Multi-level barriers to early detection of breast cancer among rural midlife women in Tanzania: A qualitative case study.

BACKGROUND: Breast cancer is the second most common cause of cancer mortality among women in Tanzania and thus, early detection and treatment methods are central to improving breast cancer outcomes. However, in low- and middle-income countries in Sub-Saharan Africa, the survival rates remains low due to late presentation. Hence, a significant number of deaths could be prevented if barriers and facilitators to early detection are known. PURPOSE: This qualitative case descriptive study explored the possible barriers to awareness and early breast cancer diagnostic services among midlife women in rural Tanzania. METHODS: Ten key informant interviews with health systems managers and community health workers and eight focus group discussions with women aged 40-65 years and their spouses were conducted to elicit the study data conducted from July to August 2021. RESULTS: The data revealed nine themes describing the barriers to early detection methods across five Socio-Ecological levels of influence, namely: 1) limited knowledge and 2) witchcraft beliefs (individual level); 3) limited male support (interpersonal level); 4) age and gender factors and 5) procrastination (community level) 6) limited availability of services 7) emphasis of curative over preventive care (institutional level); 8) poverty/inability to pay and 9) limitations of health insurance (societal/policy level). CONCLUSIONS: The study findings suggest a need to further the design, implementation and evaluation of evidence-based community breast health awareness and education interventions to promote early detection of breast cancer in Tanzania. Specifically, the study highlights the need to address multiple level determinants of influence in breast cancer control as part of the country's Community Health Strategy.

A Theory of Family Health: A Neuman's Systems Perspective.

Understanding the social contexts of health and healthcare delivery from a multilevel thinking perspective offers nurses an opportunity to prioritize research and interventions that address communicable and noncommunicable diseases across the care continuum. The content of this paper explains the development of a multilevel theory of family health for Sub-Saharan families affected by the burden of breast cancer guided by Neuman's Systems Model. Implications for knowledge development in family nursing practice and research in the region are discussed.

A Teaching Strategy to Facilitate Nursing Students' Translation of Global Health Learning from Classroom to the Community.

Integrating global health concepts in nursing curricula is important for a competent contemporary global nursing workforce. This article describes a teaching strategy that facilitates students' translation of global health content from classroom to the community. A community-academic partnership and a train-the-trainers' approach to support community capacity for working with refugees was implemented. The Community-As-A Partner model was used as the guiding framework. Additionally, the DEAL model was used to support students' reflections on their clinical experiences. A quiz, reflections, participant evaluations, and student peer evaluations were used to assess students' clinical learning experiences. Key lessons learned are also presented.

Thoughts About Nursing Curricula: Dark Clouds and Bright Lights.

In this essay, several nurse scholars who are particularly concerned about the contemporary state of nursing science present their concerns about the inclusion of nursing conceptual models and theories in the curricula of nursing programs (dark clouds) and ways in which the concerns have been addressed (bright lights). This essay is the second of two essays that were catalyzed by Barrett's paper, "Again, What Is Nursing Science?" The first essay was published in the previous issue of Nursing Science Quarterly.

Thoughts About Advancement of the Discipline: Dark Clouds and Bright Lights.

In this essay, several nurse scholars who are particularly concerned about the contemporary state of nursing science present their specific concerns (dark clouds) about the advancement of our discipline and the ways in which the concerns have been addressed (bright lights). This essay is the first of two essays that were catalyzed by Barrett's paper, "Again, What Is Nursing Science?" The second essay will be published in the next issue Nursing Science Quarterly.

Exploratory Factor Analysis of the Attitudes Towards Simulation-Based Learning Scale.

BACKGROUND: Simulation is used in nursing curricula to augment or replace the traditional clinical practice experiences. Studies reported varying attitudes of nursing students to simulation-based learning. The aim of this study was to conduct an exploratory factor analysis of the Attitudes of Nursing Students to Simulation-Based Learning scale to be used to explore the nursing students' attitudes related to simulation. METHOD: Data were collected online from 217 nursing students at a U.S. college of nursing and health from February to May 2015. Item analysis and exploratory factor analysis were performed. RESULTS: The results showed that the 17-item scale consisted of two factors: clinical competency and effectiveness of the simulation-based learning. The Cronbach's alpha reliability of the scale was .91 and .90 for factor one and .70 for factor two. CONCLUSION: The new scale can be used to measure nursing students' attitudes toward simulation. [J Nurs Educ. 2017;56(8):471-476.].

