Living with Symptoms: A Qualitative Study of Black Adults with Advanced Cancer Living in Poverty.

Cancer is associated with disease-related and treatment-related symptoms. Little is known about the symptom experience of black individuals with advanced cancer especially those with limited financial resources. Therefore, the purpose of this study was to explore the symptom experience of black adults with advanced cancer living in poverty. This qualitative descriptive study focused on the perspectives of the participants experiencing at least two symptoms related to cancer. A purposive sample of 27 individuals receiving care at a public hospital in a southeastern city participated in the study. Semi-structured audiotaped interviews were conducted by two research interviewers. Content analysis was used to develop themes to describe the symptom experience. Two main themes emerged in terms of the participants' symptom experiences: (1) "living in pain," which included the overwhelming experience of pain, both physical and emotional, and (2) "symptoms associated with functioning in everyday life." Participants frequently used the context of activities in their daily lives to explain symptoms, including the effect of symptoms on the activities of eating, moving and doing, and communicating. People with advanced cancer work to negotiate a high frequency of multiple distressful symptoms of severe-to-moderate severity. Information gained from this study can help guide research in symptom science and provide direction for clinicians working with this minority group.

Rate and predictors of human papillomavirus vaccine uptake among women who have sex with women in the United States, the National Health and Nutrition Examination Survey, 2009-2012.

AIMS AND OBJECTIVES: To examine rates and associated correlates of human papilloma virus vaccine uptake in women who have sex with women in the United States, and to determine whether they differ from those in women who do not have sex with women. BACKGROUND: Women who have sex with women are at risk for human papilloma virus infection but are less likely to receive preventive gynaecological services. Little research has been carried out to evaluate human papilloma virus vaccination rates and associated predictors of vaccination uptake in this population. DESIGN: Cross-sectional descriptive study. METHODS: Data from two consecutive cohorts of the National Health and Nutrition Examination Survey conducted by the United States' Centers for Disease Control were analysed. RESULTS: The sample (N = 1105) consisted of women aged 18-26 years. There was no difference in human papilloma virus vaccine uptake between women who have sex with women and women who do not have sex with women. Overall, the vaccination rate was low (32·5%). Having health insurance and more education were significant predictors of vaccine uptake in women who have sex with women. Higher education and younger age were predictors in women who do not have sex with women. CONCLUSIONS: Vaccination rates of women are far lower than the national target of 80%. The predictors of vaccine uptake were different in women who have sex with women than for women who do not have sex with women. RELEVANCE TO CLINICAL PRACTICE: Women in their 20s (regardless of their sexual orientation) should be recognised as an undervaccinated population and require targeted interventions to improve vaccination uptake.

Assimilation of Expert Clinician Into the Academy: A Competency-Based Faculty Development Plan.

BACKGROUND: As expert clinicians are recruited to academic positions in response to nursing faculty shortages, comprehensive plans are needed for transitioning and role development. PROBLEM: Schools of nursing often lack infrastructures to support and develop new faculty. APPROACH: Team members from an academic-clinical partnership with the Department of Veterans Affairs created a competency-based faculty development plan. OUTCOMES: A comprehensive self-directed faculty development plan was established that included a needs assessment, competency-based guide, and online modular resources. CONCLUSION: The faculty development plan provides a tailored approach to support the transition of clinicians to the academic role. This strategy is a potential solution to addressing the faculty shortage, retention, and role strain issues and builds capacity in schools of nursing. This innovative plan is a first step in establishing a mechanism to measure faculty competencies and professional growth.

Managing One's Symptoms: A Qualitative Study of Low-Income African Americans With Advanced Cancer.

BACKGROUND: African Americans endure disproportionately high advanced cancer rates and also are disproportionately represented in the lower socioeconomic strata. These individuals work to manage symptoms in order to function and have a satisfactory quality of life. OBJECTIVE: The purpose of this study was to discover what low-income African American adults with advanced cancer do on a day-to-day basis to relieve and manage symptoms. This study viewed the individuals as experts and asked them not what they are told to do, but rather what they actually do. METHODS: A purposive sample of 27 individuals participated in semistructured interviews conducted by 2 research interviewers. This qualitative descriptive approach used content analysis to develop themes to describe symptom self-management. RESULTS: Participants described 2 approaches: making continual adjustments and finding stability through spirituality. In seeking comfort from the distress of their symptoms, they were constantly altering their activities and fine-tuning strategies. They adjusted medical regimens and changed the speed and selection of daily activities, including comfort measures and diet modifications. In contrast, their spirituality was a consistent presence in their lives that provided balance to their unstable symptom experience. CONCLUSIONS: This study illustrates that people with advanced cancer actively engage in multiple complex self-management strategies in response to symptoms. IMPLICATIONS FOR PRACTICE: As providers assess how individuals manage their symptoms, they must find ways to support those efforts. Providers then will recognize the challenges faced by advanced cancer patients in obtaining the best quality of life while managing multiple symptoms, activities, and family responsibilities.

Sleep/Wake patterns of individuals with advanced cancer measured by ambulatory polysomnography.

