Empowering Lung Cancer Survivors in Post-Treatment Survivorship Care Using Participatory Action Research.

PURPOSE: To explore the experiences of lung cancer survivors (LCSs) and their informal and professional caregivers with post-treatment care and to empower them to implement action-based study findings. PARTICIPANTS & SETTING: Participants were recruited using purposeful and snowball sampling from patients at a National Cancer Institute-designated cancer center in the northeastern United States. METHODOLOGIC APPROACH: This study used a participatory action research (PAR) four-phase design. Phase 1 was a focused ethnography; phase 2 consisted of a core group of participants deciding on an action, which was implemented in phase 3; and phase 4 consisted of an evaluation of the action. FINDINGS: The study found 28 categories, eight patterns, and three themes. The themes were the need for resources and education, involvement in mentoring and advocacy, and the value of living versus surviving. The action was creating two flyers focused on resources and advocacy for post-treatment support for LCSs. All participants agreed with the themes and action. Tobacco management and smoking-related stigma for LCSs were the only topics of dissent. IMPLICATIONS FOR NURSING: Oncology nurses can use PAR to empower survivors in their post-treatment care. Future PAR cycles should focus on creating support groups and alleviating stigma for LCSs and their caregivers.

Knowledge, attitudes, and beliefs of cardiovascular disease prevention in young adults in the country of Georgia.

INTRODUCTION: Cardiovascular disease (CVD) accounts for 46% of all mortality in the country of Georgia (former Soviet Union). Young adults in that country have not been studied regarding CVD and a need exists to understand lifestyle modifications to promote cardiovascular health. DESIGN: An interpretive description qualitative design was used to explore Georgian young adults' knowledge, attitudes, and beliefs of CVD preventative practices and life experiences. METHODS: A convenience sample of 19 ethnic Georgian participants (18-40 years old) who were fluent in either English, Georgian, or Russian from a local private university was used. Semi-structured interviews were conducted via video conferencing utilizing an interpreter. RESULTS: Four themes were identified: (1) CVD and risk factor knowledge, (2) prevention attitudes, beliefs, and gender differences, (3) health literacy influences, and (4) culture and societal impacts. CVD knowledge was limited and influenced by health literacy and the current healthcare system in Georgia. CONCLUSION: Cultural and societal gender norms influence cardiovascular health behaviors. CLINICAL IMPLICATIONS: Georgian nurses can play a key role in CVD education and screening for young adults in Georgia.

Barriers to Patient Involvement in Decision-Making in Advanced Cancer Care: Culture as an Amplifier.

In advanced cancer care, patient preferences regarding treatment are sometimes insufficiently integrated in the decision-making process. This can be the case with patients from non-Western cultural backgrounds undergoing treatment in the US. This study aimed to understand oncology and palliative care physicians' and nurses' perceptions of factors that impact involvement in treatment decisions by patients from diverse cultural backgrounds. Seventeen participants (6 MDs, 9 RNs, and 2 NPs) were interviewed using a semi-structured guide. Interviews were analyzed using conventional content analysis. Findings revealed six barriers to patient involvement in decision-making: language, socio-economic status, educational status, gender, family attitudes, and healthcare providers' behavior and attitudes. Participants did not view culture itself as a barrier to patient involvement, but rather, noted culture-amplified barriers that occurred with patients across all cultural backgrounds. To overcome these barriers, a wider integration of cultural competence in patient care is needed.

The African Caribbean Immigrant Cancer Survivor Experience in the United States: A Scoping Review of the Literature.

PROBLEM IDENTIFICATION: Growing numbers of African Caribbean immigrants with cancer reside in the United States and frequently encounter different challenges than survivors born in the United States. LITERATURE SEARCH: More than a decade of research was searched in the PubMed®, Embase®, CINAHL®, and Scopus® databases using terms reflective of African Caribbean immigrant survivors in the United States. DATA EVALUATION: The initial search in this scoping review revealed 912 articles, with seven meeting inclusion criteria. Data extracted from articles included purpose/aims, design, sample/setting, methods, and results. SYNTHESIS: Five retrospective analyses, one case report, and one qualitative study comprised the final sample. Thematic analysis used to synthesize results revealed two themes: survival patterns and barriers. IMPLICATIONS FOR RESEARCH: The results indicated a need to identify and address root causes of disparity, and track the effectiveness of available treatments and outcomes by country of birth. Research capturing the experiences of African Caribbean immigrants would benefit from collaboration with community leaders and survivors. Oncology nurses play critical roles in leading research and developing culturally informed practices in clinical settings.

