Treatment Collaboration When the Stakes Are High: Ethnographically Studying Family-Centered Care in an Outpatient Pediatric Specialty Clinic.

Family-centered care (FCC) is vital for children with special health-care needs and serious chronic illnesses. Family-clinician collaboration and partnership formation are key FCC elements associated with improved health outcomes. However, FCC implementation barriers persist.

Teaching About Better Family-Clinician Partnerships in High-Risk Pediatric Asthma Care.

Family-clinician partnership including communication, trust, respect, and power leveling is essential in pediatrics. Our case study illustrates elements supporting/hindering partnership in a high-risk urban pediatric asthma clinic. Data from observation of a 100-minute visit were qualitatively analyzed by applying codes to themes, using family-centered principles.

Development of a Child Abuse Level Management (CALM) Guide for Research with Young Children.

Reporting child abuse or neglect is an ethical expectation and a legislated mandate of behavioral and health care professionals in the United States. In particular, researchers who investigate parent-child dyads are responsible for submitting procedures and informed consent documents to institutional review boards that provide for the protection of children. The challenge for researchers is to recognize failing quality of parent-child interaction, prior to any event of maltreatment and to intercede in a deteriorating dynamic.

Challenges to Recruitment of Urban African American Patients with Cancer Pain.

There are many assumptions about recruitment of African Americans to cancer studies. The population is often characterized as older, low income, with limited education, scarce resources, and distrust of the health care system. Support systems for African Americans are reported to be centered on family and church communities.

Extended family support for parents faced with life-support decisions for extremely premature infants.

Purpose: To outline parents' descriptions of extended family involvement and support surrounding decision making for their extremely preterm infant.

Design: Collective case study design in a prospective, descriptive, longitudinal research. Seventy-five digitally recorded interviews were done with parents before and after the birth.

Development of a spiritual self-care practice scale.

Background And Purpose: Development of a valid, reliable instrument to measure spiritual self-care practices of patients with heart failure.

Methods: African American patients (N = 142) with heart failure participated in the study. Spiritual advisors from several religious groups reviewed the Spiritual Self-Care Practices Scale (SSCPS) for content validity.

Conceptual and design issues in instrument development for research with bereaved parents.

Many childhood deaths in the United States occur in pediatric intensive care units (PICUs) and parents have special needs in this death context. As an interdisciplinary research team, we discuss conceptual and design issues encountered in creating a new instrument, the Bereaved Parent Needs Assessment-PICU, for assessing parents' needs in this setting. Using a qualitative approach, our team previously explored how the culture and related ways of providing care in one urban Midwestern children's hospital PICU affected parents' bereavement needs and experiences.

Testing a multi-group model of culturally competent behaviors among underrepresented nurse practitioners.

Diversifying the health professional workforce and enhancing cultural competence are recommended for decreasing health disparities. We tested a structural equation model of the predictors of culturally competent behaviors in a mailed survey of three groups of underrepresented nurse practitioners (n = 474). Our model had good fit and accounted for 29% of the variance in culturally competent behaviors.

Parental bereavement needs in the pediatric intensive care unit: review of available measures.

Background: Pediatric intensive care units (PICUs) are highly technological settings in which advanced care is used to restore health to critically ill children; however, they are also places where children die. Understanding the needs of parents bereaved in this setting is essential for better family care.

Objective: To systematically review the extant literature to identify instruments potentially useful for assessing the needs of parents bereaved in the PICU.

Spirituality and spiritual self-care: expanding self-care deficit nursing theory.

The authors propose an integration of the concepts of spirituality and spiritual self-care within Orem's self-care deficit nursing theory as a critical step in theory development. Theoretical clarity is needed to understand the contributions of spirituality to health and well-being. Spirituality is the beliefs persons hold related to their subjective sense of existential connectedness including beliefs that reflect relationships with others, acknowledge a higher power, recognize an individual's place in the world, and lead to spiritual practices.

A three-dimensional model of cultural congruence: framework for intervention.

Culture provides the context for all health care and social service throughout the human life span. Improving end-of-life and palliative care and enhancing patient and family outcomes requires a nuanced understanding of cultural contexts for those who provide care and those who receive it. The authors of this article propose an emerging model of culturally congruent care that can guide intervention for social workers, mental health professionals, nurses, and other health care workers caring for a diverse population of patients, families, and communities.

Development of a Web-based educational intervention to improve cross-cultural communication among hospice providers.

In this article, the authors describe the theoretical foundation, development, and content of a Web-based educational intervention to improve cross-cultural communication about end-of-life concerns and report on the preliminary evaluation of this intervention using a qualitative study design. The data were collected with non-structured questions in a convenience sample of 21 hospice providers. Participants reported that they found the training appropriate and useful.

Examining the needs of bereaved parents in the pediatric intensive care unit: a qualitative study.

