Journal of Transcultural Nursing

Published by SAGE Publications
Online ISSN: 1552-7832
Print ISSN: 1043-6596
The purpose of this article is to determine the effects of 9/11 on Arab American nurses' workplace discrimination in the Detroit metropolitan area. Thirty-four Arab American nurses completed a survey about perceptions and experiences related to discrimination before and after the terror attacks on 9/11. Most participants did not experience demotion, but some experienced intimidation and patient rejection more often or with the same frequency following 9/11. September 11 continues to negatively affect Arab Americans in the work environment. Studies are needed to further examine the workplace discrimination relationship with specific health indicators for Arab Americans.
There are only a few measures to assess quality of life among patients with liver disorders. The aim of this study was to determine the psychometric properties of the Liver Disease Symptom Index Version 2.0 (LDSI 2.0), a disease specific measure of health-related quality of life (HRQOL), in Persian-speaking patients with chronic hepatitis B. Using a cross-sectional design, 312 patients were recruited. Data were collected from the patients using the LDSI 2.0, Chronic Liver Disease Questionnaire, and EuroQol. Convergent and discriminant validity were investigated. Known-groups validity and factor structure of the scale were also determined. Receiver operating characteristics was used to discriminate patients based on their general health status. Significant correlations were found between HRQOL measures. Disease duration, disease stage, and serum aspartate aminotransferase differentiated patients. Factor analysis determined a seven-factor solution that explained 70% of the total variance. Area under the curve in receiver operating characteristics analysis was 0.706; 95% confidence interval = [0.648, 0.764]. The LDSI2.0 is an appropriate HRQOL scale for use among Iranian patients with chronic hepatitis B based on its solid psychometric properties in this population. © The Author(s) 2015.
The purpose of this study was to evaluate the utility of a translated instrument to screen for depressive disorders among Korean Americans (KAs). The Patient Health Questionnaire– (PHQ-9) was selected and translated into Korean (PHQ-9K). Two research questions were formulated: What is the prevalence of depression as determined by using the PHQ-9K among KAs attending a community-based health fair? Is this Korean-translated version of the PHQ-9K tool useful in screening for depression in KAs? Data were collected at an annual KA Community Medical Health Fair and analyzed following the guidelines for interpreting the PHQ-9. The results demonstrated that 15.4% of sample participants might need treatment for depression depending on the duration of symptoms, severity, and functional impairment, and 7.5% of participants definitely required treatment for depressive symptoms. The usefulness of the PHQ-9K to screen for depressive disorders in KAs at a primary care setting was confirmed.
The aim of this study was to examine the psychometric properties of the Turkish versionof the Compliance Questionnaire on Rheumatology (CQR-T) for patients with Behçet's disease (BD). A sample of 105 Turkish patients with BD participated in this study. The scale was cross-culturally adapted through a process including translation, comparison with versions in other languages, back translation, and pretesting. Construct validity was evaluated by factor analysis, and criterion validity was evaluated using the Morisky Medication Adherence Scale. The CQR-T demonstrated acceptable internal consistency (Cronbach's α = .832), adequate test-retest reliability (intraclass correlation coefficient = .630), and correlations with Morisky Medication Adherence Scale scores (r = -.389, p< .001), indicating convergent validity. The CQR-T was found to be a valid and reliable instrument for evaluating the compliance of Turkish BD patients with prescribed medications. The CQR-T might be a helpful tool in two ways: for determining the level of compliance of patients with BD and for adjusting their management and follow-up based on the results. © The Author(s) 2015.
