Introduction: Knowledge is needed about the cultural experiences, patterns, and practices of American Indian women with polycystic ovary syndrome (PCOS), so nurses can provide culturally congruent care. Method: A qualitative, ethnonursing study based on Leininger’s theory of culture care diversity and universality. Data were collected from 13 key informants living on a reservation in the Western United States. Data were analyzed with Leininger’s four phases of qualitative analysis. Results: Three universal themes were identified: (1) control of PCOS symptoms is important for the cultural well-being of tribal women, (2) culturally congruent PCOS education and health care are important with variations in approaches to treatment, and (3) tribal culture is important with variations in use of tribal practices. Discussion: Tribal culture affects the health care beliefs and practices of American Indian women with PCOS. The findings can be used to improve culturally congruent care for women with this chronic condition.

Continuing education presentations have the potential to increase rural NPs' knowledge about PCOS so they can provide evidence-based care to rural women with PCOS. J Contin Educ Nurs. 2018;49(4):164-170.

Developing a nursing research project with American Indian tribes and navigating the institutional review board approval process can appear daunting to investigators because of tribal research requirements in addition to academic requirements. Nurse investigators conducted a research project exploring experiences of American Indian women with polycystic ovary syndrome. After successful implementation of the project, a model emerged to guide researchers working with tribal communities through project development and the institutional review board process. The model is based on the American Indian medicine wheel with each quadrant aligned with a season of the year: spring, summer, fall, and winter. The seasonal approach divides project development into sections that can be developed independently or simultaneously. The model emphasizes collaborative relationships between the research team and tribe. Researchers can adapt and customize the model for their projects based on their objectives and targeted populations. The purpose of this article is to describe the medicine wheel model and, as an exemplar, demonstrate application of the model in a project involving American Indian women with polycystic ovary syndrome. Additionally, potential implications of the model for nursing research, education, and practice are presented.

ED visits with a principal diagnosis (ICD-9) of EP between 2006-2014. Parameters assessed included the number of ED visits, admission rates, hospital geographic location, patient demographic characteristics, and ED charges. Ztests were performed to compare counts and proportions across groups and years. All analyses were performed using SAS 9.4 (Cary, NC). RESULTS: Nearly 75% of all ED visits for EP were in patients belonging to the 20-34 yo age group. The estimated number of ED visits increased slightly from 44,217 to 50,607 between 2006-2014 (p¼ .028), however, the overall percentage of ED visits for EP compared to all ED visits for other diagnoses in women of the same age group remained stable at 0.13% throughout the years. The average charges per patient ED visit for EP increased 120%, from $4,808 to $10,557 between 2006-2014 (p< .0001), yielding total annual charges of $213M and $534M, respectively. During the same time period, the average charges for ED visits for all other diagnoses similarly increased 121%, from $1,336 to $2,948. Hospital admission rates for EP decreased from 51.7% to 26.2% between 2006-2014 (p< .0001). In 2014, admission rates were highest for women in the 40-44 yo category (34.0%), in the West region (37.7%), in metropolitan areas with population R1M (28.9%), in patients with Medicaid or no charge (29.7% and 28.1%, respectively), and those in the lowest quartile for household income based on zip code (27.3%). CONCLUSIONS: Despite an almost 50% fall in admission rates, the number of ED visits for EP in women age 18-50 yo remained fairly stable between 2006-2014. The persistence in the number of visits for EP in the face of markedly declined admission rates suggests an opportunity to improve the less expensive non-ED outpatient management of EP, possibly by increasing the number of clinics equipped to dispense methotrexate and offer same day ultrasound and lab testing. Furthermore, disproportionately higher ED utilization by women with Medicaid coverage and women from zip codes in the lowest income quartile raises questions about disparities in access to care and ability to follow up, suggesting we have a need for more equitable health care in treating women with EP.