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The journey of Latinas in undergraduate schools of nursing: Roadblocks and bridges
Hispanics continue to be the fastest growing minority population in the United States. The most recent U.S. Census Bureau (2000) indicates that Hispanics comprise 35 million, or 12.5%, of the total population, up from 9.0% in 1990. Despite the significant increase in the Hispanic population, the number of Hispanic nurses does not reflect this increase. As the number of Hispanics continues to grow, there will be an increasing demand for culturally competent health care providers and healthcare services. The primary purpose of this qualitative, in-depth phenomenological study was to understand the experiences of Latina nursing students in the United States in order to identify conditions that affect their educational experiences. Using an in-depth phenomenology approach, seventeen Latina nursing students and recently graduated nurses in Massachusetts and Connecticut were interviewed between 1999–2000. Participation in the study required that the participants self identify as Latina/Hispanic and be enrolled in an undergraduate nursing program. Data were obtained through three separate interviews, each with a different focus and each lasting ninety minutes. The interviews were conducted approximately a week apart. The first interview focused on collecting historical and biographical data. The second interview focused on what was currently happening in the interviewee\u27s life as a nursing student or recent graduate. The third interview explored on the meaning of the two previous interviews. Data was analyzed by crafting participant profiles and identifying thematic connections. A journey metaphor is being used to describe each participant\u27s experiences. Along this journey, the themes are discussed as roadblocks and bridges, the obstacles and supports, experienced by the student nurse/nurses. The roadblocks or obstacles are marginalization and socioeconomic status. The bridges or supports are family, mentors, and perseverance. The participants\u27 experiences provide important insights that may benefit schools of nursing and other disciplines concerned with nursing education. Recommendations in three major areas are being made as a result of this study. These focus on K–12 education, nursing education, and future research. By presenting the recent educational experiences of Latina nursing students, this study has implications for future curriculum development and multicultural education within the nursing profession
Exploring the Ethics of Clinical Research in an Urban Community
Objectives. We consulted with representatives of an urban community in Washington, DC, about the ethics of clinical research involving residents of the community with limited access to health care. Methods. A semistructured community consultation was conducted with core members of the Health Partnership Program of the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Three research case examples were discussed; questions and probes (a predetermined question or series of questions used to further investigate or follow-up a response) guided the discussion. Results. The community representatives who took part in the consultation were supportive of research and appreciated the opportunity to be heard. They noted the importance of respecting the circumstances, values, needs, and welfare of research participants; supported widely representative recruitment strategies; and cited the positive benefits of providing care or treatment to participants. Monitoring participants’ welfare and ensuring care at a study’s end were emphasized. Trust was a central theme; participants suggested several trust-enhancing strategies, including full disclosure of information and the involvement of advocates, physicians, and trusted church members. Conclusions. Several important strategies emerged for conducting ethical research in urban communities whose residents have limited access to health care
Clinical Evaluation of the Potential Utility of Computational Modeling as an HIV Treatment Selection Tool by Physicians with Considerable HIV Experience
The HIV Resistance Response Database Initiative (RDI), which comprises a small research team in the United Kingdom and collaborating clinical centers in more than 15 countries, has used antiretroviral treatment and response data from thousands of patients around the world to develop computational models that are highly predictive of virologic response. The potential utility of such models as a tool for assisting treatment selection was assessed in two clinical pilot studies: a prospective study in Canada and Italy, which was terminated early because of the availability of new drugs not covered by the system, and a retrospective study in the United States. For these studies, a Web-based user interface was constructed to provide access to the models. Participating physicians entered baseline data for cases of treatment failure and then registered their treatment intention. They then received a report listing the five alternative regimens that the models predicted would be most effective plus their own selection, ranked in order of predicted virologic response. The physicians then entered their final treatment decision. Twenty-three physicians entered 114 cases (75 unique cases with 39 entered twice by different physicians). Overall, 33% of treatment decisions were changed following review of the report. The final treatment decisions and the best of the RDI alternatives were predicted to produce greater virologic responses and involve fewer drugs than the original selections. Most physicians found the system easy to use and understand. All but one indicated they would use the system if it were available, particularly for highly treatment-experienced cases with challenging resistance profiles. Despite limitations, the first clinical evaluation of this approach by physicians with substantial HIV-experience suggests that it has the potential to deliver clinical and economic benefits