How organizational culture influences holistic review: a qualitative multiple case study.

Studies primarily involving single health professions programs suggest that holistic review in admissions can increase underrepresented minority (URM) representation among admitted students. However, data showing little improvement in the overall proportion of URMs in many health professions, despite widespread use of holistic review, suggest that relatively few programs using holistic review admit substantial proportions of underrepresented minorities. Therefore, more research is needed to understand factors that facilitate holistic review practices that successfully promote diverse student enrollment.

The "Reckoning Point" as a Marker for Formal Palliative and End-of-Life Care in Mexican American Families.

Palliative and end-of-life care (PEOLC) in Mexican American (MA) caregiving families remains unexplored. Its onset was uncovered in our mixed methods, multisite, interdisciplinary, qualitative descriptive study of 116 caregivers, most of whom had provided long-term informal home care for chronically ill, disabled older family members. This subanalysis used Life Course Perspective to examine the "point of reckoning" in these families, where an older person is taken in for care, or care escalates until one recognizes oneself as the primary caregiver.

Collective Care: Multiple Caregivers and Multiple Care Recipients in Mexican American Families.

Purpose: Specific stressors associated with caregiving in Mexican American (MA) families are not well documented, yet caregiving issues are paramount because informal care for parents is central to their culture. Although MA families who band together to provide care for one member are not unique, the literature does not describe the phenomenon of collective caregiving, which may be widespread but unrecognized. This article describes these understudied families who are poorly served by contemporary health systems because their characteristics are unknown.

Worry Among Mexican American Caregivers of Community-Dwelling Elders.

This mixed methods, multi-site, National Institute of Nursing Research (NINR)-funded, interdisciplinary, descriptive study aimed to identify expressions of worry in qualitative data obtained from caregiving Mexican American (MA) families assisting older adults. The purpose of this portion of the inquiry was to determine how worry is expressed, what happens to caregivers when they worry, and what adaptive strategies they used. We examined semi-structured interviews completed during six in-home visits with 116 caregivers.

Psychosocial, cultural, and spiritual health disparities in end-of-life and palliative care: where we are and where we need to go.

Although health disparities are well documented, the extent to which they affect end-of-life care is unknown. Limited research funding leads to sparse and often contradictory palliative care literature, with few studies on causal mechanisms. This article explores the psychosocial, cultural, and spiritual health disparities existing in palliative and end-of-life care with the goal of identifying future research needs.

Activities of daily living in Mexican American caregivers: the key to continuing informal care.

La familia drives elder care in Mexican-American (MA) families, but nursing home placement can result from day-to-day caregiving demands that increase caregiver difficulty with activities of daily living (ADLs). Using life course perspective, this article describes the initial data wave of 31 MA caregivers from a descriptive, longitudinal, mixed-methods study of 110 MA caregivers and care recipients over 15 months in their caregiving trajectories. Fifteen of 31 caregivers consistently indicated "no help needed" on the Katz ADL, whereas all but one reported "help needed" during semistructured interviews with cultural brokers.

Use of Theoretical Frameworks as a Pragmatic Guide for Mixed Methods Studies: A Methodological Necessity?

There is a growing acceptance of the utility of mixed methods in health sciences but there is no widely accepted set of ideas in regard to use of a conceptual or theoretical framework to guide inquiry. Few mixed methods health science articles report the use of such a framework. Lack of available conceptual maps provided by theoretical frameworks, necessary intricacy of design, and the qualitative "black box" tradition all contribute to a dearth of methodological guidance in such studies.

Mexican-American Males Providing Personal Care for their Mothers.

We know little about Mexican-American (MA) family adaptation to critical events in the informal caregiving experience but, in these days of economic and social turmoil, sons must sometimes step up to provide personal care for their aging mothers. This article compares two empirically real cases of MA males who provided such care, in lieu of a female relative. The cases are selected from a federally-funded, descriptive, longitudinal, mixed methods study of 110 MA caregivers and their care recipients.

Food expectations-long term care Spanish questionnaire.

Although little is known about nutrition care for Hispanic older adults in nursing homes, soon at least 4.5 million will reside there because of chronic disease. The purpose of this pilot study was to test the internal consistency reliability of a food and food service satisfaction instrument, the Food Expectations-Long Term Care Spanish (FoodEx-LTCSp) questionnaire with nursing home residents and to examine relationships between satisfaction and food intake, serum prealbumin, and functional status.

Utility of the life course perspective in research with Mexican American caregivers of older adults.

Research on caregiving of elders in Mexican American families is urgently needed. We know little about family caregivers, family transitions in relation to the caregiving role, reciprocal impact of caregivers and care recipients on one another, adaptive strategies, positive benefits of caregiving (caregiver gain), specific caregiving burdens, or supportive interventions for family caregiving. Theory derivation using the concepts and structure of life course perspective provides a way to fill the knowledge gaps concerning Mexican American caregiving families, taking into account their ethnic status as an important Hispanic subgroup and the unique cultural and contextual factors that mark their caregiving experiences.

Lessons Learned in Clinical Research: Using the MMSE With Older Mexican American Nursing Home Residents.

