RESUMEN
Aging with independence benefits individuals, family, and society. To achieve independence, older adults must be able to function in their homes. This function is determined both by their abilities and by the environment in which they maneuver. This article describes a promising program that intervenes with both older adults and their home environments to improve function. This program, called CAPABLE (Community Aging in Place, Advancing Better Living for Elders), is funded through the Affordable Care Act and can be scaled up nationally if determined to be a success in improving health and decreasing health care costs.
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Envejecimiento , Vida Independiente , Administración de la Seguridad , Actividades Cotidianas , Anciano , Humanos , Estados UnidosRESUMEN
PURPOSE/OBJECTIVES: To examine and refine the Illness Trajectory Framework, and to address transitional cancer survivorship. DATA SOURCES: CINAHL®, PubMed, and relevant Institute of Medicine reports were searched for survivors' experiences during the year following treatment. DATA SYNTHESIS: Using an abstraction tool, 68 articles were selected from the initial search (N > 700). Abstracted data were placed into a priori categories refined according to recommended procedures for theory derivation, followed by expert review. CONCLUSIONS: Derivation resulted in a framework describing the work of transitional cancer survivorship, defined as survivor tasks, performed alone or with others, to carry out a plan of action for managing one or more aspects of life following primary cancer treatment. Theoretically, survivors engage in three reciprocally interactive lines of work: (a) illness-related, (b) biographical, and (c) everyday life work. Adaptation resulted in refinement of these domains and the addition of survivorship care planning under "illness-related work." IMPLICATIONS FOR NURSING: Understanding this process of work may allow survivors and those who support them to better prepare for the post-treatment period. This adaptation provides a framework for future testing and development. Validity and utility of this framework within specific survivor populations also should be explored.
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Neoplasias/psicología , Sobrevivientes , Humanos , Modelos Psicológicos , Neoplasias/terapiaRESUMEN
Older African Americans face substantial barriers to state-of-the-art cancer care. Implementing culturally appropriate support throughout cancer therapy is critical to improving cancer outcomes and quality of life for this vulnerable population. The purpose of this study was to obtain experiential data regarding cancer diagnosis and treatment, and analyze survivors' recommendations regarding treatment-related needs, psychosocial support, and strategies and resources. Four main issues emerged from the study: (a) the need for more health-related and cancer-specific education, (b) the importance of faith and spirituality, (c) the availability of support, and (d) participants' difficulty identifying and articulating financial needs. Few participants reported requesting or receiving assistance (financial or otherwise) outside of the family during their cancer experience. However, treatment-related medication costs posed a significant hardship for many.
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Negro o Afroamericano/estadística & datos numéricos , Recursos en Salud , Necesidades y Demandas de Servicios de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Neoplasias/etnología , Factores de Edad , Anciano , Anciano de 80 o más Años , Terapia Combinada/economía , Estudios Transversales , Femenino , Apoyo Financiero , Grupos Focales , Disparidades en Atención de Salud/economía , Humanos , Renta , Masculino , Maryland , Neoplasias/diagnóstico , Neoplasias/terapia , Medición de Riesgo , Población Rural , Factores Sexuales , Factores Socioeconómicos , Encuestas y Cuestionarios , Sobrevivientes , Resultado del Tratamiento , Población Urbana , VirginiaRESUMEN
BACKGROUND: Rural African American (AA) seniors may experience significant challenges during cancer treatment. Previous research suggests community health workers (CHWs) can provide effective cancer patient navigation (CPN) support. OBJECTIVES: To develop a Train the Trainers (TTT) program for CHWs in rural Central Virginia who would navigate local AA seniors with cancer and train their support persons to provide similar types of assistance. METHODS: We conducted focus groups with rural AA seniors, consulted with experienced CHW trainers, recruited and trained CHWs through a combination of online learning and distance education, evaluated the TTT via surveys and focus groups, and hired CHWs to the study team. RESULTS/LESSONS LEARNED: Lessons learned from our TTT experience include the value of incorporating CHW trainers and trainees as full members of the research team. CONCLUSIONS: Training should be accessible and flexible, providing trainees community-level resources and enriched educational experiences. Findings have informed a culturally tailored support CHW intervention to address cancer diagnosis and treatment needs for older rural AAs.
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Negro o Afroamericano , Agentes Comunitarios de Salud/educación , Accesibilidad a los Servicios de Salud/organización & administración , Neoplasias , Servicios de Salud Rural , Anciano , Grupos Focales , Servicios de Salud para Ancianos , Humanos , Defensa del PacienteRESUMEN
PURPOSE: The purpose of this study was to explore the experiences of nurse volunteers caring for children after the Haiti earthquake in January 2010. DESIGN AND METHODS: This descriptive qualitative study using in-depth interviews focuses on the experiences of 10 nurse volunteers. RESULTS: Four themes emerged: hope amid devastation, professional compromises, universality of children, and emotional impact on nurses. PRACTICE IMPLICATIONS: Nurses who volunteer after natural disasters have rich personal and professional experiences, including extremes of sadness and joy. Nurse volunteers will likely need to care for children. Nurses and humanitarian agencies should prepare for the unique challenges of pediatric care.
