Association Between Decisional Conflict and Quality of Life Among Parents with a Child Undergoing Hospital-based Treatment for a Recent Cancer Diagnosis

Having a child with a chronic illness, such as cancer, can cause families significant distress. Parents of these children must make frequent decisions relating to their child’s care. Depending on factors such as health literacy and support from medical staff, parents may have varying levels of decisional conflict (DC) throughout the decision-making process. Compounding stress throughout their child’s illness can often contribute to lower levels of health-related quality of life (HRQoL) while their child is receiving hospital-based treatment. Parents with a non-English language preference (NELP) often have greater challenges navigating healthcare systems due to a lack of resources and limited health literacy. The present study investigated the association between parental DC and HRQoL among 35 Latinx and White parents caring for a child with cancer. Differences in DC and HRQoL between three language groups: monolingual English, monolingual Spanish, and bilingual English and Spanish were also examined. Results indicated that higher DC was a statistically significant predictor of lower HRQoL. Additionally, there was no significant difference between language groups on either DC or HRQoL. Results suggest the need for further support for parents making decisions for their children to limit possible impacts on their HRQoL while caring for their child. Future research should include studies in various geographic locations to gain data from more diverse hospital systems and improve the generalizability of results. Furthermore, qualitative research studies could be implemented to provide parents with opportunities to explain their experiences more in-depth, which could help inform directions for additional quantitative studies

Trauma-Informed Care: A Therapeutic Approach in Communication

As medical providers, it is crucial to use therapeutic communication when building relationships with patients. Bias, stigma, and judgment often manifest through a provider’s body language and choice of words, exacerbating patient trauma and leading to health disparities. Trauma-informed care (TIC) addresses these issues by emphasizing respect, compassion, and empathy. TIC has been extensively studied in high-income regions such as Australia, Europe and the United States, but its application in low- and middle-income countries (LMIC) such as Kenya, is less understood. The aim of this study was to assess the knowledge, attitudes, and skills of nurses working in a rural community clinic in Chogoria, Kenya. Objectives were achieved through pre- and post-workshop surveys and exploratory qualitative interviews conducted after an in-service workshop on Trauma-Informed Care (TIC). Healthcare workers demonstrated a 3% increase in knowledge, attitudes, and skills in postsurvey results following an in-service workshop on TIC. Analysis of focus group narrative data revealed three themes: relevance, cultural stigma and bias, and additional needs in the community. TIC’s therapeutic communication helps to mitigate biases and stigma, foster empathy, and address patient trauma, ultimately reducing health disparities. The findings of this study indicate further research regarding TIC should be conducted in LMIC to identify ways in which providers can enhance the quality of health care delivery and promote holistic healing. Keywords: adult trauma, adverse childhood events, harm reduction, trauma-informed car

Addressing Informal Caregiver Burnout in the United States: Policies, Interventions, and Recommendations

Informal caregiver burnout has been and will continue to be a significant public health concern in the United States, necessitating a comprehensive analysis of initiatives and policies to reduce its negative impacts. This paper provides an overview of existing approaches to address caregiver burnout at the individual, community, and national level, identifying critical gaps in policies and programs. By highlighting successful approaches in other developed countries, this paper presents comprehensive program and policy recommendations to strengthen informal caregiver support systems in the United States. Prioritizing these proposals can guide policymakers in creating a more supportive environment that values the crucial role of caregivers and improves their overall well-being. The paper concludes that to effectively address caregiver burnout, it is essential to implement integrated, wrap-around services tailored to the diverse needs of caregivers and ensure ongoing program evaluation. It emphasizes the need for the U.S. to re-evaluate its fiscal priorities related to public health by increasing caregiver support, especially given the growing elderly population and their increasing care needs

Navigating Insulin Access for Pediatric Type 1 Diabetes: Caregivers\u27 Experiences and Challenges

