The number of interracial couples in the United States has reached an all-time high, with one in every 10 American opposite-sex married couples saying they're of mixed races, according to the most recent Census data released Wednesday.
In 2000, that figure was about 7%.
The rate of interracial partnerships also is much higher among the unmarried, the 2010 Census showed.
About 18% of opposite-sex unmarried couples and 21% of same-sex unmarried partners identify themselves as interracial.
The term interracial, as it pertains to the study, is defined as members of a couple identifying as of different races or ethnicities.
Analysts suggest the new figures could reflect U.S. population shifts, broader social acceptance of such unions and a more widespread willingness among those polled to be classified as mixed race.
"Identifying as an interracial couple shifts over time," census spokeswoman Rose Kreider said.
Among interracial opposite-sex married couples, non-Hispanics and Hispanics are by far the most frequent combination, making up about 45% of such partnerships, Kreider said.
The second most represented group are those in which at least one person identifies as multiracial, while the third are marriages between whites and Asians.
Marriages between blacks and whites are the fourth most frequent group among married opposite-sex interracial couples.
Having professional translators in the emergency room for non-English-speaking patients might help limit potentially dangerous miscommunication, a new study suggests.
But it hadn't been clear how well professional interpreters perform against amateurs, such as an English-speaking family member, or against no translator at all.
The current findings, reported in the Annals of Emergency Medicine, are based on 57 families seen in either of two Massachusetts pediatric ERs. All were primarily Spanish-speaking.
The research team audiotaped the families' interactions with their ER doctor. Twenty families had help from a professional interpreter and 27 had a non-professional. Ten had no translation help.
It's not clear why some families had no professional interpreter. In some cases, Flores said, there may have been no one available immediately. Or the doctor might not have requested an interpreter.
The findings suggest that professionals can help avoid potentially dangerous miscommunication between patients and doctors, according to Flores and his colleagues.
In one example from their study, an amateur interpreter -- a family friend -- told the doctor that the child was not on any medications and had no drug allergies. But the friend had not actually asked the mother whether that was true.
There are still plenty of questions regarding professional interpreters, according to Flores.
For one, he said studies are needed to compare the effectiveness of in-person professional translators versus phone and video translation services.
There are also questions about what type of translation help families and doctors prefer, and what's most cost-effective. Federal law may require many hospitals to offer interpreters, but it does not compel the government or private insurance to pay for them. Right now, some U.S. states require reimbursement, but the majority do not. So in most states, Flores told Reuters Health, "the hospitals and clinics, and ultimately the taxpayers (because of uncompensated/charity care), are left covering the costs." But the cost-per-patient can be kept down. One study found that when a group of California hospitals banded together to offer translators by phone and video, the cost per patient was $25.
As for national costs, Flores pointed to a 2002 report from the White House Office of Management and Budget. It estimated that it would cost the U.S. $268 million per year to offer interpreter services at hospitals and outpatient doctor and dentist visits.
Another issue is training -- including the question of how much is enough. In the current study, errors were least common when interpreters had 100 hours of training or more: two percent of their translation slips had the potential for doing kids harm. There are numerous training programs for medical interpreters nationwide. But few of them provide at least 100 hours of training, Flores noted.
As for hospitals, it seems that most do not offer their own training programs. And even when they do, the hours vary substantially, Flores said. Based on these findings, he and his colleagues write, requiring 100-plus hours of training "might have a major impact" on preventing translation errors -- and any consequences for patients' health.
Have you ever used a translator as a nurse or as a patient? How did it go? What is the ideal training program?
Cultural competency is having specific cognitive and affective skills that are essential for building culturally relevant relationships between providers and patients. Obtaining cultural competency is an ongoing, lifetime process, not an endpoint. Becoming culturally competent requires continuous self-evaluation, skill development, and knowledge building about culturally diverse groups.
Healthcare disparities are inequalities in healthcare access, quality, and/or outcomes between groups. In the United States, these inequalities may be due to differences in care-seeking behaviors, cultural beliefs, health practices, linguistic barriers, degree of trust in healthcare providers, geographical access to care, insurance status, or ability to pay. Factors influencing these disparities include education, housing, nutrition, biological factors, economics, and sociopolitical power.
