Stories of Hope and Health: Wisdom From Older Mexican-American Women Who Broke Free From the Entangled Web of Love and Violence.

This interpretive qualitative study explores the lived experience of intimate partner violence (IPV) among 12 older Mexican-American women aged 55-85 with past experiences of IPV to understand how it shaped their lives. Sociocultural factors that influenced the IPV experience and sustained health amidst adversity were explored. Denzin's interpretive interactionism along with Antonovsky's salutogenic theory guided this study. These women survived IPV and discovered ways to foster health and thrive in later years. They all vowed to break the cycle of violence for future generations. Their wisdom offers hope and has implications for healthcare professionals, future research, and advocacy efforts.

Supportive Care Needs and Health-Related Quality of Life of Esophageal Cancer Survivors.

OBJECTIVE: The aim of this study is (1) to describe the prevalence and correlates of unmet needs among esophageal cancer survivors (ECS) in Korea and (2) to identify the association between unmet needs and health-related quality of life (HRQOL). METHODS: We used a cross-sectional descriptive study design. Participants were 118 ECS from a hospital in Korea who received surgery at least 12 months before participating. We collected data including the Supportive Care Needs Survey-short form 34 and to measure HRQOL, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 with a self-report questionnaire. RESULTS: Participants' mean age was 65.2 years, and 92.4% were male. Among five domains of supportive care needs, unmet need prevalence ranged from 0.8% to 50%. The most commonly reported domains of unmet needs were Health System and Information and Physical and Daily Living. Participants with unmet needs in Psychological Needs, Physical and Daily Living Needs, and Patient Care and Support Needs demonstrated significantly poorer HRQOL in almost all measured domains. CONCLUSIONS: Our finding suggests that Korean ECS had substantial unmet needs, especially in the Health System and Information domain. Psychological, Patient Care and Support, and Physical and Daily Living Needs were related to HRQOL. The study can advance understanding of priority issues in ECS.

Storytelling Through Music to Improve Well-being in Oncology Nurses: A Feasibility Study.

BACKGROUND: Professional grief is one cause of psychosocial stress that, if not attended to, may contribute to burnout and compassion fatigue. Oncology nurses often avoid their emotions and learn to cope with professional grief in isolation. Interventions aimed at professional grief are limited. OBJECTIVES: To determine the feasibility of implementing a multidimensional intervention, Storytelling Through Music, with oncology nurses. INTERVENTION/METHODS: This was a 2-group, quasi-experimental design utilizing both qualitative and quantitative methods. The 6-week intervention combined storytelling, reflective writing, music, and psychoeducation. Descriptive statistics and conventional content analysis were used to analyze the feasibility data. RESULTS: Most participants (n = 43) were female, white, working full-time in the outpatient oncology setting, with an average 8.5 years (range, 2-36 years) of oncology experience. Ninety-eight percent of the intervention was completed, and 98% of participants were retained. Analysis indicates that the intervention was acceptable, the participants learned they were not alone in their feelings, and they were supported by the group. CONCLUSIONS: Results indicate that Storytelling Through Music is a feasible and acceptable intervention to address work-related emotions and psychosocial stress in this group of oncology nurses. IMPLICATIONS FOR PRACTICE: In 2017, the National Academy of Medicine stated clinician well-being must be a priority. Participation in this study was independently sought out by the oncology nurses and completed during their personal time. A future policy recommendation is to make participation in wellness interventions part of the mandatory competency training required by accrediting bodies so that institutions ensure the well-being of clinicians as a priority.

Storytelling Through Music: A Multidimensional Expressive Arts Intervention to Improve Emotional Well-Being of Oncology Nurses.