The pediatric intensive care unit (PICU) is a high-tech setting aimed at restoring health to critically ill children. When childhood death occurs in the PICU, it constitutes a special context for parent bereavement. The purpose of this interdisciplinary qualitative research was to gain a deeper understanding of parents' needs around the time of their child's death in the PICU.

Exploring parents' environmental needs at the time of a child's death in the pediatric intensive care unit.

Objective: Many childhood deaths in the United States occur in intensive care settings. The environmental needs of parents experiencing their child's death in a pediatric intensive care unit must be understood to design facilities that comfort at the time of death and promote healing after loss. The purpose of this study is to explore parents' environmental needs during their child's hospitalization and death in the pediatric intensive care unit.

Implementing a triangulation protocol in bereavement research: a methodological discussion.

Triangulation is a comparative strategy for examining data that strengthens qualitative and multi-method research. Despite the benefits of triangulation noted in the research methods literature, few concrete models for operationalization of protocols exist. Lack of documentation of explicit triangulation procedures is especially true in the area of bereavement research.

Special considerations in conducting bereavement focus groups.

Focus groups conducted with grieving people pose special challenges. However, this method can be successfully used in bereavement research especially when group interaction is central to the research aim. This article builds on key articles discussing ethical, methodological, logistical, and analytical issues in conducting focus groups with vulnerable populations (Owen, 2001; Seymour, Bellamy, Gott, Ahmedzai, & Clark, 2002).

Crossing disciplinary boundaries in end-of-life education.

There is a tremendous need to educate professional nurses and other health care providers in the care of the dying person. Both nurses and physicians have begun to recognize the need to cross traditional disciplinary boundaries to provide the complex care required during the last human transition. This article describes the evolution of a unique interdisciplinary graduate course on end-of-life issues at Wayne State University.

Life as death scholars: passion, personality, and professional perspectives.

In death-averse American society, the field of thanatology is often socially and academically isolating. The purpose of this article is to describe the experiences of a group of death scholars and share insights gained as members of an interdisciplinary team. They discuss the ways in which they have created a special "safe" space for death study collaboration.

Social justice: added metaparadigm concept for urban health nursing.

Historically, the nursing metaparadigm has been used to describe 4 concepts of nursing knowledge (person, environment, health, and nursing) that reflect beliefs held by the profession about nursing's context and content. The authors offer an assessment of the metaparadigm as it applies to community and public health nursing in urban settings and offer an amendment of the metaparadigm to include the central concept of social justice. Each of the metaparadigm concepts and the central concept of social justice is discussed as it applies to a model of urban health nursing teaching, research, and practice.

Enhancing cultural competence among hospice staff.

A critical component in making hospice and palliative care services accessible and acceptable to diverse communities is preparation of all providers to enhance cultural competence. This article reports a study designed to test an educational intervention aimed at expanding cultural awareness, sensitivity, and competence with a multi-disciplinary and multilevel team of hospice workers. The purpose of this quasi-experimental, longitudinal, crossover design was to test the effects of an educational intervention for multidisciplinary hospice providers.

Differences in veterans' and nonveterans' end-of-life preferences: a pilot study.

Background: Investigators conducting focus groups on end-of-life preferences noted that veterans voiced opinions that strongly differed from those of nonveterans.

Objective: The objective of this study was to further explore differences between veterans' and nonveterans' end-of-life preferences.

Methods: Ten focus groups and a pilot survey were conducted.

Environments of care: a curriculum model for preparing a new generation of nurses.

This article provides a perspective on the community-based curriculum model that has guided undergraduate education for the past decade, discusses some of the problems that have emerged with the community-based approach, and proposes an alternative approach for consideration and discussion. The community-based model is discussed in relation to three major areas of concern: faculty and preceptor implementation of the curriculum, entry into practice and hiring pattern disjunctions, and trends and unexpected consequences of changes in the health care system. The Environments of Care Model, proposed as an alternative curriculum approach, conveys a broad perspective on health and illness, based on a multiple determinants of health paradigm and a systems framework.

Cultural competence among Ontario and Michigan healthcare providers.

Purpose: To examine variables associated with cultural competence among urban, hospital-based healthcare providers in Ontario (Canada) and Michigan (US).

Design And Sample: A cross-sectional descriptive design with a convenience sample of hospital-based providers was used. The sample was 145 providers (n=71 Ontario; n=74 Michigan).

Psychometric evaluation of the cultural competence assessment instrument among healthcare providers.

Background: The relevance of healthcare provider cultural competency to the achievement of goals for reduction in extant health disparities has been demonstrated; however, there are deficits with regard to cultural competency measurement.

Objectives: To examine the test-retest reliability of the cultural competence assessment instrument (CCA) among hospice providers, and to examine the reliability and validity of the CCA among healthcare providers in nonhospice settings.

Method: Test-retest reliability of the CCA was assessed using a sample of 51 hospice respondents who completed the CCA at two time points.