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Terremotos , Enfermería Pediátrica/organización & administración , Trabajo de Rescate/organización & administración , Voluntarios/organización & administración , Adulto , Actitud del Personal de Salud , Niño , Preescolar , Femenino , Haití , Humanos , Masculino , Persona de Mediana Edad , Rol de la Enfermera , Relaciones Enfermero-Paciente , Investigación Cualitativa , Estrés Psicológico , Encuestas y Cuestionarios , Voluntarios/psicología , Adulto JovenRESUMEN
PURPOSE/OBJECTIVES: To obtain experiential data regarding African American older adult survivors' perceptions of and recommendations on the role of community health workers (CHWs) in providing a cancer navigation intervention. RESEARCH APPROACH: Focus groups. SETTING: Rural Virginia and urban Maryland. PARTICIPANTS: 48 African American solid-tumor cancer survivors, aged 65 years or older, with Medicare insurance. METHODOLOGIC APPROACH: Analysis was accomplished through a reflexive process of transcript review, categorization, and interpretation. FINDINGS: Themes and accompanying categories identified were uneasiness surrounding the CHW role (disconnect between identified support needs and CHW role, essential CHW characteristics, and potential application of CHWs), recommendations to adequately address cancer needs (coordinating cancer treatment and unmet needs during cancer), and the importance of individualized interventions. Participants provided specific recommendations regarding the role of the CHW and how to develop supportive interventions. CONCLUSIONS: Study participants had surprisingly limited prior exposure to the CHW role. However, they stated that, in certain circumstances, CHWs could effectively assist older adult African Americans undergoing cancer diagnosis or treatment. INTERPRETATION: Study findings can be helpful to researchers and to healthcare providers engaged in assisting older African Americans during cancer diagnosis and treatment. The results lay a foundation for developing culturally appropriate interventions to assist this at-risk population.
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Negro o Afroamericano/psicología , Agentes Comunitarios de Salud/psicología , Neoplasias/psicología , Aceptación de la Atención de Salud/psicología , Sobrevivientes/psicología , Negro o Afroamericano/etnología , Anciano , Anciano de 80 o más Años , Manejo de Caso , Femenino , Grupos Focales , Humanos , Masculino , Medicare , Neoplasias/etnología , Satisfacción del Paciente , Factores de Riesgo , Apoyo Social , Estados UnidosRESUMEN
PURPOSE/OBJECTIVES: To determine facilitators and barriers to managing patient loss from the combined perspectives of oncology nurses and to extract essential components of a supportive intervention. RESEARCH APPROACH: Qualitative, descriptive. SETTING: The comprehensive National Cancer Institute-designated cancer center of a mid-Atlantic university teaching hospital. PARTICIPANTS: 34 nurses from inpatient and outpatient adult and pediatric oncology units. METHODOLOGIC APPROACH: Focus groups were held with oncology staff nurses to identify challenges regarding work-related bereavement, current support for managing grief and loss, and how to support interpersonal functioning and resiliency. MAIN RESEARCH VARIABLES: Work-related bereavement, bereavement support, and interventions and management strategies for bereavement and loss. FINDINGS: Two primary themes emerged: dimensions of work-related loss and working through bereavement. Participants also provided many concrete suggestions for the creation of a supportive self-care environment. CONCLUSIONS: Support issues were numerous, multilevel, and varied. However, addressing those concerns can improve job satisfaction and decrease compassion fatigue. The findings lay the foundation for appropriate interventions to assist nurses in managing those situations. INTERPRETATION: Administrators, managers, and individuals interested in furthering the multifaceted goals of oncology care, including nurses themselves, are challenged to create and maintain mutually supportive environments for providing optimal care to patients and families.
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Actitud del Personal de Salud , Aflicción , Relaciones Enfermero-Paciente , Personal de Enfermería en Hospital/psicología , Enfermería Oncológica , Adaptación Psicológica , Grupos Focales , Pesar , Humanos , Investigación Metodológica en Enfermería , Investigación Cualitativa , Apoyo SocialRESUMEN
Cancer survivors in the United States often encounter significant challenges in obtaining and paying for medical care. Multiple research studies have examined these issues in Medicare and Medicaid populations and the underinsured, but very little is known about insurance-related challenges encountered by cancer survivors enrolled in private insurance programs such as managed care. This secondary analysis of data explored the insurance-related and financial challenges reported by women enrolled in a managed care organization during cancer treatment and early follow-up. The researchers reviewed semistructured interviews with 14 women with breast cancer near the time of diagnosis, midway through treatment, and after treatment completion. Most women reported considerable stress related to performance of insurance-related tasks during or immediately after treatment, which resulted in negative emotional and psychological experiences. This article presents recommendations for how oncology nurses can intervene to assess and address these challenges and their effects. Future research should examine best practices related to nursing management of insurance-related and financial challenges during cancer.