PURPOSE: Rates of burnout among health care professionals are rising. Oncology nurses are at the forefront of cancer care, and maintenance of their well-being is crucial to delivering high-quality care to people with cancer. The purpose of this pilot study was to implement a novel intervention, Storytelling Through Music, and examine the effects on depression, insomnia, loneliness, self-awareness, self-compassion, burnout, secondary traumatic stress, and compassion satisfaction in oncology nurses. METHODS: This two-group (intervention and control), quasi-experimental study of a 6-week intervention combined storytelling, reflective writing, songwriting, and stress management skills. RESULTS: Participants (N = 43) were predominately white (98%), with 27% reporting Hispanic ethnicity, and female (95%); their average oncology experience was 8.5 years. Both groups improved significantly over time on all measures. Compared with the control group, participants in the intervention group also had significantly less loneliness (F[3, 98] = 7.46; P < .001) and insomnia (F[3, 120] = 5.77; P < .001) and greater self-compassion (F[3, 105] = 2.88; P < .05) and self-awareness (F[3, 120] = 2.42; P < .10). CONCLUSION: There are few opportunities for health care professionals to reflect on the impact of caregiving. The Storytelling Through Music intervention provided a structured space for reflection by participants, individually and among their peers, which decreased loneliness and increased self-compassion. Both factors relate to the burnout that affects the oncology health care workforce.

Riding the Roller Coaster: A Qualitative Study of Oncology Nurses' Emotional Experience in Caring for Patients and Their Families.

BACKGROUND: Rates of burnout and compassion fatigue among oncology nurses are rising, and the emotional impact of the work increases the risk. This study examined how oncology nurses describe the evolution of emotions from first significant patient loss through cumulative patient death. OBJECTIVE: To explore the emotional evolution of being an oncology nurse. METHODS: Semistructured interviews with 7 oncology nurses. Thematic analysis was used to analyze the data. RESULTS: Participant's mean age was 41.3 years, with 13.9 years of nursing experience and 10.6 years of oncology experience. One metatheme, "riding the roller coaster," described the overall emotional experience of the nurses. Three subthemes, "all in and then," "finding your way," and "impact on self," further outlined the process taken to cope with workplace emotions. CONCLUSIONS: Oncology nurses are frequently exposed to loss and suffering. Findings from this study suggest that new nurses are underprepared for the emotional experience of being an oncology nurse. Further, they define their emotional boundaries in isolation and without guidance on how to develop healthy coping skills. Changing the culture of silence around mental health and well-being among healthcare professionals can provide space for important conversations to occur. IMPLICATIONS FOR PRACTICE: Oncology nurses have few resources to teach them how to cope with the emotions experienced while caring for oncology patients. These findings suggest that alternative approaches to the traditional bereavement programs and innovative interventions offered to new oncology nurses within their first few years are needed.

Live Discharge From Hospice: A Systematic Review.

Live discharges from hospice may occur because of patient choice or provider choice. However, when discharges occur before death, patients and families may feel abandoned and left to manage care needs previously provided by hospice. The purpose of this systematic review was to better understand the nature of live discharges, including frequency, patient characteristics, and hospice characteristics. Of 44 studies identified for review, 13 met inclusion criteria and were published between 2008 and 2018. Live discharge rates varied from 5% to 23%. Patients' prehospice characteristics varied widely based on diagnosis, comorbidities, gender, race, and ethnicity. Hospice characteristics indicated that the likelihood of a live discharge was increased for patients enrolled in for-profit hospices and in rural areas. Only 2 studies captured the patient/family perspective of the live discharge experience, finding that the loss of hospice support was fraught with difficulties. A need for further study of the live discharge experience and the practices of hospices with high live discharge rates was identified.

A Pilot Study of a Cognitive-Behavioral Intervention for Breast Cancer Survivors.

