Illness perceptions and blood pressure control among hypertensive Filipino Americans: A cross-sectional study.

BACKGROUND: Among Asian Americans, Filipino Americans (FAs)-who constitute the fourth largest US immigrant group and who fill in health care workforce shortages-experience high prevalence but low control rates of high blood pressure (HBP). Research reveals that patients' illness perceptions, their common-sense model (CSM) of the illness, influence treatment behaviors, and management outcomes. However, scarce information exists about FAs' perceptions about HBP. PURPOSE: To address this gap, we conducted a cross-sectional study to (a) identify the illness perceptions of hypertensive FAs, (b) classify these perceptions into clusters, and (c) determine the association between illness perceptions and BP control. METHODOLOGY: The responses of 248 FAs with HBP to the Brief Illness Perception Questionnaire were analyzed using JMP Pro version 17 to discover their CSMs or illness perceptions. We used iterative K means cluster analysis to classify variations in CSMs and analysis of means chart to determine the association of illness perceptions and BP control. RESULTS: Hypertensive FAs expressed threatening (negative) views of HBP through their emotional perceptions of the illness and its chronic time line, whereas their positive views centered on their cognitive beliefs about understanding HBP and its controllability. Based on the biomedical model of HBP, the overall illness perceptions or CSMs encompassed three clusters. Generally, threatening illness perceptions were associated with stage 2 HBP. CONCLUSIONS/IMPLICATIONS: The findings underscore the need for nurse practitioners to elicit, listen, discern, and understand the illness perceptions or CSMs of hypertensive FAs to improve BP treatment and control with scientifically and culturally tailored interventions.

African American women's perceptions of the meaning of support groups for improving adherence to hypertension treatment: a conceptual model.

AIM: To investigate the meaning of support groups and the features of these groups that African American (AA) women view as improving adherence to high blood pressure (HBP) treatment. The study generated a conceptual model to illuminate features of these groups that influence adherence of AA women to HBP treatment. DESIGN: Qualitative research. METHODS: Used focus groups and open-ended questions to obtain the views of 26 eligible AA women, recruited from South Los Angeles. Line-by-line review and coding of interview transcripts were done. The feedback was used to specify a conceptual model depicting the meaning of support groups. The Consolidated Criteria for the Reporting of Qualitative Research guidelines were used. RESULTS: The conceptual model depicts the meaning of support groups as information giving/knowledge sharing, emotional or psychological support, instrumental support and coaching, and facilitators and barriers to joining support groups and factors for consideration in forming these groups.

The factor structure of a short acculturation scale for Filipino Americans in an adult U.S.-born sample.

The influx of non-European immigrants since 1965 ushered the development and use of acculturation measures in immigrant health studies. A Short Acculturation Scale for Filipino Americans (ASASFA) represents a validated, unidirectional ethnic-specific measure used with first-generation FAs. ASASFA's psychometric properties with adult U.S.-born children-the second generation-remain unexplored. This study determined (a) the factor structure of ASASFA with adult U.S.-born FAs and (b) the predictors of their acculturation scores. A secondary analysis was conducted on ASASFA data from a mental health survey of 116 U.S.-born FAs. Exploratory factor and parallel analyses showed a two-factor solution: language use and preference (Factor 1) and ethnic social relations (Factor 2). Ordinary least squares regression indicated gender and ethnic self-identification predict Factor 1 scores; self-identification solely predicts Factor 2 scores. Results demonstrate ASASFA's validity and parsimony, supporting its use in FA health studies when lengthy bidirectional acculturation measures become impractical.

Level of acculturation, food intake, dietary changes, and health status of first-generation Filipino Americans in Southern California.

PURPOSE: This exploratory descriptive study investigates the acculturation level, food intake, dietary changes and practices, health status perceptions, and diet-related health indicators-body mass index (BMI), waist and hip circumferences, and waist-to-hip ratio-of first-generation Filipino Americans (FAs) in Southern California. DATA SOURCES: Healthy FA adults-20 women and 10 men-were interviewed. Acculturation level was obtained using A Short Acculturation Scale for Filipino Americans. A 24-h dietary recall elicited their food intake. Survey questions revealed dietary changes and practices, health status perceptions, and sociodemographic characteristics. Height, weight, waist and hip circumferences were measured. CONCLUSIONS: FAs consider themselves more Filipino than American, but their acculturation level reflects transitioning into biculturalism. FAs relinquish, maintain, and adapt elements of both Philippine and U.S. cultures in food intake, dietary changes, and practices. Although FAs perceive their health status as very good to excellent, many exceed the cut-off points for BMI, waist circumference, and waist-to-hip ratio. IMPLICATIONS FOR PRACTICE: This study underscores the importance of nurse practitioners and other healthcare givers conducting cultural dietary assessment as a basis for culturally appropriate dietary counseling. The inclusion of waist measurement to regularly monitor abdominal obesity-a predictor of cardiovascular disease and diabetes-is highly recommended.

Facilitating the career transition of second-career students into professional nursing.

This article describes the approaches used by the Second Careers and Nursing (SCAN) program to socialize second-career students into professional nursing. The pre-licensure phase of the program is guided by Schlossberg's transition theory of moving in, moving through, and moving out. Moving in involves setting expectations, from the admission interview to the two-day intensive orientation. Moving through entails imparting and instilling nursing's cultural content and values through the program's formal and informal curriculum. Moving out strengthens students' feelings of pride and their commitment to becoming professional nurses during a concentrated internship, NCLEX-RN preparation, and coaching for their first RN position. The article also reports on the socialization outcomes and lessons learned during the pre-licensure phase. Outcomes provide evidence that the SCAN program has successfully transitioned non-nursing college graduates into professional nursing by socializing them into the profession's knowledge, skills, and behaviors while they internalize nursing's values and goals.

