Bridging a Cultural Healthcare Gap—Like other new immigrant groups, Korean Americans' health risks—diabetes, high blood pressure, and cancer—increase after arriving in the U.S. Unfortunately, too many also miss out on needed healthcare services until they are seriously, often chronically ill. Johns Hopkins University School of Nursing (JHUSON) researchers, professor Miyong T. Kim, PhD, RN, FAAN, associate professor Hae-Ra Han, PhD, RN, and post-doctoral students Jong-Eun Lee, PhD, RN, and Jiyun Kim, PhD, RN, have found that older Koreans with a traditional diet use too much salt and get too little fiber and calcium—risky behaviors when it comes to high blood pressure, colon cancer, and osteoporosis [In-depth assessment of the nutritional status of Korean American elderly," Geriatric Nursing, September 2009]. They also note that despite rising breast cancer rates, only half of age-appropriate Korean-American women report having mammograms. ["Do cultural factors predict mammography behavior among Korean immigrants in the USA?," Journal of Advanced Nursing, November 2009]. "Language, culture, and a work ethic that emphasizes earning over personal health can lead to delayed diagnosis and treatment," notes M. Kim. "Our research to break through these and other barriers shows change starts by sharing health knowledge in a common language and with sensitivity to the immigrant culture." When the team found self-care confidence is a key to successful management of high blood pressure among Korean Americans, they also found a low-cost way to boost confidence: a monthly hypertension counseling phone call by a bilingual nurse. With an 80% success rate, this technique markedly increased medication compliance and exercise and reduced alcohol use. ["Implications and success of nurse telephone counseling in linguistically isolated Korean American patients with high blood pressure," Patient Education and Counseling, November 2009; and "Correlates of self-care behaviors for managing hypertension among Korean Americans," International Journal of Nursing Studies, December 2009]. Han notes, "Nursing interventions well-matched to Korean culture and habits help improve outcomes for Korean Americans with type 2 diabetes, just as they do for hypertension." Reporting in the Diabetes Educator [November/December 2009], her team found culturally relevant local interventions also stabilize diabetes and reduce the emotional fallout from diagnosis of this chronic illness. ["A community-based, culturally tailored behavioral intervention for Korean Americans with type 2 diabetes."]
Staff Behaving Badly—Hospitals aren't immune from disruptive clinician behaviors; nor are the nurses or other healthcare team members that work there, whether victims or perpetrators. Disruptive behavior can affect not only the safety of patients but also the cohesiveness of the healthcare team and the long-term health of the nursing workforce. In "Hospital RNs' experience with disruptive behavior," Journal of Nursing Care Quality [online, November 2009], JHUSON assistant professor Jo M. Walrath, PhD, MS, RN, and Johns Hopkins Hospital's Deborah Dang, PhD, RN, NEA-BC, and Dorothy Nyberg, MS, RN give voice to nurses' experiences with these behaviors. Based on nurse focus group findings, the research team created taxonomy of disruptive behaviors ranging from incivility to psychological aggression to physical violence. The most frequent adverse behaviors are triggered by issues related to personal characteristics, stress, fatigue, or competency. Whatever its source, disruptive clinician behavior can affect quality of care, patient safety, and the quality of a nurse's work life. Surprisingly, when confronted by rude, insulting, or condescending behavior from peers, staff, physicians, or administrators, many nurses choose not to speak up, despite their longstanding role as patient advocates. Some hunker down; others choose to leave. These findings underscore the Joint Commission on the Accreditation of Healthcare Organizations standard that bad behavior warrants immediate attention. Walrath notes, "Much can be done to promote more emotionally healthy workplaces for nurses. Disruptive behavior should be recognized, openly discussed and equitably addressed for the safety of all, particularly for that of our patients."