Between 2012 and 2018, the annual 14% increase in insulin prices made Type 1 Diabetes (T1D) the most expensive chronic health condition, significantly raising out-of-pocket costs for uninsured or underinsured individuals in the United States (Hayes & Farmer, 2020; Willner et al., 2020). This study utilized a qualitative content analysis methodology to explore the challenges and experiences of parents with children diagnosed with T1D with accessing insulin for their child. Five participants from various areas of the United States responded to open-ended questions both in person and via Zoom. The analysis revealed three main themes: pragmatics of managing diabetic care, the emotional impact and caregiver concerns, and the art of coordination and support networks. Three subthemes emerged: financial constraints, insulin injections/pump, and navigating insurance. The study emphasizes the importance of access to healthcare services in order to address the multifaceted needs of children with T1D and their families, and also raises clinical implications related to T1D management. Practical recommendations for clinicians, educators, and policymakers to enhance support and improve outcomes for pediatric patients with T1D are provided and discussed. Future research should prioritize inclusive recruitment strategies and address barriers to participation among minority populations to ensure interventions are tailored to the diverse needs of all individuals and families affected by T1D, particularly given the widespread mistrust within the healthcare system among marginalized communities. Additionally, exploring systemic barriers, including social determinants of health (SDOH), and advocating for policy reforms aimed at expanding healthcare coverage and promoting health equity are essential steps in addressing healthcare disparities and improving access to care for vulnerable populations affected by T1D

An Exploration of the Contributions of Parenting Styles and Peer Relationships on the Emotional Expression of Second-Generation Indian-Americans

This dissertation used a qualitative analysis methodology to study the contributions of parenting styles and peer relationships on the emotional expressivity of second generation Asian Indian-Americans. Seven participants participated in a 60 - 90 minute long semi-structured interview and the content was analyzed using a thematic analysis approach. Most previous research regarding this topic has been conducted on White American or European individuals and does not take into consideration the many intersectionalities that second-generation Indian-Americans hold. Many participants discussed the lack of direction they experienced in regards to learning about their emotions and disclosed that college and young adulthood provided most with corrective emotional experiences. Participants additionally talked about how their parents immigration journey to the United States greatly influenced how they parented the participants. Most participants showed an ability to both understand their parents parenting approaches while also describing a yearning to have emotionally focused conversations. Participants identified the need for more openness about emotions and mental health within the larger South Asian community and shine a light on the mental health stigma they experienced throughout their childhood. They described hoping that the narrative regarding emotional expression, regulation, and disclosure continues to change. It is important to remember that though there are many similarities between these participants, there are significant differences in their experiences. As the South Asian population is one of the largest and quickly growing minority groups in the United States, increasing clinician awareness and understanding regarding potential difficulties with emotional vocabulary and emotional processing that this group may experience is essential. Additionally, due to the negative attitudes towards mental health utilization that exist within this community, clinicians must understand the resiliency required for these individuals to pursue services and the stigma of seeking mental health treatment they might experience both within themselves and from their community. Furthermore, it is imperative that clinicians understand the impacts of immigration on this population and how to best tailor treatment goals to serve these clients

Reducing HAPI on a Medical Surgical Telemetry Unit

Abstract Problem: Hospital-acquired pressure injuries (HAPI) are a global issue that harms patients, prolongs lengths of stay, and increases hospital costs and financial burdens. Because HAPIs are preventable, hospital organizations worldwide are implementing prevention strategies to improve the quality of care and quality of life and decrease costs associated with them. Context: The 24-bed medical-surgical telemetry unit is one of five adult inpatient units within a Northern California hospital. The patient population includes an increased number of patients who are at risk of HAPI. The unit struggles with HAPI prevention, and the staff is challenged with implementing proper HAPI prevention strategies. Interventions: A HAPI committee was formulated and tasked with developing a quality improvement project to address the increased number of HAPIs. The project’s interventions aim to implement a static overlay mattress for all patients at high risk of HAPI. Other interventions include staff education and training, continued use of current HAPI prevention strategies, and early identification and escalation of at-risk patients. Measures: The measures for this project were the implementation of the static overlay mattress for patients with a Braden Score of 18 and less, documentation of PLOF and CLOF within 8 hours of admission, and documentation of a Braden assessment within 8 hours of admission. Results: Implementing the waffle overlay mattress for patients at high risk for skin injury led to decreased HAPI occurrences. Conclusions: Standardizing the waffle overlay mattress as part of the HAPI bundle led to a 34% decrease in HAPI occurrences from a baseline of 0.58 per month to 0.33 per month

