Jessica Keim-Malpass

Talking With Death at a Diner: Young Women's Online Narratives of Cancer

PURPOSE/OBJECTIVES To gain a unique perspective of the experiences of young women with cancer (age 20-39 years at diagnosis) through analysis of their online illness blogs. DESIGN A qualitative analysis of online narratives based on hermeneutic phenomenology. SETTING Online illness blogs found through young adult cancer Web sites and social media sites such Twitter. SAMPLE 16 women, aged 20-39 years, who self-identified as being diagnosed with cancer and who initiated and maintained an illness blog based on their cancer experience. METHODS Ethnographic immersion in online culture, thematic analysis based on line-by-line coding, and construction of themes and meanings. MAIN RESEARCH VARIABLES Transitions from diagnosis, through treatment, to long-term survivorship. FINDINGS Themes were identified as the women processed their diagnosis: living in the middle, new normal, urgency, and transition into the abyss. CONCLUSIONS The narratives shared on illness blogs offer an online place for expression of emotion, information exchange, and online social support. Emotional catharsis in the young womens narrative elucidated the experiences of transition through diagnosis, treatment, and survivorship that allow a better understanding of their emotional and psychosocial needs. IMPLICATIONS FOR NURSING Illness narratives are a naturalistic form of inquiry that allow nurses to understand the experience of the patient beyond the traditional clinic setting. This initial study provides a point for understanding the content of online narratives and has vast implications for nursing-based interventions.

Blogging through cancer: young women's persistent problems shared online.

Background: Many young women have turned to illness blogs to describe their lived experience with cancer. Blogs represent an untapped source of knowledge for researchers and clinicians. Objective: The purpose of this qualitative, exploratory study was to describe the life disruptions caused by cancer among young women, as well as to understand the facilitators and barriers in accessing healthcare services during and after active treatment. Methods: Sixteen Internet illness blogs were analyzed among women, aged between 20 and 39 years, diagnosed with cancer. These blogs were analyzed based on phenomenological qualitative methods and thematic analysis. Results: There were 4 dimensions of persistent problems that were articulated in the narratives of the young women without any relief. They included pain and fatigue, insurance and financial barriers, concerns related to fertility, and symptoms of posttraumatic stress and anxiety. Conclusion: The young women’s narratives capture fear, uncertainty, anger, and the debilitating nature of these persistent issues. Many of the women expressed their lingering physical, psychosocial, and emotional problems. Implications for Practice: Online illness narratives are a naturalistic form of inquiry that allows nurses to understand the experience of the patient through their own words and accounts. This study provides a foundation for nursing-based interventions that transcend traditional clinic experiences.

Diabetes and the Association of Postoperative Hyperglycemia With Clinical and Economic Outcomes in Cardiac Surgery

OBJECTIVE The management of postoperative hyperglycemia is controversial and generally does not take into account pre-existing diabetes. We analyzed clinical and economic outcomes associated with postoperative hyperglycemia in cardiac surgery patients, stratifying by diabetes status. RESEARCH DESIGN AND METHODS Multicenter cohort study in 4,316 cardiac surgery patients operated on in 2010. Glucose was measured at 6-h intervals for 48 h postoperatively. Outcomes included cost, hospital length of stay (LOS), cardiac and respiratory complications, major infections, and death. Associations between maximum glucose levels and outcomes were assessed with multivariable regression and recycled prediction analyses. RESULTS In patients without diabetes, increasing glucose levels were associated with a gradual worsening of outcomes. In these patients, hyperglycemia (≥180 mg/dL) was associated with an additional cost of

Coverage of Palliative and Hospice Care for Pediatric Patients With a Life-Limiting Illness: A Policy Brief

3,192 (95% CI 1,972 to 4,456), an additional hospital LOS of 0.8 days (0.4 to 1.3), an increase in infections of 1.6% (0.5 to 2.8), and an increase in respiratory complications of 2.6% (0.0 to 5.3). However, among patients with insulin-treated diabetes, optimal outcomes were associated with glucose levels considered to be hyperglycemic (180 to 240 mg/dL). This level of hyperglycemia was associated with cost reductions of

Young women’s experiences with complementary therapies during cancer described through illness blogs

6,225 (−12,886 to −222), hospital LOS reductions of 1.6 days (−3.7 to 0.4), infection reductions of 4.1% (−9.1 to 0.0), and reductions in respiratory complication of 12.5% (−22.4 to −3.0). In patients with non–insulin-treated diabetes, outcomes did not differ significantly when hyperglycemia was present. CONCLUSIONS Glucose levels <180 mg/dL are associated with better outcomes in most patients, but worse outcomes in patients with diabetes with a history of prior insulin use. These findings support further investigation of a stratified approach to the management of patients with stress-induced postoperative hyperglycemia based on prior diabetes status.

