Nutrition-Related Clinical Decision Making of Pediatric Oncology Nurses.

Children with a cancer diagnosis have risk factors leading to unique nutritional challenges. Malnutrition in this population is correlated with worse patient outcomes. Nurses are responsible for providing holistic care to their patients; however, the quality of nutritional assessments by pediatric oncology nurses is unknown. The purpose of this study was to investigate staff nurses' clinical decision making regarding nutritional assessment of children with cancer. A web-based survey composed of a demographic form, vignettes of patients with diverse nutritional status and the New General Self-Efficacy Scale, was distributed to members of the Association of Pediatric Hematology Oncology Nurses. Participants were also asked to rate their confidence in responses as well as select key nutritional cues. Nurses were significantly more likely to under-rate the nutritional status and select far fewer cues than the experts. Further research regarding nutritional assessment is warranted. Evidenced-based guidelines for nutritional assessment of children with cancer should be developed to ensure the highest quality of care is provided to this patient population.

Item Generation and Content Validity of the Child-Adolescent Bullying Scale.

BACKGROUND: Healthcare providers do not uniformly screen young patients for exposure to bullying, and no screening instruments have been developed for widespread use in clinical settings. OBJECTIVES: The objectives of this study were to (a) generate scale items by identifying and eliciting concepts relevant to youths with potential exposure to bullying as well as to professionals who work with bullied youths and (b) assess the content validity of the new Child-Adolescent Bullying Scale (CABS) instrument. METHODS: A mixed-methods design was used to develop an initial pool of 52 items. The study was conducted in four phases: (I) comprehensive review of the existing literature; (II) concept elicitation through the conduct of focus groups with school-age youths and professionals who work with bullied youths; (III) concept selection and item construction; and (IV) content validation assessment of relevance, clarity, and dimension of each item by a panel of 30 international bullying and measurement experts through completion of an online survey. RESULTS: An initial pool of 52 potential items was developed during Phases I-III of the study. During Phase IV, item- and scale-level content validity indices were calculated and were used to refine the item pool. These strategies resulted in a new, 22-item tool, with scale-level content validity indices of .954 for clarity and .920 for representativeness. DISCUSSION: Evaluation of the CABS tool with a sample of youths drawn from healthcare settings will be necessary to assess the performance of the CABS items, further evaluate its psychometric properties, and further refine the tool.

Building Bridges From Hospital to Home: Understanding the Transition Experience for the Newly Diagnosed Pediatric Oncology Patient.

Caregivers of pediatric oncology patients are expected to understand and adhere to a complex medical plan of care while at home; yet little is known about how to assess and evaluate the caregivers' abilities to adequately meet these demands. The purpose of this study was to describe the issues and daily challenges faced by caregivers as they transition from hospital to home after their child's cancer diagnosis. Patients and caregivers received a home visit by an expert pediatric oncology nurse within 72 hours postdischarge after initial diagnosis. The nursing narrative notes from these visits were analyzed using content analysis. Four explanatory themes emerged: (1) "We're doing okay," (2) "This isn't going so well," (3) "I could use a little help with this," and (4) "An RN in the house makes you feel safe and know what is correct." These analyses revealed many caregivers achieved mastery of caring for the child at home; however, an overwhelming majority of caregivers expressed questions or concerns to the nurse during the home visit, even those achieving mastery of care. A home visit by an expert pediatric oncology nurse assisted the caregiver in transitioning to caring for the child at home. Such programs should be considered when planning transition programs from hospital to home.

Implicatoins of youth bulling on mental health / Implicancias del bullying sobre la salud mental de los adolescentes

INTRODUCTION: Youth bullying is an international phenomenon that has similar mental health implications in different populations globally. The purpose of this literature review is to describe bullying and its impact on youths' mental health, examines the state of science on bullying interventions, and describes implications for nursing for addressing this problem. METHODOLOGY: Four international databases were searched for all English and Spanish language articles including youth bullying and mental health effects. Articles chosen for review included meta-analyses, and systematic and integrated reviews which focused on youth bullying and mental health. DISCUSSION/CONCLUSIONS: Findings indicated that youths who differed from their peers in some way are at high risk of being a victim of bullying. Victims of bullying can display externalizing behaviors such as aggression, but more commonly display internalizing behavior such as withdrawal, and increasing suicidality. Nurses, in schools or other community settings, as well as primary and acute care are well positioned to help identify victims of bullying and to intervene, potentially reducing or eliminating the long term negative mental health effects of bullying. Future research should focus on groups likely to be bullied but not yet extensively studied, like lesbian, gay, bisexual, queer, transgender youth and those with autism spectrum disorders. More effective interventions are needed to decrease the prevalence of bullying and reduce the effect of bullying on victims.

