The role of the health care organization in supporting nurses in the delivery of culturally competent care

This study was designed to explore ways in which health care organizations (HCOs) can support nurses in their delivery of culturally competent care. While cultural competence has become a priority for the federal government as well as the major health professional organizations, its integration into care delivery has not yet been realized. Health professionals cite a lack of educational preparation, time, and organizational resources as barriers. Most experts in the field agree that the cultural and linguistic needs of ethnic minorities pose challenges that individual care providers are unable to manage without the support of the health care organizations within which they practice. While several studies have identified implications for HCOs, there is a paucity of research on their role in this aspect of care delivery. Using a qualitative design with a case study approach, data collection included face-to-face interviews with 23 registered nurses, document analysis, and reports of critical incidents. The site chosen was a large health care system in South Florida that serves a culturally diverse population. Major findings from the study included language barriers, lack of training, difficulty with cultural differences, lack of organizational support, and reliance on culturally diverse staff members. Most nurses thought the ethnic mix was adequate, but rated other supports such as language services, training, and patient education materials as inadequate. Some of the recommendations for organizational performance were to provide the expectations and support for culturally competent care. Implications and recommendations for practice include nurses using trained interpreters instead of relying on coworkers or trying to "wing it", pursuing training, and advocating for organizational supports for culturally competent care. Implications and recommendations for theory included a blended model that combines both models in the conceptual framework. Recommendations for future research were for studies on the impact of language bathers on care delivery, develop and test a quantitative instrument, and to incorporate Gilbert's model into nursing research.

Florida International University College of Medicine and Jackson Health System Partner to Establish New Teaching Program

Press Release from Florida International University 's Office of Media Relations on the partnership between the Florida International University College of Medicine and Jackson Health System to establish a new teaching program.

Maternal-Fetal Attachment and Health Behaviors among Women with HIV/AIDS

Background: Mothers with HIV often face personal and environmental risks for poor maternal health behaviors and infant neglect, even when HIV transmission to the infant was prevented. Maternal-fetal attachment (MFA), the pre-birth relationship of a woman with her fetus, may be the precursor to maternal caregiving. Using the strengths perspective in social work, which embeds MFA within a socio-ecological conceptual framework, it is hypothesized that high levels of maternal-fetal attachment may protect mothers and infants against poor maternal health behaviors. Objective: To assess whether MFA together with history of substance use, living marital status, planned pregnancy status, and timing of HIV diagnosis predict three desirable maternal health behaviors (pregnancy care, adherence to prenatal antiretroviral therapy–ART, and infant’s screening clinic care) among pregnant women with HIV/AIDS. Method: Prospective observation and hypothesis-testing multivariate analyses. Over 17 consecutive months, all eligible English- or Spanish-speaking pregnant women with HIV ( n = 110) were approached in the principal obstetric and screening clinics in Miami-Dade County, Florida at 24 weeks’ gestation; 82 agreed to enroll. During three data collection periods from enrollment until 16 weeks after childbirth (range: 16 to 32 weeks), participants reported on socio-demographic and predictor variables, MFA, and pregnancy care. Measures of adherence to ART and infant care were extracted from medical records. Findings: Sociodemographic, pregnancy, and HIV disease characteristics in this sample suggest changes in the makeup of HIV-infected pregnant women parallel to the evolution of the HIV epidemic in the USA over the past two decades. The MFA model predicted maternal health behaviors for pregnancy care (R2 = .37), with MFA, marital living status, and planned pregnancy status independently contributing ( = .50, = .28, = .23, respectively). It did not predict adherence to ART medication or infant care. Relevance: These findings provide the first focused evidence of the protective role of MFA against poor maternal health behaviors among pregnant women with HIV, in the presence of adverse life circumstances. Social desirability biases in some self-report measures may limit the findings. Suggestions are made for orienting future inquiry on maternal health behaviors during childbirth toward relationship and protection.

Variables affecting the success of older applicants for employment in a public organization: An age -cued cognitive model of administrative decision-making

The dissertation takes a multivariate approach to answer the question of how applicant age, after controlling for other variables, affects employment success in a public organization. In addition to applicant age, there are five other categories of variables examined: organization/applicant variables describing the relationship of the applicant to the organization; organization/position variables describing the target position as it relates to the organization; episodic variables such as applicant age relative to the ages of competing applicants; economic variables relating to the salary needs of older applicants; and cognitive variables that may affect the decision maker's evaluation of the applicant. ^ An exploratory phase of research employs archival data from approximately 500 decisions made in the past three years to hire or promote applicants for positions in one public health administration organization. A logit regression model is employed to examine the probability that the variables modify the effect of applicant age on employment success. A confirmatory phase of the dissertation is a controlled experiment in which hiring decision makers from the same public organization perform a simulated hiring decision exercise to evaluate hypothetical applicants of similar qualifications but of different ages. The responses of the decision makers to a series of bipolar adjective scales add support to the cognitive component of the theoretical model of the hiring decision. A final section contains information gathered from interviews with key informants. ^ Applicant age has tended to have a curvilinear relationship with employment success. For some positions, the mean age of the applicants most likely to succeed varies with the values of the five groups of moderating variables. The research contributes not only to the practice of public personnel administration, but is useful in examining larger public policy issues associated with an aging workforce. ^