Parent/caregiver health literacy among children with special health care needs: a systematic review of the literature

Jessica Keim-Malpass, PhD, RN1,*, Terra G. Hart, MSN, RN2, and Joy R. Miller, MSN, RN, CPNP-PC, CPN3 1Post-Doctoral Fellow, Wake Forest University Department of Public Health Sciences, Division of Social Sciences and Health Policy 2Nurse Clinician, University of Virginia Childrens Hospital 3Pediatric Palliative Care Nurse Practitioner, University of Virginia Childrens Hospital, Division of Pediatric Palliative Care

Legislative activity related to the human papillomavirus (HPV) vaccine in the United States (2006–2015): a need for evidence-based policy

Many young women with cancer have a high symptom burden and negative psychosocial consequences as a result of their disease. To offset some of these experiences, a growing number of young women with cancer are writing about their experience with complementary therapies through online illness blogs. The purpose of this qualitative study was to examine descriptions of complementary therapy use among young women (diagnosed between 20 and 39 years of age) who maintained an online cancer blog. Women’s narratives describe several themes of the experience of using complementary therapies including awakening, new identities (that incorporate loss), the good stuff, and release. Online illness blogs allow researchers to understand the complete experience of the patient through personal accounts and substantially contributes to the body of knowledge surrounding cancer in young adulthood and complementary therapy use.

Adverse Childhood Experiences and Cervical Cancer Screening

BackgroundChildren with special health care needs (CSHCN) are children with medical or behavioral diagnoses that require services beyond those generally needed by pediatric populations. They account for a significant portion of pediatric health care expenditures and often have complicated treatment regiments. Health literacy has recently been recognized as a key indicator of quality chronic disease self-management and parental/caregiver health literacy of CSHCN is an understudied area. The purpose of this systematic review was to assess the available evidence of studies investigating parent/caregiver health literacy of CSHCN.MethodsDatabases were searched to retrieve relevant articles for inclusion (dating from 1998 to 2014). Only studies that assessed the relationship between parent/caregiver health literacy on outcomes pertinent to CSHCN were included. Because of the limited number of studies, there were no restrictions placed on type of outcome.ResultsThirteen studies were included in the final review with a range of health literacy assessments and outcome ascertainment. The majority of studies; (1) focused on the relationship between parental/caregiver health literacy and asthma outcomes, (2) were cross-sectional study designs, and (3) included samples recruited from pediatric clinics in academic medical settings.ConclusionsThere were several gaps in the literature where future research is needed including; (1) direct assessment of child/adolescent health literacy, (2) inclusion of children with co-morbid conditions, (3) further assessment of the relationship between health literacy and health care utilization and cost, and (4) assessment of parental/caregiver health literacy in the inpatient care setting.

The Interhospital Medical Intensive Care Unit Transfer Instrument Facilitates Early Implementation of Critical Therapies and Is Associated With Fewer Emergent Procedures Upon Arrival

State-based policies to mandate HPV vaccination are politically challenging and have received broad criticisms. There is a critical need to understand the legislative activities that underpin subsequent policy implementation. The objective of this policy analysis was to analyze state legislation that focused on HPV vaccination from 2006–2015. A content analysis was conducted among primary sources of legislative data from HPV vaccine-related bills, including using the National Conference of State Legislatures as a search-source. Findings reveal that much of the legislative activity occurred early after the HPV vaccination was introduced, and focused on increased information for parents, public financing, awareness campaigns, etc. Far fewer states focused on voluntary or mandatory vaccination. Understanding the barriers to achieving mandatory vaccination policy and implementation of such policies for HPV vaccines remains a public health priority.

Knowledge, attitudes, and preferences of healthy young adults regarding advance care planning: a focus group study of university students in Pittsburgh, USA

BACKGROUND Adverse childhood experiences (ACEs) have been associated with an increased risk of a variety of diseases, including cancer. However, research has largely ignored how ACEs impact cancer screening, a potential intermediate outcome. As such, the present study examined the association between ACEs and ever and recent use of Papanicolaou (Pap) test, among women aged 21 and older. MATERIALS AND METHODS Analyses used the 2009 Tennessee Behavioral Risk Factor Surveillance System (n = 1527) to model odds of ever and recently (within the last 3 years) engaging in Pap tests screening from nine different adversities. Bivariate and multivariate logistic regression models were run to accomplish this. RESULTS In bivariate and multivariate models, living in a household in which adults treated each other violently increased odds of ever receiving a Pap test. In bivariate models, physical and sexual abuse was associated with decreased odds of receiving a recent Pap test. After accounting for confounders, only the latter association remained significant. CONCLUSIONS Results highlight a potential mechanism by which early childhood experiences can impact the development of cervical cancer. Providers of care should consider modifications to their screening practices, including screening for child abuse, to better serve all women.