PURPOSE/OBJECTIVES: To test combining a group intervention to build self-efficacy for using compensatory strategies and lifestyle adjustments with brain-training practice to improve cognition.
. DESIGN: A quasiexperimental design.
. SETTING: Texas Oncology, a community oncology practice in Austin.
. SAMPLE: 20 women aged 35-65 years, who had finished chemotherapy at least three months before the study, were within five years of completing all treatment, and had self-reported cognitive concerns. 
. METHODS: Six group sessions to build self-efficacy for using compensatory strategies, along with other health behaviors that affect cognitive performance, were combined with practice on a computer-based training program. Female breast cancer survivors were recruited through flyers, mailings, and personal contacts. 
. MAIN RESEARCH VARIABLES: Cognitive performance, cognitive concerns, cognitive/memory strategies, fatigue, emotional distress, sleep disorders, and quality of life.
. FINDINGS: Participants reported that the intervention was useful in building cognitive abilities. Although scores on performance tests did not increase, ratings of cognitive concerns, fatigue, emotional distress, and sleep disturbance decreased significantly. Use of cognitive/memory strategies increased significantly. 
. CONCLUSIONS: This pilot study demonstrated the feasibility of combining a group intervention with brain-training practice. A larger randomized trial would afford a more rigorous test of efficacy.
. IMPLICATIONS FOR NURSING: A growing body of evidence regarding potential interventions to address survivors' cognitive problems exists. Nurses should counsel breast cancer survivors about fatigue, sleep deprivation, and emotional distress, as well as the effects of cancer treatment on cognition.

Intimate partner violence in Mexican-American women with disabilities: a secondary data analysis of cross-language research.

The aim of this qualitative descriptive study, guided by Antonovsky's salutogenic model, was to explore the manifestations of strength within the interviews of Spanish-speaking Mexican-American women aging with mobility impairments who also experienced intimate partner violence (IPV). IPV events gleaned from 26 audiotaped interviews from 7 Spanish-speaking Mexican-American women, who ranged in age from 55 to 75 years, constituted the sample for this secondary analysis. Five categories were identified: abuse from early on that shaped sense of coherence; violencia tan cruel--threatened sense of coherence; "salutogenic" choices within the context of IPV; a quest for peace; and strength amid struggle.

Advance directives, control, and quality of life for persons with disabilities.

BACKGROUND: Personal control over end-of-life (EOL) care via advance care planning is a key component of high-quality care. Although this desire for control has been well documented in some populations, EOL care issues are not well understood within the disabilities community. OBJECTIVE: The objective for this study was to describe the relationships between individual demographic characteristics, health-related quality of life, health locus of control, and attitudes toward advance directives (ADs) in individuals who are disabilities activists. METHODS: We surveyed 55 participants attending a disability conference. Instruments included a demographic data sheet, the Advance Directive Attitude Survey (ADAS), the Multidimensional Health Locus of Control scale, and the Functional Assessment of Non-Life Threatening Conditions quality of life (QOL) scale. RESULTS: Most participants were Hispanic females with some college education. About 46% had a disability. Group means revealed a high level of QOL (M=75.72, SD=19.09) and a positive attitude about ADs (M=66.49, SD=8.03). On the Opportunities for Treatment Choices subscale of the ADAS, activists without disabilities (M=14.23) were more positive about their control over EOL decisions than were the activists with disabilities (M=12.97) [t(2,52)=2.116, p<0.05]. CONCLUSIONS: Although participants were positive about ADs, differences in attitudes about control over opportunities for treatment choices between the nondisabled and disabled groups support previous findings that people with disabilities may have concerns regarding undertreatment for serious health conditions. Further study of EOL care issues for persons with disabilities is warranted.

A double whammy: health promotion among cancer survivors with preexisting functional limitations.

