Nakia C. Best

Psychosocial Predictors of Depression Among Older African American Patients With Cancer

PURPOSE/OBJECTIVES To determine whether psychosocial factors predict depression among older African American patients with cancer. DESIGN A descriptive correlational study. SETTING Outpatient oncology clinic of a National Cancer Institute-designated cancer center in the southeastern United States. SAMPLE African American patients with cancer aged 50-88 years. METHODS Fishers exact and Wilcoxon rank-sum tests were used to evaluate differences between patients who were possibly depressed (Geriatric Depression Scale) or not. Multivariate linear regression statistics were used to identify the psychosocial factors that predicted higher depression scores. Education and gender were included as covariates. MAIN RESEARCH VARIABLES Religiosity, emotional support, collectivism, perceived stigma, and depression. FINDINGS Participants (N = 77) had a mean age of 61 years (SD = 8.4), and a majority were well-educated, insured, religiously affiliated, and currently in treatment. Participants who were in the lowest income category, not married, or male had higher depression scores. The multivariable model consisting of organized religion, emotional support, collectivism, education, and gender explained 52% (adjusted R2) of the variation in depression scores. Stigma became insignificant in the multivariable model. CONCLUSIONS Psychosocial factors are important predictors of depression. Emotional support and organized religious activities may represent protective factors against depression, whereas collectivism may increase their risk. IMPLICATIONS FOR NURSING Nurses need to be particularly aware of the potential psychological strain for patients with collectivist values, experienced stigma, disruptions in church attendance, and lack of emotional support. In addition, the treatment plans for these patients should ensure that family members are knowledgeable about cancer, its treatment, and side effects so they are empowered to meet support needs. KNOWLEDGE TRANSLATION Among older African American patients with cancer, emotional support and reassurance from family and friends that they will not abandon them decreases the likelihood of depressive symptoms and minimizes the impact of stigmatizing responses, but the perception that the illness is placing a strain on the family increases the likelihood of such symptoms. Emotional support likely is a stronger predictor of depressive symptoms than religious service attendance.

Are psychosocial interventions targeting older African American cancer survivors culturally appropriate?: a review of the literature.

Background: The alleviation of cancer health disparities makes it necessary to understand and apply the knowledge about cultural behaviors in the design of interventions deemed culturally appropriate. Objective: This review aimed to provide an overview of the ways in which strategies were used to facilitate the cultural appropriateness of psychosocial interventions delivered to African American cancer survivors. Methods: An electronic and hand search of 5 major databases was performed to identify intervention studies that targeted African American cancer patients/survivors 50 years or older. We review researchers’ efforts to achieve culturally appropriate intervention research by evaluating whether peripheral, evidential, linguistic, constituent-involving, or sociocultural strategies were used. Results: Only 6 intervention studies met the criteria for inclusion in this review, with each study using 1 or more strategies to achieve cultural appropriateness. However, few studies incorporated sociocultural factors in the intervention design. Conclusion: Strategies to achieve cultural appropriateness in psychosocial interventions targeting older African Americans have focused more on enhancing recruitment and retention and less on the inclusion of sociocultural concepts into the content of the intervention. Implications for Practice: Intervention studies delivered to older African American cancer patients/survivors should aim to incorporate those concepts of relevance to the population and likely to facilitate healthcare outcomes.

African-American Cancer Survivors' Use of Religious Beliefs to Positively Influence the Utilization of Cancer Care.

Abstract Among African-Americans, religion impacts health-seeking behaviors. This qualitative study used criterion purposeful sampling and thematic analysis in analysis of data from 31 African-American cancer patients to understand the influence of religion on the utilization of cancer care services. Our findings suggest that religious beliefs and practices positively influenced attitudes toward their illness and ability to endure treatment. God’s ability to heal and cure, God’s control over survival, God’s will over their lives, and God’s promise for health and prosperity were examples of survivor’s religious beliefs. Religious practices such as prayer promoted a trusting relationship with healthcare providers and were a source of strength and encouragement.