This focused ethnographic study explores and describes the conceptions of care among family caregivers of people living with HIV/AIDS (PLWAs) in Addis Ababa, Ethiopia. Leininger's theory of culture care diversity and universality is the conceptual anchor of this ethnographic study. Using semistructured interviews and participant observation, 6 key informants and 12 general informants were interviewed in their home in Amharic language. Data were analyzed in Amharic using Leininger's phases of ethnonursing analysis for qualitative data and then translated to English. Four major themes representing family caregivers' conceptions of care were identified: nourishing the PLWA while struggling with poverty, maintenance of cleanliness and hygiene of the person and surroundings, comforting the PLWA, and sacrificing self to sustain the PLWA. Valuable data were gathered about the family caregivers' conceptions of care. Nurses can use this knowledge to design and provide culturally congruent care to family caregivers and PLWAs in the community.
This ethnographic study explored the question, How do urban-based First Nations peoples use healing traditions to address their health issues? The objectives were to examine how Aboriginal traditions addressed health issues and explore the link between such traditions and holism in nursing practice. Data collection consisted of individual interviews, participant observations, and field notes. Three major categories that emerged from the data analysis were: following a cultural path, gaining balance, and sharing in the circle of life. The global theme of healing holistically included following a cultural path by regaining culture through the use of healing traditions; gaining balance in the four realms of spiritual, emotional, mental, and physical health; and sharing in the circle of life by cultural interactions between Aboriginal peoples and non-Aboriginal health professionals. Implications for practice include incorporating the concepts of balance, holism, and cultural healing into the health care services for diverse Aboriginal peoples.
Research is an essential component of effective, evidence-based nursing practice. Limited scientific data have been published on Canadian Aboriginals, and even less information is available on HIV prevention efforts aimed at Aboriginal youth. The need for more research on HIV and AIDS among Aboriginals, and especially Aboriginal youth, is highlighted throughout the article as a means to improving prevention interventions for this vulnerable population. At the same time, insights gained from a culture-sensitive, HIV/AIDS educational program that targeted a group of Aboriginal adolescents from a local First Nations community in Ontario are discussed. Implications for future HIV/AIDS peer-based prevention efforts using the train-the-trainer technique are also considered.
This interpretive ethnographic study describes the experiences of northern British Columbian Aboriginal mothers raising adolescents with fetal alcohol spectrum disorder (FASD) and provides an understanding of how the mothers interpreted and responded to their adolescents' FASD. The all-encompassing theoretical perspectives of postcolonialism provided the conceptual guide for this study. This ontological stance facilitates discourse on the social and historical context of this research focused on northern British Columbian Aboriginal mothers. Using semistructured interviews and participant observation, eight participants were interviewed three times over a period of several months. Data were analyzed using an interpretive analysis to generate an overarching cultural theme, Mothering from the Margins. The theme conveyed how study participants understood FASD and how they were raising their adolescents within the social and historical context unique to postcolonial societies.
Significant Predictors of Cultural Knowledge Self-Efficacy and Cultural Skills Self-Efficacy 
Cultural self-efficacy refers to how capable one feels functioning in culturally diverse situations. The purpose of this study was to gain a better understanding of cultural self-efficacy among nursing students, specifically in relation to individuals of Aboriginal ancestry. The authors examined the extent to which intercultural anxiety, intercultural communication, and experience with persons of Aboriginal ancestry predicted two aspects of cultural self-efficacy, namely, knowledge and skills. In this correlational study, non-Aboriginal Canadian nursing students (N = 59) completed a survey assessing these variables. Overall, cultural self-efficacy was rated as moderate by nursing students. Regression analyses indicated that greater intercultural communication skills and experience with persons of Aboriginal ancestry were significant unique predictors of higher cultural knowledge self-efficacy. Greater intercultural communication and lower intercultural anxiety significantly predicted higher cultural skills self-efficacy. The results provide direction to nursing programs interested in facilitating higher levels of cultural self-efficacy among nursing students.
