1. Identify the clinical experience and describe the events noting the 4 areas of Community Health Nursing: Intake, Chronic Care, Medication Administration, and Episodic Care/Sick Call.2.

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1.            Identify the clinical experience and describe the events noting the 4 areas of Community Health Nursing:  Intake, Chronic Care, Medication Administration, and Episodic Care/Sick Call.

2.            Based on your knowledge of the core functions and essential services of public health nursing and/or community based nursing, what did you observe to be the role of the RN and/or other personnel involved in this clinical experience/event?

3.            What was positive about this experience?

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4.            What concerns can you identify about this experience?

5.            How will today’s experience enhance your knowledge base?

6.            Research a different topic area (see weekly topics choices below) per week and its application to Public/Community Health Nursing.  Write a reflection paper (minimum of 3 pages) incorporating your research and your reflection on the topic.

7.            A copy of a scholarly article must be attached to each entry.

8.            Modified APA format will be used, including a Reference Page and Title Page, as well as citation(s) within the paper.


Needs to include :did you observe the 4cares of community chronic one medication administration episode care


Core function be specific


Positives


Concerns


Knowledgebase


Discuss your article incorporating it

1. Identify the clinical experience and describe the events noting the 4 areas of Community Health Nursing: Intake, Chronic Care, Medication Administration, and Episodic Care/Sick Call.2.
Clinical Journal Identify the clinical experience and describe the events noting four areas of Community Health Nursing: Intake, Chronic Care, Medication Administration, and Episodic Care/Sick Call. Intake: Open Cities Health Center covers families facing challenges, such as poverty, violence, no insurance, unemployed, and inmates, undocumented immigrants, the homeless, the retired senior citizens, and the children without health insurance. Chronic care has always been the highest priority in the Open cities Health Center. Clients who have chronic diseases like diabetes and hypertension are given the best attention possible. Majority of the clients who attend the Open cities are lower class clients who have either high school or GED as their highest level of education. The two most important chronic diseases covered by the Open Cities Health Center are; diabetes and hypertension. During my clinical experience , I was able to offer some education about diabetes with the help of the wonderful medical assistants. I had an opportunity to interview diabetic patients and most of them were African Americans. A disproportionate number of African American are affected by type 2 diabetes. According to the Centers for Disease Control and Prevention (CDC; 2012) it is estimated that by the year 2050 as many as one third of all Americans will be diabetic or at a high risk of developing the disease. (“CDC Press Releases”, 2012) Type 2 diabetes is the most common and it is characterized by an inability of the body to produce or appropriately metabolize insulin. (“Current Approaches to Support the Psychosocial Care of African American Adults with Diabetes: A Brief Review”, 2012) Diabetes is the seventh leading cause of death in the United States, and currently 8% of the U.S. population or nearly 26 million people are affected by this condition; the Centers for Disease Control and Prevention (CDC; 2012) estimates that by the year 2050 as many as one third of all Americans will be diabetic or at high risk of developing the disease. (“CDC Press Releases”, 2012) During my interview with three diabetic patients, I found out that most of them have diabetes related complications. Most of these patients are non- compliant and this has led to them having diabetic related complications. I asked them if they got education about the diabetic disease. The response I got was that they are frustrated with the diabetes self-care routines, they feel overwhelmed by disease related lifestyle changes and the perceived loss of control among the newly diagnosed adults has greatly contributed to their being non- compliant. Most of the clients when they are newly diagnosed with diabetes, they tend to monitor their blood sugar, get involved in more intense exercise routine, administer insulin as needed and follow up appointments with primary doctors. With time, the diabetic patients experience psychosocial distress and depression usually associated with poor adjustment to a diabetic diagnosis and the new life style changes. This is usually aggravated by lack of family, community and professional support. (Mitchell & Hawkins, 2014). As a result this leads to Poor management of Type 2 diabetes which can result in disabling complications that include a lower life expectancy, increased risk of heart disease, lower limb amputation, kidney failure, and adult-onset blindness. (Mitchell & Hawkins, 2014) The diabetic related complications make it critical to continue to develop clinical Strategies for social workers and other health care providers working with this population. Clinical strategies need to be developed in order to reduce and control the high rate of type 2 diabetes among African Americans. Effective strategies need to be implemented towards African American with type 2 diabetes. Most of the diabetic patients do not have confidence about diabetes management and this is usually mistaken for medication non- compliance. As previously discussed, receiving emotional, social, psychological, material, and educational support (i.e., psychosocial care) can have a significant impact on successful diabetes management, particularly among populations with high