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Despite their interest in completing advance directives (ADs), persons experiencing homelessness (PEH) appear to have fewer surrogate decision-makers and limited opportunities for advance care planning (ACP). Nursing students and faculty, a hospital bioethicist, and social service agency staff formed a community-academic partnership that helps PEH complete advance directives. This unique service-learning opportunity offers a model for assisting vulnerable populations with advance care planning. Model effectiveness and limitations are described from each partner's perspective in their own words.

Introduction: Rural Appalachian older adults (RAOAs) constitute a vulnerable population and experience significant health disparities. The combination of age, poverty, rural residence, health care provider shortages, and limited transportation increases risks for poor health outcomes. Spirituality enhances older adult health; however, little is known about spirituality–health linkages of RAOAs. Therefore, the purpose of this study was to discover the influences of spirituality on RAOA health. Methodology: Culture Care Theory and ethnonursing method guided analysis of 32 RAOA interviews in community settings in East Tennessee. Results: "Faith" is an integral component of RAOA culture and health. Three themes were extrapolated: (a) Relationship with God is personal; (b) faith beliefs and practices influence health, illness, death, and dying; and [the need to] (c) "Open the door" for spiritual care. Discussion: Faith assessment and spiritual care recommendations contribute to culturally congruent care for RAOAs and may be transferable to care for other older adults. [ABSTRACT FROM AUTHOR]

Despite research findings that rural Appalachians prefer to die at home, few people access palliative and hospice care services, and many report limited knowledge about palliative/end-of-life care resources. A community-academic partnership was formed to address this need. Train-the-trainer workshop and materials were co-developed. This study tested the feasibility and cultural acceptability of the training intervention to increase community members' knowledge about palliative/end-oflife care resources for East Tennessee Appalachian people. Community-based participatory research design and culture care theory guided the project, intervention, and research. After engaging in end-of-life training, participants completed a retrospective pretest-posttest survey. Paired samples t tests were used to compare knowledge before and after training. Means and standard deviations were used to report training material usefulness and cultural acceptability. Short-answer qualitative data were analyzed using content analysis. Sixty-six adults completed the survey. Ratings for training materials and cultural/theological acceptability were high. Participant knowledge rankings showed significant improvement after training at the P <.001 level. Qualitative feedback was positive. The training intervention was feasible, culturally acceptable, and effective for increasing East Tennessee Appalachian persons' palliative/end-of-life care knowledge. Community member expertise/collaboration integrated into every stage of the project is the bedrock of cultural acceptability and feasibility. [ABSTRACT FROM AUTHOR]

As the College of Nursing at the University of Tennessee, Knoxville prepared to move their graduate programs online, a nursing faculty grass-roots movement led to the implementation of a faculty development program. This instructional design portfolio describes the design, development, implementation, and evaluation of this program, with the goal of identifying best practices in the design of programs for learning to teach online. These include understanding the importance of just-in-time learning, developing the ability to meet diverse needs, defining workshop expectations and workload requirements, increased integration of technology and pedagogy training, and the importance of modeling. (Contains 3 tables and 1 figure.)

Introduction: Advance directive completion rates among the general population are low, with even lower completion rates among African Americans (AAs). This study's purpose was to identify culturally based meanings, expressions, and traditions of end-of-life (EOL) advance care planning (ACP) and decision making in order to promote culturally congruent nursing care among African Americans. Methodology: Leininger's Culture Care Theory and Ethnonursing Research Method guided the study. A convenience sample of 21 informants were interviewed in community settings. Data analysis was guided using Leininger's phases of ethnonursing data analysis for qualitative data. Results: Three themes emerged that affect EOL decision making: (a) faith in God and belief in life after death, (b) a strong matriarchal family structure, and (c) fear of talking about death and mistrust of the U.S. health care system. Discussion: AA culture, beliefs, and traditions influence EOL ACP and practices, and must be considered while providing culturally congruent care. [ABSTRACT FROM AUTHOR]

In this manuscript, we report the pilot results of the Transforming RN Roles in Community Based Integrated Primary Care (TRIP) undergraduate nursing curriculum. Junior nursing students participated in TRIP didactic, simulation and clinical activities and completed a focus group at the midpoint and conclusion of year one. Focus group themes addressed recruitment, understanding or primary care, connections between clinical and didactic, and team based care. TRIP offers the first comprehensive community based integrated primary care training for students in our region. Overall, the TRIP curriculum enhanced student learning and promoted leadership. [ABSTRACT FROM AUTHOR]

Caring for persons at the end of life has dramatically changed in the last 20 years. Improved chronic illness management and aggressive life-sustaining measures for once-fatal illnesses have significantly increased longevity. People with life-limiting illnesses and their families are asked to make complex and difficult decisions about end-of-life, palliative, and hospice care. The purpose of this study was to discover and describe the culture care expressions, patterns, and practices influencing rural Appalachian families making decisions at the end of life. The qualitative, ethnonursing research method was used to analyze data from 25 interviews. The 4 themes discovered provide insights that could help improve this underserved population's access to palliative and hospice care, which in turn could help them experience a dignified death. Recommendations for health care providers could help reduce rural Appalachians' health disparities and promote meaningful, culturally congruent end-of-life care. [ABSTRACT FROM AUTHOR]

Introduction: Childhood obesity remains an unrelenting public health problem disproportionately affecting ethnic minorities. Although research has examined ethnicity as a factor of childhood obesity, few studies have examined cultural influences. The purpose of this systematic review was to examine the qualitative evidence of cultural influences on childhood obesity in ethnic minority groups. Methodology: Selective sampling of studies since 2008 yielded 251 articles. Twelve articles that addressed cultural influences on childhood obesity were identified for review. The Culture Care Theory Sunrise Enabler factors were used as an a priori framework for theme coding. Results: Nine themes emerged: child feeding, family, gender roles, food, healthy child appearance, physical activity, sedentary activity, food cost, and obesogenic environment. Discussion: Cultural care practices such as traditional foods and family meals are protective factors in childhood obesity and should be encouraged by nurses caring for and working with ethnic minority populations. [ABSTRACT FROM AUTHOR]

Despite their interest in completing advance directives (ADs), persons experiencing homelessness (PEH) appear to have fewer surrogate decision-makers and limited opportunities for advance care planning (ACP). Nursing students and faculty, a hospital bioethicist, and social service agency staff formed a community-academic partnership that helps PEH complete advance directives. This unique service-learning opportunity offers a model for assisting vulnerable populations with advance care planning. Model effectiveness and limitations are described from each partner's perspective in their own words. [ABSTRACT FROM AUTHOR]