Characteristics of Postabortive Women 
Summary of Abortion Narratives 
The purpose of this study was to explore the reasons women in rural, southern Gabon, Africa, chose to terminate their pregnancies, the methods used to induce abortions, and postabortion effects experienced by these women. Abortion is illegal in this country. A descriptive qualitative design guided the methodology for this study. Five women with a history of induced abortion were interviewed in-depth for their abortion story. Reasons cited for an abortion included lack of financial and partner support. Abortion methods included oral, rectal, and vaginal concoctions of leaves, bark, and water and over-the-counter medications, including misoprostol. Affects were physical, spiritual, and relational. Health care professionals need to provide women with guidance for appropriate contraceptive usage. Abortion after-care of women with physical and spiritual needs is important. Future research is suggested on the use of misoprostol in Gabon to understand its affects on women's reproductive health.
Nursing in a global community is a study abroad program at Georgia Southern University School of Nursing. The program hosted at the University of Cape Coast in Ghana, West Africa, provides opportunity for undergraduate and graduate health profession students to experience nursing, health care service and delivery in a developing country. Description of the program and benefits of study abroad programs are discussed as well as a student perspective on the transcutural experience in Ghana.
The Program for Mexican Communities Abroad offices, which are located throughout the United States, represent an ideal site for outreach for both Mexican- and United States-based governmental and nongovernmental organizations interested in the well-being of Mexican migrants working in the United States. A brief overview of the PCME and the health-related programs in which it is involved is provided.
Nurse educators are calling for the transformation of nursing education toward curricula that promote clinical reasoning through reflective practice and understanding of patient experiences in an effort to motivate students to become change agents. Study abroad programs can play an important role in this transformation through educating nurses in the delivery of culturally safe health care in a diverse world. Exposing nursing students to study abroad experiences that are guided by critical approaches such as a postcolonial feminist framework provides nursing students with opportunities to be immersed in the life and culture of people who have a completely different positioning and location while reflecting on the "us" versus "them" phenomenon that is pervasive in modern Western society and generates negative cultural comparisons. Attention to the design and implementation of such programs is important if nursing schools in the Western world are to uphold ethical standards, promote equality in relationships with host communities and avoid inadvertent exploitation and marginalization of vulnerable peoples. We present the development and implementation of a community health study abroad program for American nursing students in Malawi, Africa using a postcolonial feminist framework.
Relationships Between Sociodemographics Characteristics of Medical and Nursing Students, and Scales of Wife Abuse 
To explore the perceptions of and attitudes toward violence and beliefs of contextual justification of wife abuse among Syrian medical and nursing students. A descriptive, cross-sectional design was used. The Perceptions of and Attitudes toward Wife Abuse Questionnaire was used to collect data from a convenience sample of 621 medical and nursing students from three public universities in Syria. Only 18.4% of the students had positive attitudes toward interpersonal violence reflecting low tolerance to wife beating and use of physical force for problem solving and child discipline, and 16.1% did not justify wife beating. Medical, older, female students, from urban areas, with more educated parents, and those who did not experience violence or witness violence between their parents had significantly more positive attitudes toward wife abuse and significantly less justification of wife beating (p < .05). Education about violence against women of future medical and nursing students is the responsibility of medical and nursing educators and health policy makers, who have to acknowledge the influence of the sociocultural factors in shaping student's attitudes toward wife abuse and develop strategies to enhance these attitudes at the early stages of professional preparation.
A conceptual analysis focuses on defining child maltreatment from the perspective of two Island nations in the Pacific Basin, American Samoa and the Federated States of Micronesia. Based on a review of the literature on child maltreatment laws and cultural factors in each region, a range definition is proposed. The range definition is comprised of defining features and borderline features for child maltreatment as it exists across these cultures in the Pacific Basin. Defining features were derived from evaluation of child abuse and neglect laws in each specified population. Borderline features were derived from cultural factors in American Samoa and the Federated States of Micronesia. While these Island nations already have child abuse and neglect laws, they are adapted from the United States. The degree at which unreasonable harm becomes abuse is culturally dictated, hence, these territories of the Pacific Basin are seeking culturally specific terminology when defining child maltreatment. The findings of this analysis indicate the significance of transcultural knowledge in nursing practice and the legal accountability nurses hold on the issue of child maltreatment.