rates of psychological distress related to diabetes diagnoses and management such as African Americans. (Mitchell & Hawkins, 2014). Social workers can play a critical role in providing services and support to individuals with diabetes. After my interaction with the diabetic patients, some strategies need to be applied to help them manage the disease so as to avoid secondary complications. Some of the strategies include encouragement Community based psychosocial care: Diabetic patients should be encouraged to join diabetic community groups. Community-based participatory strategies are among the most well studied methods of addressing psychological, social, and educational barriers to diabetes self-management in African American communities. Diabetic patients should be encouraged to express their feelings about diabetics, the struggles they go through trying to adhere to the diabetic diet, financial struggles of getting insulin. Community based diabetic groups have greatly benefitted the diabetic patients. For example in Michigan, the racial and ethnic approaches to community health (REACH) program was an innovative study in Detroit that targeted 150 African Americans and Latinos with diabetes. This intervention was arranged with vital input from local community members on form of focus groups and a community advisory board. With the help of the intervention, local residents were trained as “ family health advocates” to deliver education focused on stress reduction, depression, health eating habits, physical activity and the use of social support to maintain life style changes. A number of family health advocates were also trained to empower the diabetic patients. According to Two Feathers et al., 2005, participants experienced tremendous improvements in their blood sugar control, improved knowledge about self-care and diabetes management. As a result, the participants were provided with non- judgmental environment where they could express themselves without any fear. In conclusion, African American diabetic patients should be encouraged to join diabetic community groups in order to address their fears as far as diabetic management is concerned. References CDC Press Releases. (2019). Retrieved from https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html Mitchell, J., & Hawkins, J. (2014). Current Approaches to Support the Psychosocial Care of African American Adults with Diabetes: A Brief Review. Social Work In Public Health, 29(6), 518-527. doi: 10.1080/19371918.2014.888533 Two Feathers, J., Kieffer, E., Palmisano, G., Anderson, M., Sinco, B., & Janz, N. et al. (2005). Racial and Ethnic Approaches to Community Health (REACH) Detroit Partnership: Improving Diabetes-Related Outcomes Among African American and Latino Adults. American Journal Of Public Health, 95(9), 1552-1560. doi: 10.2105/ajph.2005.066134
1. Identify the clinical experience and describe the events noting the 4 areas of Community Health Nursing: Intake, Chronic Care, Medication Administration, and Episodic Care/Sick Call.2.
Running head: CLINICAL JOURNAL Reflective Clinical Journal- #1 Reflective Clinical Journal- #1 In this reflective journal, this writer would reflect on her clinical experience by describing the events that was noted. During clinical rotation with the correctional nurse, this student observed certain role the nurses played while they cared for their patients. This journal would also reflect on certain positive areas, knowledge gained, and the areas that were concerning. Finally, this writer would reflect on the research article that evaluating the ways of controlling tuberculosis in prison. Identify the clinical experience and describe the events noting the 4 areas of community Health Nursing: Intake, Chronic Care, Medication Administration, and Episodic Care/Sick Call. This writer was able to observe the intake, chronic care, medication administration, and episodic care process. The intake process involves the processing of a new inmate by the correctional officer. The correctional officer would ask them some set of questions about their physical health, mental health, and history of drug usage and then send the information to the correctional nurses. The correctional nurse then do a quick triage to identify the high risk patient such as those with history of drug usage so that they would be able to closely monitor for withdrawal symptoms. The correctional nurse obtains a health record from an inmate’s primary care provider in other to have access to the medication they are on and to ensure continuity of care. The inmate with history of chronic illness who requires chronic care are seen regularly by the correctional nurse and accessed based on their chronic disease. An example would be to ensure that those who have hypertension have their blood sugar monitored. Medication administration occurs three times a day by the correctional nurse. The correctional nurse goes to administer the meds under a secured and monitored environment in other to ensure the safety of the nurses. The correctional nurse ensures the medication administered is swallowed prior to leaving. This writer was fortunate to see a case of an acute asthmatic attack. The correctional nurse was promptly alerted to see this inmate. The inmate was accessed and then moved to the nursing unit for oxygen to be commenced as well as albuterol. The nurse monitored the inmate until he was stable enough with no difficulty breathing before discharging him back to the unit. This inmate was also educated on ways of avoiding predisposing factors. What was Positive about this experience? This writer learned a lot from observing the facility, the nurses, and the correctional officer. The correctional nurses treated the inmate who had the asthmatic attack with genuine care and kept observing him. The correctional nurse’s also responded promptly to an emergency case during this rotation. What concerns can you identify about this experience? This writer was concerned