Interpretation time in an ethnically diverse pediatric orthopedic clinic.

Purpose - The purpose of this paper is to determine whether there were differences in clinical encounter time between patients who speak English and those who require an interpretation service in an ethnically diverse pediatric clinic. Design/methodology/approach - Encounter time with patients requiring interpretation was compared to encounter time with patients who spoke English. The sample consisted of 310 encounters at a pediatric orthopedic clinic where patients spoke over 18 primary languages. Data were analyzed using ANOVA to compare four types of encounters. Findings - Approximately 12 percent (n=38) required interpretation and encounters requiring interpretation took 30 percent (nine minutes) longer than those that did not, p < 0.01(25 vs 16 minutes). Furthermore, this difference was mainly among new patients: Approximately, 53 percent increase in time for new patient encounters requiring interpretation (36 vs 23 minutes) while only 25 percent increase in encounter time for established patients (20 vs 16 minutes) was detected. Research limitations/implications - Preventing problems due to language barriers requires time for interpretation which places demands on staff resources and presents clinical challenges. However, long-term benefits of quality health care outweigh the costs associated with interpretation service. Originality/value - To the knowledge, this is the first study to investigate actual encounter time differences in a pediatric clinical setting. The authors found that clinical encounters requiring interpretation took approximately nine minutes longer in general and four minutes longer for established patients. These findings could give much needed information for hospital administrators to allocate appropriate amounts of time and resources to care for those who need interpretation services. However, they also indicate a broader concern of the reduction of clinical encounter time for overall health care system in the country that might need further investigation.

Potential Motivators and Barriers for Encouraging Health Screening for Cardiovascular Disease Among Latino Men in Rural Communities in the Northwestern United States.

Cardiovascular disease (CVD) is the leading cause of death across all races and ethnicities. In particular, Latino men suffer disproportionately from conditions that lead to CVD such as hypertension, high cholesterol, and diabetes. There are easy and inexpensive ways to screen for certain cardiovascular conditions, yet Latino men are not benefiting from these. It is important to identify motivators and barriers to screening among this population. The purpose of this qualitative, descriptive study was to determine what motivates Latino men to participate in health screening for diabetes, high blood pressure, and high cholesterol. Self-identified Latino men (n = 17) were interviewed following a community health screening targeting Latinos. Individual semi-structured interviews were conducted in either Spanish or English after giving written consent. Trained interpreters were used for Spanish interviews. Emerging themes include motivating factors and barriers to participate in screening. Data findings direct future studies and provide culturally meaningful and relevant strategies to reduce health disparities.

Complications of supracondylar osteotomies for cubitus varus.

BACKGROUND: Humeral osteotomies for cubitus varus have a notoriously high complication rate. Pitfalls of this difficult procedure are highlighted. METHODS: A 50-year experience of 68 consecutive surgeries was reviewed. Factors such as surgical approach and fixation technique were compared for complication incidence and type. RESULTS: Seventeen patients (25%) had 23 (34%) clinically remarkable complications. Nine postoperative nerve palsies occurred in 8 patients. Loss of reduction requiring revision or manipulation was seen in 3 patients. The following complications were noted in 2 patients each: nonunion, loss of flexion, lateral prominence, and unsatisfactory scar. Growth arrest, osteomyelitis, and under-correction requiring revision each occurred once. A lateral, triceps-sparing approach was associated with an overall prevalence of complications of 24% (5 of 21) equivalent to the posterior, triceps splitting approach of 24% (10 of 42). An olecranon osteotomy was used in 2 patients both with complications. No nerve injuries occurred in patients who underwent a lateral approach, whereas nerve palsies occurred in 14% (6 of 42) of the patients where a posterior approach was used. An olecranon osteotomy was used in 2 patients with nerve injury occurring in both. A medial approach in 2 patients and a combined medial-lateral approach in 1 patient were used with no complications. Plate and screw fixation was implemented in 29 cases with complications occurring in 6 of them; pin fixation, in 30 cases, 7 of which had complications. There was a higher incidence of under-correction requiring additional surgery with plate fixation (1 of 29) compared with pin fixation which had no under correction but had loss of fixation in 2 of 30. The average correction obtained was similar in the group with complications (32 degrees) versus those without (27 degrees). CONCLUSIONS: Supracondylar humeral osteotomy is a technically demanding procedure fraught with complications. Plate fixation and pin fixation techniques resulted in similar complication rates, but the surgical approach used appeared to make a difference. The posterior, triceps splitting, approach resulted in a high incidence of nerve palsies versus none with the lateral, triceps-sparing approach. LEVEL OF EVIDENCE: This is a retrospective case series, Level IV.

