Pediatric Oncology Nurses’ Perceptions of Prognosis-Related Communication

Background Disclosure of prognosis-related information is an essential aspect of communication with pediatric patients with cancer and their families. The nurse is believed to play an important role in this process, but nurse perceptions and experiences have not been well-described. Purpose Provide an exploration of pediatric oncology nurses’ experiences with prognosis-related communication (PRC). Method Mixed-methods, multiphase design. This paper highlights the qualitative portion of the study. Findings Three themes were identified: Importance of collaboration, impact of PRC, and delivery of prognostic information. Discussion Collaboration is a critical element of PRC. Nurses are often not included in the disclosure process, which limits the ability of nurses to fully function in their roles, compromising patient, family, and nurse outcomes. A paradigm shift is required to empower nurses to be more active participants. More education of physicians and nurses is necessary to consistently engage nurses in PRC and prepare nurses for critical conversations

Nonpoint source pollution uncertainty: Stakeholder perceptions

High variability of nonpoint source (NPS) pollutant loads caused primarily by uncontrollable precipitation events creates great uncertainty for those charged with NPS management. Stakeholder disagreement on the best way to address the uncertainty issue can lead to inaction. However, understanding different stakeholder perspectives could promote consensus and a unified effort to effectively address this difficult pollution problem. This paper probes methodologies for quantifying the uncertainty of soil erosion and sediment load predictions and evaluates stakeholder perceptions of the issue through a focus group study. Three groups, each consisting of 5 to 8 individuals, convened to answer a set of questions designed to promote discussion of soil erosion and sediment load prediction uncertainty. One group was composed of natural resource professionals and scientists, another of individuals with environmental interests, and the third of producers and producer association representatives. The goal of the study is to gain insight into perceptions of NPS pollution uncertainty, the need for its quantification, and its impact on water quality improvement efforts. The findings of this study have important implications for EPA’s TMDL program and other NPS pollution control initiatives

Quantifying uncertainty of sediment TMDLs using a stochastic approach

Scientific uncertainty inherent in the development of Total Maximum Daily Load (TMDL) standards for non-point source pollutants such as sediment hampers the program’s effectiveness. Sediment is an important water quality parameter because deposition in streams and lakes adversely affects aquatic ecosystems. Equally important, suspended sediment is a transport mechanism for nutrients, pesticides and pathogens. This paper presents an alternative methodology that permits statistically valid calculation of sediment TMDL uncertainty. The sediment delivery computer simulation technology used for this project, the Geo-spatial interface for the Water Erosion Prediction Project (GeoWEPP), is capable of simulating single storm events and provides daily output useful for TMDL statistical analysis

Nurses\u27 Perceptions of Diagnosis and Prognosis-Related Communication: An Integrative Review

Background: Disclosure of diagnostic and prognostic information has become the standard in the United States and increasingly around the world. Disclosure is generally identified as the responsibility of the physician. However, nurses are active participants in the process both intentionally and inadvertently. If not included in initial discussions regarding diagnosis and prognosis, the nurse may find it challenging to openly support the patient and family. Objective: The aim of this study is to synthesize published literature regarding nurses’ perceptions and experiences with diagnosis and prognosis-related communication. Methods: The Whittemore and Knafl method guided the integrative review process. Electronic databases including Cumulative Index to Nursing and Allied Health Literature, Health Sciences in ProQuest, PubMed, and Web of Science were used to review the literature from 2000 to 2015. Constant comparison methods were used to analyze the data and develop themes. Results: Thirty articles met all of the inclusion criteria and were included in this review. Several themes emerged from the data, including the nurse’s role in the process of diagnosis and prognosis-related communication, barriers and difficulties related to communication, and positive and negative outcomes. Conclusions: Nurses play an integral role in the process of diagnostic and prognostic disclosure. Further exploration of both physician and patient perceptions of the nurse’s role are needed. Interprofessional training regarding diagnosis and prognosis-related communication is essential to promote collaboration and better empower nurses in this process. Implications for Practice: Nurses should aim to purposefully partner with physician colleagues to plan and participate in diagnostic and prognostic discussions. Nurses should identify opportunities to improve their knowledge, understanding, and comfort with challenging conversations

