Perceptions of Older Adult Care Among Ambulatory Oncology Nurses.

BACKGROUND: Most cancer treatment is provided in the ambulatory setting; thus, it is important to know what issues ambulatory oncology nurses identify in their practice with older cancer patients as well as resources that are helpful or are needed. OBJECTIVE: The aim of this study was to capture ambulatory oncology nurses' perceptions of the unique aspects of caring for older patients and to present the development process, content validity testing, and psychometric evaluation of a survey designed to denote nurse perceptions of older adult care. METHODS: An expert panel and 2 focus groups informed the development of a 34-item survey scored on a 5-point Likert-type agreement scale and 2 open-ended questions. Psychometric testing and descriptive statistics summarized the quantitative responses. Using thematic analysis, we identified the themes from the open-ended responses. RESULTS: The survey demonstrated good psychometric qualities. A total of 401 participants, mostly staff from large, academic cancer centers, reported an average total score of 3.76, indicating generally positive perceptions of older adult care. The 269 (67%) open-ended responses were categorized into 4 main themes: concerns over medical issues, the need for specialized services, adequate support systems, and appropriate communication. CONCLUSIONS: Although most perceived their geriatric practice environment favorably, nurses recognized the complexity of caring for older adults with cancer. They identified gaps in care, such as the need for geriatric specialists and better community resources, paid by insurance. IMPLICATIONS FOR PRACTICE: Nurses need more time in the clinic to address complex advanced care planning, symptom burden and home services of older adults with cancer. Each institution should seek feedback from nurses to guide resource allocation.

Using an eclectic model to educate students about cultural influences on the nurse-patient relationship.

This article describes how the concepts of cultural awareness, cultural sensitivity, and cultural competence are integrated into the nursing curriculum at Lehman College, City University of New York. A culturally diverse student population engaged in lectures, classroom exercises, and clinical experiences in order to learn the ideas and imperatives of cultural diversity in nursing care. The exercises were problem-based learning experiences guided by a university-developed model for teaching students to understand cultural diversity. The model is derived from Leininger's comparative cultural caring model and Paterson and Zderad's humanistic nursing model. By observing differences and similarities among diverse cultures, students learned that the assignment of cultural attributes is an inexact process and should be organized as hints rather than as certainties. Students also learned the importance of integrating cultural awareness, cultural sensitivity, and cultural competence into their nursing care.