about the amount of time the correctional nurse had with each clients. The clients had little or no time to express themselves about their health issues making the quality of care delivered minimal. Another concern is the level of confidentiality. This writer felt like the inmates did not have their health information protected or private enough and seemed like the Health Insurance Portability and Accountability Act (HIPAA) did not apply to the inmates. How will today’s experience enhance your knowledge base? This clinical rotation is the first time this writer was exposed to and learning about how health care is delivered in a correctional facility. The writer learned about ways to ensure and maintain safety in this environment and also learned about the management of an asthmatic attack. Finally, this writer gained knowledge about how the healthcare funding of inmate in a correctional facility. Research Article This writer’s research article is on healthy people 2020 and it’s effect on pediatric nurses (Meadows-Oliver & Allen, 2012). Healthy People 2020 are aimed at improving healthy living in the United State. Healthy people 2020 was released in December 2010 and focused on increasing the awareness of determinant of health and the improvement of research and the use of evidence based practices (Meadows-Oliver & Allen, 2012). Several new topics were added to Healthy People 2020 to help achieve health equity and eliminate disparity among children and adolescent. Nurses should make it a goal to improve the health and safety of adolescent in other to prevent accidents and injury, which is known to be the highest killer of individual’s in this age group (Meadows-Oliver & Allen, 2012). According to the article, homicide, suicide, sexually transmitted infection, and unplanned pregnancy are health issues that are common in this group that should be addressed by a community health nurse. While educating adolescent on healthier lifestyle it is important for a nurse to provide an environment of safety and trust in other for the adolescent to be comfortable and be able to open up to the nurse. The article by Meadows-Oliver and Allen (2012) showed a study on adolescents about what they felt about how to improve health and wellness in them and concluded that adolescent viewed attitude, confidentiality, and good communication skills as the key to reach out to adolescent. In other for Healthy People 2020 to meet the objective the community must be involved. A nurse must be aware of this and thus encourage community involvement in other to achieve this goal. In addition to this, a nurse must also set a goal and objectives that must be followed and measured with a specific time frame for Healthy People 2020 to be a reality. Conclusion In summary, this writer did a reflection journal on her first clinical experience in public health. This writer was able to gain from this experience and believes that this would be useful during her nursing career. Finally, this writer is opened to learning more about public and community health nursing during the next clinical day. References Meadows-Oliver, M., & Allen, P. L. J. (2012). Healthy People 2020: Implications for Pediatric Nurses. Pediatric Nursing, 38(2), 101–105. Retrieved from http://ezproxy.rasmussen.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=104551980&site=eds-live
1. Identify the clinical experience and describe the events noting the 4 areas of Community Health Nursing: Intake, Chronic Care, Medication Administration, and Episodic Care/Sick Call.2.
Social Work in Public Health, 29:518–527, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 1937-1918 print/1937-190X online DOI: 10.1080/19371918.2014.888533 Current Approaches to Support the Psychosocial Care of African American Adults with Diabetes: A Brief Review Jamie Ann Mitchell School of Social Work, Wayne State University, Detroit, Mic higan, USA Jaclynn Hawkins School of Social Work, University of Michigan, Ann Arbor, Mi chigan, USA African Americans are disproportionately affected by Type 2 diabetes and experience signi cantly higher age-adjusted prevalence of the disease. Psychosoci al support, material resources, and education can have a signi cant impact on successful diabetes managem ent, particularly among populations with diabetes-related psychological distress such as Afri can Americans. This brief review of the literature identi es and synthesizes current evidence on f aith-based, community-based, empowerment- based, strength-based, and culturally competent strategi es that may be particularly relevant for social work practitioners supporting African American adults at r isk for or diagnosed with Type 2 diabetes. Discussion focuses on multiple in uences on the self-deter mination of clients working to manage their condition. Keywords : Diabetes, African American, social work With the increase in numbers of Americans living with diabet es, speci cally among minority populations, clinicians are seeing an increase of clients w ith diabetes and diabetes-related com- plications. Often overlooked is the lack of psychosocial ca re available to individuals managing a Type 2 diabetes diagnosis. Psychosocial care has been desc ribed in the diabetes care literature as social, psychological, and emotional support, material resources, and education that helps to reduce stigma, promote social functioning, and improve qua lity of life (Barnard, Peyrot, & Holt, 2012) for individuals with diabetes. Prior relevant litera ture found that frustration with diabetes self-care routines, feeling overwhelmed by disease-relat ed lifestyle changes, and a perceived loss of control are common among newly diagnosed adults (Pouwer e t al., 2010; Roy & Lloyd, 2012). For example, it is common for individuals newly diagnosed wi th diabetes to be expected to monitor or address their blood sugar, a new or more intense exercise r outine, insulin supplementation and other medications, and several health care appointments