According to a recent study in the Journal of the American Society of Nephrology (JASN), some ethnic groups can be found at the bottom, or missing, from waitlists for kidney transplants. Though the exact causes are not known, experts have a variety of theories and are working hard to address this issue.
At the University of Washington in Seattle, Yoshio Hall, M.D., and his colleagues were determined to fi nd some answers. In their study, they surveyed 503,090 non-elderly adults from different ethnic backgrounds who had started dialysis between the years of 1995 and 2006. In 2008, the researchers had some answers. Of all waitlisted patients, white non-Hispanics were 40% more likely to receive a transplant than African Americans, Hispanics, Asian Americans/Pacific Islanders, and others minorities. Also of note, the rates of deceased-donor transplantations after dialysis were lowest in American Indians/Alaska Natives (2.4%) and highest in non-Hispanic whites (5.9%) and Asians (6.4%).
Today, the reasons behind these discrepancies are still not completely clear, which highlights the need for further investigation. Some theories point to socioeconomic factors, while others suggest a lack of organ availability, or even cultural isolation.
Dr. Hall believes that more research and understanding could result in the reduction of racial, ethnic, and socioeconomic disparities for kidney transplants in the future.
In one of the first studies of its kind, researchers at the University of Michigan’s School of Public Health have illustrated how physical health outcomes within the black population vary based on environment.
The research compared two populations, African Americans and Caribbean blacks, and the varied relationships between ethnicity, nativity, depressive symptoms, and physical health in these two populations. According to the research, a Caribbean-born black person living in the United States has a higher chance of being physically healthy than an African American or a U.S.-born black person of Caribbean descent, which was the least healthy group.
The survey relied on participants’ self-ratings of their physical health, so depressive symptoms were also noted. The study also demonstrated how important linking the physical and mental areas of wellness were. In all three groups, increased depressive symptoms lead directly to predictable health outcomes.
The research also discovered the least healthy age for all groups ranged 45–59, a time when doctors expect people to be improving their health. Middle age is also when family, career, and social life typically converge, so health might be a last priority when these other obligations are more demanding.
This study gives researchers a better understanding of the health patterns within different racial groups, and how environment can have a major effect on a person’s health.
Childhood obesity is usually linked to overeating, fast food, and insufficient exercise. Now, researchers have found one more thing to add to the list. A study by the Children’s Hospital of Philadelphia has shown there are several genetic variants connected with adult obesity that are also detected in childhood obesity, including two new variants never associated with obesity before. These variants are said to increase the risk of obesity in children in the first few years of life. How these variants cause obesity is still not known, but according to the Associate Director of the Center for Applied Genomics, it is possible they affect the intestine. Childhood obesity has tripled in the United States over the past few decades, but human genetics have remained static, leading researchers to believe there are still environmental causes of obesity as well.
The researchers collected data from 14 studies conducted in the United States, Canada, Europe, and Australia. They scanned the genomes of 5,530 obese and 8,300 non-obese children. Findings displayed eight new signals of genetics associated with childhood obesity. For validation purposes, researchers studied these signals in 2,000 additional obese and 4,000 non-obese children; they found two signals associated with childhood obesity. Since it is possible for the signals to be picked up from the surrounding genes, additional research must be done in order to confirm the genes giving off the signals are actually the same genes responsible for childhood obesity. Additionally, further research could eventually lead to treatments for obese children.
In Saskatchewan, Canada, the most rapidly growing segment of the population is the Aboriginal (Native) community, which is expected to increase to 400,000 by the year 2040. The Royal Commission on Aboriginal Peoples estimates that in Canada as a whole, approximately 10,000 more Aboriginal health care professionals will be needed in the next 10 years to respond to the health challenges experienced by Aboriginal people and to meet this population’s preventive, diagnostic, treatment and rehabilitative needs. There is an especially strong need for more Aboriginal nurses and nursing researchers. Currently, less than 1% of registered nurses in Canada are Aboriginal.1
The Nursing Education Program of Saskatchewan (NEPS)–a collaborative program of the University of Saskatchewan, the Saskatchewan Institute of Applied Science and Technology (SIAST) and, as of March 2003, the First Nations University of Canada–values research as a core competency for undergraduate nursing students. The program also recognizes the critical need to build Aboriginal nursing research capacity. For these reasons, NEPS has developed a capacity-building initiative that is supporting and enhancing research expertise among Aboriginal nursing students.
The students work with researchers, Aboriginal communities and NEPS faculty as part of an inclusive research environment. While the short-term outcomes are exciting, this initiative demonstrates even greater promise for building and sustaining research capacity for Aboriginal nurses over the long term.
Learning from the Literature
A review of the nursing literature indicates that a number of articles have been written about the process of building research capacity in organizations and institutions. According to a 1999 study by Jennifer Rowley published in the International Journal of Education Management, the first stage of research capacity building focuses on the development of research teams, personal growth, support and guidance for members of the team and a continuous learning environment. The second stage is the integration of these elements into the greater academic community. The study also states that “…research leaders have responsibility for establishing a sense of direction and for the facilitation of opportunities to support the individual learning of others.”2
Rowley lists the four key elements for successful research planning as ownership, objectives, outcomes and organization. She suggests that ownership requires a participative and collaborative approach to designing and monitoring the research activity: “Ownership can only be achieved if all researchers (from research students to professors) have involvement in the planning process, and, conversely, if all participants in the planning process are active researchers.”