This qualitative study was conducted with 14 South Asian women in Hong Kong to explore their perception and experiences of domestic violence by an intimate partner. All interviews were transcribed and then coded based on the process of coding suggested by Strauss and Corbin, including both open and axial coding. Data analysis resulted in two main core categories, "Women's perception of domestic violence" and "Cultural factors that influence their help-seeking behavior," denoting that the context in which domestic violence is experienced influences women's perception and understanding of domestic violence. Participants also drew on the discourse of culture to explain its role in their experiences of domestic violence. Domestic violence is a concern among this group of South Asian women. Culturally appropriate domestic violence services and public education on domestic violence are needed for this community.
The purpose a descriptive design was employed using a self-administrated questionnaire to collect the data from 400 high school students. A multistage, random sample was generated in selecting schools from the educational directorate located in a large urban city located in the north of Jordan. This city district contains 23 public secondary schools and serves 56.8% of the adolescents in the entire province. The results revealed the following: Students of both sexes were knowledgeable about aspects of substance abuse, including its harmful effects on the body and society and reported that even occasional or frequent use of cigarettes, alcohol, and other drugs was extremely harmful. A majority of the students perceived substance abuse as a problem, although the older students were more acutely aware than the younger group. However, the results revealed that the students lack in-depth knowledge of substance abuse. In addition, the adolescents consistently refer to Islamic principles forbidding use of intoxicants but mistakenly presume that mosques are sources for assistance regarding substance abuse. Policy makers, health workers, and religious leaders must collaborate to build structured educational programs and readily accessible, evidence-based treatment programs for adolescents. Given that young people constitute the majority of the Jordanian population and that drug trafficking is prevalent in the region, the implications of prevention programs are critical to maintaining gains in public health outcomes as well as economic progress and development in Jordan.
Categories and subcategories of Theme 1, Transplantadas en otro mundo (Uprooted in another world)
Categories and subcategories of Theme 2, Criador de abuso (Breeding ground for abuse)
Categories and subcategories of Theme 3, Rompiendo el silencio (Breaking the silence)  
Unlabelled: Hispanic females are disproportionately affected by substance abuse, intimate partner violence, and HIV. Despite these disparities, research describing the cultural and gender-specific experiences of Hispanic women with regard to these conditions is lacking. The purpose: Transplantadas en otro mundo (Uprooted in another world), El criador de abuso (The breeding ground of abuse), and Rompiendo el silencio (Breaking the silence). This study supports the importance of addressing substance abuse, violence, and risk for HIV in an integrated manner and stresses the importance of addressing associated cultural factors (e.g., acculturation, machismo ) in interventions targeting Hispanics.
Hispanic men who have sex with men (MSM) experience a number of health disparities including high rates of HIV infection from high-risk sex, substance abuse, and intimate partner violence. Although some research is available to document the relationships of these health disparities in the literature, few studies have explored the intersection of these disparities and the factors that influence them. The purpose of this study was to explore the experiences that Hispanic MSM residing in South Florida have with high-risk sex, substance abuse, and intimate partner violence. Focus groups were conducted and analyzed using grounded theory methodology until data saturation was reached (n = 20). Two core categories with subcategories emerged from the data: The Roots of Risk (Los raices del riesgo) and The Tangled Branches (Las Ramas Enredadas). The results of the study provided some important clinical implications as well as directions for future research with Hispanic MSM.
Correlation Between Psychological Well-Being Variables and Marital Abuse Variables Among Women in the Southern Region of Jordan (N = 772) 
The purpose of this study was to examine the relationship between marital abuse and psychological well-being among women in the southern region of Jordan. A descriptive correlational design was used to collect data from a randomly selected sample of 915 women in the southern region of Jordan. Data collected were related to forms of marital abuse and six domains of psychological well-being. The analysis showed that women have moderate to high level of psychological well-being. The prevalence of ever being abused during the past 12 months ranged from 3.2% (n = 25) for being threatened with a knife to 45.1% (n = 348) for their husbands being unconcerned about them while they were sick. There were significant differences in marital abuse related to having ever had school education (χ(2) = 8.56, df = 2, p = .014). All forms of marital abuse were highly correlated (p < .01). Self-acceptance and environmental mastery domains of psychological well-being had negative and significant correlation with all forms of marital abuse (p < .01). DISCUSSION OF CONCLUSION: Health professionals in health care centers need to assess for marital abuse and its consequence on women's health. Interventions should emphasize promotion of psychological well-being and the factors that influence women empowerment.