Pediatric Oncology Nurses\u27 Experiences with Prognosis-Related Communication

Health care providers (HCPs) in pediatric oncology are faced with the challenge of communicating the devastating news of a cancer diagnosis and prognosis. This type of communication can be referred to as prognosis-related communication (PRC). While the initial conversation with the patient and family regarding prognosis is generally considered the responsibility of the physician, patients and family members will subsequently turn to nurses for clarification of the information presented. If nurses are excluded from initial conversations, they may feel as though they are “working in the dark,” trying to answer questions while not contradicting what the physician said. This strained communication limits the nurse’s ability to fully advocate and care for patients. Little has been reported regarding pediatric oncology nurses’ experiences with PRC. A cross-sectional survey design framed by the Quality Care Model© was used to examine 1) nurses’ experiences with PRC with parents of children with cancer; 2) factors associated with experiences; and 3) associations with interprofessional collaboration, quality of care, and moral distress. Three hundred and sixteen members of the Association of Pediatric Hematology/Oncology Nurses completed an online survey containing measures of study variables. Correlation and regression were used to explore relationships among variables. Findings demonstrated that nurses strongly agreed that prognostic disclosure is critical for decision making, but are challenged in determining their role. Nurses who had more years of experience, more training in PRC, worked outpatient or inpatient/outpatient, and indicated higher levels of collaboration reported more positive experiences with PRC. A significant correlation was identified between experiences with PRC and collaboration, and both were significantly associated with measures of quality of care and moral distress. Implications for nursing practice, education and research are identified. Nurses should work to be active participants in PRC. When nurses sense that prognostic discussions have not occurred or if clarity is needed, nurses should feel confident in approaching physician colleagues to ensure parent understanding and satisfaction around communication. Future research and education should aim to develop interprofessional training to enhance communication and collaboration among nurses and physicians to ensure the highest quality of communication and care to patients and families

Facial composition, body language, and interpersonal judgements: individual differences in partner choice

Background and Objectives: Human mate choice is a complex, multi-faceted area of research. This thesis aims to investigate the contested relationship between facial appearance and fathering ability, based on the idea that women make a trade-off between a partner with good genes, and someone who will invest in the offspring. Additionally, a further investigation into sexual disgust at the prospect of mating with kin, with self-similar male faces as a proxy, to observe the Westermarck effect in action. The similarity of couples in appearance, personality, and genetics has been well documented, but less known is the similarity of body language of couples, and if they can be differentiated from pairs of strangers. Finally, a look into imprinting-like mechanism upon parental eye colour across individuals dating histories, as well as seeing if there is a self-similar preference for eye colour. Methods: Innovative technology is mixed with traditional survey methods (Chapters 5 and 6) in this thesis, including facial measurements and facial morphing (Chapters 2 and 3), electromyography measuring disgust (Chapter 3), and motion capture (Chapter 4). Results and Conclusions: We found that masculine fathers are not worse fathers, and that perceived masculinity has no association with structural masculinity in our sample, that self-reported disgust supports the Westermarck hypothesis that cues of kinship are unattractive after some similarity. We also found that couples move differently to strangers and can be identified as such, that individuals do not appear to actualise eye colour preference in dating partners, and that same-sex parent matching occurs more than opposite-sex parent eye colour matching. It is clear that there is much work still to do to disentangle the evolutionary aspects of human mate choice, but the use of novel methodology in this thesis adds further knowledge and clarity to some contentious areas of research, as well as new avenues

Couples\u27 Views of the Effects of Natural Family Planning on Marital Dynamics

Purpose: Natural Family Planning (NFP) requires periodic abstinence and partner cooperation to prevent pregnancy. The aim of this study was to learn about the effects of modern NFP methods on marital relationships. Design: Descriptive survey. Methods: Questionnaires were mailed to 1,400 randomly selected couples known to use NFP and residing in the United States of America; 334 couples (24%) responded. Content analysis was used to identify meanings and themes. Numeric analyses were used to determine frequencies. Findings: Nearly two-thirds of the qualitative comments were positive. Four themes were identified in the positive responses: relationship enhancements, knowledge improvements, spirituality enrichments, and method successes. Three negative themes were identified: strained sexual interactions, worsened relationships, and method problems. Although about onefourth of the comments indicated that NFP presented challenges, the majority (74%) found it beneficial, often resulting in stronger bonds, better communication, and improved knowledge. Conclusions: NFP had more positive than negative effects and its use warrants further consideration