PURPOSE/OBJECTIVES: To explore the experience of living with a preexisting functional disability and a cancer diagnosis and to identify strategies that promote health in the growing population of cancer survivors. RESEARCH APPROACH: Qualitative, descriptive. SETTING: Four sites in the United States. PARTICIPANTS: 19 female cancer survivors with preexisting disabling conditions. METHODOLOGIC APPROACH: Four focus groups were conducted. The group discussions were audio recorded and transcribed and analyzed using content analysis techniques. FINDINGS: Analytic categories included living with a cancer diagnosis, health-promotion strategies, and wellness program development for survivors with preexisting functional limitations. Participants described many challenges associated with managing a cancer diagnosis on top of living with a chronic disabling functional limitation. They identified strategies to maintain health and topics in health-promotion programs tailored for this unique group of cancer survivors. CONCLUSIONS: The "double whammy" of a cancer diagnosis for people with preexisting functional limitations requires modification of health-promotion strategies and programs to promote wellness in this group of cancer survivors. INTERPRETATION: Nurses and other healthcare providers must attend to patients' preexisting conditions as well as the challenges of the physical, emotional, social, and economic sequelae of a cancer diagnosis. KNOWLEDGE TRANSLATION: Cancer survivors with preexisting functional disabilities had difficulties finding cancer care providers who could manage their unique needs. That may be because some cancer-care providers are inadequately prepared to care for patients with cancer who have complex preexisting conditions. Cancer survivors with preexisting conditions may benefit from health-promotion programs that emphasize self-advocacy strategies, management of the economic impact of multiple diagnoses, and wellness activities adapted to their unique functional limitations.

Caring for students with type 1 diabetes: school nurses' experiences.

This qualitative study used a Husserlian phenomenological approach to obtain an understanding of the essences of five experienced Taiwanese school nurses' lived experience of caring for students with type 1 diabetes mellitus (T1DM). Audio-recorded, semi-structured, in-depth interviews were conducted. Data analysis entailed a modified method from Colaizzi. Four intertwined themes were discovered: (a) I try to put myself in the parents' and students' shoes, (b) I am not a diabetes expert, (c) managing T1DM requires teamwork, and (d) caring for students with T1DM is a struggle with practical limitations. The findings show that these school nurses encountered many challenges as they implemented their roles and responsibilities in caring for students with T1DM. The findings suggest that increasing school nurses' competence in caring for students with T1DM and developing effective strategies to overcome the challenges faced may be useful. Multidisciplinary teamwork could benefit the diabetes management activities in school settings.

End of life and women aging with a disability.

Approximately 21 million noninstitutionalized Americans with physical disabilities will ultimately face end-of-life [EOL] issues. Studies have documented disparate care and poorer outcomes for persons with preexisting disabilities who have life-limiting illnesses, which raises the question of how EOL experiences may differ for these individuals. The aim of this qualitative, descriptive study was to explore how EOL issues might emerge within the life stories of women aging with functional disabilities. Interview data were obtained from a larger, ongoing ethnographic study focused on the creation of an explanatory model of health disparities of disablement in women with mobility impairment. Each participant was interviewed three to four times using a life-course perspective that captures life trajectories and transitions experienced over time. For this analysis, 41 interviews were selected from 20 participants who discussed issues related to death and dying. Content analysis of the data revealed five analytic categories: death as a signpost, impact of others' deaths, deaths that affected personal insights and choice, EOL possibilities, and a personal brush with death. EOL issues were manifested in a variety of ways that revealed both determination to remain as independent as possible within the context of declining functional ability and uncertainty regarding the future.

Humanistic Nursing Theory: application to hospice and palliative care.

AIM: This article presents a discussion of the relevance of Humanistic Nursing Theory to hospice and palliative care nursing. BACKGROUND: The World Health Organization has characterized the need for expert, palliative and end-of-life care as a top priority for global health care. The specialty of hospice and palliative care nursing embraces a humanistic caring and holistic approach to patient care. As this resonates with Paterson and Zderad's Humanistic Nursing Theory, an understanding of hospice nurses' experiences can be investigated by application of relevant constructs in the theory. DATA SOURCES: This article is based on Paterson and Zderad's publications and other theoretical and research articles and books focused on Humanistic Nursing Theory (1976-2009), and data from a phenomenological study of the lived experience of Taiwanese hospice nurses conducted in 2007. DISCUSSION: Theoretical concepts relevant to hospice and palliative nursing included moreness-choice, call-and-response, intersubjective transaction, uniqueness-otherness, being and doing and community. IMPLICATIONS FOR NURSING: The philosophical perspectives of Humanistic Nursing Theory are relevant to the practice of hospice and palliative care nursing. By 'being with and doing with', hospice and palliative nurses can work with patients to achieve their final goals in the last phase of life. CONCLUSION: Use of core concepts from Humanistic Nursing Theory can provide a unifying language for planning care and describing interventions. Future research efforts in hospice and palliative nursing should define and evaluate these concepts for efficacy in practice settings.