Process of Theory Development.  
Demographic Background of Participants
A Theoretical Framework of Married Korean Women's Responses to Abuse. NOTE: Rectangles: observed (manifest) variables. SSP: sociostructural power (emergent variable). PRP: psychological-relational power (latent variable).  
Many abused married Korean women have a strong desire to leave their abusive husbands but remain in the abusive situations because of the strong influence of their sociocultural context. The article discusses Korean women's responses to spousal abuse in the context of patriarchal, cultural, and social exchange theory. Age, education, and income as component elements share common effects on the emergent variable, sociostructural power. Gender role attitudes, traditional family ideology, individualism/collectivism, marital satisfaction, and marital conflict predict psychological-relational power as a latent variable. Sociostructural, patriarchal, cultural, and social exchange theories are reconceptualized to generate the model of Korean women's responses to abuse.
Grounded theory methodology was used to explore the social processes involved in the use of illicit drugs in older African Americans as an underpinning to the development of approaches to nursing care and treatment. Interviews were conducted with six older African American substance users who were currently in drug treatment programs. Responses to the questions were recorded, transcribed, and analyzed using constant comparative methods. Three core themes emerged: (a) family, (b) media images, and (c) environment. The core issues of substance abuse, such as the environment and larger societal forces, cannot be addressed by one discipline and mandate that clinicians move to an interdisciplinary approach to achieve a plan of care for this growing population.
The purpose of this study was to explore nurses' experiences and perspectives regarding child abuse in Taiwan. Semistructured interviews with Taiwanese nurses were audiotaped and transcribed verbatim for this descriptive study. The method of category development proposed by the grounded theory method was used to develop categorical themes that reflected the nurses' experiences and perspectives. From the 18 registered nurses interviewed, four major categorical themes emerged that were integral to nurses' experiences working with abused children: the meaning of child abuse, conflict, feeling frustrated, and nurses' roles. Findings provide a base for understanding child abuse from the perspectives of nurses and a beginning understanding of interventions needed to improve identification and reporting of child abuse in Taiwan. Although nurses have considerable awareness and concern about child abuse, additional education related to this issue is needed.
To determine the community resources most often used, most needed, and most difficult to use for immigrants. A naturalistic study using principles of community-based participatory research. A group of 106 abused immigrant women were interviewed in person with the Community Agency Use, Frequency, Helpfulness, and Difficulty form as part of a 7-year prospective study. The most frequently noted service needed most was counseling (n = 34, 33.0%) followed by legal services (n = 23, 22.3%) and social services (n = 13, 12.6%). Law enforcement was the most commonly used service (n = 63, 59.4%) and the most difficult to receive (n = 16, 48.5%). Counseling (n = 6, 18.2%) and legal services (n = 5, 15.2%) were also reported as difficult. Law enforcement is often called on to help in partner violence, but immigrant women report difficulty in using this service. Abused immigrant women have risk factors for abuse, and they face barriers in accessing the services they need. It is important for service providers in the community to be aware of the unique challenges of abused immigrant women and to address their needs accordingly.
Negotiating Three Worlds: Research Focus and Project Initiation Model 
The purpose of this article is to use a cross-cultural model to guide the exploration of common issues and the dynamic interrelationships surrounding entrée to tribal communities as experienced by four nursing research teams. Method: Members of four research teams discuss the primary lessons learned about successful strategies and challenges encountered during their projects' early stages. Understanding the cultural values of relationship and reciprocity is critical to the success of research projects conducted in Native American communities. Conducting cross-cultural research involves complex negotiations among members of three entities: academia, nursing science, and tribal communities. The lessons learned in these four research projects may be instructive to investigators who have the opportunity to conduct research with tribal communities.