The team needs to support individuals who are at varying stages of their educational development, Rowley notes. In addition, the team must have a sense of vision, a plan for the research activities that can be completed during an expected time frame, and must define the general purpose of the research, the subject focus and the anticipated networking. The outcomes should link to the objectives of the research and should be able to be disseminated through activities such as presentations, conferences, Web sites, student projects and publications. For success in building research capacity, an organization must have a strong infrastructure as well as strong, creative individuals who contribute to the overall research culture.2
Another, more recent (2003) study indicates that undergraduate nursing students are capable of performing qualitative data analysis with proper guidance and support. Furthermore, students at this educational level are able to apply the steps of a content analysis to data they collect and begin to conduct a thematic analysis.3 This study also found that there was “improved student performance in the subsequent research process course [and] in other courses requiring application of research skills.”
Other recent studies have found that teaching nursing students to conduct all parts of the research process, with guidance from professors, prepares them for the realities of health care practice.4, 5, 3
Building Capacity through Collaboration
Currently, close to 200 students of Aboriginal heritage are enrolled in the Nursing Education Program of Saskatchewan, representing approximately 14 % of the student population. NEPS is a four-year program leading to a Bachelor of Science in Nursing (BSN) degree awarded by the University of Saskatchewan. SIAST offers years one and two in Saskatoon and Regina; First Nations University of Canada, Northern Campus offers years one and two in Prince Albert; and the College of Nursing, University of Saskatchewan offers years three and four in all three cities.
SIAST’s Native Access Program to Nursing (NAPN) is a nationally and internationally recognized recruitment, support and retention program and is a significant factor in the success of Aboriginal students in the NEPS. Student advisors (three at the Saskatoon site and one at the Regina site) provide academic and personal advisement, tutoring, mentoring and culturally appropriate counseling. The advisors are also available to assist students with childcare, housing and funding concerns.
Over the past three years, the NEPS faculty and NAPN advisors have been involved in a number of collaborative initiatives funded by Prairie Women’s Health Centre of Excellence and the Indigenous Peoples’ Health Research Centre (IPHRC). IPHRC funds research in the areas of Aboriginal women’s health and culturally respectful health care for Aboriginal people. It also funds Summer Undergraduate Research Awards for students.
Each of these initiatives has identified the development of research capacity in Aboriginal nursing students as a fundamental goal. Students who are interested in participating in research projects must have a successful academic background, be enrolled in a health science program and have an Aboriginal heritage. This goal is embedded in the conceptual framework for building research capacity in NEPS, which is based on the standards for research set forth by the Saskatchewan Registered Nurses’ Association (SRNA). The specific foundational competencies applicable for nursing students on research teams require that the students:
Demonstrate openness to new ideas, which may change, enhance, promote or support nursing practice;
Incorporate evidence-based knowledge from research in nursing and other disciplines into nursing practice;
Read and critique research articles and reports in nursing, health sciences and related disciplines; and
Participate in a variety of activities as part of a research team.6
The following examples illustrate how these four competencies are incorporated into the learning experience of the Aboriginal nursing students in the NEPS:
Openness to new ideas. Several of the Aboriginal students who are enrolled in the NEPS are involved in the research capacity building. They function as members of the research team and participate in processes that are responsive to the participating Aboriginal communities and the research context. The students are encouraged to challenge the status quo and explore new options and opportunities to approach the topic of interest.
As part of their self-assessments and feedback about specific research projects, some students have commented: “I came to understand how to address the political agendas of others”; “I had problems being able to suspend my own experiences as an Aboriginal woman as I looked at the research–so it challenged my beliefs” and “openness to new ideas is what kept this research group together and functioning.”
Incorporation of evidence-based knowledge.Health planners and providers working with Aboriginal communities are increasingly in need of the most current and reliable research information to guide their decision-making and planning processes. Through their research experiences, the Aboriginal nursing students participate in knowledge exchange, culturally respectful research processes and relationship building. One of the students working with NEPS faculty and members of a Native community stated: “The experience reinforced the principles of primary health care and how to apply them in my workplace and the community.”
Evaluation and critiquing of existing resources.For each research project, student members of the team are assigned a primary area (topic of interest). For example, an emerging challenge in the area of research ethics in Aboriginal communities sparked an interest for one student, and she subsequently worked on the identification, collation and critique of the extant literature. Other students have conducted literature searches related to culturally competent care, community development and decision-making, and Aboriginal research methods. The knowledge the nursing students gain from this process contributes to the development and further refinement of research questions and methodologies.
The students have learned that conducting literature searches and reviews is a valuable experience. Their feedback reflects this: “Because of this experience, I now look for opportunities to participate or initiate research on my practice unit”; “I hope I can be an example to others as they watch me give care that is respectful and equal across cultures” and “I feel I have been rewarded with the knowledge I have taken away from this experience.”
