An intervention for changing high-risk HIV behaviors of African American drug-dependent women.

The purpose of this study was to test the effectiveness of an AIDS education intervention for methadone-dependent, African American women. The women were randomly assigned to experimental (n=107) or control (n=97) group. The experimental group participated in a peer counseling and leadership training program conducted by two experienced nurse counselors over an 8-week period, followed by 8 weeks of reinforcement. The program was designed to reduce AIDS high-risk sexual behavior, increase self-esteem, decrease depressive affect, and increase the women's community-based AIDS prevention communication activities. A total of 130 women completed all phases of the study, including longitudinal Posttests at 2, 4, and 7 months after enrollment. Compared to the control group, there were statistically significant differences in three of the outcomes for the experimental group: The experimental group reported an increased number of safer sexual behaviors (p=.029), showed decreases in depression (p=.001), and reported engaging in more AIDS-related, community-based communication activities regarding prevention (p=.005).

Summers of no return: transforming care through a nursing field school.

Nursing education is developing a wide variety of ways to educate for cultural competence that expedites culture-congruent care and effective diversity management in practice. Using a praxis orientation, this article reports research done on an innovative nursing field school during the past four summers on the Pine Ridge Indian Reservation in South Dakota. Learning context emphasizing formation of a collaborative, caring community is created for 6-week immersion learning experiences during which student groups work with the High Plains Oglala Lakota in tribal programs. Triangulated data based on participant observation and student journals, stories, discussions, interviews, academic coursework, and evaluation surveys provide a comprehensive record of complex and multifaceted field school and immersion learning processes. Through collaboration with students, Diekelmann's "Concernful Practices" are tested and adapted for fit as a framework for organizing and examining the field school experience, as well as the practice of health care across cultures.

AIDS prevention in high-risk African American women: behavioral, psychological, and gender issues.

A three-year longitudinal intervention study was implemented to reduce high-risk drug and sexual behaviors in methadone-dependent African American women. Participants were recruited from four inner-city methadone maintenance programs and randomly assigned either to an eight-week peer counseling and leadership training group or to a control group. The 107 trainees and 97 controls completed pretests and posttests at two, four, and seven months. This paper focuses on final data related to the subjects' sexual beliefs, attitudes, knowledge, and behaviors that put them at risk for HIV/AIDS. Reasons for not using condoms are categorized and discussed. Despite the women's awareness of the seriousness of AIDS, perceived powerlessness to negotiate condom use, negative attitudes about the use of condoms, influence of drugs, and unavailablility of condoms interfered with safer sex practices. The inability of education alone to prevent many high-risk sexual behaviors suggests that more serious consideration be given to expanded distribution of condoms as well as needle exchange programs and legalization of illicit drugs.

PIP: The US Centers for Disease Control report that although African-American women comprise only 12% of the US female population, they account for 56.9% of AIDS cases in women. In 1994, 41% of women with AIDS reported IV-drug use and 38% reported heterosexual contact with a partner at risk for or known to have HIV infection or AIDS. Findings are presented from a 3-year study conducted to assess and reduce high-risk drug and sex behavior among methadone-dependent African-American women in Baltimore, Maryland. Through random assignment, 107 women received 8 weeks of peer counseling and leadership training, and 97 women formed the control group. The women were 20-59 years old of mean age 35.5. 84-90% were unemployed and 16% had been homeless within the preceding 6 months. Subjects completed pretests and post-tests at 2, 4, and 7 months. Despite the women's awareness of the seriousness of AIDS, their perceived powerlessness to negotiate condom use, negative attitudes about condom use, the influence of drugs, and the unavailability of condoms interfered with the practice of safer sex behavior. The authors believe that the inability of education alone to prevent many high-risk sexual behaviors is cause to give more serious consideration to expanding the distribution of condoms as well as needle exchange programs and the legalization of currently illicit drugs.

Perception of AIDS risk and high-risk behaviors in African-American methadone-dependent women.

AIDS poses a particularly serious threat to African-American women who are or have been intravenous drug users. This study evaluated relationships among AIDS knowledge, perceptions of chances of contracting AIDS, and high-risk AIDS behaviors in 102 low-income African-American women from four methadone-maintenance clinics in Baltimore, who volunteered to answer questions about AIDS and their sexual and drug-use behaviors. The participants demonstrated a high level of AIDS knowledge, which was significantly correlated with their perception of likelihood of having the AIDS virus (r = .49, p < .05). However, there was little evidence of avoidance of high-risk sexual behaviors. Despite this knowledge, these data indicate that understanding how the virus is transmitted does not assure a change in behavior. The issue is complicated by the question of how knowledge possessed by individuals relates to their sense of powerlessness or empowerment and the risks and benefits associated with using that knowledge.

Chinese perspectives on culture and mental health.

Central to providing culturally appropriate nursing care is sensitivity to and knowledge about the group being cared for. Although "mental health" and "mental illness" are artificial concepts among people who do not differentiate and treat mind, body, and spirit separately, and who may not differentiate illness from other problems of living, many individuals ethnically rooted in one or more Asian cultures enter Western mental health care systems. Quality nursing care requires understanding and respect for traditional values, beliefs, and practices that may differ significantly from those typical of Western European-based societies. Whether clients are traditional in orientation or highly acculturated to Western ways, nurses are responsible for providing culturally appropriate care. This article discusses mental health and nursing care from various perspectives of Asian and Asian-American clients, and in particular those of Chinese descent.

Family: is there anything more diverse?

