Communicating with Patients and Their Families About Palliative and End-of-Life Care: Comfort and Educational Needs of Nurses

Introduction: Effectively discussing palliative care with patients and families requires knowledge and skill. The purpose of this study was to determine perceived needs of inpatient nurses for communicating with patients and families about palliative and end-of-life (EoL) care. Method: A non-experimental design was used. In total, 60 inpatient nurses from one hospital in Idaho completed the End of Life Professional Caregiver Survey (EPCS), which examines three domains: patient and family-centered communication, cultural and ethical values, and effective care delivery. Results: The number of years’ experience nurses had (F(9,131.57)=2.22, p=0.0246; Wilk\u27s ^=0.709) and the unit they worked on (F(6,110)=2.49, p=0.0269; Wilk\u27s ^=0.775) had a significant effect on their comfort discussing EoL and palliative care with patients and their families. For all three domains, years of nursing experience was positively associated with comfort in communicating about EoL care. Oncology nurses were most comfortable with regard to patient and family-centered communication. Discussion: The success and sustainability of this service is dependent on education for health-care providers. Studies are needed to determine the most effective ways to meet this educational challenge

Evaluation of Food Insecurity in Adults and Children With Cystic Fibrosis: Community Case Study

Advances in the care and treatment of cystic fibrosis (CF) have led to improved mortality rates; therefore, considerably more individuals with CF are living into adulthood. With an increased number of CF patients advancing into adulthood, there is the need for more research that surrounds the aging adult CF patient. It is important to conduct research and collect results on the aging CF population to help better prepare the CF patient, who is dealing with the heavy treatment and financial burden of their disease, build autonomy and increase their quality of life. Of note, research has found that social, behavioral, and physical factors influence the ability of those with CF to follow dietary recommendations. A primary treatment goal in CF is a high calorie, high protein, and high fat diet. A socio-economic factor that has not been adequately investigated with regards to dietary compliance of individuals with CF is food insecurity. The aim of this community case study was to document the experiences and estimate the prevalence of food insecurity among CF patients residing in Idaho. The correlation between food insecurity and health outcomes (lung function and body mass index) was also examined. Participants included adult patients and parents of pediatric patients with CF. Food insecurity rates among CF patients of all ages were found to be significantly higher than that seen in the overall community; however, no specific correlation between food insecurity and body mass index (BMI) or lung function emerged. This case study highlights the need for continued research around food access issues in this patient population. The data resulting from this study shows the value of CF advocacy organizations promoting efforts to build resources and provide education around food insecurity issues

She Ain No Crack Ho', She's Her Baby's Mama: Counternarratives of Drug Addiction, Parent -Child Interactions, and Academic Achievement From African American Mothers

304 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2007.The purpose of this dissertation is to enhance awareness about prenatal drug use, drug addiction, parent-child interactions, and academic achievement from the African American mothers' perspectives. Black feminist thought, critical race feminism, and resilience were used as theoretical frameworks for this study. Five African American mothers who used crack, powder cocaine, crank, and/or heroin participated in a series of three in-depth, face-to-face interviews. A constant-comparative method was used to analyze and interpret the data. Findings suggest that kinship networks and strong religious beliefs were significant to their resilience. The mothers provided counternarratives of drug addiction, parent-child interactions as well as their perceptions of their children's academic achievement. Important insights were provided regarding the mothers' perspectives of their maternal roles and their contributions to their children's development and academic achievement. The mothers provided self-definitions of their expressions of warmth, responsiveness and love to their children as they spoke about parent-child interactions. Counternnarratives from mothers who were prenatal drug users and no longer use drugs bring a unique perspective to understanding the impact of prenatal drug exposure on child competence. Gaining insight into how these mothers contribute to or interfere with their child's progress will assist in establishing and maintaining home-school partnerships with families impacted by prenatal drug exposure.LimitedRestricted to Closed Access indefinitely by request of the author. Request approved by Thesis Office because dissertation was ingested as a legacy item, prior to mandatory electronic deposit

Evaluation of a Designated Family BondingTime to Decrease Interruptions andIncrease Exclusive Breastfeeding

Objective: The purpose of this quality improvement project was to plan and implement a daily family bonding time on our mother/baby care unit and evaluate its effect on interruptions, mothers’ perceptions of interruptions, and exclusive breastfeeding rates. Design: A separate sample pre-/postintervention design conducted in three phases. Setting/Local Problem: Healthy breastfeeding newborns had double the odds of receiving supplementation before discharge if they stayed more than 1 night or were born at night. Night nurses suggested implementing a daily quiet time as a strategy for limiting interruptions. Participants: A convenience sample of 60 postpartum women. Intervention/Measures: During Phases 1 and 3, data were collected on interruptions (number, duration, and by whom), women’s perceptions of interruptions, and exclusive breastfeeding rates. Family bonding time was launched in Phase 2 during the hours of 2 p.m. to 4 p.m. Women were encouraged to rest with their newborns in their rooms; interruptions were limited to those that were urgent, medically necessary, or requested by the women. Results: Outcome data were analyzed using descriptive statistics, a repeated-measures analysis of variance, t test, and chi-square test. Analysis of interruptions by the unit nursing staff indicated a decrease in interruptions between 2 p.m. and 4 p.m. that could be attributed to family bonding time (F(1, 58) = 7.50, p = .008). Analysis of interruptions by other hospital staff and visitors indicated a significant interaction of time with interruptions; interruptions decreased in both phases between 2 p.m. and 4 p.m. (F(3, 174) = 4.83, p = .0029; F(3, 174) = 2.95, p = .034). Exclusive breastfeeding rates increased significantly (χ2(4) = 21.27, p = .0003); there were no significant differences in women’s perceptions of interruptions. Conclusion: New mothers experience many interruptions during their hospital stays, particularly when visitors arrive in large groups and stay more than 60 minutes. Documenting sources of interruptions before launching family bonding time helps identify hospital staff who need to be informed. Addressing their concerns before implementation can facilitate project sustainability

Successful adherence and retention to daily monitoring of physical activity: Lessons learned.

Research utilizing repeated-measures such as daily assessments with self-report and/or objective measures [e.g., physical activity (PA) monitors] are important in understanding health behaviors and informing practice and policy. However, studies that utilize daily assessment often encounter issues with attrition and non-compliance. The current research yielded high levels of retention and adherence with both self-report and objective daily measures. The purpose of this paper is to highlight and discuss strategies utilized in maximizing retention, minimizing missing data, and some lessons learned from the research experience. Fifty community participants took part in a 4-week study utilizing both daily self-report questionnaires and daily use of PA monitors (Fitbit One™). This study focused on typical daily PA and was not an intervention study (e.g., participants were not randomized nor asked to change their PA behavior). Participants completed the study in two waves (wave 1 n = 10, wave 2 n = 40). The research team utilized several retention strategies including automating the data collection process, a prorated incentive structure, having a dedicated and responsive study staff, and utilizing the 2-wave process to optimize data collection during the 2nd wave. The study had 100% retention and generally positive anonymous feedback post-study. Overall, participants completed the vast majority of daily surveys (97%) and wore their Fitbits (for at least part of the day) on almost all days (99.57%) of the study, although there were individual differences. The strategies discussed and lessons learned may be useful to other researchers using daily measurements for whom adherence and retention are important issues. Future research employing these strategies in different populations, with different measurements, and for longer durations is warranted to determine generalizability