Lung Cancer Survivor Experiences With Post-Treatment Care: An Integrative Review.

PROBLEM IDENTIFICATION: Lung cancer survival rates are improving, and survivors may have unmet post-treatment care needs. Oncology nurses' understanding of these needs can guide development of holistic survivorship care. LITERATURE SEARCH: A comprehensive search of CINAHL®, PubMed®, and Embase® databases was performed to explore lung cancer survivor experiences with post-treatment care. DATA EVALUATION: The final sample included 25 studies that were critically appraised for methodologic quality. SYNTHESIS: Eight themes were identified. IMPLICATIONS FOR RESEARCH: Issues, such as race, gender, and stigma, represent barriers to holistic lung cancer survivorship care. Little mention of care coordination emphasizes the need for research in this area. Understanding the interplay of symptom and healthy lifestyle management is needed.

Impact of a Digital Intervention on Perceived Stress, Resiliency, Social Support, and Intention to Leave Among Newly Licensed Graduate Nurses: A Randomized Controlled Trial.

BACKGROUND: The nursing shortage has been deemed a public health crisis as the turnover rate of newly licensed graduate nurses (NLGNs) continues to grow. One of five NLGNs are leaving the profession due to work dissatisfaction and feelings of inadequacy, risking patient safety. METHOD: A prospective, randomized controlled trial evaluated the impact of a 6-week digital intervention (text messaging) on NLGNs' self-reported stress, resiliency, sense of support, and intention to leave their jobs, organization, and profession. Messages to the experimental group (n = 10) conveyed emotional, esteem, and networking support, and messages to the control group (n = 11) were medical facts. RESULTS: The digital intervention in the form of medical facts increased the control group's sense of social support. Stress, resilience, and intention to leave their jobs, organizations, or profession did not change for either the control or experimental group. CONCLUSION: A digital intervention, such as text messaging, potentially can increase NLGNs' sense of support during their first year of hire. [J Contin Educ Nurs. 2021;52(8):367-374.].

Cultural Aspects of End-of-Life Advance Care Planning for African Americans: An Ethnonursing Study.

INTRODUCTION: Advance directive completion rates among the general population are low, with even lower completion rates among African Americans (AAs). This study's purpose was to identify culturally based meanings, expressions, and traditions of end-of-life (EOL) advance care planning (ACP) and decision making in order to promote culturally congruent nursing care among African Americans. METHODOLOGY: Leininger's Culture Care Theory and Ethnonursing Research Method guided the study. A convenience sample of 21 informants were interviewed in community settings. Data analysis was guided using Leininger's phases of ethnonursing data analysis for qualitative data. RESULTS: Three themes emerged that affect EOL decision making: (a) faith in God and belief in life after death, (b) a strong matriarchal family structure, and (c) fear of talking about death and mistrust of the U.S. health care system. DISCUSSION: AA culture, beliefs, and traditions influence EOL ACP and practices, and must be considered while providing culturally congruent care.

Coping Behaviors of African Americans With Inflammatory Bowel Disease: A Focused Ethnography.

INTRODUCTION: Increased numbers of African Americans (AAs) are being diagnosed with inflammatory bowel disease (IBD), little is known about the influence of culture on their coping. PURPOSE: To explore the beliefs and experiences of AAs with IBD and coping in the context of their culture. METHOD: Twelve AA adults with IBD were interviewed and observed using focused ethnography. RESULTS: Data analysis revealed four themes: (1) spending time living in the bathroom, (2) time and food restricted eating practices and cultural food avoidance, (3) dealing with chronic stress and perceived racial injustice, and (4) the practice of seclusion to manage bathroom urgency and emotions of fear, anxiety, and embarrassment. DISCUSSION: Participants described coping and culture with experiences similar to other IBD populations, except in the area of perceived racial injustice. Opportunities for nurses to assist with stressors related to bathroom access, cultural eating practices, and participating in activities outside their homes.

An integrative review of nurse practitioner practice and its relationship to the core competencies.

