Scholarly Work - Nursing
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Item Perspectives of registered nurse cultural competence in a rural state: Part II(2007) Seright, Teresa J.The article is the second in a two-article series. The first article in the series provided the reader a conceptual definition of cultural competence, a literature review and a description of the relevance of culturally competent care in a rural state. In this article, the author described the outcomes of a self-assessment survey completed by registered nurses in a homogenous rural state. The purpose of this study was to determine the relationship between cultural competence and educational preparation. It was hypothesized that the North Dakota nurses who reported participation in cultural competency educational programs would rank themselves higher on the IAPCC-R than those who had not reported participation in such programs. A voluntary sample of registered nurses from urban and rural hospitals in the state of North Dakota were surveyed using the Inventory for Assessing the Process of Cultural Competence –Revised version (IAPCC-R) and a demographic survey tool. The data analysis was accomplished through correlational statistics. Results of this research indicate that a majority (>80%) of the participants did not consider themselves culturally competent. While higher self rating scores did correlate to participation in educational activities, the quality and frequency of those activities varies. The author offered suggestions for improved rate and quality of cultural competence education as well as suggestions for further research.Item Perspectives of registered nurse cultural competence in a rural state: Part I(2007) Seright, Teresa J.Inferences have been made from recent research that there is a correlation between lack of cultural competence and the incidence of health disparity. As our society becomes more global and more diverse, it is apparent that culture can no longer be considered as solely associated with ethnic/racial/cultural groups. Nurses permeate all areas of health care and are therefore in a position to have positive impact on cultural competency. This paper describes the 5 constructs of cultural competence as described by Dr. Josepha Campinha-Bacote: cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire. She emphasizes, as do others in the literature, that cultural desire and awareness are antecedents to knowledge acquisition and skill. Is mere cultural awareness enough? How do healthcare providers in homogenous rural states attain cultural competence when cultural encounters and cultural knowledge may not be readily accessible? This is the first in a series of two articles which explores Cultural Competence of health care providers in a rural state. The first article in the series provides literature review and definitions related to cultural competence as well as the impact of cultural competence. The second article reveal results of a cultural competence self-assessment survey of registered nurses in North Dakota, a sprawling rural state described as 9th in the union for percentage of caucasions and 5th in rank for the most American Indians.Item Clinical decision-making of rural novice nurses(2011-07) Seright, Teresa J.Introduction: Nurses in rural settings are often the first to assess and interpret the patient’s clinical presentations. Therefore, an understanding of how nurses experience decision-making is important in terms of educational preparation, resource allocation to rural areas, institutional cultures, and patient outcomes. Methods: Theory development was based on the in-depth investigation of 12 novice nurses practicing in rural critical access hospitals in a north central state. This grounded theory study consisted of face-to-face interviews with 12 registered nurses, nine of whom were observed during their work day. The participants were interviewed a second time, as a method of member checking, and during this interview they reviewed their transcripts, the emerging themes and categories. Directors of nursing from both the research sites and rural hospitals not involved in the study, experienced researchers, and nurse educators facilitated triangulation of the findings. Results: ‘Sociocentric rationalizing’ emerged as the central phenomenon and referred to the sense of belonging and agency which impacted the decision-making in this small group of novice nurses in rural critical access hospitals. The observed consequences, which were conceptualized during the axial coding process and were derived from observations and interviews of the 12 novice nurses in this study include: (1) gathering information before making a decision included assessment of: the credibility of co-workers, patients’ subjective and objective data, and one’s own past and current experiences; (2) conferring with co-workers as a direct method of confirming/denying decisions being made was considered more realistic and expedient than policy books and decision trees; (3) rural practicum clinical experiences, along with support after orientation, provide for transition to the rural nurse role; (4) involved directors of nursing served as both models and protectors of novice nurses placed in high accountability positions early in their careers. These novice nurses were often working with a limited staff, while managing an ever-changing census and acuity of patients. The significance of interdependence and welcoming relationships with their co-workers and directors of nursing was pivotal in the clinical decision-making process. Conclusions: Despite access to a number of resources at their disposal (including policy books, decision trees, standing orders, textbooks, and in some cases internet resources), the 12 nurses in this study indicated collaboration with co-workers was a major means of facilitating their decision-making. Rural novice nurses require facilitation of social skills as much as critical thinking skills both within their programs of nursing and during their new employee orientation; however, decision-making must be guided by more experienced nurses who are willing to mentor novice nurses and advise them to to reflect upon their decisions as they care for patients using evidenced based practice. In a rural setting, this is especially important because novice nurses are tasked early in their career with decision-making, which often involves ill-structured problems set in dynamic and changing environments, in high-stakes situations where patient safety is a concern.Item Critical Care in Critical Access Hospitals.(2015-10) Seright, Teresa J.; Winters, Charlene A.What began as a grant-funded demonstration project, as a means of bridging the gap in rural health care, has developed into a critical access hospital system comprising 1328 facilities across 45 states. A critical access hospital is not just a safety net for health care in a rural community. Such hospitals may also provide specialized services such as same-day surgery, infusion therapy, and intensive care. For hospitals located near the required minimum of 35 miles from a tertiary care center, management of critically ill patients may be a matter of stabilization and transfer. Critical access hospitals in more rural areas are often much farther from tertiary care; some of these hospitals are situated within frontier areas of the United States. This article describes the development of critical access hospitals, provision of care and services, challenges to critical care in critical access hospitals, and suggestions to address gaps in research and collaborative care.