A review of the literature on care of clients in pain who are culturally diverse.

AIM: This article reviews the literature on the care of clients from diverse cultures who are in pain and provides strategies for care. BACKGROUND: Pain is a critical concept for caring for clients and particularly for clients from another culture. Culture shapes the values, beliefs, norms, and practices of individuals, including the ways persons react to pain. Culture affects the assessment and management of pain. CONCLUSIONS: Seven strategies can assist in culturally appropriate assessment and management of pain: (1) utilize assessment tools to assist in measuring pain, (2) appreciate variations in affective response to pain, (3) be sensitive to variations in communication styles, (4) recognize that communication of pain may not be acceptable within a culture, (5) appreciate that the meaning of pain varies between cultures, (6) utilize knowledge of biological variations, and (7) develop personal awareness of values and beliefs which may affect responses to pain.

Social problem-solving telephone partnerships with family caregivers of persons with stroke.

As individuals with significant functional deficits are discharged earlier from the hospital, health care professionals are challenged to develop cost-effective intervention programmes that will assist family members to manage caregiving problems in the home. The literature suggests that social problem-solving can positively influence the physical and psychological well-being of individuals. This paper describes a social problem-solving training procedure provided primarily by telephone to assist family caregivers to manage caregiving issues in the home.

Sociodemographic, physical, and psychosocial characteristics of depressed and non-depressed family caregivers of stroke survivors.

A variety of sociodemographic, physical, and psychosocial variables are linked to depressive behaviour in family caregivers. This study was conducted to determine the best predictors of caregiver depression at onset of the caregiver role among persons providing care to a stroke survivor. The relative contributions of stroke survivor and caregiver sociodemographic characteristics, as well as caregiver general health, physical functioning, social support, life satisfaction, preparedness, and reaction in the prediction of depression status, were examined. A correlational study of 52 primary family caregivers of individuals who had a cerebrovascular accident was conducted. General health and physical functioning scales from the SF-36, and measures of caregiver social support, life satisfaction, preparedness, and reaction were used. Caregiver depression was best predicted by lower life satisfaction, lower physical functioning, and a lack of tangible social support.

Finding meaning in illness. Can nurses help?

They are common comments from people facing a life-threatening or chronic illness: "Why did this happen to me? I don't deserve this." "Am I being punished for something? Why do I have to go through this?"

Fat distribution and cardiovascular disease risk in African-American women.

We have previously shown that in Caucasian men and women fat in the trunk, and especially visceral fat, was related to cardiovascular disease (CVD) risk even after adjusting for fat in other depots. We also found that leg fat was negatively related to CVD. In order to determine if these relationships also exist in African-American women, blood lipids, insulin, and blood pressure in 26 pre-menopausal African-American women were evaluated. In addition, magnetic resonance imaging measured fat distribution was evaluated from the lateral malleolus to top of the shoulder. Percent fat was related to VLDL cholesterol, VLDL3 cholesterol, triglycerides, insulin, and diastolic blood pressure. Inclusion of visceral and trunk fat together in multiple regression did little to improve the relationship with CVD risk. Leg fat, however, tended to be negatively related to CVD risk after adjusting for trunk fat and visceral fat. Partial correlations indicated that leg fat was negatively related to VLDL cholesterol (r = -0.36), triglycerides (r = -0.36), insulin (r = -0.46), and diastolic blood pressure (r = -0.43). These results indicate that in African-American women, visceral fat may be less atherogenic than in Caucasian men and women since it was poorly related to CVD risk after adjusting for fat in the trunk. In addition, consistent with results from Caucasians, leg fat is inversely related to CVD risk after adjusting for fat in other parts of the body. Caution must be made in the interpretation of correlational data. Further research is warranted to explore these intriguing relationships.

Helping others when you are hurting: strategies for delivering quality care while dealing with personal bereavement.

Nurse managers are in a strategic position to assist clients, their family members, and other staff in dealing with normal grief and to provide additional assistance if the grief becomes complicated. A variety of strategies can be used by the nurse to assist individuals through the grief process. In some cases, the nurse must deal with personal grief while simultaneously helping others. This article addresses useful strategies for nurses to enhance the delivery of quality care while dealing with personal loss and grief.

Will you fit if you move to a job in another culture?

In today's health care environment, many health care managers choose to move to a new setting. Because environments vary from setting to setting, a manager who plans to move needs to evaluate potential "fit" in the new locality. An evaluation of "fit" includes an assessment of both the job culture and persons in the environment. The Giger-Davidhizar transcultural assessment model provides a model for evaluating a new job culture.

Recognizing abuse in culturally diverse clients.

Abuse is a major problem in American society. The problem of abuse among ethnically diverse persons is an area about which most health care professionals know little. This article describes the Giger-Davidhizar Model of Transcultural Assessment as a tool of assessment of the client who is abused. Use of a framework for assessment can enable more culturally competent care to be delivered.

Time-bound madness.

The concept of the passage of time is familiar to most people regardless of ethnic heritage. However, some persons are more time-bound than others. This article discusses the qualities of time-bound individuals and outlines strategies for responding to time-bound madness.

Nursing clients of Greek ethnicity at home.

The home healthcare nurse who cares for persons with Greek ancestry should be aware of their unique cultural heritage. The nurse should also be aware that Greek people throughout the world are proud and independent, valuing their religious faith and practices, good health, education, and success. Care should be designed to include appreciation of traditions and customs that these clients may have. The nurse should make a special effort to develop trust with the Greek client and family members in order to effectively implement culturally competent healthcare.

Patients' use of denial: coping with the unacceptable.

Nurses working with terminally ill or bereaved clients and their families need to understand the defence mechanism of denial and how it helps people to cope with unacceptable physical and psychological threats.

Use of Giger and Davidhizar's Transcultural Assessment Model by health professions.

Nursing science is increasingly gaining recognition. Witness the growing use by other disciplines of nursing's models and ideas. One example is the adoption of the Giger and Davidhizar Model of Transcultural Assessment by non-nursing disciplines to understand and address the needs of a pluralistic multicultural society. Below the authors describe a model to understand culturally diverse clients and show how health professions are using it to provide culturally competent care.

When your patient uses denial.

There are may factors to consider when denial is encountered in a patient situation. Denial is a simple concept but is complicated by ego-maintaining mechanisms that denial may produce. It is important to evaluate each individual situation in order to identify suitable approaches for the situation. Denial may not be something that the nurse should take away since it can serve an important balancing function between depression and wellness.

Growing older is not what it used to be.

Growing old is not what it used to be. Many self-care actions can enhance one's chance of growing old without illness or disease. This necessitates preparing for old age while one is young. Preparation for second adulthood can vastly improve physical and emotional health in old age. It is important that nurses and other health care professionals teach health promotion strategies to persons at all ages in order to assist individuals to live life to its fullest throughout their lifetime.