wi th primary physicians and specialists (Ayalon et al., 2008). There is a growing literature base ind icating that African American adults are at increased risk for experiencing psychosocial distre ss and depression associated with poor adjustment to a diabetes diagnosis and the accompanying lif estyle changes (Spencer et al., 2006), particularly when exacerbated by a lack of family, communit y, or professional support (Chesla et al., 2004; Kogan, Brody, Crawley, Logan, & Murry, 2007). Address correspondence to Jamie Ann Mitchell, MSW, PhD, Ass istant Professor, School of Social Work, Wayne State University, 337 Thompson Home, 4756 Cass Avenue, Detroit, M I 48202, USA. E-mail: [email protected] 518 PSYCHOSOCIAL CARE OF AFRICAN AMERICANS WITH DIABETES519 A community-based qualitative study of African American ad ults with Type 2 diabetes in Arkansas indicated that helplessness, fatalism, and fear o f failure about adhering to rigid diet, exercise, and medication recommendations was a reported ba rrier to self-con dence about diabetes management (Bhattacharya, 2012). Although several studie s exist examining the psychosocial bar- riers facing adults with Type 2 diabetes generally, few in re cent years address speci c interventions or approaches employed with African American patients to im prove their psychosocial health in the context of their diabetes care (Steinhardt, Mamerow, Br own, & Jolly, 2009). Thus, the purpose of this review is to highlight successful or promising strat egies speci cally tailored to African Americans with Type 2 diabetes as described in peer-reviewe d literature, as a resource for social work clinicians supporting this population. Diabetes Epidemiology Calling attention to effective clinical strategies for wor king with clients with diabetes is essential given the increasing number of Americans living with diabet es and diabetes-related complications. Diabetes is the seventh leading cause of death in the United S tates, and currently 8% of the U.S. population or nearly 26 million people are affected by this c ondition; the Centers for Disease Control and Prevention (CDC; 2012) estimates that by the yea r 2050 as many as one third of all Americans will be diabetic or at high risk of developing the d isease. Type 2 diabetes is the most common form of this condition, which is characterized by an i nability of the body to produce or appropriately metabolize insulin (Naranjo, Hessler, De ol, & Chesla, 2012). Poor management of Type 2 diabetes can result in disabling complications tha t include a lower life expectancy, increased risk of heart disease, lower limb amputation, kid ney failure, and adult-onset blindness (Katzmarzyk & Staiano, 2012), making it critical to highlig ht and continue to develop clinical strategies for social workers and other health care provide rs working with this population. The increased prevalence of diabetes and diabetes-related complications among African Amer- icans requires more attention be given to calling attention to and developing clinical strategies in this population. African Americans are disproportionat ely affected by Type 2 diabetes and experience signi cantly higher age-adjusted prevalence o f the disease (including diagnosed and undiagnosed cases) compared to non-Hispanic Whites (Katzm arzyk & Staiano, 2012); with nearly 13% of all African Americans older than age 20 diagnosed with diabetes compared to just 7.1% for non-Hispanic Whites (Castro, Shaibi, & Boehm-Smith, 20 09); and an additional 7% of African Americans have undiagnosed diabetes (Naranjo et al., 2012) . In addition, African American adults are between 2 and 4 times more likely to experience blindness , amputations, and renal disease as a result of their unmanaged diabetes than Whites of the same a ge (CDC, 2012), and 20% more likely to die of those diabetes-related complications than their White counterparts (Naranjo et al., 2012). As a result of the disproportionate impact of diabete s on African Americans, the following focuses on and overview of clinical strategies within this p opulation. This article is a minireview of effective psychosocial clin ical strategies for working with clients with Type 2 diabetes. A systematic literature review was con ducted using PubMed, Cochrane Library, and Scopus from 2000 to January 2012 to assess the cu rrent status of psychosocial clinical strategies for working with persons with Type 2 dia betes, speci cally African Americans. Although the literature base on psychosocial strategies sp eci cally targeting African Americans with diabetes is somewhat limited, we feel that the scope of t ime chosen for this review strikes the appropriate balance of recency and attention to the chan ging landscape of knowledge and interventions for diabetes care. Studies were identi ed us ing the following headings and search terms alone and in combination: diabetes, clinical, program, intervention, adult, Black, African American, self-management, self-care, utilization, andhealth care use . To the author’s knowledge, no other literature review exists that focuses on identifyi ng effective clinical strategies for social work practitioners working with persons with Type 2 diabete s. The authors conducted a critical 520J. A. MITCHELL AND J. HAWKINS review of the literature .The following offers an overview o f psychosocial strategies in diabetes care and concludes with directions for future research. As s tated previously, the purpose of this article is to review effective clinical strategies in diabe tes care speci cally tailored to African Americans with Type 2 diabetes, as described in peer-review ed literature, in an effort to assist social work clinicians working with this population. An Overview of Psychosocial Strategies in Diabetes Care As previously discussed, receiving emotional, social, psy chological, material, and educational support (i.e., psychosocial care) can have a signi cant imp act on successful diabetes manage- ment, particularly