PURPOSE: Sleep/wake disturbances are prevalent in patients with advanced cancer, but 24-hour polysomnography (PSG) examinations of these patterns have not been undertaken. The purpose of this study was to describe these sleep/wake patterns using continuous PSG and to explore relationships with selected demographic and clinical variables. PATIENTS AND METHODS: The sample included patients with advanced cancer (solid tumors); those with neurologic disorders or psychosis, substance abuse, or brain metastasis were excluded. The final sample included 114 participants with a mean age of 51.1 years (+/- 9.1 years). Participants underwent continuous, ambulatory PSG for 42 hours in their home environments. Standard PSG measures were calculated. Analysis included data from 2 nights and the intervening day. Descriptive statistics were used to summarize sleep/wake parameters of the average of the 2 nights and the intervening day. Nonparametric analyses were used to detect differences and relationships among the variables. RESULTS: Compared with normative data, participants had reduced quantity and quality of nocturnal sleep and episodes of sleep scattered throughout the day. Increased daytime sleep was negatively associated with several key parameters of nocturnal sleep quantity and quality. Women, whites, and those who were married/partnered and had more education had better nocturnal sleep. Cancer type and selected medications may be risk factors for disturbed sleep and waking. CONCLUSION: Participants experienced severe difficulty with "state maintenance", or the ability to maintain both the sleep and waking states. Research designed to identify the etiology of these problems is needed to develop effective interventions.

Sleep-wake disturbances and quality of life in patients with advanced lung cancer.

PURPOSE/OBJECTIVES: To examine the scope and severity of subjective sleep-wake disturbances in patients with lung cancer and compare them to a group of healthy adults who were similar in age, gender, and race, and to examine the impact of sleep-wake disturbances on measures of health-related quality of life (QOL). DESIGN: Descriptive, comparative. SETTING: University-based and private urban ambulatory care clinics. SAMPLE: 43 patients with advanced non-small cell or small cell lung cancer and 36 healthy adults. All participants were cognitively intact, and none had any known neurologic disorder, polysomnographically diagnosed sleep disorder, mood or anxiety disorders, or cerebral metastasis. METHODS: Questionnaires, interview, and medical record review. MAIN RESEARCH VARIABLES: Nocturnal sleep (quality, quantity, and disturbance), daytime sleepiness, and health-related QOL (physical, mental). FINDINGS: Patients with lung cancer had poor perceived nocturnal sleep quality and excessive daytime sleepiness that differed significantly from the comparison group. Sleep disturbances in the group with lung cancer were characterized by breathing difficulty, cough, nocturia, and frequent awakenings. Sleep-wake disturbances were significantly associated with poorer health-related QOL after controlling for group. Excessive daytime sleepiness was associated most often with decreases in mental health, whereas poor nocturnal sleep was associated most often with decreases in physical health. CONCLUSIONS: Findings suggest that sleep-wake disturbances are common in patients with lung cancer and that the disturbances are significantly associated with health-related QOL. Patients with lung cancer may be at risk for sleep-disordered breathing. IMPLICATIONS FOR NURSING: The magnitude of nocturnal sleep disturbance and daytime sleepiness identified in this study reinforces the importance of ongoing screening and effective intervention for sleep-wake disturbances in patients with lung cancer.

Sleep-wake disturbances in people with cancer part II: evaluating the evidence for clinical decision making.

PURPOSE/OBJECTIVES: To evaluate the quality of evidence on sleep-wake disturbances in people with cancer as a basis for clinical decision making and to discuss implications of the evidence for oncology clinicians, educators, and researchers. DATA SOURCES: Published, peer-reviewed articles. DATA SYNTHESIS: Members of the 2001 Oncology Nursing Society (ONS) Advanced Practice Nurse Retreat Evidence-Based Practice Sleep Working Group selected and evaluated data sources using criteria and processes outlined by ONS. CONCLUSIONS: The development of nursing science related to sleep-wake disturbances among people with cancer and the application of research findings to clinical decision making are limited by the quantity and quality of published evidence. IMPLICATIONS FOR NURSING: Clinicians are challenged to develop a plan of care that includes the assessment of sleep-wake disturbances and interventions to address them. Nurse educators are challenged to include sleep-wake content and skills to evaluate empirical data and interventions for sleep-wake disturbances in degree and continuing education curricula. Nurse researchers are challenged to specify consistent conceptual and operational definitions of key variables in sleep-wake models, use measurement instruments with evidence of reliability and validity, and design clinical trials to test interventions for sleep-wake disturbances among people with cancer.

Sleep-wake disturbances in people with cancer part I: an overview of sleep, sleep regulation, and effects of disease and treatment.

PURPOSE/OBJECTIVES: To provide an overview of normal sleep, describe common sleep disorders, and discuss underlying sleep regulatory processes and how cancer, cancer treatment, and associated patient responses may adversely affect sleep. DATA SOURCES: Published peer-reviewed articles and textbooks. DATA SYNTHESIS: The duration, structure, and timing of sleep have a profound impact on health, well-being, and performance. Patients with cancer may be at risk for disturbances in sleeping and waking resulting from disease- and nondisease-related circumstances that interfere with normal sleep regulation, including demographic, lifestyle, psychological, and disease- and treatment-related factors. CONCLUSIONS: Patients with cancer are at high risk for sleep-wake disturbances. IMPLICATIONS FOR NURSING: An understanding of normal sleep, sleep pathology, and the factors that can precipitate sleep disturbance provides a context for nurses to interpret sleep complaints in their patients, evaluate responses to sleep-promoting interventions, and guide decision making regarding referrals.