This authors examined the utility of the Mini-Mental State Examination (MMSE) in a pilot study to measure cognitive function in older Mexican American nursing home residents. Many of the lessons learned are transferable to the community: Cognitive screening instruments must be carefully examined for validity and utility, they may need to be administered in Spanish, certain items may need alteration in the questions or expected responses, phrases to be repeated must be culturally appropriate, cutoff scores may need adjustment, "serial sevens" must be used, and education and socioeconomic status must be considered in interpretation of results. Consequently, the MMSE may not be an appropriate measure to use to assess cognitive functioning in older Hispanic populations whose educational levels or literacy is low or unknown.

"Attached at the umbilicus": barriers to educational success for Hispanic/Latino and American Indian nursing students.

Hispanic/Latino and American Indian students receiving services from a 3-year Nursing Workforce Diversity Grant called ALCANCE responded every semester to a semistructured interview protocol about their program experiences. Eighteen Anglo student volunteers also participated in one such interview. Comparison of the transcribed interview sets using methods outlined by (Miles, M.

The importance of educational and social backgrounds of diverse students to nursing program success.

This article compares the educational and social backgrounds of Anglo students with those of Hispanic/Latino and American Indian students receiving stipends and other services from a Nursing Workforce Diversity Grant to determine the possible effects of such backgrounds on success in a baccalaureate nursing program. Stipend recipients provided baseline background data by interview on admission, and the results were compared with corresponding data from a volunteer sample of Anglo students to enhance understanding of the educational and social circumstances of the stipend recipients and to identify a need for individualized, tailored grant approaches. The Hispanic/Latino and American Indian students demonstrated less adequate educational backgrounds and lower social class as gauged by parental occupation, than did the Anglo students.

Quality Improvement in Nursing Homes: Identifying Depressed Residents is Critical to Improving Quality of Life.

The prevalence of depression in nursing home residents is three to five times higher than in older adults from the community.1 Depression is thought to be related to the gloomy institutionalized environment and an assortment of losses, including those associated with function, independence, social roles, friends and relatives, and past leisure activities.2 Despite the public's increased awareness of depression, it remains underrecognized and undertreated by professionals who care for older residents in nursing homes.

Storytelling intervention for patients with cancer: part 2--pilot testing.

Purpose/objectives: To evaluate symptom reports and the impact of a nurse-led storytelling intervention in a supportive group setting on mood, stress level, coping with stress, pain, self-efficacy, and satisfaction with life in patients with cancer.

Design: Descriptive pilot project using a pretest/post-test control group.

Setting: Local regional medical center in the Pacific Northwest region of the United States.

Storytelling intervention for patients with cancer: part 1--development and implementation.

Purpose/objectives: To develop a nurse-led storytelling intervention for patients with cancer and implement the intervention using trained oncology nurses.

Design: Descriptive pilot project using qualitative methods to assess implementation of an intervention tool kit, with investigators blinded to control and intervention group membership.

Setting: Local regional medical center in the Pacific Northwest region of the United States.

Personalismo and breaking barriers: accessing Hispanic populations for clinical services and research.

Thirteen percent of Hispanic households provide care to an adult aged 50 or older, but given their dramatic population growth, an increasingly large number of families will soon be placed in a caregiving role. The purpose of this study was to determine whether Hispanic caregivers could be accessed through local provider groups, with the goal of generating interventions to decrease caregiver burden. Study findings raise Anglo nurses' awareness of the need for staff who share the values and language of diverse subgroups.

Student perceptions: the influence of a Nursing Workforce Diversity Grant on retention.

This article reports the perceptions of Hispanic/Latino and American Indian students concerning the influence of a Nursing Workforce Diversity Grant (ALCANCE) on their educational experiences in a baccalaureate nursing program. The grant provided an educational pipeline for these students, supporting them financially, personally, and academically from middle school through graduation from the nursing program. Fifteen students receiving grant services during the upper-division nursing major completed a 76-item questionnaire assessing the influence of such services at the end of each of four semesters in the nursing program.

Clostridium difficile: an emerging epidemic in nursing homes.

Clostridium difficile is currently recognized as the most common cause of nosocomial infectious diarrhea in the nursing home setting. Data from the Centers for Disease Control and Prevention confirm that the incidence of C. difficile has doubled in recent years and accounts for approximately 3 million cases of diarrhea and colitis each year.

Translating a food and food service satisfaction measure into Spanish.

By 2030, at least 4.5 million U.S.

The shortened food expectations--Long-term care questionnaire: Assessing nursing home residents' satisfaction with food and food service.

Lack of nursing home resident satisfaction with meals often results in reduced food intake, leading to poor nutritional status, weight loss, functional decline, and depression. The purpose of this article is to describe the development and initial testing of the 28-item revised Food Expectations-Long-Term Care (FoodEx-LTC) questionnaire with a convenience sample of nursing home residents (N = 61). Because of possible respondent burden, the original 44-item, five-domain FoodEx-LTC was revised, resulting in the deletion of 16 redundant items and those with inter-item correlations less than .

Building a scientific base for nutrition care of Hispanic nursing home residents.

By 2030, one-quarter of the U.S. Hispanic population will be aged 80 or over.