• Becoming a stranger: The experience of African students' transformation in a baccalaureate school of nursing

      Omotosho, Samson Akinloye; Neal, Maggie T. (1998)
      This phenomenological study sought to understand the experience of African nursing students as they transition into nursing within the American culture. The central question was, what is it like to be an African nursing student in the United States? Students told stories about their experience that held significant meaning for them. Analysis of themes generated from the conversations revealed that the students' experience meant a personal transition and transformation, both as students and as strangers. The students' experience began with their detachment from home, a place that meant familiarity, security and comfort, indeed, was part of their very being. The detachment, experienced as a loss, was grieved by the students through frequent reference to home as they made comparisons of home's texture to that of their present life in America. The experience opened possibilities for realizing life's dreams. It also led to being a stranger. Being a stranger, the student was confronted with the challenges of making language effective, confronting issues about difference, learning new technology, facing unfamiliar methods of testing, and learning unfamiliar cultural practices. The students' transitioning encompassed adaptation, determination to succeed, reconciliation of new and old experiences, and the realization that some experiences were not reconcilable. Students were transformed by becoming more independent and developing new perspectives on life. Personally, the study initiated an inward journey that awakened a more holistic vision of the phenomenon of transition and transformation. It provided a new knowing that kindled a second chance at the meaning of being an African student. Finally, educators are urged to seek understanding of students through the art of unknowing; a call for open-mindedness, a posture for cherishing of diversity, a capacity for sensitivity to students' attachment to home places, and a consciousness for the historical nature of being. Administrators are urged to design orientation programs to address African students' difficulties related to technology, diversity and communication. African students need to reflect on memories of home and past, nourish those that make life flourish and unbound from those that are limiting. What might curriculum be like if these insights become praxis?
    • Debriefing Practices in Nursing Education Programs in the United States

      Fey, Mary K.; Jenkins, Louise Sherman (2014)
      Debriefing is essential to learning in simulation based education. However, little is known about current debriefing practices. While there is no single theory of debriefing, consistent themes about the characteristics of debriefing emerge from the simulation literature. The purpose of this study was to describe debriefing practices in prelicensure nursing programs. Logistic regression analysis identified the characteristics of the nursing program and the simulation administrator that are associated with the use of theory based debriefing. A descriptive cross-sectional design was used. Data was collected via the internet. The study questionnaire consisted of three parts: demographic questions about the nursing program, questions about the simulation administrator, and questions about debriefing practices. The study sample comprised prelicensure nursing programs from across the United States representing all entry level degree programs (n = 502). Descriptive analyses showed that most programs have integrated simulation into their curriculum. Most schools designate a faculty member to have responsibility for simulation activities. The majority of debriefing facilitators have no training in debriefing. Less than 20% of all debriefers have their competence assessed. Debriefing is not usually guided by a theory or model. The majority of respondents (82%) reported debriefing practices that incorporated the concepts of Kolb's experiential learning theory. Further data analysis explored the relationships that significantly affected the use of theory based debriefing practices. The presence of a designated simulation administrator was significantly associated with the use of theory based debriefing. Simulation administrators who had formal training in simulation and who were in the 46-55 year old age group were significantly more likely to practice theory based debriefing. Training and competency assessment, along with structuring debriefing discussions were significantly associated with the use of theory based debriefing. Findings suggest that nursing programs should allocated resources to several aspects of the simulation program. Programs should have a designated simulation administrator. This person should have training in simulation based education. All faculty who facilitate debriefings should have training and should have their competence assessed regularly. This study provides information about debriefing practices; the study should be repeated with other types of learners (e.g. medical students, licensed practitioners).
    • Decision-making among philanthropic foundations in the U.S.: Factors that influence international giving

      Chatterjee, Anusha; Reisch, Michael, 1948-; 0000-0002-1273-3979 (2018)
      Philanthropic foundations utilize private money for public purposes. U.S. based foundations play an increasingly important role in shaping global agendas and efforts, providing $22.03 billion towards international causes in 2016. As their resources are vital but limited, grant-making foundations are always making decisions aimed at improving the effectiveness and reach of their grant dollars. Understanding the decision-making processes adopted by foundations help identify decision-making patterns, examine donor preferences, and learn about the various factors that affect foundations decisions. This study sought to address the gap in literature on international grant-making decisions by foundations. The research questions of the study were: 1) What factors influence foundations' decision-making processes, their determination of funding priorities or goals, and the philanthropic strategies they employ in their grant making to international civil society organizations? 2) What characteristics of targeted beneficiaries or recipient organizations do foundations consider in making funding decisions? This study used a multiple case study approach to examine international grantmaking in five independent foundations that have offices in mid-Atlantic U.S. Primary data on were collected through in-depth interviews with a key staff member at each foundation. In addition to the interviews, publicly available information about the foundations including web content, reports and publications were used to supplement the data collected. In each of the five case studies, the participants discussed how the grant making practices at their foundations have evolved over time, highlighting that although the core mission of their foundations may remain unchanged, foundations adapt priorities, goals, strategies and decision-making. Factors in the external environment of the foundation that influence decision-making processes include international policies and priorities, U.S. policies, tax regulations, and priorities, local country policies and priorities, grantmaking behavior of peers, and market forces. At the foundation level, leadership and staff, donor motivations, and foundation structure affect decision-making. Foundations also seek to increase impact and fund programs that are a philanthropic fit. Foundations support needy and vulnerable beneficiaries, build institutional capacities, and seek knowledge development. Foundations support grantees based on familiarity and reputation, past experience, and organization size. The implications for theory, research and practice are discussed.
    • Epidemiology and Trends of Staphylococcus aureus Infections in a Large United States Veteran Population

