Cultural Competence in Health Care: Implications for Human Resource Development

This paper reviews the need for cultural competence in health care, the barriers faced by health care professionals as they attempt to deliver culturally competent care, and the implications for human resource development initiatives.

Wellness and Obesity: Implications for Health Care Costs Among Restaurant Managers

Overeating, inadequate exercise, work-related stress, and long working hours are accepted issues among restaurant managers. The underlying question was whether such life styles affect employers' health care cost and restaurant managers' health and ability to cope with imposed business requirements. The author discusses strategies to help employers reduce health care costs, increase employee productivity, and improve job satisfaction.

Children with special health care needs: Comparison of the effects of home care setting, prescribed pediatric extended care setting, and long-term care setting on child and family health outcomes and health care service use

Technological advances during the past 30 years have dramatically improved survival rates for children with life-threatening conditions (preterm births, congenital anomalies, disease, or injury) resulting in children with special health care needs (CSHCN), children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services beyond that required by children generally. There are approximately 10.2 million of these children in the United States or one in five households with a child with special health care needs. Care for these children is limited to home care, medical day care (Prescribed Pediatric Extended Care; P-PEC) or a long term care (LTC) facility. There is very limited research examining health outcomes of CSHCN and their families. The purpose of this research was to compare the effects of home care settings, P-PEC settings, and LTC settings on child health and functioning, family health and function, and health care service use of families with CSHCN. Eighty four CSHCN ages 2 to 21 years having a medically fragile or complex medical condition that required continual monitoring were enrolled with their parents/guardians. Interviews were conducted monthly for five months using the PedsQL™ Generic Core Module for child health and functioning, PedsQL™ Family Impact Module for family health and functioning, and Access to Care from the NS-CSHCN survey for health care services. Descriptive statistics, chi square, and ANCOVA were conducted to determine differences across care settings. Children in the P-PEC settings had a highest health care quality of life (HRQL) overall including physical and psychosocial functioning. Parents/guardians with CSHCN in LTC had the highest HRQL including having time and energy for a social life and employment. Parents/guardians with CSHCN in home care settings had the poorest HRQL including physical and psychosocial functioning with cognitive difficulties, difficulties with worry, communication, and daily activities. They had the fewest hours of employment and the most hours providing direct care for their children. Overall health care service use was the same across the care settings.

Diabetes Self Management: Are Cuban Americans Receiving Quality Health Care?

Objectives: We investigated the relationship among factors predicting inadequate glucose control among 182 Cuban-American adults (Females=110, Males=72) with type 2 diabetes mellitus (CAA). Study Design: Cross-sectional study of CAA from a randomized mailing list in two counties of South Florida Methods: Fasted blood parameters and anthropometric measures were collected during the study. BMI was calculated (kg/ m2). Characteristics and diabetes care of CAA were self-reported Participants were screened by trained interviewers for heritage and diabetes status (inclusion criteria: self-reported having type 2 diabetes; age  35 years, male and female; not pregnant or lactating; no thyroid disorders; no major psychiatric disorders). Participants signed informed consent form. Statistical analyses used SPSS and included descriptive statistic, multiple logistic and ordinal logistic regression models, where all CI 95%. Results: Eighty-eight percent of CAA had BMI of ≥ 25 kg/ m2. Only 54% reported having a diet prescribed/told to schedule meals. We found CAA told to schedule meals were 3.62 more likely to plan meals (1.81, 7.26), p<0.001) and given a prescribed diet, controlling for age, corresponded with following a meal plan OR 4.43 (2.52, 7.79, p<0.001). The overall relationship for HbA1c < 8.5 to following a meal plan was OR 9.34 (2.84, 30.7. p<0.001). Conclusions: The advantage of having a medical professional prescribe a diet seems to be an important environmental support factor in this sample’s diabetes care, since obesity rates are well above the national average. Nearly half CAA are not given dietary guidance, yet our results indicate CAA may improve glycemic control by receiving dietary instructions.

A study for the establishment of higher foodservice standards in health-care facilities

1. Area of Investigation The relative need of higher standards in healthcare foodservice facilities. Individual opinions of foodservice directors. 2. Materials and Methods Used Existing text, trade publications, interviews with industry leaders, conferences with estemmed professors and the author's own experience were used for research and evaluation. An important method used to evaluate the need for higher standards was a descriptive survey and the analysis thereof. 3. Major Findings A. The survey showed, with a 42 percent response, that the overwhelming majority of the respondents have problems within their department. B. It is presumed that these problems are caused by a lack of standards and/or a failure to meet existing standards. 4. Results and Conclusions A. The objectives of the majority of health-care facilities is to provide the best possible care at lowest possible price. The objectives of the foodservice department is to provide the best possible food at the most reasonable cost. B. Continuous education of foodservice directors in all facets of the industry are necessary so that each foodservice director has the capacity to establish and maintain, and in some cases surpass his or her own standards. C. Where no standards exist minimum requirements should be set to satisfy the objectives and goals of both the facility and foodservice department.

A phenomenological perspective of the lived experiences of Jewish holocaust survivors seeking health care in the United States today

Seven Jewish Holocaust survivors were interviewed using a phenomenological method to determine the essence of the Jewish Holocaust survivor's experience with health care in the United States today. The transcriptions were analyzed using Colaizzi's approach to phenomenological research. This approach includes extraction of significant statements, from the transcriptions, that described the participant's health care behaviors and needs. Formulated meanings of the significant statements were then organized into six themes: Hiding and Avoidance, Self care, Fear/Trust Dichotomy, Security, Luck, and Need for Understanding. These six themes were forms of protection for the participants, which ultimately led to continued survival, the essence of their experience. Knowledge of their experience may direct the nurse in implementing creative and appropriate nursing interventions to provide comfort and assist the survivor with their needs in today's health care arena.