Application of Lymphedema Education Toolkit for Nurse Coordinators

Problem: There is approximately one in five breast cancer survivors affected by breast cancer-related lymphedema (BCRL), a potentially debilitating condition affecting the physical, emotional, social, and financial well-being of individuals. Context: This Quality Improvement (QI) project was conducted at an outpatient facility of Hospital X’s Women’s Cancer Center. Within this microsystem, there are 24 permanent clinical nurse coordinators and advanced practice providers, with 15 nurse coordinators dedicated to care for patients with breast cancer or gynecological conditions. Intervention: The intervention aims to evaluate if a standardized educational tool improves early interventions for patients with lymphedema and knowledge among healthcare providers on the comprehension of lymphedema stages, diagnostic modalities, risk reduction, and treatments. By implementing this toolkit for nurse coordinators, intervention helps assist patients make informed decisions about their care. Measures: Data collection gathered evidence-based research to improve early lymphedema interventions compared to current methods. The application of a pre-and post-survey assesses stakeholder’s efficacy of the education toolkit. Results: A pre-assessment survey evaluating the effectiveness of an education toolkit achieved an 81% response rate, and the post-assessment survey had an average score of 93%. To institute early interventions for patients the average response rate improved by 12% after implementing a standardized education tool for nurse coordinators. Conclusion: In the transition of the change process of this microsystem, an increase in knowledge following the implementation of a standardized toolkit enhanced early interventions for patients and clinical nurse coordinators at Hospital X Women’s Cancer Center

Themes in Help-seeking of Female Military Sexual Assault Survivors

While large efforts have been made to address military sexual assault, there are still barriers in the help-seeking journey that need attention. This study aimed to examine barriers and facilitators to formal and informal help-seeking behaviors and to understand the role of stigma in survivors\u27 help-seeking behaviors for female military sexual assault survivors. Through semi-structured interviews, the study explored the help-seeking experiences and mental health sequela of fourteen female military sexual assault survivors. This study focused on cis-gender women over the age of eighteen who experienced a military sexual assault, by another military service member, while on active-duty. Women shared their narratives, and how their help-seeking experiences were impacted by cultural norms, facilitators, barriers, and affected growth for some of the women. Thematic analysis (Braun & Clarke, 2006) produced seven themes in help-seeking: types of help-seeking, barriers to help-seeking, facilitators to help-seeking, coping, mental health impacts, disclosure, and post-traumatic growth. Findings from this study further inform the research community of facilitators and barriers to help-seeking and informs changes to decrease the mental health impact on survivors by increasing areas of support. The findings of this research highlighted that help-seeking was impacted by military culture, societal attitudes toward sexual assault, and self-perceptions of mental health. Further research is needed to minimize the widespread barriers to help-seeking, decrease the delay in receiving mental health services, and ultimately address and eliminate underlying factors that perpetuate military sexual assault

Effects of Misinformation and Disinformation on Vaccine Hesitancy and Routine Vaccine Uptake

This literature review was conducted to identify the role misinformation and disinformation plays on the rates of vaccine hesitancy and vaccine uptake for routine immunization among the child and adult populations of the United States. Fifteen articles between 2018-2024 were extracted from PubMed and Google Scholar databases. As shelter-in-place and social distancing protocol wanes, the risk of common vaccine preventable diseases (VPDs) reemerges, especially in populations that have not kept up with routine immunization schedules. Current efforts to restore mass vaccination campaigns are underway, but do not provide the necessary modifications to include social, behavioral, and cultural factors that influence vaccine hesitancy. To address these gaps, recommendations to provide educational information on vaccine hesitancy and disinformation using the Behavioral and Social Drivers (BeSD) framework were utilized in efforts to improve on current mass vaccination campaigns and routine immunization schedules. The inclusion of the BeSD framework can benefit marginalized populations in the United States in efforts to improve vaccine uptake and overall health outcomes