Several models of cultural competency exist. In a model called The Process of Cultural Competence in the Delivery of Healthcare Services, by Campinha-Bacote, nurses are directed to ask themselves questions based on the five constructs-awareness, skill, knowledge, encounters, and desire (ASKED)-to determine their own cultural competency. According to this model, nurses need an awareness of their own cultural biases and prejudices, cultural knowledge, and assessment and communication skills. Nurses also need to be motivated to have encounters with culturally diverse groups. In its most recent form, this model suggests that these encounters are the pivotal key constructs in the process of developing cultural competency.
The Giger and Davidhizar Transcultural Assessment Model identifies six cultural phenomena nurses and other healthcare providers assess in their patients: biological variations, environmental control, time, social organization, space, and communication.
Staff should select a model that best fits your specific work setting and patient population.
Discussions about culture in healthcare often focus on race and ethnicity. Taking this approach excludes other factors (biological, psychological, religious, economical, political) that are all aspects of one's cultural experience. When race and ethnicity are overemphasized in conversations about healthcare disparities, the results can be polarizing because nursing remains a White, female-dominated profession. Also, emphasis on racial difference over other equally important differences sets up an "us versus them" dynamic between nurses that may lead to some minority nurses' disengagement from these initiatives. In addition, no one is immune to prejudice. Minorities are just as likely to have room for improvement in cultural competency.
Taking it all in
You can gain helpful information by performing a cultural assessment and using a broad definition of culture that reflects the differences in healthcare besides race and ethnicity. These definitions include age, gender, disability, sexual orientation, immigration status, employment status, socioeconomic status, culture, and religion.
To avoid stereotyping, keep in mind that individuals within a particular group can vary in many respects. For example, among older adults, certain characteristics may be typical but some older adults may demonstrate attributes that differ from the group. Many believe that all older people resist the use of modern technology; however, many people who are elderly enjoy using smartphones, tablets, electronic readers, and other devices. These intracultural differences are important to consider; having group knowledge never justifies predicting behaviors of any individual members. As part of a cultural assessment, determine the specific values, beliefs, attitudes, and health needs of each patient. See Performing a cultural assessment for an example using the Giger and Davidhizar Transcultural Assessment Model.
In the United States, the healthcare system is a cultural entity with its own norms and values. Yet nurses may overlook a facility's institutional culture when they consider the impact culture has on patients' healthcare access and outcomes. Both organizational and hospital unit culture play a role in determining the quality of care a patient receives. When you can determine what interpersonal or institutional barriers exist within a particular institution, clinic, or community setting, you're better able to assist your patients in overcoming them to achieve better healthcare outcomes.
Goals and Considerations of cultural competency
How do you know whether you're providing culturally competent care? Some believe that they've reached the goal of cultural competency as they gain new knowledge or skills, or have encounters with culturally diverse groups. But while providers may meet goals, there is always room for improvement. Helpful questions and considerations when determining cultural competency include:
* What does being culturally competent mean to me and the patients I serve?
* Which cultural competency model and/or assessment tool is most useful to me, given my patient population?
* As I gain cultural knowledge and skills, how can I use that knowledge to improve my patients' healthcare outcomes and assist in reducing healthcare disparities for underserved populations?
* Did the patient demonstrate an understanding of what I was trying to convey or teach?
* What can I do to improve the quality of care I deliver to members of this group?
Title: Confident Voices: The Nurses' Guide to Improving Communication & Creating Positive Workplaces
Author: Beth Boynton, RN MS
“Confident Voices is a "must read" for every nurse who has had conversations with peers, supervisors, physicians and health care providers that have ended badly or wanted a different outcome. Confident Voices is designed to negotiate health care in the 21st Century and for communicating in a way that leaves everyone feeling included and honored in the process of day-to-day discussions in getting the job done. Beth Boynton's book provides the nurse with conversation tools to navigate difficult situations and provides support and feedback to reframe the situation so all involved win. I appreciate all the work Beth Boynton did in writing this book and the necessity of clear, concise communications in this difficult period we are all facing in the health care today.”
Have you read Confident Voices? What did you think of it? Has it helped you communicate at work?
Are you a nurse who uses an iPhone? The iPhone is especially useful for nurses who are mobile, as this tool can help you stay in touch with medical teams and patients’ needs. Additionally, many new apps have been developed for the iPhone that fit a nurse’s lifestyle and professional requirements. Why carry 15 tools around with you when one will do the work for them all? Many of the iPhone apps listed below are not open source or free. And, many require wireless networks to operate. But, when you consider the cost of the tools you might need to simulate these apps, the app may be worth the investment.