INTRODUCCIÓN: El bullying en adolescentes es un fenómeno internacional cuyas implicaciones sobre la salud mental son similares en distintas poblaciones a nivel global. El propósito de esta revisión bibliográfica es describir el concepto de bullying y su impacto sobre la salud mental de los jóvenes'. Asimismo, examinar el estado de la ciencia en relación con las intervenciones en casos de bullying y describir las implicaciones que tiene para la enfermería el abordaje de este problema. METODOLOGÍA: Se efectuó la búsqueda en cuatro bases de datos internacionales de todos los artículos escritos en inglés y en español que incluyeran efectos sobre la salud mental y bullying en adolescentes. Los artículos seleccionados para esta revisión incluyeron tanto metaanálisis como revisiones sistemáticas e integradas enfocadas de manera fundamental a los aspectos de bullying en adolescentes y la salud mental. DISCUSIÓN/CONCLUSIONES: Se encontró que aquellos jóvenes que tienen características diferentes de sus compañeros se encuentran de alguna manera en alto riesgo de ser víctimas de bullying. Estas víctimas pueden mostrar conductas de externalización como agresión, y conductas de internalización como retraimiento y más comúnmente, tendencias suicidas. Las enfermeras, tanto en escuelas como en otras instalaciones comunitarias, tanto en cuidados primarios como agudos se encuentran bien capacitadas para ayudar a identificar a las víctimas de bullying y para intervenir reduciendo potencialmente e incluso eliminando los efectos negativos del bullying sobre la salud mental a largo plazo. Las futuras investigaciones deberán centrarse en los grupos susceptibles de ser intimidados y los cuales aún no han sido suficientemente estudiados, como aquellos de jóvenes lesbianas, gays, bisexuales, transexuales y personas con trastornos del espectro autista. Intervenciones más eficaces para disminuir la prevalencia del bullying y reducir el efecto de la intimidación sobre las víctimas son necesarias.

Measuring coping in pregnant minority women.

Coping strategies may help explain why some minority women experience more stress and poorer birth outcomes, so a psychometrically sound instrument to assess coping is needed. We examined the psychometric properties, readability, and correlates of coping in pregnant Black (n = 186) and Hispanic (n = 220) women using the Brief COPE. Exploratory and confirmatory factor analysis tested psychometric properties. The Flesch-Kincaid Reading Level test assessed readability. Linear regression models tested correlates of coping. Findings suggested two factors for the questionnaire: active and disengaged coping, as well as adequate reliability, validity, and readability level. For disengaged coping, Cronbach's α was .78 (English) and .70 (Spanish), and for active coping .86 (English) and .92 (Spanish). A two group confirmatory factor analysis revealed both minority groups had equivalent factor loadings. The reading level was at the sixth grade. Age, education, and gravidity were all found to be significant correlates with active coping.

Secondhand smoke exposure among nonsmoking pregnant women in New York City.

INTRODUCTION: Although secondhand smoke (SHS) exposure during pregnancy has detrimental effects on fetal health, little is known about levels of SHS in nonsmoking pregnant women. We examined disparities in SHS exposure among nonsmoking, ethnic minority pregnant women in New York City. METHODS: We used self-reported smoking and serum cotinine collected from 244 pregnant women from the Bronx who self-identified as African American, Caribbean American, or Black Hispanic to examine smoking prevalence (>3 ng/ml) and, in an adjusted logistic regression model, risk factors for SHS (≥ 0.05 ng/ml and ≤ 3 ng/ml). RESULTS: Although only 4.1% of women self-reported they were smokers, 10.7% had serum cotinine levels indicating they were smokers. Among the 218 nonsmokers, 46.8% had serum cotinine levels indicating SHS exposure. Women at highest risk included those with less than a high school degree (66.7%) and those who were U.S.-born Black Hispanic (63.2%) or African American (63.0%). Women with more than 12 years of education were less likely to have detectable SHS exposure than women with fewer than 12 years (adjusted odds ratio 0.39, 95% CI = 0.17, 0.91). Compared with African American U.S.-born women, those who were African American foreign-born or Caribbean American and either U.S.-born or foreign-born were less likely to have detectable SHS exposure (all p ≤ .05). CONCLUSIONS: Nearly half of nonsmoking pregnant women in New York City had elevated cotinine levels despite living in a city with comprehensive tobacco control policies. Health professionals need to assess sources of SHS exposure during pregnancy and promote smoke-free environments to improve maternal and fetal health.