Community Stakeholders' Perceptions of the Role of Family in HIV Prevention in Iringa, Tanzania.

Although HIV is identified as a family disease, the overall response to the global HIV epidemic continues to predominantly focus on individuals. The aim of this qualitative study was to explore how the role of the family in HIV prevention is perceived by community-based stakeholders. Understanding the role of the family within the context of the HIV/AIDS is essential for community/public health nurses. In total, 34 stakeholders participated in the study. Three major categories were identified namely: fostering positive intra-familial relations, utilizing external resources, and barriers to family roles. The study findings have implications for community-based HIV family interventions.

The meaning of family nursing intervention: what do acute care nurses think?

Understanding the concept of family nursing intervention from the perspective of practicing nurses is essential for implementing a family-centered approach in the acute care context. Data from this qualitative study were analyzed using a colloquial concept analysis method derived from Rodgers' evolutionary theory. Five main attributes of family nursing interventions were identified. Family nursing interventions were viewed as a time-limited, collaborative process, initiated and/or facilitated by nurses and directed at either the individual or the family to solve problems. The antecedents of family nursing interventions were "family assessment," "the presence of a family-related problem," "willingness to participate (provider and family)" and a "supportive organizational structure." The most common consequences (outcomes) were identified as positive (good) or negative (bad) individual or family-related out-comes following a family nursing intervention. The analysis suggests that family nursing interventions are essential but variable in nature within nursing practice. In addition, the analysis implies a need for further inquiry in diverse settings to define the concept and test relationships between the antecedents and outcomes to advance nurses' translational knowledge of culturally appropriate family nursing interventions.

Simulation-based end-of-life care training during surgical clerkship: assessment of skills and perceptions.

BACKGROUND: Assessment of interpersonal and psychosocial competencies during end-of-life care training is essential. This study reports the relationship between simulation-based end-of-life care Objective Structured Clinical Examination ratings and communication skills, trust, and self-assessed empathy along with the perceptions of students regarding their training experiences. METHOD: Medical students underwent simulation-based end-of-life care OSCE training that involved standardized patients who evaluated students' communication skills and physician trust with the Kalamazoo Essential Elements Communication Checklist and the Wake Forest Physician Trust Scale. Students also completed the Jefferson Scale of Physician Empathy. Pearson correlation was used to examine the relationship between OSCE performance grades and communication, trust, and empathy scores. Student comments were analyzed using the constant comparative method of analysis to identify dominant themes. RESULTS: The 389 students (mean age 26.6 ± 2.8 y; 54.5% female) had OSCE grades that were positively correlated with physician trust scores (r = 0.325, P < 0.01) and communication skills (r = 0.383, P < 0.01). However, OSCE grades and self-reported empathy were not related (r = 0.021, P = 0.68). Time of clerkship differed for OSCE grade and physician trust scores; however, there was no trend identified. No differences were noted between the time of clerkship and communication skills or empathy. Overall, students perceived simulation-based end-of-life care training to be a valuable learning experience and appreciated its placement early in clinical training. CONCLUSIONS: We found that simulation-based OSCE training in palliative and end-of-life care can be effectively conducted during a surgery clerkship. Moreover, the standardized patient encounters combined with the formal assessment of communication skills, physician trust, and empathy provide feedback to students at an early phase of their professional life. The positive and appreciative comments of students regarding the opportunity to practice difficult patient conversations suggest that attention to these professional characteristics and skills is a valued element of clinical training and conceivably a step toward better patient outcomes and satisfaction.

Coping with colorectal cancer: a qualitative exploration with patients and their family members.