The apps below are linked either to download sites or reviews with a link to the download site. They are listed in alphabetical order, a methodology that shows we don’t favor one app over another.
- A.D.A.M. Symptom Navigator: If patients are using this app, maybe you should, too – easily find out what to do about any symptoms. Learn self care, when to go to the doctor, and when it is an emergency.
- Bishop’s Score Calc: This obstetric calculator is used to calculate Bishop’s Score, a score used to assess probability of impending delivery as well as expected success rate if labor is induced. Expectant parents may also find this of use in aiding their obstetrician in determining whether induction of labor is reasonable.
- Bio Dictionary: Bio Dictionary covers most of general biological terms. Two methods are offered for searching, and terms and their explanations are audible!
- Cockcroft: Calculate the estimated clearance of creatinine (eCcr) with the creatinine serum rate (in mg/dL or in micromol/L). Weight can be either in kilogram or in pounds.
- Epocrates Rx: One of the few free iPhone apps, Epocrates Rx includes a drug guide, formulary information and drug interaction checker. This product also includes continual free updates and medical news. Plus, this app resides on your device so you can look for information without wireless connections.
- Eponyms for the iPhone: Downloadable through the iTunes store and courtesy of Pascal Pfiffner, this app brings the beautiful eponym database from Andrew J. Yee to your iPhone or iPod touch.
- Glucose Charter: Glucose-Charter is a blood glucose, insulin and medication recording app for any iPhone. Patients can self-monitor, nurses can use it to check patients.
- iAnesthesia: Case Logs: iAnesthesia: Case Logs allows all anesthesia providers to easily create, manage and backup case logs quickly in the operating room, leaving you with more free time when not at work.
- iChart: Keep track of patients through this personal medical assistant. It stores everything from patient data to charts and lists of medications in a streamlined, organized fashion.
- In Case of Emergency (ICE): You may not always practice in a hospital setting. If not, this app can provide you with all the information you need to contact emergency services in your location.
- iRx: iRx is a pharmaceutical reference tool to get FDA information on specific drugs. This application is currently in beta status, but is fully functional.
- Lab Tests: This laboratory test database is broken up into categories including, Blood Bank, Clinical Chemistry, Coagulation, Hematology, Serology, Immunology, Tumor Markers, Urinalysis and Therapeutic Drugs. Reference ranges and notes on the clinical significance of the test are given when indicated.
- Medical Reference: Why memorize medical terminology when you can look it up on your iPhone?
- Mediquations: Mediquations for the iPhone and iPod Touch brings over 201 common medical calculations and scoring tools to your fingertips with the simplicity and elegance you expect out of an iPhone application.
- MIM Radiology: The MIM iPhone Application provides multi-planar reconstruction of data sets from modalities including CT, PET, MRI and SPECT, as well as multi-modality image fusion.
- Mosby’s iTerms Flash Cards for Medical Terminology: Mosby’s iTerms Flash Cards for Medical Terminology, the premier study guide for mastering the prefixes, suffixes, combining forms, and abbreviations used to build medical terms, is now available for the iPhone and iPod touch.
- NCLEX-RN Medications: Nursing students can cram for their NCLEX exam with this app that will help you study medications and conditions.
- Netter’s Anatomy Flash Cards: Using outstanding anatomical illustrations from Netter’s hugely popular Atlas of Human Anatomy (4th Edition), Netter’s Anatomy Flash Cards allows you to carry the bestselling reference for human anatomy on your iPhone or iPod touch.
- Netter’s Musculoskeletal Flash Cards: Master the musculoskeletal anatomy and pathology you need to know with 210 flash cards.
- Netter’s Neuroscience Flash Cards: Enhance your understanding of key neuroscience concepts with Netter’s Neuroscience Flash Cards for iPhone and iPod touch.
- Nursing Central: Nursing Central is the complete mobile solution for nursing produced by Unbound Medicine. The app includes premier disease, drug and test information by and for nurses.
- Pocket First Aid Guide: Do you panic when caring for several people at once? Get a grip with this iPhone app. This is a first-aid guide for your iPhone that will help you treat anything from beestings to burns to eye injuries while you are within range of the Internet.
- ReachMD: The ReachMD CME iPhone application is an easy-to-use and fully accredited Continuing Medical Education tool that gives healthcare practitioners a convenient way to earn free CME credits through their iPhone or iTouch.