The illness beliefs, perceptions, and practices of Filipino Americans with hypertension.

PURPOSE: The purpose of this study was to describe the illness beliefs, perceptions, and practices of Filipino Americans (FAs) with hypertension (HTN) to reveal their explanatory models (EMs) of the illness. DATA SOURCES: Audiotapes and transcripts of focus group interviews and observational notes were subjected to content analysis. Medical records and related empirical studies provided supporting data. CONCLUSIONS: In general, the EMs of FAs with HTN correspond to the biomedical model in relation to causes, consequences, and treatment of HTN. However, in spite of this biomedical knowledge, FAs with HTN have difficulty maintaining the required lifestyle changes and adhering to the medication regimen to control their illness. IMPLICATIONS FOR PRACTICE: It is important for NPs to assess the EMs of FAs with HTN, including their use of traditional folk remedies and practitioners of folk medicine. The challenge is to provide cardiovascular health promotion and education in a culturally sensitive, congruent, and tailored manner to FAs with HTN to help them control their illness.

Validating the Interpersonal Communication Assessment Scale.

Despite the centrality of interpersonal communication in nursing, there are few psychometrically sound instruments to measure the communication competencies of undergraduate and graduate nursing students. This article reports on the development and testing of the Interpersonal Communication Assessment Scale (ICAS), which was designed to assess the communication competencies of students in undergraduate and graduate nursing programs. Retroductive triangulation, using both deductive and inductive methods, and the Model of Relational Competence guided the measure's conceptualization and development. We used responses from 531 (24%) undergraduate and graduate clinical faculty from 246 American Association of Colleges of Nursing member schools for the psychometric testing of the 54-item content-validated and pilot-tested ICAS. Exploratory-factor analysis resulted in a three-factor solution labeled as advocacy, therapeutic use of self, and validation. These factors accounted for 60% of the variance. Items that loaded .60 or higher were retained, resulting in a 23-item scale with a Cronbach's alpha of .96. The ICAS significantly differentiated the communication competencies of beginning and graduating students in both undergraduate and graduate programs. The ICAS was found to have construct validity and internal consistency, underscoring its potential as a formative and summative tool to assess the interpersonal communication competencies of nursing students.

Use of intuition by nursing students: instrument development and testing.

BACKGROUND: Intuition has been described as an important type of nursing knowledge and has gained acceptance as a valid way of knowing in clinical nursing. Use of intuition has become one way of explaining professional expertise. Measures of the use of intuition have been developed primarily for experienced nurses, but few measures of intuition use among nursing students exist. AIM: The aim of this paper is to describe the development and psychometric testing of an instrument to measure use of intuition by nursing students. METHODS: Instrument development consisted of concept clarification, item development, and psychometric testing. Intuition was defined as a non-linear process of knowing perceived through physical awareness, emotional awareness, and/or through physical or spiritual connections. Initial measurement items were derived inductively from the literature and informal interviews with senior nursing students. Seven content experts established a content validity index of 0.86 for the initial 33-item measure. It was pretested with a sample of 20 senior nursing students prior to its nationwide validation with a random sample of 1000 senior bachelor of science and associate degree nursing students. RESULTS: Postal mail data collection resulted in 349 responses (35% response rate). Principal component analysis with orthogonal varimax rotation resulted in seven factors accounting for 66.2% of the variance: physical sensations (28.4%); premonitions (9.7%); spiritual connections (7.7%); reading of cues (6.1%); sensing energy (5.7%); apprehension (4.3%); and reassuring feelings (4%). Eigenvalues ranged from 1 to 7.1 and factor loadings ranged from 0.534 to 0.858. The validation resulted in a revised 25-item measure that demonstrated an overall Cronbach's alpha of 0.89 and a range of 0.69-0.84 for each factor. The study is limited by the use of a self-report measure and the attrition in the randomized sample. CONCLUSIONS: The intuition measure for use with students showed evidence of construct validity and reliability. With further testing, the measure could serve as a stimulus to foster students' intuitive abilities.

Transformation in family nurse practitioner students' attitudes toward homeless individuals after participation in a homeless outreach clinic.

PURPOSE: To use a retrospective pre/post self-assessment survey to determine the attitudes of family nurse practitioner (FNP) students toward homeless individuals before and after participating in a homeless outreach clinic (HOC) and to elicit, through focus groups, their perspectives on the homeless population after their HOC participation. DATA SOURCES: A mixed-methods study using focus group tapes and transcripts of 15 FNP students who were divided into two separate focus groups as well as three completed survey measures: Demographic Data Form, Attitudes Toward Homelessness Inventory, and HOC Attendance Form. CONCLUSIONS: Overall, the FNP students revealed no stigmatizing attitudes toward homeless people prior to their HOC participation, but a significant positive change in their attitudes occurred after the experience. There were significant mean differences in 6 out of the 11 scale items and in the overall total mean scores after the HOC experience (p = .013). The focus groups revealed the transformation of the students' attitudes toward homeless individuals after their HOC participation, supporting and illuminating the survey findings. IMPLICATIONS FOR PRACTICE: The study findings underscore the importance of including the care of homeless patients in FNP educational programs. Such exposure provides FNP students with an opportunity to develop the social responsibility to care for all segments of society, especially homeless people, in keeping with nursing's social contract as a helping profession.