gap in health disparities and achieving cultural competence, (b) discuss a beginning plan of action from the Expert Panel on Cultural Competence for future endeavors and continued work in these areas beyond the 2002 annual conference on Closing the Gap in Health Disparities, and (c) provide clearly delineated recommendations to assist the Academy to plan strategies and to step forward in taking the lead in reshaping health care policies to eliminate health care and health disparities.

We don't want to go there.

Managers must have many skills, among which is the ability to carefully select which challenges and issues should be responded to and which should be better left alone. A wise manager listens to the troubles of staff and concerns in the workplace and then selects which problems to respond to and when. Sometimes, "We don't want to go there" is the appropriate reaction and limits further conversation and energy on the topic. Because the statement cuts others off, it is important to use this phrase with deliberation and tact.

Does having a "brand" help you lead others?

Every manager has the opportunity to develop a personal brand of unique characteristics that are valuable in his or her own right. Recognizing a personal brand and developing it to its fullest can enhance leadership potential. These qualities enable others to notice and follow the leader and can enhance cooperation. Credibility is key to developing a personal brand. Then come style, consistency, and change. A brand can enable the manager to connect with others. Use of technology can enhance the use of a brand because cyberspace promotes communication. Other necessities are using organization, selling vision, sharing information, and staying personal.

The mystery of altruism and transcultural nursing.

Why do some individuals choose the professions they do? Is it for altruistic reasons? This article examines this question from the standpoints of sociobiology, evolutionary biology, game theory, and memetics. Implications for transcultural nursing are included. The Giger-Davidhizar Transcultural Assessment Model is presented as a nursing model and might explain altruism even beyond other models. An overview of the Giger-Davidhizar Transcultural Assessment Model is included.

Taking criticism.

The manner in which criticism is dealt with is one of the important behaviors to master in a healthcare work environment: 1.) respond calmly, 2) use a problem solving approach, 3) avoid blaming others, 4) increase the complainers feelings of power, 4) increase feelings of power, 5) communicate respect, 6) do not respond to criticism with an e-mail, 7) forgive the complainer and not hold a grudge; and 8) let the buck stop as soon as possible, and 9) take criticism seriously. Dealing with criticism will never be easy. It just isn't! But using a reasoned approach will help, and get us back to why we entered healthcare - to take care of patients.