among populations with high rates of psy chological distress related to diabetes diagnoses and management such as African Americans. Althou gh we know that social workers can play a critical role in providing services and support to individuals with diabetes, the literature on psychosocial interventions designed or delivered by soc ial workers in this area is scant. The following discussion covers a range of multidisciplinary s trategies that highlight trends in diabetes- related psychosocial care of African Americans with diabet es. Although each of these strategies are not exclusively social work focused, they are particula rly relevant for social work practitioners supporting individuals at risk for or diagnosed with Type 2 d iabetes. Predominant psychosocial strategies for diabetes care inc lude the empowerment, faith-based, cultural competence, and community-based approaches. The empowerment approach has been used to assist persons with diabetes to engage in diabetes se lf-management (Two Feathers et al., 2007). Anderson, Funnel, and Arnold (2002) stated that the e mpowerment approach involves three principals that integrate “the psychology of behavio r change” to promote successful diabetes management. The principles include (a) an acknowledgment t hat a majority of diabetes care relies on action by the patient making the patient the locus of contr ol and primary decision maker in regular diabetes self-care activities; (b) identifying he alth care teams primary tasks as providing psychosocial support, be a resource for diabetes education to ensure clients can make informed decisions regarding diabetes self-care; and lastly (c) req uiring health care professionals keep in mind that behavior change is more likely to occur when client s engage in change behavior that is salient on a personal level. Diabetes lifestyle interven tions that have utilized the empowerment approach as described by Anderson, Funnel, and Arnold (2002 ) by providing psychosocial support and diabetes education in a way that empowers clients and eng ages them in the decision process, have resulted in increased diabetes self-management in at- risk populations (Two Feathers et al., 2007). Social work practitioners working with individuals with a diabetes diagnosis can utilize the empowerment approach to help clients achieve successfu l diabetes self-management. Faith-based psychosocial approaches to diabetes care have also been utilized with success- ful results, particularly in the African American communit y (Boltri et al., 2006). Faith-based psychosocial approaches involve engaging community membe rs in church-based settings and integrating aspects of faith into diabetes self-care, such as beginning diabetes education classes with prayer and administering intervention components bef ore or after church services (Boltri et al., 2006; Hoyo et al., 2004). Faith-based settings can pr ovide the ideal setting for helping communities engage in diabetes education, prevention, and self-care particularly because of the existing social networks and support, the potential histor y of other health-related programs, and because the African American community is already at greate r risk for the disease (Campbell et al., 1999; Oexmann, Ascanio, & Egan, 2001). It is importan t for social workers to emphasize the integration of faith-based strategies for certain populat ions to ensure successful diabetes prevention and management. Culturally competent psychosocial strategies can also enh ance the promotion of diabetes self- care within diverse populations (Brown, Garcia, Kouzekana ni, & Hanis, 2002; Whittemore, 2007). Culturally competent diabetes care integrates the cultura l characteristics of the targeted population PSYCHOSOCIAL CARE OF AFRICAN AMERICANS WITH DIABETES521 with standard diabetes self-care practices (Brown et al., 2 002), such as delivering care accessible community-based locations, using the client’s native lang uage, engaging in self-care activities that are culturally relevant (i.e., integration of culturally t ailored diet regimens), and utilizing commu- nity members and/or leaders to deliver diabetes education ( Brown et al., 2002; Whittemore, 2007). Community-based (or population-based) approaches to deli vering diabetes-related care can lead to increased knowledge and preventive behaviors (such as adherence to physical activity and dietary guidelines; Satter eld et al., 2003; Two Feathers e t al., 2007). A goal of community-based care is to assess community strengths and integrate cultura l characteristics into diabetes care and to deliver care in the community setting. One such techni que, participatory action research (PAR), involves researchers working with and supporting th e community to develop strategies to best engage in diabetes-related care in a culturally rele vant way (Green, Daniel, & Novick, 2001; Harris & Zinman, 2000; Minkler, 2000). Social workers should engage in community-based approaches to more effectively deliver care to at-risk popu lations. Below offers a more in-depth discussion of these psychosoci al strategies, speci cally, empow- erment and cultural competence perspectives, and faith-ba sed, and community-based approaches. TRENDS IN DIABETES-RELATED PSYCHOSOCIAL CARE OF AFRICAN AMERICANS Empowerment and Strengths Perspective in Psychosocial Car e Two prominent strategies employed in psychosocial interve ntions with various client populations in social work practice are the empowerment and strengths pe rspectives.Empowerment practice in social work can be de ned as “a social action process by whi ch individuals, communities, and organizations gain mastery over their lives in the context o f changing their social and political environment to improve equity and quality of life” (Wallers tein, 2002, p. 73). Empowerment practice speaks to the value orientation that individuals a nd families bring unique experiences and resources to the table and has at their disposal, personal va