- ScribbleDoc: If you can’t read the good doctor’s writing, perhaps this app can help. Use your iPhone to scan the problem and ScribbleDoc should convert the image to text.
- Skyscape Medical Resources: Available from the iTunes Apps Store, this app offers Outlines in Clinical Medicine, Archimedes – Medical Calculator, RxDrugs: Drug Dosing Tool and MedAlert for free with their download.
Physicians, nurses, allied health professionals and pharmacists are using social media tools to network with professional colleagues, track down job leads and apply for new positions, according to a new survey.
The survey was conducted by AMN Healthcare, which bills itself as the nation's largest healthcare staffing and workforce solutions company. AMN Healthcare's "2010 Social Media Survey of Healthcare Professionals" was designed to provide healthcare employers and leaders a snapshot of how healthcare professionals are currently using social media and other online applications for networking, job hunting and other career development activities. The survey, which was conducted this fall, received 1,248 responses.
The survey suggests that traditional methods of recruitment such as referrals, online job boards and search engines are not being superseded by social media, whereas social media does surpass other job search methods such as newspaper ads, career fairs and other methods. At the same time, social networking sites are experiencing tremendous growth, and have become the new frontier in professional networking and career development for physicians, nurses, allied health professionals and pharmacists. Job candidates are spending more time online and experimenting with media sites for job searches, but have thus far found minimal success in securing interviews, job offers and positions.
"It's not surprising that social media and mobile media usage have become additional job sourcing methods for healthcare professionals and a way to network with peers and companies," said Susan Salka, AMN's president and CEO. "What this tells us is that job seekers will add new methods and continue to replace those that don't work as they have access to innovative new resources. As the nation's largest healthcare staffing company, we find this information valuable in being able to connect with top talent in healthcare today. It will be interesting to compare this year's results with those from 2011 and beyond to gauge the search methods and developing preferences of job seekers."
Key survey findings:
Thirty-eight percent of clinicians surveyed are currently seeking employment, and 12 percent of current job seekers have been looking for more than a year.
Nurses have had a significantly shorter job search than their fellow professionals, averaging three months, compared to just less than seven months for physicians and allied professionals, and nine months for pharmacists.
Thirty-seven percent of clinicians reported using social media for professional networking; nurses had the highest use among healthcare workers at 41 percent.
Ten percent of healthcare professionals are using mobile job alerts, but only 3 percent have received an interview, 2 percent have received a job offer and 1 percent secured a new job.
Physicians are by far the heaviest users of mobile devices for professional reasons among their medical colleagues; 37 percent used healthcare-related applications and 17 percent used mobile devices for healthcare-related content or jobs.
Sixty-four percent of the clinicians surveyed would choose Facebook, the clear favorite, if they could choose only one social networking site.
Legislation in California that set nurse-to-patient ratios added more registered nurses to the hospital staffing mix, not fewer as feared, researchers say.
Lead researcher Matthew McHugh, a nursing professor at the University of Pennsylvania in Philadelphia, says California was the first state to pass legislation setting staffing levels. However, mindful of the ongoing nurse shortage California legislators determined that hospitals could employ licensed practical nurses as well as registered nurses to meet the requirements of the law, McHugh says.
“California’s state-mandated nurse staffing ratios have been shown to be successful in terms of increasing registered nurse staffing,” McHugh says in a statement. “From a policy perspective, this should be useful information to the states currently debating legislation on nurse-to-patient ratios.”
California experienced a more serious nurse shortage than other areas of the country but made up the gap by hiring “travel nurses” — temporary workers who move from hospital to hospital as needed and ae not less educated LPNs, the researchers say.
The study, published in the journal Health Affairs, examined hiring practices from 1997 to 2008, pre- and post-implementation of the legislation, concluding that the increase in nurse staffing did not come at the expense of decreasing RNs.
“Our findings demonstrate that the nurse-to-patient ratio mandate in California was effective in increasing registered nurse staffing in hospitals,” McHugh says.
Does your state have legislation like this? What do you think? Does it help or hinder you in doing your job? How about your patients? Let us know in the comments!
“Working on the front lines of patient care, nurses can play a vital role in helping realize the objectives set forth in the 2010 Affordable Care Act, legislation that represents the broadest health care overhaul since the 1965 creation of the Medicare and Medicaid programs. A number of barriers prevent nurses from being able to respond effectively to rapidly changing health care settings and an evolving health care system. These barriers need to be overcome to ensure that nurses are well-positioned to lead change and advance health.”