A postcolonial queer analysis of aboriginal queer clients' experiences of health care services in St. John's, Newfoundland

This thesis examines the gaps between health care services aimed at Aboriginal queer individuals living in St. John’s, Newfoundland and their health care needs. I used a multi-methods research design that includes interviews and demographic surveys, unobtrusive observation and qualitative content analysis. I conducted semi-structured interviews with institutional representatives from selected health related organizations – Eastern Health, Planned Parenthood Newfoundland and Labrador, the AIDS Committee of Newfoundland and Labrador, and St. John’s Native Friendship Center; as well as a transgender activist and three people who identify as Aboriginal and queer. I conducted observational research at two public seminars on Aboriginal people and health. Finally, I carried out qualitative content analysis of organizational reports and webpages of the selected community organizations. Using a postcolonial queer framework that analyzes how Newfoundland and Labrador’s colonial history is reflected in current health care realities I argue that the lack of appropriate services and culturally insensitive delivery of services reproduce the historical marginalization of an already vulnerable group.

Perceptions of health care: perspectives from adolescents with physical disabilities and their parents

Patient satisfaction with health care is an important indicator of quality services and has been related to positive health outcomes. Because little is known about whether adolescents with physical disabilities are satisfied with the services they receive, the current study investigated the extent to which adolescents are satisfied with health care services, aspects of care adolescents identify as important to their satisfaction, similarities between adolescent and parent perceptions of care, and the relationship between adolescent perceptions of care and their intentions to adhere to treatment recommendations. Following recruitment from a pediatric health center, adolescents and their parents (n = 42) completed questionnaires to assess their perceptions regarding various aspects of health care services. Participants were very satisfied with services received; interpersonal aspects of care were very important to them. Adolescents’ satisfaction was not predictive of their intentions to adhere to treatment recommendations and their perspectives differed from those of their parents.

Dimensions, discourses and differences : trainees conceptualising health care leadership and followership

© 2015 John Wiley & Sons Ltd.

Health Care Delivery Practices in Huntington's Disease Specialty Clinics : An International Survey

The CHDI Foundation, Inc. funds Enroll-HD and the activities of the Enroll-HD Care Improvement Committee, including the present survey. We would like to acknowledge the Enroll-HD and REGISTRY administrative staff that assisted in the recruitment of sites and sites that completed the survey.

Compromise or Quit Medical Practice: Is there Another Option for Catholic Health Care Professionals

More and more, medical practitioners are being told that they must either compromise their beliefs and provide whatever services patients demand or they should quit medical practice. This paper will explore other options that would offer a more just and respectful solution for our pluralistic society.

A Framework to Support the Sharing and Reuse of Computable Phenotype Definitions Across Health Care Delivery and Clinical Research Applications.

INTRODUCTION: The ability to reproducibly identify clinically equivalent patient populations is critical to the vision of learning health care systems that implement and evaluate evidence-based treatments. The use of common or semantically equivalent phenotype definitions across research and health care use cases will support this aim. Currently, there is no single consolidated repository for computable phenotype definitions, making it difficult to find all definitions that already exist, and also hindering the sharing of definitions between user groups. METHOD: Drawing from our experience in an academic medical center that supports a number of multisite research projects and quality improvement studies, we articulate a framework that will support the sharing of phenotype definitions across research and health care use cases, and highlight gaps and areas that need attention and collaborative solutions. FRAMEWORK: An infrastructure for re-using computable phenotype definitions and sharing experience across health care delivery and clinical research applications includes: access to a collection of existing phenotype definitions, information to evaluate their appropriateness for particular applications, a knowledge base of implementation guidance, supporting tools that are user-friendly and intuitive, and a willingness to use them. NEXT STEPS: We encourage prospective researchers and health administrators to re-use existing EHR-based condition definitions where appropriate and share their results with others to support a national culture of learning health care. There are a number of federally funded resources to support these activities, and research sponsors should encourage their use.

The Affordable Care Act and the Transformation of US Health Care

The neoliberal period was accompanied by a momentous transformation within the US health care system.  As the result of a number of political and historical dynamics, the healthcare law signed by President Barack Obama in 2010 ‑the Affordable Care Act (ACA)‑ drew less on universal models from abroad than it did on earlier conservative healthcare reform proposals. This was in part the result of the influence of powerful corporate healthcare interests. While the ACA expands healthcare coverage, it does so incompletely and unevenly, with persistent uninsurance and disparities in access based on insurance status. Additionally, the law accommodates an overall shift towards a consumerist model of care characterized by high cost sharing at time of use. Finally, the law encourages the further consolidation of the healthcare sector, for instance into units named “Accountable Care Organizations” that closely resemble the health maintenance organizations favored by managed care advocates. The overall effect has been to maintain a fragmented system that is neither equitable nor efficient. A single payer universal system would, in contrast, help transform healthcare into a social right.

Anthroponyms in health care interventions

Anthroponyms in Health Care Interventions. This research aims to examine the personal names used by health care professionals to refer to and speak with patients in medical consultations. To this end, a large corpus was created with anthroponyms used in this type of settings and extracted from a variety of sources. The data obtained were then analyzed, classified, described and explained. Our hypothesis is that personal names are relevant elements in the relationship between the health care provider and the patient; however, their use is decidedly complex. In the following pages we will discuss this designative complexity by way of an introduction, an analysis of anthroponymic studies and a conclusion.