lues, beliefs, identities, and strengths to draw upon for improving their situation or outcome (Dabel ko & DeCoster, 2007; DeCoster & Dabelko, 2008). Likewise, a strengths-based perspective s peaks to how social work practitioners view clients and their innate abilities to accomplish desir ed change. Strengths-based perspectives require that the social worker foster hope within the client by focusing on what clients have done successfully in the past (even if very little) and uses t hose previous successes as building blocks for future change and growth (Labonte, 1994). Streng ths perspective also promotes seeing clients as the expert on their problems and avoids stigmatiz ing labels of the client that promote the clinician as expert (Labonte, 1994). Empowerment practice has speci cally been used in working w ith clients with diabetes to pro- mote self-management and mastery of the, often burdensome, medical regimens that accompanies a diagnosis of diabetes. For example, DeCoster and Dabelko ( 2008) suggested more than 40 social work practices that promote the empowerment of older patien ts with diabetes, some being: encouraging older adults to express their feelings about di abetes; recognizing the older adult as the expert [in their care]; accept older adults and avoid trying to change them; recognize the elder in the environment; redistribute power; identify existing st rengths, competencies and resources; endorse attainable goals; solicit and support intuitive solutions ; focus on the here and now; and foster self- awareness and insight. (pp. 77–79) Additionally, Miley and DuBois (2007) encouraged social wo rkers to conceptualize empower- ment practice as a “social justice contract” between the cli nician and society at large; ensuring that social workers practice in a way that ensures “the socia l participation of individuals and their 522J. A. MITCHELL AND J. HAWKINS capacity to contribute to the resource pool of society” (p. 3 1). Empowerment-oriented social work practice most often incorporates the strengths perspectiv e. When applied to clinical interventions in diabetes prevention or management, social workers offer a unique care perspective, which seeks to partner with the clients, value their expertise, highlig ht the resources and skill set clients can utilize to solve the presenting problem, and build upon past successes to encourage future growth (DeCoster & Dabelko, 2008; Labonte, 1994; Wallerstein, 200 2). Faith-Based Psychosocial Care Social workers and other health care providers may be reluct ant to integrate aspects of a client’s spirituality or religiosity in efforts to promote diabetes education and self-management (Austin & Claiborne, 2011). However, a growing body of knowledge deli neates the usefulness of faith-based diabetes interventions, particularly for African America ns who view and value spirituality and reli- gious institutions as signi cant sources of psychological and social support (Austin & Claiborne, 2011; Kilbourne, Cummings, & Levine, 2009). For example, Au stin and Claiborne (2011), in collaboration with the health ministries (i.e., committee s or boards) of four predominately African American churches in the Northeast, developed a 7-week educ ational intervention at each of the four churches focused on heart health, healthy eating, phys ical activity, and routine health care among congregants of each church who were diagnosed with Typ e 2 diabetes (Austin & Claiborne, 2011). Using a large focus group .ND23/ comprising congregants and the input of church health ministers, investigators of this study emphasized that the key to successful implementation of this study was the integration of spiritual elements in each aspe ct of the intervention. For example, congregants insisted that each educational session in the i ntervention began and concluded with a prayer, and that educational sessions included time for ex tended discussions on how caring for one’s body is addressed in their faith and spiritual text (Au stin & Claiborne, 2011). These authors concluded that the integration of spiritual practices in co llaboration with and physically situated within such a culturally-relevant institution (i.e., chur ch) promoted increased understanding of diabetes-related education and improved speci c diabetes self-management behaviors among participants who completed the majority of intervention se ssions. Boltri et al. (2006) translated the National Institutes of Health (NIH)-Diabetes Preventi on Program (DPP) into a church-based setting focusing on the diabetes lifestyle aspect of the DDP . The DDP is an intensive diabetes lifestyle modi cation program (Knowler et al., 2002). The s tudy showed that engaging with participants in a church-based setting utilizing conducti ng blood glucose screening and diabetes education classes, resulted in better diabetes self-manag ement and positive health outcomes (Boltri et al., 2006). Beyond affecting diabetes-speci c outcomes in interventi on studies, varied aspects of religiosity have been examined for their protective effects against dep ression in individuals with Type 2 diabetes. For instance, a community-based cross-sectiona l study of lower-income adults with Type 2 diabetes who lived in low-resource communities, two third s of whom were African American, found that speci c religious practices such as religious re ading, attending services, and especially prayer, was inversely associated with depression and other indicators of psychological distress in African American participants (Kilbourne et al., 2009). Th ese authors suggested that clinicians screen for depression among diabetic patients and also incl ude discussions of religiosity in initial assessments, particularly among African Americans, so tha t clients who wish to interpret health challenges through the lens of spirituality can be appropri ately matched to resources and support. Culturally Competent Psychosocial Care Capable social work practice is built upon