Language to Support Dignity for Children With Advanced Cancer and Their Families.

BACKGROUND AND OBJECTIVES: Conversations about dignity are fundamental to person-centered care in pediatrics, yet practical language strategies to promote and support dignity remain understudied. To address this gap, we aimed to identify and characterize language used by pediatric oncologists to recognize and affirm dignity across advancing illness. METHODS: In this longitudinal prospective study, we audio-recorded serial disease reevaluation encounters between pediatric oncologists, children with cancer, and families across 24 months or until the child's death. Using a hybrid deductive-inductive qualitative approach, we defined dignity language a priori on the basis of existing descriptions of dignity in the literature and then conducted a content analysis to refine the definition specific to pediatric cancer care before coding serial medical encounters. Thematic frequencies were reported by using descriptive statistics. RESULTS: A total of 91 discussions at timepoints of disease progression were audio-recorded for 36 patients and their families. No dignity language was identified in nearly half (45%) of "bad news" encounters, and the time spent by the oncologist engaging in dignity language represented a minority (<7%) of overall recorded dialogue. Within coded dialogue, we characterized 3 key themes upholding dignity language (empowerment, autonomy, respect). CONCLUSIONS: Opportunities exist to improve dignity communication in childhood cancer, and the authors propose a conceptual model ("Lend an EAR") to guide dignity-based communication in pediatric cancer. Future research should emphasize patient and parent perspectives on language to support dignity for children with advanced cancer, with stakeholder-driven refinement of the Lend an EAR model before integration and testing in communication skills training programs.

Guidelines for Education and Training at the Doctoral and Postdoctoral Levels in Consulting Psychology/Organizational Consulting Psychology: Executive summary of the 2017 revision.

This article provides an executive summary of the American Psychological Association (APA)-approved 2017 revision of the Guidelines for Education and Training at the Doctoral and Postdoctoral Levels in Consulting Psychology/Organizational Consulting Psychology. The guidelines were developed by the Society of Consulting Psychology (SCP), Division 13 of the American Psychological Association, to provide updated guidance and recommendations for education and training of doctoral-level consulting psychologists. This article provides an overview of the complete guidelines, reviews the process by which the guidelines were generated, and identifies some of the important contextual factors involved in this work, including overarching principles; the concept of individual, group, and organizational levels; and specific consulting psychology competencies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Blood exposure incidence rates from the North Carolina study of home care and hospice nurses.

BACKGROUND: Home care/hospice nurses may be at elevated risk of blood exposure because of the nature of their work and work environment. However, little is known about the incidence of blood exposure in this population. METHODS: A mail survey (n = 1,473) was conducted among home care/hospice nurses in North Carolina in 2006. RESULTS: The adjusted response rate was 69%. Nine percent of nurses had at least one exposure/year. Overall incidence was 27.4 (95% confidence interval: 20.2, 34.6)/100,000 visits. Nurses who had worked in home care < or =5 years had higher exposure rates than other nurses-seven times higher for needlesticks and 3.5 times higher for non-intact skin exposures. Nurses who worked part time/contract had higher exposure rates than nurses who worked full time-seven times higher for needlesticks and 1.5 times higher for non-intact skin exposures. The rates for part-time/contract nurses with < or =5 years experience were extremely high. Sensitivity analysis showed that it is unlikely that response bias had an important impact on these results. CONCLUSIONS: Approximately 150 North Carolina home care/hospice nurses are exposed to blood annually. If these results are representative of other states, then approximately 12,000 home care/hospice nurses are exposed each year nationwide. Improved prevention efforts are needed to reduce blood exposure in home care/hospice nurses. Am. J. Ind. Med. 52:99-104, 2009. (c) 2008 Wiley-Liss, Inc.