BACKGROUND: Extensive family coping research has been conducted among breast cancer, prostate cancer and melanoma with lesser emphasis on the coping experiences of colorectal cancer (CRC) patients and their family members. OBJECTIVE: To examine ways in which patients and their family members cope with the diagnosis of CRC. METHODS: A total of 73 participants (21 patients, 52 family members) from 23 families described their experiences during and after a CRC diagnosis, including their coping experiences with the diagnosis. Data from semi-structured interviews were audio recorded and transcribed. The data were analyzed utilizing content analysis with inductive coding methods. RESULTS: Eight major themes were identified: positive reframing, holding on to a sense of normalcy, religion and spirituality, joining a group, creating awareness of CRC, lifestyle change, seeking information and alternative treatments. Maintaining an emotional sense of normalcy through positive thinking, engaging in activities to take one's mind off the diagnosis and believing that there is a higher authority which has control over the diagnosis and life were vital for the patients and their family members. Patients and family members used similar coping strategies. CONCLUSION: Findings from this study have implications for understanding how families blend emotion-based and problem-focused coping strategies in the face of a CRC diagnosis. Further developing evidence-based interventions that target coping and well-being in cancer patients and extending them to family members is necessary and holds great promise for providers who care for patients with familial cancers.

A discussion of HIV/AIDS family interventions: implications for family-focused nursing practice.

AIM: This article presents a discussion on the role of family interventions in HIV/AIDS disease prevention and care. BACKGROUND: Although HIV/AIDS epidemic and its impact on the society traditionally has been measured in terms of individual risk behaviours and individual-level HIV prevention, HIV/AIDS family-focused prevention and management strategies are increasingly becoming a priority. However, little is known as to what constitutes a HIV/AIDS family intervention. DATA SOURCES: The search was limited to English and published literature starting in the year 1983 to date. CINAHL and PubMed were emphasized using a combination of text words and subject headings. Cochrane Library, PsycInfo, Scopus, and the ISI Web of Science databases were also searched using keywords and in the case of PsycInfo, subject headings were used. The main keywords were 'nurse', or 'nursing', 'HIV/AIDS', 'family interventions', 'family support' and 'family education', and/or 'family subsystems'. DISCUSSION: The process of theorizing about 'family interventions' and 'HIV/AIDS-family interventions' is critical for putting forth essential components unique for designing culturally specific HIV/AIDS family interventions. In addition, any proposed design of HIV/AIDS family intervention should consider the impact of HIV/AIDS on the family across the family life span, disease trajectory, and from an interdisciplinary perspective. CONCLUSION: Training needs of family nurses should be met when designing multidisciplinary HIV/AIDS-FIs. Furthermore, nurses should be proactive in advocating for HIV/AIDS family intervention and HIV/AIDS family policies to improve outcomes in family functioning, processes, and relationships. More needs to be done in regard to research on families, family interventions, effectiveness, and cost of family-focused approaches.

HIV disclosure among HIV positive individuals: a concept analysis.

AIM: This paper is a report of an analysis of the concept of HIV disclosure. BACKGROUND: There is a growing interest among healthcare providers and researchers in HIV disclosure as an effective HIV prevention and early disease management initiative. However, the concept still remains unclear. Conceptual clarity is important for providing an expanded theoretical definition and understanding of attributes of HIV disclosure. This information is useful in constructing better HIV disclosure measures in HIV/AIDS nursing practice and research. DATA SOURCES: A computer search of the following databases was conducted to capture the meaning and processes of HIV disclosure among HIV-positive individuals: PubMed, CINAHL and PSYCINFO. Only English language journals were used. Publication dates of the literature review ranged from 1999 to 2009. The following key words were used: HIV disclosure, self-disclosure, disclosure and serostatus disclosure. METHODS: The Walker and Avant (2005) concept analysis model (Strategies for Theory Construction in Nursing, Pearson Prentice Hall, River, NJ, 2005) was used to guide the analysis process, which was completed in 2009. RESULTS: The concept analysis revealed that HIV disclosure is a complex process characterized by the following attributes: experiencing an event, communicating something, timing, and contextual environment, protecting someone, relationship status and improving something or being therapeutic. In addition, the process of HIV disclosure varies across time. CONCLUSION: The proposed HIV disclosure attributes provide nursing scholars and researchers with new directions on how to reframe research questions, develop measurement tools to reflect better the diversity and fluidity of the process of HIV disclosure among HIV-positive individuals. Policy implications include the need to develop approaches that protect individual and public rights.