an understanding of and responsiveness to how social and cultural patterns in uence mental and physical h ealth status. Moreover, individual PSYCHOSOCIAL CARE OF AFRICAN AMERICANS WITH DIABETES523 and collective attitudes and motivations to engage in certa in health behaviors are shaped by these cultural in uences. Research indicates that diabetes inte rventions that are closely aligned with African American cultural values and beliefs have been succ essful in improving self-management of the disease in this population (Betancourt, Duong, & Bond aryk, 2012; DeCoster & Cummings, 2005; Utz et al., 2008; Williams et al., 2006). For example, i n a health education intervention study of rural African Americans with Type 2 diabetes, Alexa nder, Uz, Hinton, Williams, and Jones (2008) utilized an anthropological strategy called “ cultural brokerage.” This intervention was delivered by a nurse liaison who worked alongside partic ipants to bridge divides between the health system, requirements for successful diabetes self- management, and cultural norms which in uenced health behavior using what authors characterize d as an “insider perspective.” This perspective and the subsequent diabetes education int ervention sessions were informed by focus groups of African Americans with diabetes that reveal ed that participants preferred to make use of personal narratives and storytelling in the interven tion curriculum, the acknowledgment and inclusion of family or signi cant others was decisive to effective diabetes management, there were barriers to self-care that were unique to the rural envi ronment such as a lack of educational programs and medical specialists, there was a social stigma associated with being diagnosed with diabetes; and spirituality and faith was often utilize d as a reference point and source of encouragement during challenges to managing illness (Alex ander et al., 2008). This culturally- relevant knowledge became the guiding framework for how inv estigators tailored their recruitment methods, the content of intervention materials, the method s of delivering educational content, and the tone of interaction between study participants and thei r “nurse-broker” (Alexander et al., 2008). Other pilot studies utilizing trained community members as “cultural health brokers” have also been effective in improving diabetes knowledge and self-ma nagement among African American adults with Type 2 diabetes who reside in low-resource envir onments (Cadzow, Craig, Rowe, & Kahn, 2012). The cultural competence perspective also calls for clinici ans to be aware of the in uence of cul- ture on how health and mental health conditions are interpre ted in different communities (Naranjo et al., 2012). A recent study reviewed current evidence on ps ychosocial outcomes among minority adults with Type 2 diabetes and found that satisfaction with the patient–provider relationship was enhanced and medical mistrust was lessened when clinicians expressed a genuine interest in the distinctive diabetes-related experiences of African Amer ican and Latino clients (Naranjo et al., 2012). The authors also reported that an important componen t of psychosocial diabetes care is addressing the potential for depression, emotional distre ss, and reduced perceived quality of life in a way that is respectful and relevant to clients’ cultural pe rspective. They recommend clinicians acknowledge how mental illness may be perceived differentl y some racial/ethnic communities while emphasizing the potential for depression to be effect ively treated (Naranjo et al., 2012). Community-Based Psychosocial Care Community-based participatory strategies are among the mo st well studied methods of addressing psychological, social, and educational barriers to diabet es self-management in African American communities. For example, the Racial and Ethnic Approaches to Community Health (REACH) program was an innovative intervention study in Detroit, Mi chigan, that targeted 150 African Americans and Latinos with diabetes for a peer-led, cultura lly tailored lifestyle intervention (Two Feathers et al., 2005). This intervention was structured wi th signi cant input from local community members in the form of focus groups and a community advisory b oard. Not only did the culturally relevant knowledge gleaned from community members result i n 10 hours of educational sessions, but other local residents were trained as “family health adv ocates” to deliver the a curriculum focused on stress reduction, depression, health eating, ph ysical activity, and the use of social support to maintain lifestyle changes. Family health advoc ates were speci cally trained to deliver 524J. A. MITCHELL AND J. HAWKINS content using an empowerment perspective (Two Feathers et a l., 2005). The authors reported that participants experienced statistically signi cant i mprovements in blood sugar control (as measured by A1C levels at baseline and postintervention) as well as improved knowledge about proper diet and self-care (Two Feathers et al., 2005). Hendr icks and Hendricks (2000) conducted a diabetes self-management education program with 30 Afric an American men with Type 2 diabetes with the goal of testing the intervention and testi ng whether monthly and 3-month follow- up in uenced patient performance, diabetes-related quali ty of life, and diabetes-related health outcomes. Participants were recruited from diabetes organ izations located in Washington, DC, churches, and via community advertisement. The educationa l component involved a diabetes self- management portion administered at a community-based diab etes self-management center. The primary goal of the trainings was to increase diabetes knowl edge based on 15 diabetes self-care guidelines provided by the American Diabetes Association ( ADA). The trainings included lectures, group discussion, and audio and visual aids. Clinicians rel ied on establishing trust, appealing to men on a personal level, and expressing