      Tracy, LaRee; Roghmann, Mary-Claire (2009)
      Background: A public health need exists to describe the epidemiology and trends of all Staphylococcus aureus (S. aureus) infections given the emergence of USA300 methicillin-resistant S. aureus (MRSA) and changing epidemiology of MRSA infection. Also needed is a validated algorithm to identify S. aureus infections using large healthcare databases. Methods: We conducted a retrospective population-based study in veterans receiving health care in the VAMHCS from fiscal years (FY) 1999-2008. A non-invasive S. aureus infection was defined as a positive clinical culture from a non-sterile site with an ICD-9 code for infection. An invasive S. aureus infection was defined as a positive blood or clinical culture from a sterile site. Infections were classified by hospital-onset (HO: culture > 48 hrs after hospitalization) or community-onset (CO: culture while outpatient or ≤48 hrs after hospitalization), methicillin-susceptibility (MSSA or MRSA) and body site. Positive (PPV) and negative predictive values (NPV) for non-invasive infections were determined by chart review using a reference standard. Incidence was calculated per 100,000 veterans or inpatient days. Time series were analyzed using Quasi-Poisson generalized linear regression models (GLMs). Results: There were 3,674 S. aureus infections of which 77% were non-invasive and 61% due to MRSA. PPV and NPV of a clinical culture and ICD-9 were 79% (95% CI 70-86%) and 82% (95% CI 73-88) respectively. Proportion of CO and HO were 69% and 32% respectively. The averaged annual incidences were 749, 178, and 571 per 100,000 veterans for all, invasive and non-invasive infections respectively. The annual incidence significantly increased (p<0.001) due to increases in non-invasive MRSA infections (271 to 504/100,000 veterans, 1.9 fold increase) and non-invasive CO infections (360 to 546/100,000 veterans, 1.5 fold increase) of which >60% were skin and soft tissue infections (SSTIs). GLMs revealed an increased risk of all infections. Incidence of invasive S. aureus infections decreased 2.3 fold. Conclusion: Clinical culture and ICD-9 is a predictive approach to identify non-invasive S. aureusinfection. From FY1999 to 2008, the incidence of all S. aureus infections significantly increased due to increases in CO non-invasive MRSA SSTIs; however, gradual decreases in invasive S. aureus infections were observed.
    • Psychological and physical health of Chinese immigrants in the Howard County, Maryland: A community survey

      Lee, Mei Ching; Thomas, Sue Ann, 1947- (2011)
      Background: Immigrants are the fastest growing fraction of the United States (USA) population. One in every ten people in USA is foreign born. Migration is a stressful event. Immigrants are vulnerable to psychological distress symptoms which increase their risk of heart disease, stroke and diabetes. Chinese are the third largest immigrant group in USA. From 1980 to 2006, the numbers of Chinese immigrants has increased by five-fold. However, little is known about their psychological health. Study of Chinese immigrants increases our understanding of their psychological health condition and the relationship to physical health and can inform the development of culturally sensitive community programs to improve psychological health in Chinese immigrants. Purpose: The purpose of this study was to identify risk factors for psychological distress of Chinese immigrants using a biopsychosocial model. The intention was to identify modifiable factors for psychological distress in Chinese immigrants. Methods: A cross-sectional design was used to conduct a descriptive-correlation survey study. A total of 247 Chinese speaking immigrants in Howard County were recruited. All instruments used in the study were written in Chinese including the Chinese Cultural Orientation Scale, Chinese Bicultural Identity Integration Scale, Chinese Riverside Acculturation Stress Inventory and Chinese Kessler Psychological Distress Scale. Data were analyzed using descriptive statistics, Chi squares, t-tests, Pearson's correlations and hierarchical linear multiple regressions. Results: The psychological distress rate among Chinese immigrants in the study was 22.3%. Biological and social factors explained 17.8% of the variability in psychological distress scores, adjusted R2 = .155 (p<.001). Adding acculturation factors into the regression model increased R2 by .104 (p<.001). The interaction effect of acculturation stress and English proficiency was the strongest predictor of psychological distress scores in Chinese immigrants. Other predictors in the model included age, self-reported health status and financial strain. The final model explained 26.1% of the variability in psychological distress scores. Conclusion: Howard County is the third richest county by per capita income in the nation. Yet, financial uncertainty remains a strong predictor of psychological distress for Chinese immigrants. Interventions of social services could be developed to meet Chinese immigrants' needs. English proficiency is important for psychological health in Chinese immigrants, especially when facing acculturation stress. Participants with low Englishproficiency are more susceptible to acculturation stress to develop psychological distress symptoms. Culturally sensitive strategies are recommended to improve English proficiency in Chinese immigrants. In this sample, there was a fairly low rate of chronic disease. However self-reported health remained a significant risk factor in the model. Further study is needed to examine what factors contribute to an individuals' perception of health and how that perception of health influences psychological health.