Families are small social systems that provide for nurturance, security and love, as well as the basics of existence. Families teach children how to be in the world. Families do not fit a single definition: diversity and variability characterize these systems held together primarily by commitment of family members to each other over time. Changes throughout the life stages and as a result of societal trends influence family structures and parenting styles. An expanded view of families and how they live is part of a family-centered model of care. A focus on family strengths is key to meaningful care.

Transcultural nursing: facing the challenges of advocacy and diversity/universality.

This paper is in response to an invitation to address the topic of advocacy and diversity from the perspective of past and present transcultural nursing. With origins in nursing, with its philosophy of active intervention, and in anthropology, where relativism proposes merit in diverse (including non-interventive) approaches to health and illness, transcultural nursing grapples with potential epistemological conflict as it helps shape health care in highly industrialized, multicultural societies and even more varied global contexts. As a developing subdiscipline, transcultural nursing continuously reexamines dialectical relationships between change and preservation and between health care needs and the risk of imposition. Whereas advocacy is viewed as a moral imperative in nursing, diversity (which can be used to argue against acknowledgement of differences and to promote the pretense that everything is the same for everyone) remains better developed conceptually than operationally, while universality too often falls prey to misuse as an argument against acknowledgement of diversity. Within a framework constructed from the juxtaposition of advocacy with diversity/universality (Leininger, 1988c, 1991), this article appraises the accomplishments and challenges of transcultural nursing as it moves into its second quarter century. It is proposed that the future of transcultural nursing should emphasize development of realistic nursing roles that include a confluence of advocacy and diversity/universality and negotiation of responsible social conceptualizations of cultural issues such as "race" and diversity.

Collaboration as a strategy for acquired immunodeficiency syndrome prevention.

An eight-session training model used a social interactive framework to combine theoretical and methodological aspects of peer counseling, cross-cultural communication, and transcultural nursing, with a conviction that the participants (volunteers from an ongoing, urban methadone maintenance program) had significant strengths on which to build. The objective was to assist urban, drug dependent black women in taking control of their own lives through collaboration with health care professionals to develop and promote culturally acceptable behavioral alternatives related to reduction of risk for human immunodeficiency virus. The collaborative approach focused on rewards of behavioral change and minimized attention to prevention of negative behaviors, while openly valuing input from the women who are potential health promoters in their own communities. Evaluation of the Peer Counseling Leadership Training Program suggested that the approach facilitated personal risk-reducing behavioral change, improved self esteem, and successfully promoted involvement in community-based prevention efforts.

Strategies for AIDS prevention: leadership training and peer counseling for high-risk African-American women in the drug user community.

A culturally congruent training program to promote HIV risk-reduction behaviors was implemented in a convenient sample of 9 African-American women in an urban methadone treatment program. At each of eight peer counseling and leadership training (PCLT) program sessions, the transmission and prevention of AIDS were discussed while emphasizing enhancement of participants' self-esteem, confidence, and control over high-risk behaviors. The results indicate that support of the women helped develop their sense of purpose and self-worth, reduced sexual and drug use practices associated with risk for HIV and AIDS infection, and promoted assumption of leadership roles and dissemination of accurate AIDS-related information in their communities. It was apparent that knowledge alone does not change behavior if it conflicts with established norms, values, beliefs, and life-styles and that individuals who have a sense of personal control are more willing to explore alternative lower-risk behaviors.

Invisibility and selective avoidance: gender and ethnicity in psychiatry and psychiatric nursing staff interaction.

This research-based article analyzes institutionalized inequity and discrimination in the forms of sexism and racism within a large, busy, contemporary medical center's Department of Psychiatry. Within that context, issues of control and mechanisms of avoidance served to perpetuate contradictions inherent in what professes to be a psychologically therapeutic and empowering milieu. Despite cognizance of the roles that culture and gender play in care and treatment of patients, psychiatric and mental health professionals at "Central" tended to avoid critical examination of their own and co-workers' ethnicity and gender as those characteristics influenced life experiences, occupational roles and statuses, and hierarchical relationships.

When an institution dies. Nursing's role in closing a facility.

1. This article documents the development of a nursing role to support the staff and faculty of a state residential school for adolescents during closure of that institution. 2. The process of institutional closure resulted in increased ambiguity and need to redefine social expectations and responsibilities. Supportive nursing intervention facilitated the transition. 3. Theory and intervention associated with loss through death and dying can be appropriately adapted for use in nursing intervention during loss experienced with organizational death and institutional closure. 4. Because the meaning and experience of loss during institutional closure involves everyone and does not occur in a uniform or linear manner, nurses' roles must be flexible, responsive to contextual change, and introspective, as well as analytical and supportive.

Nurses' networks: obstacles and challenge.

Occupational cohesiveness and network formation among nurses are widely advocated as logical solutions to practical problems and as sources of emotional support. However, actual nurses' networks have not been studied. As part of a larger study, this report analyzes the social support networks of 35 psychiatric nurses. The nurses, who were employed in a large public hospital, were studied as individuals who had private as well as occupational roles. Properties, significance, and articulation of private and public portions of networks were examined for patterns that correlated with characteristics of the nurses. Evidence of significant barriers to practice-level relationships among nurses is presented. Realistic expectations for development of effective networks require management of those obstacles.

An enigma: the world of the child aphasic.

This glimpse into the reality of a child aphasic--a child with a problem whose cause, diagnosis, remedy, and prognosis are undefined--points to the need for further research and understanding of children who elude categories of treatment, yet must be helped to face the ineluctable tasks of adulthood.