sincere interests in their health to motivate men to adhere to treatment regimens. The authors found that the intervent ion was effective on a variety of diabetes outcome measures and that men who received monthly follow-u p versus 3-month follow-up had no signi cant differences in outcomes. Anderson and colleagues (2003) evaluated the effectivenes s of personalized follow-up for African Americans diagnosed with diabetes receiving routi ne eye examinations in free community- based urban clinics; 106 patients received a diabetes eye ev aluation and were requested to complete the examination yearly. Participants were randomized to st andard follow-up (receiving a letter a month before the appointment) and to the intervention grou p, which received an “intensive personalized” intervention that involved a personal phone call after reminder letters were sent. During the phone call patients were reminded of the importan ce of getting the eye exam and addressed any barriers or concerns related to eye health. Th e study found that individuals who received personalized phone call reminders were more likel y to return for diabetes eye evaluations than those who did not. A separate qualitative study of African American REACH part icipants sought to explicate the speci c components of the intervention, which were effe ctive in participants’ estimation. Participants reported that the REACH program provided a non judgmental environment in which they could address issues with fear and motivation related t o managing Type 2 diabetes (Heisler et al., 2009). In addition, participants felt that the indiv idual attention of family health advisors, emotional support of fellow participants in the group sessi ons, and opportunities to practice and reinforce new diabetes management strategies increased th eir level of comfort interacting with health providers—speci cally in terms of asking questions and requesting medical tests and results (Heisler et al., 2009). A third study of postintervention re sults from the REACH study af rmed that using community health workers who are speci cally tra ined in empowerment strategies do facilitate improved self-management behaviors among low- income underserved African Ameri- cans with diabetes (Spencer et al., 2011). These ndings are signi cant because they represent promising alternatives to an often impersonal medical mode l of care, which may not be culturally relevant or accessible to populations with high disease bur dens and few resources. CONCLUSIONS Although this brief review of studies addressing the psycho logical and social needs of African American adults with diabetes is not exhaustive, it is illus trative of recent strategies that acknowl- edge multiple in uences on the self-determination of clien ts working to manage their condition. Social work clinicians can ascertain from this review that e fforts to address the psychosocial needs of African Americans and clients, in general, should consid er the reciprocal relationship between PSYCHOSOCIAL CARE OF AFRICAN AMERICANS WITH DIABETES525 psychological, social, and environmental factors and the d iagnosis and management of diabetes as a condition. For example, we now better understand how the ne ed to actively monitor and comply with a rigorous diabetes management plan can be psychologic ally disruptive for African American adults. As social work clinicians, it is also imperative to i dentify how preexisting mental illness could impede efforts to consistently manage a complex condi tion like diabetes. Interestingly, no studies were identi ed for review that addressed the co-o ccurrence of diabetes with one or more mental health problems; future research should explor e this speci c and relevant aspect of psychosocial care. This review was able to clarify the context in which a number o f psychosocial interventions have been applied with success. Studies were reviewed that p oint to the value of assessing participation in religious communities at the outset of the rapeutic work, giving clients time and space to express how their beliefs shape and support their he alth efforts. Drawing on culturally competent psychosocial care, we have identi ed how clinici ans may have opportunities to assess whether recommended diabetes interventions are responsiv e to the cultural context of their clients. Indeed many social workers are translating the concept of cu ltural brokerage to practice settings, tailoring teaching and learning styles, bringing cultural relevance to educational content, and uncovering unique barriers to care by using narrative techn iques that open communication channels between clients and their health providers. Further, resea rch related to improving psychological and social care in the context of diabetes management for Afr ican Americans suggests that utilizing community-based approaches, educating clients on the potential for depressive symptoms in culturally sensitive way, and acknowledging clients as e qual and engaged partners in their own care fosters improved psychosocial and health-related out comes. Lastly, empowerment practice and strengths perspectives, already prominent strategies in social work practice, were interwoven throughout several interventions across thematic categor ies—owing to the perspective that clients or patients should be provided with the information, skills , and support to in uence their own diabetes care. Embedded within empowerment and strengths p erspectives is the principle of self- determination, a core social work ethic re ected across nea rly all of the interventions reviewed. Although the REACH intervention (Heisler et al., 2009) spec i cally addressed efforts to strengthen the patient-provider relationship and include familial support, we noted a dearth of additional studies in these two areas; future research shou ld give attention to these and other important relational aspects of psychosocial diabetes car e. 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