Experiences of genetic counselors in referring young and metastatic breast cancer patients to support services: A needs assessment.

OBJECTIVE: Conduct a needs assessment to explore the experiences, barriers, and needs of genetic counselors (GCs), who counsel and refer young and metastatic breast cancer (BC) patients to support services, in order to develop resources to address any noticeable gaps. METHODS: GCs providing care to BC patients were eligible to complete the survey. Support services were defined as resources to address patient-centered healthcare, emotional, and quality-of-life needs. RESULTS: Most participants (n = 117) reported familiarity with cancer prevention services (93%); fewer were familiar with services secondary to a BC diagnosis (e.g., fatigue=16% and sexual health=24%). The volume of GCs indicating familiarity with support services increased significantly as work experience increased for seven services. Many (>50%) never referred patients to most (9/12) support services, excluding cancer prevention, mental health, and financial issues. Open-ended responses highlighted that GCs considered referrals to be outside their scope of practice or that healthcare systems prevent GCs from making referrals. CONCLUSION: GCs may benefit from curated resources and materials, especially for support services secondary to a BC diagnosis, to better support their patients. PRACTICAL IMPLICATIONS: Collaboration of GCs with other health professionals through integrative care programs may decrease burdens to accessing support services.

Pediatric nurse educator shortage: implications for the nursing care of children.

Maternal and child health (MCH) nurses are vital to caring for the nation's infants, children, and adolescents. A shortage of pediatric nursing educators has important consequences for the preparation of the next generation of MCH nurses. A Web-based survey of administrators and pediatric nursing faculty from U.S. schools of nursing with baccalaureate and advanced degree programs was conducted to assess perceptions of a pediatric nursing faculty shortage, and implications and solutions to such a shortage. Deans (n = 191) and pediatric faculty (n = 237) from schools of nursing responded to the survey. Institutions are representative of the 660 schools of nursing across the United States. Fifty percent of deans and 70% of pediatric nursing faculty members reported a shortage of pediatric nursing faculty. Large, public institutions (total school student enrollment over 15,000) expressed the most concern. The educational impact of the reported shortage included increased faculty workload, difficulty getting appropriate clinical practice settings, elimination of acute care clinical experiences, and reduction in pediatric content in curricula. Expected retirements of the current workforce (76% were over 45 years of age) without an increase in replacements will deepen the shortage in the coming decade. Pediatric faculty members focused on the need for competitive salaries (particularly compared to clinical salaries) and active mentoring programs as important factors in recruitment and retention of new faculty. Recommendations for stemming the decline in availability of pediatric nursing faculty are provided.

Urban American Indian family caregivers' perceptions of barriers to management of childhood asthma.

American Indian family caregivers of children with asthma face numerous barriers to effective management of the illness. The purpose of this qualitative, community-based study is to identify those barriers as perceived by family caregivers in a large Midwestern city. An ecological perspective and principles of family-centered care provided the theoretical orientation for the study. Interviews were conducted with 16 urban Ojibwe family caregivers of children with asthma. Five categories of barriers characterize the families' experiences: provider (individual and system), condition-related, family caregiver, socioeconomic, and environmental. Examination of these findings suggests directions for improving care to American Indian children with asthma and their families.