80% BSN Nurses by 2020?
One of the most ambitious recommendations in the report is the section on advancement of nursing education. It proposes the goal of transitioning the average 50% of the nursing workforce at the BSN level today to that of 80% of the workforce in the next 10 years. While this is a worthwhile goal, without the funding to pay for the ADN nurses to advance to the BSN level and the increase in pay that such an advance might ordinarily offer in another field, there is little hope of achieving this goal.
It makes no sense to shut down the existing pipeline of ADN nursing programs and requiring BSN as the minimum standard of education for registered nurse (RN). With the predicted nursing shortage, these ADN programs will be the only way we can meet the needs of the aging population and declining nursing workforce. Unless there is a major influx of scholarship funding from public and private sources to encourage nurses to go back to school in droves and provide them the financial incentive to do so, it is unlikely that the 80% goal will be reached by 2020.
Practice Within Full Scope of Nurse Training
One part of the process that met with approval from all of the panelists was the focus on expanding the scope and inclusion of advanced practice nurses nationwide. With health care costs continuing to skyrocket and a lack of needed primary care resources, offering a full provider status to nurse practitioners nationwide is one of the most effective ways to approach the broad primary care gap that exists. When physicians purport that they should be the only primary prescribers and decision makers for all patients, the IOM reports suggests that these objections be treated as anti-competitive practices and price fixing in the health care marketplace.
If you are a nurse, what do you think about shifting the educational percentages to 80% BSN? In some organizations, there is even a push for higher percentages of MSN degrees. What are you seeing where you work?
Pay should not be your only considering when deciding on a specialty, but the list below of the highest paying nursing specialties provides a good primer on which types of nurses have the greatest earning potential.
1) Certified Registered Nurse Anesthetist – $135,000
A Certified Registered Nurse Anesthetist is someone who administers anesthesia to patients. They collaborate with surgeons, anesthesiologists, dentists and podiatrists to safely administer anesthesia medications. For additional information, please refer to the entire CRNA profile.
2) Nurse Researcher – $95,000
Nurse researchers work as analysts for private companies or health policy nonprofits. They publish research studies based on data collected on specific pharmaceutical/medical/nursing product and practices.
3) Psychiatric Nurse Practitioner – $95,000
Psychiatric Nurse Practitioners are advanced practice nurses who provide care and consultation to patients suffering from psychiatric and mental health disorders.
4) Certified Nurse Midwife – $84,000
Nurse midwives provide primary care to women, including gynecological exams, family planning advice, prenatal care, assistance in labor and delivery, and neonatal care. CNMs work in hospitals, clinics, health departments, homes and private practices. Midwives will often have to work unpredictable hours (due to the unpredictable nature of childbirth). They should have good communications skills and be willing to commit to a holistic approach to patient care.
5) Pediatric Endocrinology Nurse – $81,000
Pediatric endocrinology nurses provide care to young children who are suffering from diseases and disorders of the endocrine system. This often involves educating both parents and children on the the physical and sexual development issues that arise from these disorders.
6) Orthopedic Nurse – $81,000
Orthopedic nurses provide care for patients suffering for musculoskeletal ailments, such as arthritis, joint replacement and diabetes. They are responsible for educating patients on these disorders and on available self-care and support systems.
7) Nurse Practitioner – $78,000
Nurse practitioners provide basic preventive health care to patients, and increasingly serve as primary and specialty care providers in mainly medically underserved areas. The most common areas of specialty for nurse practitioners are family practice, adult practice, women’s health, pediatrics, acute care, and gerontology; however, there are many other specialties. In most states, advanced practice nurses can prescribe medications.
8) Clinical Nurse Specialist – $76,000
Clinical Nurse Specialists develop uniform standards for quality care and work with staff nurses to ensure that those standards are being met. They are required to possess strong managerial skills and an ability to anticipate potential staff/patient conflicts.
9) Gerontological Nurse Practitioner – $75,000
Gerontological Nurse Practitioners (GNPs) hold advanced degrees specializing in geriatrics. They are able to diagnose and manage their patients’ often long-term and debilitating conditions and provide regular assessments to patients’ family members. Similar to all geriatric nurses, GNPs must approach nursing holistically and pay special attention to maintaining a comforting bedside manner for their elderly patients.
10) Neonatal Nurse – $74,000
Neonatal nurses care for sick and/or premature newborn babies. They also provide consultation to the newborn’s family during what can be an emotionally draining period.