Inclusiveness in the research team.The students are mentored by faculty through all phases of the research, from grant writing to dissemination of research results. Several of the Aboriginal nursing student researchers have been successful in obtaining undergraduate grants from the IPHRC and from Health Canada’s First Nations and Inuit Health Branch (FNIHB) to facilitate their development in health care research. The students have told us that being members of the research team is “a great learning experience. . . [I am] learning how to prepare documents for an ethics committee” and “this collaborative effort definitely gave me more insight on working with others for a common goal.”
Showcasing Students’ Success
Through a coordinated approach and organizational support at all levels, the ongoing development of research capacity with the Aboriginal nursing students remains a priority in the NEPS. Summer studentships, research assistant opportunities and community linkages all contribute to the eagerness of the students, the ongoing commitment by faculty and the positive response from the local Aboriginal communities.
The nursing students’ successes as researchers have been showcased through publication, presentations, newsletters and posters. This past February, three undergraduate students and one graduate student participated in a student panel as part of Research Day at the College of Nursing, University of Saskatchewan. The feedback from participants at the Research Day indicated a very positive response to the student presentations.
The momentum and positive energy from these research initiatives are contributing to new projects and grants and are enhancing the learning of all members of the research team. Moreover, the research capacity building continues even after the students graduate. One recent graduate has already enrolled in a Masters of Nursing program. Another continues, as a registered nurse, to be involved in funded research related to community development within an urban Aboriginal community.
These Native nurse researchers are leaders in both the nursing community and in the Aboriginal communities. They are demonstrating the positive impacts of research on the health of their patients and the enhancement of culturally sensitive nursing practice. The Cree word Sihtoskatowin captures the value of working together on research projects, providing ongoing support and building research capacity with Aboriginal nursing students.
The authors would like to thank the following Nursing Education Program of Saskatchewan (NEPS) students and graduates who provided statements that were used as quotes in this article: Alex Keewatin (student), Dwayne Nagy (graduate), Andrea Pouteau (student) and Nora Weber (graduate).
1. Royal Commission on Aboriginal Peoples (1996). Report of the Royal Commission on Aboriginal Peoples. Retrieved from http://www.ainc-inac.gc.ca/ .
2. Rowley, J. (1999). “Developing Research Capacity: The Second Step.” International Journal of Educational Management, Vol. 13, No. 4, pp. 208-212.
3. Reising, D.L. (2003). “Establishing Student Competency in Qualitative Research: Can
Undergraduate Nursing Students Perform Qualitative Data Analysis?” Journal of Nursing Education, Vol. 42, No. 5, p. 216.
4. Fazzone, P.A. (2001). “An Experiential Method for Teaching Research to Graduate Nursing Students.” Journal of Nursing Education, Vol. 40, No. 4, pp. 174-179.
5. Neafsey, P.J. and Shellman, J. (2002). “Senior Nursing Students’ Participation in a Community Research Project: Effect on Student Self-Efficacy and Knowledge Concerning Drug Interactions Arising from Self-Medication in Older Adults.” Journal of Nursing Education, Vol.41, No. 4, pp. 178-181.
6. Saskatchewan Registered Nurses’ Association (2000). Standards and Foundation Competencies for the Practice of Registered Nurses.
Eun-Ok Im, PhD, MPH, RN, CNS, FAAN, School of Nursing, The University of Texas at Austin, and her colleagues are conducting a study to explore ethnic differences in midlife women’s attitudes toward physical activity.
You are eligible to participate in this study if you are a midlife woman aged 40 to 60 years old who does not have any mobility problems; who can read and write English; who is online; and whose self-reported ethnic identity is Hispanic, non-Hispanic (N-H) White, N-H African American, or N-H Asian.
Data will be collected through the Internet from Feb. 1, 2008 to May 31, 2011. Methods for the data collection include an Internet survey among 500 midlife women in the U.S. on the Internet and four ethnic-specific online forum discussions among about 30 midlife women per ethnic group recruited among the Internet survey participants.
Your involvement will consist of the following: (a) about 30 minutes are usually needed to complete the Internet survey questionnaire; and (b) the online forums will be conducted for 6 months, should you agree to participate in the additional online forum discussion. Your participation is asynchronous (you can visit the online forum site and read and post messages at your convenience).
You will receive a gift certificate of $10 for filling out the Internet survey, and an additional gift certificate of $50 for participating in the additional online forum (only those who participate in the additional online forum for 6 months will be provided with this additional gift certificate). To get reimbursed for the online forums, you must post at least one message per topic. For more information, please contact us.
Wa Cheng Chan, Research Assistant, School of Nursing, University of Texas at Austin 1700 Red River, Austin, TX 78701 E-mail: [email protected]
Eun-Ok Im, PhD, MPH, RN, CNS, FAAN, Professor School of Nursing, The University of Texas at Austin 1700 Red River, Austin, TX, 78701 Phone: (512) 475-6352 E-mail: [email protected]