Risks and benefits of parent/child bed sharing.

PURPOSE: To recognize the concerns for and against parent/child bed-sharing (co-sleeping) practices. DATA SOURCES: Review of the literature and the clinical experiences of the authors. CONCLUSIONS: The decision to bed share ultimately lies with the parent, but it is the responsibility of the nurse practitioner (NP) to discuss risks and benefits of parent preferences and to help families make a safe decision regarding the sleeping arrangement for their child. IMPLICATIONS FOR PRACTICE: If NPs know the benefits and risks regarding co-sleeping and bed sharing, they can better promote safe and culturally congruent family centered care.

Machismo sustains health and illness beliefs of Mexican American men.

PURPOSE: To inform nurse practitioners (NPs) about Mexican American men's health and illness beliefs and the ways in which these are influenced by their masculine identity and how they view themselves as men in their culture. DATA SOURCES: The data sources used were based on a selected review of the literature about Mexican American men's health and illness beliefs and the concept of machismo. Several studies, including the author's study on Mexican American men's healthcare-seeking beliefs and behaviors and experience in providing primary health care to men across cultures, contributed new data. CONCLUSIONS: The meaning of manhood in the Mexican American culture is critical in understanding how men perceive health and illness and what they do when they are ill. Machismo enhances men's awareness of their health because they have to be healthy to be good fathers, husbands, brothers, sons, workers, and community members. Pain and disability are motivating factors in finding ways to regain their health. IMPLICATIONS FOR PRACTICE: Men's health beliefs across cultures need further investigation by nurse researchers and NPs. How culture influences healthcare delivery to men should be better understood. If NPs are aware of men's views on masculinity, they are better prepared to understand and assist men in becoming more aware of their health status and to seek health care when appropriate.

Health care seeking among Mexican American men.

This focused ethnography explored health care seeking beliefs and behaviors of Mexican American men living in south central Washington State. Data collection included interviews with 36 research participants living in the community, participant observation in the research setting, and examination of ethnographic documents and cultural artifacts. Four major themes were identified: the identity of manhood dictates health care seeking, health means being able to be a man by fulfilling cultural obligations, illness means not being able to be a man, and men seek health care when their manhood is threatened or impaired. Machismo, the cultural concept of manliness, persisted among men despite the level of acculturation and other factors. Women influenced men's health care seeking behaviors. To fulfill their obligations, men must stay healthy and seek care when needed. Knowing when and why men do not seek health care enables nurses to better understand and serve the Mexican American community.

Culturally competent care of patients with acute chest pain.

PURPOSE: To inform nurse practitioners (NPs) about the influence of culture on patients' responses to pain using the example of acute chest pain. DATA SOURCES: Selected clinical and research articles on pain and culture and the authors' clinical experiences providing care across a variety of cultures. CONCLUSIONS: There is very little written and even fewer studies on the connection of culture and the response to acute chest pain. This topic needs more attention by nurse researchers. Implications for practice If NPs are not aware that some patients may not demonstrate behavior typically expected in acute myocardial infarction, they may miss the diagnosis and fail to treat or refer these patients for immediate treatment.

Primary care needs of patients who have undergone gender reassignment.

PURPOSE: The purpose of this article is to inform nurse practitioners (NPs) about the primary care needs of patients who have undergone gender reassignment, either by hormone therapy alone or in conjunction with surgery. DATA SOURCES: Data sources used were mainly from a review of the literature about gender identity disorder and gender reassignment. Information was also gathered from several leading surgeons on gender reassignment surgical procedures and subsequent clinical considerations. CONCLUSIONS: There is very little written on the primary care clinical ramifications of transsexual patients and how clinicians can adapt their approaches to healthcare delivery to accommodate their special situations. IMPLICATIONS FOR PRACTICE: Implications for practice include how an NP can adapt clinical practice approaches to provide for patients who have undergone gender reassignment. Changes that occur in the transsexual process may warrant noncustomary primary healthcare screening and examination.