BACKGROUND: Competency based education (CBE) has been suggested for nurse practitioner (NP) education reform. For this to occur, competencies should reflect the knowledge, skills, and attitudes that NPs need for independent practice. PURPOSE: This integrative review examined the general practice activities of NPs across all population foci to determine the extent to which these activities are reflected in current NP competencies. METHOD: Using the Whittemore and Knafl (2005) integrative review method, 17 studies that focused on NP practice between 2008 and 2018 were retrieved from three electronic databases. These studies were evaluated, analyzed and synthesized for themes. Afterwards the themes were compared with seven sets of current NP core competencies. RESULTS: The themes for NP practice activities were direct and indirect patient care activities with a majority of NP time spent performing direct patient care activities. However, only 14% of the NP core competencies reflected these direct care activities. CONCLUSION: In order to successfully implement CBE, a need exists for the NP core competencies to reflect current NP practice.

Generating Oncology Patient Trust in the Nurse: An Integrative Review.

An integrative review was conducted to evaluate the extent and quality of literature regarding adult oncology patients' trust in nurses. Nineteen studies met the inclusion criteria. Three themes were identified, which are as follows: nurse trust facilitating behaviors, nurse attributes, and the influence of patient-nurse trust on health and psychosocial well-being. Findings indicate that the extent of literature is limited in specific examples of nurse interventions that facilitate interpersonal patient-nurse trust. Future research should include more detailed nurse actions and attributes that build patient-nurse trust to fully understand the benefits of trust in oncology patients.

Oncology Resources for Students Enrolled in Pre-Licensure and Graduate Nursing Programs in the United States: A Scoping Review of the Literature.

OBJECTIVES: This scoping review summarizes oncology resources for pre-licensure and graduate nursing programs in the United States. DATA SOURCES: PubMed, CINAHL, and Scopus databases were searched to identify resources (2008-2019) published in peer-reviewed journals. While 1,503 papers were initially identified, 49 met inclusion criteria. CONCLUSION: Thematic analysis revealed five themes with subthemes: (1) didactic courses; (2) clinical opportunities; (3) didactic and clinical resources; (4) simulation resources; and (5) other. IMPLICATIONS FOR NURSING PRACTICE: Academic educators are charged with preparing a nursing workforce capable of providing safe and quality evidence-based care across the cancer continuum. Findings offer examples that overcome curriculum barriers.

The Asian Immigrant Cancer Survivor Experience in the United States: A Scoping Review of the Literature.

BACKGROUND: Cancer is the leading cause of death for Asian Americans, a growing population in the United States. While cancer survivors often experience complex issues after diagnosis, being an immigrant and having cancer pose additional challenges. OBJECTIVE: This scoping review analyzed research about immigrant cancer survivors of Asian ethnicity in the United States and provided a structured method to understand an area of research and evidence. Aims focused on immigrants' experiences and how findings could tailor evidence-based interventions, programs, and resources. METHODS: The PubMed, CINAHL, and Scopus databases were searched to identify studies in English (2009-2018) targeting Asian immigrant cancer survivors in the United States. While 385 records were initially identified, 32 studies met the inclusion criteria. RESULTS: Thematic analysis of charted study elements revealed 4 themes with subthemes: (1) survival patterns, (2) barriers, (3) culturally informed care, and (4) quality of life (QOL). While qualitative studies provided insight about the cancer experience from immigrants' perspectives, quantitative designs posed descriptions and associations among QOL concepts. CONCLUSIONS: Study results illustrate the need for survival research that explores outcomes by Asian ethnic subgroups and tracks the influence of acculturation. Future research should test culturally informed interventions that minimize barriers and foster QOL across the cancer continuum. Culturally tailored instruments can expedite larger-scaled studies that allow generalization. IMPLICATIONS FOR PRACTICE: Asian immigrants comprise an underserved, vulnerable, and growing group with various cancers. Nurses who care for immigrants and their families should be cognizant of cultural beliefs, values, practices, and issues related to communication, care access, and socioeconomics.

Determining nurse practitioner core competencies using a Delphi approach.

BACKGROUND: Competency-based education (CBE) has been recommended for nurse practitioner (NP) education. To implement CBE, existing NP core competencies need to be reduced in number and refined. PURPOSE: This study refined and reduced redundancy in the National Organization of Nurse Practitioner Faculties (NONPF) and the American Association of Colleges of Nursing (AACN) NP core competencies through the consensus of experts in NP practice. This study used the current NP Core Competencies (NONPF, 2017), the Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006), and the Common Advanced Practice Registered Nurse Doctoral-Level Competencies (AACN, 2017a) because these documents are the competencies-accredited NP programs commonly used in curriculum development. The primary aim of this study was to refine and reduce redundancy of these competencies; a secondary aim was to ensure that the final competencies were clear and measurable. METHODS: A Delphi approach was used to reach consensus among an expert panel who reviewed the core competencies via an online questionnaire. Descriptive statistics were used to calculate median and interquartile ranges; content analysis was conducted with qualitative data. RESULTS: Consensus was reached after 3 rounds and resulted in 49 final core competencies. IMPLICATIONS FOR PRACTICE: This study provides the NP community with a manageable list of relevant, clear, and measurable competencies that faculty members can use to implement CBE in their programs.