Cancer patients' preferences for control at the end of life.

The achievement of a death consistent with personal preferences is an elusive outcome for most people with cancer. Maintaining a sense of control is a core component of a dignified death; however, control might be a Western bioethical notion with questionable relevance to culturally diverse groups. Thus, the purpose of our study was to explore the meaning of control and control preferences in a group of racially and ethnically diverse patients with an advanced cancer diagnosis. Using a hermeneutic, phenomenological approach, we interviewed 20 patients with advanced cancer and uncovered two themes: (a) preferences for everyday control over treatment decisions, family issues, final days of life, and arrangements after death, vs. (b) awareness that cancer and death are controlled by a higher power. Although the sample included non-Hispanic Whites, African Americans, and Hispanics, participants shared common views that are characteristic of American cultural norms regarding the value of autonomy.

Assessing cancer-related learning needs of Texas nurses.

BACKGROUND: Given the growing number of cancer survivors, all nurses must have current knowledge and skills to provide competent cancer care. Accordingly, access to evidence-based educational opportunities designed to promote ongoing competency must be ensured. Program offerings and services should be based on a systematic and periodic approach to provide appropriate programming that meets learners' self-identified needs, priorities, and self-reported gaps in existing knowledge and practice. OBJECTIVE: The purpose of this article was to report the process and findings of a statewide needs assessment of cancer-related needs of nurses across all practice settings. METHODS: A convenience sample of licensed nurses was recruited from throughout Texas to complete a learning needs assessment instrument. RESULTS: Five hundred twenty-one nurses completed the survey. Results revealed several priority areas for educational programming, including clinical care topics, survivorship issues, tobacco cessation strategies, and clinical trials. Although results varied somewhat between oncology and nononcology nurses, both groups cited time constraints as the biggest barrier to integrating cancer-related knowledge and skills into their practice. CONCLUSION: Findings from the survey can be used to direct program priorities and approaches for ongoing educational services that promote delivery of competent cancer care. IMPLICATIONS FOR PRACTICE: This approach to a cancer-focused needs assessment serves as an exemplar for nursing education leaders who are charged with developing and delivering cancer-specific programming for nurses.

Cervical cancer screening and older Mexican American women.

The purpose of this study was to explore an older Mexican American woman's decision-making process to engage in cervical cancer screening. A qualitative single case study design was used along with a purposive, typical case sampling strategy. The participant, a 52-year-old Mexican American woman, was interviewed using a semi-structured format. Qualitative content analysis was used to analyze the data. The analytic process revealed three concepts and motivators that influenced the participant's behavior regarding cervical cancer screening practices: knowledge, family history, and sexual history. As such, these findings are useful for crafting subsequent investigations. Although the study participant's experience is instructive regarding facilitators or motivators for engaging in screening practices, further exploration of barriers faced by older Mexican American women who decline to be screened is warranted.

The meaning of surviving cancer for Latino adolescents and emerging young adults.

Adolescent and young adult (AYA) survivors of cancer are an understudied population with unique developmental and medical needs that extend well beyond their active treatment. Survivors diagnosed as AYAs may experience both physical and emotional late effects. In particular, the experiences of Latino cancer survivors have not been explored. The purpose of this study was to conduct interviews with AYA Latino cancer survivors to inform professionals working with these survivors. A hermeneutic phenomenological approach was selected based on the focus on experiences and meanings of Latino adolescents' cancer survivorship. Phenomenology allows for understanding the subjective meaning and lived experience of populations that are understudied or marginalized. In-depth interviews were conducted with participants. Enrolled in the study were Latino AYAs between the ages of 14 and 21 years, after treatment. Interviews revealed 7 themes regarding the experience and meaning of survivorship for this population: gratitude, humor/positive attitude, empathy for younger children with cancer, God and faith, cancer happens for a reason/cancer changed my life, familial support, and staff relationships. Latino AYA cancer survivors develop meaning out of unique cancer experiences. Programs need to be developed specifically to address Latino adolescents and young adult survivors of cancer.