With the belief that diversity is strength, the community of Reading, Pennsylvania, set forth an effort to meet the challenges of the disparity within the local nursing workforce with a comprehensive, long-term approach for the recruitment and retention of an underrepresented group. An academic-community partnership was formed to develop multifaceted programs and support across school and community agency systems. The Alvernia College Nursing Department has taken a leadership role to coordinate many community and health care agencies with the goal of increasing the number of baccalaureate-prepared Hispanic and bilingual nurses to provide culturally competent and sensitive care to the community.
Work on cultural competence has a long history in nursing, yet we have not successfully institutionalized these attitudes and skills throughout education and practice. An effective approach to promoting widespread cultural competence is to work at the system level in which coalitions of community agencies partner with academic and health care organizations. A systems approach includes all health practitioners, reducing current discrepancies across disciplines, and establishes cultural competence as the standard. Work in and with communities places students and practitioners more consistently in cross-cultural circumstances. Implementing this vision will require national as well as local leadership across public and private sectors.
The American Academy of Nursing's (AAN) Expert Panel on Global Health's white paper examines critical issues in the international nursing arena, including the global shortage of nurses, legal and ethical issues in recruiting international students for nursing positions in developed countries, the nurse faculty shortage, faculty and student exchanges, effects of the U.S. Citizenship and Immigration Services law, and laws governing new practice within the public domain. Realistic models directed toward viable solutions to these issues are critically needed. It offers 13 recommendations to address issues from a global perspective, including hosting a conference on global nursing, health research, and faculty exchanges; annual meetings; and an international conference of world nurse leaders, the AAN, and Global Panel representatives to discuss this white paper and plan follow-up actions. The final white paper approved by the AAN in 2005 and is published here to stimulate discussion regarding current and future initiatives.
The members of the Expert Panel on Cultural Competence of the American Academy of Nursing (AAN) envisioned this article to serve as a catalyst to action by the Academy to take the lead in ensuring that measurable outcomes be achieved that reduce or eliminate health disparities commonly found among racial, ethnic, uninsured, underserved, and underrepresented populations residing throughout the United States. The purposes of this article are to (a) assess current issues related to closing the gap in health disparities and achieving cultural competence, (b) discuss a beginning plan of action from the Expert Panel on Cultural Competence for future endeavors and continued work in these areas beyond the 2002 annual conference on Closing the Gap in Health Disparities, and (c) provide clearly delineated recommendations to assist the Academy to plan strategies and to step forward in taking the lead in reshaping health care policies to eliminate health care and health disparities.
The purpose of this project was to explore the chronic pain experience and establish cultural appropriateness of cognitive behavioral pain management (CBPM) techniques in American Indians and Alaska Natives (AI/ANs). A semistructured interview guide was used with three focus groups of AI/AN patients in the U.S. Southwest and Pacific Northwest regions to explore pain and CBPM in AI/ANs. The participants provided rich qualitative data regarding chronic pain and willingness to use CBPM. Themes included empty promises and health care insufficiencies, individuality, pain management strategies, and suggestions for health care providers. Results suggest that there is room for improvement in chronic pain care among AI/ANs and that CBPM would likely be a viable and culturally appropriate approach for chronic pain management. This research provides evidence that CBPM is culturally acceptable and in alignment with existing traditional AI/AN strategies for coping and healing. © The Author(s) 2014.
Top-cited authors
Larry Purnell
  • University of Delaware
Maren Reinholdt
  • University of Rochester
Diana Baptiste
  • Johns Hopkins University
Cynthia L. Foronda
  • University of Miami
Jana Lauderdale
  • Vanderbilt University