Using Evidence to Prepare Non-Oncology Nurses for Cancer Survivor Care.

BACKGROUND: Growing increases in current and projected cancer survivors demands a workforce that can safely meet their health care needs spanning a lifetime. The literature lacks sufficient evidence regarding the knowledge needed by non-oncology nurses who care for cancer survivors in settings not designated for cancer care. This study identified this oncology knowledge and perceived barriers. METHOD: The Cancer Nursing Curriculum Survey was completed by a national pool of 302 oncology and 313 medical-surgical nurses who rated the depth and importance of 33 cancer concepts needed by non-oncology nurses for cancer survivor care. RESULTS: Concept means for depth and importance were similar between both groups, with importance rated higher. Major concepts focused on symptom management. Barriers included lack of time, knowledge, and access to resources. CONCLUSION: The findings indicate the understanding of knowledge needed by non-oncology nurses for survivor care and provide a first step to design continuing education to address needs. J Contin Educ Nurs. 2018;49(1):12-18.

Cultural Aspects of End-of-Life Care Planning for African Americans: An Integrative Review of Literature.

Advance directive completion rates among the general population are low. Studies report even lower completion rates among African Americans are affected by demographic variables, cultural distinctives related to patient autonomy, mistrust of the health care system, low health literacy, strong spiritual beliefs, desire for aggressive interventions, importance of family-communal decision making, and presence of comorbidities. An integrative review was conducted to synthesize nursing knowledge regarding cultural perspectives of end-of-life and advance care planning among African Americans. Twenty-four articles were reviewed. Nurses educate patients and families about end-of-life planning as mandated by the Patient Self-Determination Act of 1991. Implementation of advance directives promote patient and family centered care, and should be encouraged. Clinicians must be sensitive and respectful of values and practices of patients of diverse cultures, and initiate conversations with open-ended questions facilitating patient trust and sharing within the context of complex beliefs, traditions, and lifeways.

The Lived Experience of Black Nurse Faculty in Predominantly White Schools of Nursing.

PURPOSE: This study explored the experiences of Black nurse faculty employed in predominantly White schools of nursing. High attrition rates of this group were noted in previous literature. Understanding their experiences is important to increase nurse diversity. DESIGN: Hermeneutic phenomenology was used to explore the experiences of 15 Black nurse faculty using interviews. FINDINGS: Four themes were extracted as the following: cultural norms of the workplace, coping with improper assets, life as a "Lone Ranger," and surviving the workplace environment. DISCUSSION: The study provided insight to understand the meaning that Black faculty members give to their experiences working in predominantly White schools of nursing. Findings exemplify the need to improve culturally competent work environments and mentoring programs. IMPLICATIONS FOR PRACTICE: Results suggest that better communication and proper respect from students, colleagues, and administrators are necessary. The limited research on this topic illustrates that Black nurse faculty remain under investigated; research is necessary to determine effective change strategies.

Meditation's Effect on Attentional Efficiency, Stress, and Mindfulness Characteristics of Nursing Students.

BACKGROUND: Strengthening attention-regulation efficiency of nurse graduates is important to the quality and safety of nursing practice in increasingly complex and cognitively distracting workplaces. Neuroscientific evidence suggests that regular practice of focused meditation can enhance attentional skills. This study explored meditation as an educational strategy for enhancing nursing students' attentional efficiency. METHOD: A randomized-control trial with 52 prelicensure nursing students examined differences between those who meditated and those who did not on measurements of alerting, orienting, and executive attention. Stress and mindfulness were also explored. RESULTS: Meditation demonstrated moderate strength for enhancing executive attention, F = 4.26 (1, 49), n2 = .080, p = .044. Additional outcomes specific to the meditation group were reduced stress and increased mindfulness, F = 7.16 (2, 47), n2 = .234, p = .002. CONCLUSION: Results support the consideration of meditation training as a strategy for enhancing nursing students' attentional efficiency and other self-regulatory skills necessary for safe nursing practice. [J Nurs Educ. 2017;56(7):430-434.].