The use of theory in qualitative approaches to research: application in end-of-life studies.

AIM: This paper is a report of an analysis of the use of theory in qualitative approaches to research as exemplified in qualitative end-of-life studies. BACKGROUND: Nurses researchers turn to theory to conceptualize research problems and guide investigations. However, researchers using qualitative approaches do not consistently articulate how theory has been applied, and no clear consensus exists regarding the appropriate application of theory in qualitative studies. A review of qualitative, end-of-life studies is used to illustrate application of theory to study design and findings. DATA SOURCES: A review of theoretical literature was carried out, focusing on definitions and use of theory in qualitative end-of-life studies published in English between 1990 and 2008. DISCUSSION: The term 'theory' continues to be used in a variety of ways by theorists and researchers. Within the reviewed end-of-life studies, the use of theory included theory creation or provision of a comparative framework for data analysis and interpretation. Implications for nursing. Nurses who conduct qualitative studies should examine the philosophical and theoretical bases of their selected methodological approach, articulate a theoretical framework that fits the phenomenon being studied, and adopt a critical, flexible and creative attitude when applying theory to a study. CONCLUSION: Theory can be put to several uses in qualitative inquiry and should guide nurse researchers as they develop and implement their studies. Nurse educators who teach qualitative approaches to research should emphasize a variety of ways to incorporate theory in qualitative designs.

Living with death and dying: the experience of Taiwanese hospice nurses.

PURPOSE/OBJECTIVES: To explore and describe the experiences of Taiwanese nurses who care for dying patients in hospices, a relatively recent healthcare option in Taiwan. RESEARCH APPROACH: Qualitative, hermeneutic, phenomenologic approach. SETTING: Six hospices in central and southern Taiwan. PARTICIPANTS: 14 Taiwanese hospice nurses. METHODOLOGIC APPROACH: Interviews were audiotaped and analyzed with Colaizzi's guidelines. MAIN RESEARCH VARIABLES: Caregiving experiences of Taiwanese hospice nurses. FINDINGS: Four main themes emerged from the analysis: entering the hospice specialty, managing everyday work, living with the challenges, and reaping the rewards. Three subthemes of managing everyday work were providing holistic, meaningful care through close relationships; confronting and managing negative beliefs about hospice; and managing the dying process. CONCLUSIONS: The fundamental structure of the caregiving experiences of Taiwanese hospice nurses is a dynamic, multidimensional process that evolved over time. The hospice nurses demonstrated how they achieved balance in their daily nursing practice within the Taiwanese cultural context. INTERPRETATION: Improved end-of-life education for the Taiwanese public, nurses, and other healthcare professionals that includes hospice concepts is needed. Administrators should provide adequate support to encourage and empower their nursing staff in hospice settings.

What constitutes a dignified death? The voice of oncology advanced practice nurses.

PURPOSE: The purpose of this study was to explore the concept of dignified dying from the perspective of oncology advanced practice nurses. METHODOLOGY: A naturalistic, hermeneutic approach was used to interview the study participants. A sample of 19 oncology advanced practice nurses was obtained by combining data sets from 2 larger studies of patient control and end-of-life care. Audiotaped interviews of the nurses were transcribed verbatim and were analyzed using a phenomenological approach. RESULTS: The analysis revealed that dignified dying is an experience that includes the following themes: going in peace, maintaining bodily integrity, and dying on their own terms. CONCLUSIONS: Advanced practice nurses lend an important perspective that expands understanding of the concept of dignified dying. Future studies of patient and family perceptions will enhance knowledge of their needs and lead to intervention studies to promote an end-of-life experience that is consistent with patient priorities and values.