Journal of Transcultural Nursing current issue

Toward a New Definition of Health Disparity: A Concept Analysis

Fink, A. M. — Mon, 14 Sep 2009 11:15:12 PDT

In response to federal requests for investigation into measures to eradicate health disparities, a concept analysis of the term health disparity was conducted. Health-related and multidisciplinary literature was reviewed. Multiple terms were explored alone and in combination with no limitations on search date parameters. Findings indicated several definitions of the concept, with the term health care disparity being used interchangeably with the term health disparity . New theoretical and operational definitions, antecedents, characteristics, and consequences of the concept are proffered. Model, borderline, and contrary cases are developed to illustrate the concept. Nursing implications and recommendations for future research are discussed.

Acculturation and the Cancer Pain Experience

Im, E.-O., Ho, T.-H., Brown, A., Chee, W. — Mon, 14 Sep 2009 11:15:12 PDT

Purpose: Using a feminist perspective, the relationship between acculturation and cancer pain experience was explored. Design: This was a cross-sectional, correlational Internet study among 104 Hispanic and 114 Asian cancer patients. The instruments included both unidimensional and multidimensional cancer pain measures. Findings: There were significant differences in cancer pain scores by country of birth. Yet there was no significant association of acculturation to cancer pain scores. Discussion and Conclusions: This study indicated inconsistent findings. Implications for Practice: To provide directions for adequate cancer pain management, further studies with a larger number of diverse groups of immigrant cancer patients are needed.

Assessing Diabetes Dietary Goals and Self-Management Based on In-Depth Interviews With Latino and Caucasian Clients With Type 2 Diabetes

Early, K. B., Shultz, J. A., Corbett, C. — Mon, 14 Sep 2009 11:15:12 PDT

Latino (n = 10) and Caucasian (n = 8) clients with type 2 diabetes receiving care at a community health clinic participated in individual in-depth interviews assessing diabetes dietary self-management goal behaviors. Themes from interviews were identified using content analysis, which revealed current and future goals, influencing factors, and motivators and barriers to dietary modification for diabetes management. Implications for practice include simplifying goal setting to those goals with the greatest potential clinical impact or the greatest significance to the patient, in a socially supportive environment. Results contribute to future survey development and understanding how to optimize diabetes education for these populations.

Cultural Values and Political Economic Contexts of Diabetes Among Low-Income Mexican Americans

Clark, L., Vincent, D., Zimmer, L., Sanchez, J. — Mon, 14 Sep 2009 11:15:12 PDT

Purpose: To explore the political and economic dimensions of diabetes self-management for Mexican American adults. Design and Methods: Critical ethnographic analysis of focus group data from caregivers and adults with diabetes. Findings: Three themes were identified: diabetes self-management is tied to other mental and bodily states, family and neighborhood environments cause stress and prevent diabetes solutions, and hassles of the health care environment subvert self-management. Discussion and Conclusions: Cultural constructs about diabetes merge with social—political forces in explaining diabetes. Implications for Practice: Cultural competence in diabetes care requires attention to the political economy of the disease and advocacy for healthful political and economic change.

Rationalization of Indigenous Male Circumcision as a Sacred Religious Custom: Health Beliefs of Xhosa Men in South Africa

Mavundla, T. R., Netswera, F. G., Bottoman, B., Toth, F. — Mon, 14 Sep 2009 11:15:12 PDT

This article presents research findings based on the meaning of indigenous circumcision to Xhosa men in South Africa. In South Africa, male circumcision is a rite of passage from adolescence to adulthood. The country has experienced serious problems associated with the practice of this rite ranging from dehydration to death in the traditional "bush" circumcision schools. A qualitative, endogenous research design that is explorative, descriptive, and contextual was undertaken using individual interviews, focus group interviews, and community meetings discussing this ritual. A total of 25 men were interviewed. Only one question was posed throughout the research process: "How do you experience having a son who is undergoing the circumcision rite?" The study revealed cultural circumcision as a "sacred religious practice" with five themes, namely (a) readiness of Xhosa families to engage in the circumcision ritual, (b) the act of circumcision and preparation for manhood, (c) the importance of symbolic purity during the circumcision ritual, (d) celebrating acquired manhood, and (5) aspects of manhood and the rejection of clinical care. Secondary to this are health promotion recommendations made for individuals involved in this ritual.

Ethics and Advance Care Planning in a Culturally Diverse Society

Johnstone, M.-J., Kanitsaki, O. — Mon, 14 Sep 2009 11:15:12 PDT

Emerging international research suggests that in multicultural countries, such as Australia and the United States, there are significant disparities in end-of-life care planning and decision making by people of minority ethnic backgrounds compared with members of mainstream English-speaking background populations. Despite a growing interest in the profound influence of culture and ethnicity on patient choices in end-of-life care, and the limited uptake of advance care plans and advance directives by ethnic minority groups in mainstream health care contexts, there has been curiously little attention given to cross-cultural considerations in advance care planning and end-of-life care. Also overlooked are the possible implications of cross-cultural considerations for nurses, policy makers, and others at the forefront of planning and providing end-of-life care to people of diverse cultural and language backgrounds. An important aim of this article is to redress this oversight.

President's Message: Connection-Reconnection: What does it mean to you?

Lauderdale, J. — Mon, 14 Sep 2009 11:15:12 PDT

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