Symptoms in children with advanced cancer: child and nurse reports.

BACKGROUND: Systematic studies on the specific symptom experience in children with advanced cancer are limited. OBJECTIVE: The objective of the study was to examine the common symptoms and to explore commonly occurring symptoms over time. METHODS: A prospective and longitudinal study design was used. Data were collected at 10 data points from 60 children over a 5-month period. Children ranged from 6 to 17 years old, spoke English or Spanish, were diagnosed with advanced cancer, and were receiving healthcare in 1 of 4 Southern California hospitals. Nurses' documentations of symptoms were examined. RESULTS: The study sample was composed of children 6 to 12 years old (52%) and 13 to 17 years old (48%); 42% were female, and 58% were male. Fifty-five percent were Latino, and 30% were Caucasian. Pain, nausea, drowsiness, and energy loss were reported by children in more than 50% of the interviews. Children's and nurses' reports of symptoms were similar except children reported significantly more frequency and intensity of pain. CONCLUSION: Children with advanced cancer were able to report and describe their symptoms. There were few differences by gender, age, and ethnicity. IMPLICATIONS FOR PRACTICE: It is important that children's symptoms are clearly communicated to nurses, and these study findings may be used to anticipate and manage the symptoms experienced by children with advanced cancer.

A bold adventure in innovation: an international off-campus master's degree program.

In response to the global shortage of nursing faculty, Loma Linda University School of Nursing offered an off-campus master's degree program to prepare nurse educators who would commit to remain in their home countries following graduation. The program was approved by the Western Association of Schools and Colleges to be offered in both English and Spanish. Students and faculty met for 1 month each year for 4 years at one of two international sites: Thailand or Argentina. Forty-five of 49 students completed the program. The cultural diversity in both cohorts enriched classroom discussions, social interaction, and student-faculty conversations. The program was a life-changing experience for all involved and helped to meet the global need for nursing faculty. The faculty reported that it broadened their world view and opened their minds to the potential for innovation to transform nursing education.

The pain experience of children with leukemia during the first year after diagnosis.

BACKGROUND: Children with cancer experience pain related to the disease process, the treatment, and the associated procedures. For children with leukemia, the pain experienced after diagnosis has received scant attention. OBJECTIVE: To examine the pain experience, management strategies, and outcomes during the first year after the diagnosis of acute leukemia. METHODS: A longitudinal descriptive approach was used to collect data at seven data points from 95 English- and Spanish-speaking children, ages 4 to 17 years, receiving care in one of three southern California hospitals, and from their English- and Spanish-speaking parents. Age-appropriate instruments were used to examine the variables of pain intensity, location, pattern over time, and quality, as well as strategies for managing pain, perceived effectiveness of management strategies, and functional status. RESULTS: All the children reported pain over the course of the year. Pain intensity scores incorporated the full range of possible responses. For the children 4 to 7 years old, the highest and lowest mean scores, respectively, were 2 and 1.6 (scale, 0-4). For the children 8 to 17 years old, the highest and lowest mean scores, respectively, were 50.1 and 39.5 (scale, 0-100). The most common location of pain was the legs (26.5%) in all seven interviews. Other frequently noted sites were the abdomen (16.6%), head/neck (16.6%), and back (14.2%). The words used most frequently by the older English- and Spanish-speaking children to describe pain were "uncomfortable" (incómodo) and "annoying" (molesto). According to the interviews, the most frequently used strategy for pain management was stressor modification (e.g., medication, sleep, hot/cold, and massage). The most common coping strategies according to a Likert scale rating were "watch TV" (n = 426), "lie down" (n = 421), "wish for it to go away" (n = 417), and "tell my mother or father" (n = 416). The pain intensity scores after pain management were significantly lower for the younger children in three of the seven interviews and for the older children in all seven interviews. For both the younger and older children, functional status (i.e., the ability to engage in routine activities) was above the median score at the seven interviews. CONCLUSIONS: Children with leukemia experience pain throughout the first year of treatment. In this study, the pain was responsive to the management strategies used by the parents and children.

Multisite research: a systems approach.

Multisite research is becoming increasingly common because of the need for an adequate sample size and for generalizability of results beyond a single facility. Collaboration in a research project poses unique challenges due to the number of persons and facilities involved. The use of a systems approach to structure the research process in a study of pain in children with leukemia is described, using the principles to structure, conduct, and conclude the multisite project.

Pain and leukemia: the stories of three children.

The stories of the pain experience of three children with acute leukemia during the first year after diagnosis are presented in this report. To provide a broad picture, children who represent various characteristics were selected: ages 6, 9, and 15 years; two male and one female; two Latino and one Caucasian; two English-speaking and one Spanish; two with acute lymphocytic leukemia and one with acute myelocytic leukemia. Consideration of the disease, procedures, treatment, and normal childhood pain experiences will provide the nurse who cares for these children guidance in knowing why and when pain may occur, which will lead to timely interventions for the pain.