Exploring School Nurse Interventions and Health and Education Outcomes: An Integrative Review:

School nurses intervene with students, parents, and school staff to advance the health and academic success of students. We conducted an integrative literature review of published research to describe the types of school nurse interventions and health and education outcome measures and to examine how school nurse interventions were linked to student outcomes. Sixty-five studies met the inclusion criteria. We used the National Association of School Nurses’ Framework for 21st Century School Nursing Practice to categorize school nurse interventions and health and education outcome measures. The majority of interventions were categorized under the care coordination principle, most commonly, motivational interviewing and counseling. In 17 studies, school nurse interventions were linked to improved student outcomes. Most studies (80%) were descriptive. To advance school nursing science, researchers can build on this foundation with more rigorous research methods to evaluate the impact of school nurse interventions and activities on student health and education outcomes.

Younger African American Adults’ Use of Religious Songs to Manage Stressful Life Events

The aim of this study was to explore the use of religious songs in response to stressful life events among young African American adults. Fifty-five young African American adults aged 18–49 participated in a qualitative study involving criterion sampling and open-ended interviews. Data analysis included content analysis and descriptive statistics. Stressful life events were related to work or school; caregiving and death of a family member; and relationships. Religious songs represented five categories: Instructive, Communication with God, Thanksgiving and Praise, Memory of Forefathers, and Life after Death. The tradition of using religious songs in response to stressful life events continues among these young adults. Incorporating religious songs into health-promoting interventions might enhance their cultural relevance to this population.

Messages of Hope: Helping Family Members to Overcome Fears and Fatalistic Attitudes Toward Cancer

This qualitative study explored strategies family members of African-American cancer patients used to overcome their fears and fatalistic attitudes toward cancer. Twenty-four family members were recruited through criterion purposeful sampling. Data were collected and analyzed using open-ended interviews and thematic analysis. Fears and fatalistic attitudes could be traced to personal experiences with cancer and information being communicated within their networks. Strategies used to overcome fears and fatalistic attitudes toward cancer included an awareness of advances in cancer treatments, information obtained from their health-care providers, and faith in God. Family members supported the patient through efforts of encouraging them to talk about what they were going through, to be strong, to maintain a positive environment and normalcy, and to use spirituality as a source of strength. Family members also suggested that health-care providers and researchers tailor intervention studies to consider that the patient is a part of a larger family system and that the entire family needs support to overcome long-held fears and fatalistic attitudes toward cancer. These findings suggest that despite advances in cancer care and widespread media coverage to change perceptions about cancer, fears and fatalistic attitudes toward cancer persist and likely influence the family members’ ability to optimally support the cancer patient. At the time of diagnosis, both patient and the entire family unit should be educated of advances in cancer care, that cancer is no longer a death sentence, and supported to overcome fears and fatalistic attitudes.

Response to Letter to the Editor for “Exploring School Nurse Interventions and Health and Education Outcomes: An Integrative Review”

Thank you for the opportunity to respond to the letter from Dr. Maughan and colleagues regarding our use of National Association of School Nurse’s (NASN, 2016) Framework for 21st Century School Nursing Practice (Framework). We would also like to thank Dr. Maughan and her colleagues at NASN for their interest in our integrative review on school nurse interventions and health and education outcomes (Best, Oppewal, & Travers, 2018) and for taking the time to share their clarification and highlights. In their letter to the editor, Dr. Maughan and colleagues noted a clarification related to one principle of the Framework. In our integrative review, we used four of the five Framework principles (care coordination, public health/ community, leadership, and quality improvement) to categorize school nurse interventions/activities and student health and education outcomes. We mentioned that the four principles were surrounded by the Standards of Practice principle but did not communicate our rationale for why we did not use it as a category like we did for the other four principles. We appreciate the opportunity to do so now. Soon after starting our research, we found that some studies had components in more than one Framework principle; however, each study fit one principle the best. Our research team decided to categorize the research studies according to one primary principle. We did not locate studies that met our inclusion criteria that fit the components within the Standards of Practice principle. It is apparent that we share similar goals with Dr. Maughan and colleagues—to encourage researchers to strengthen school nurse studies with more robust research designs and to conduct studies that focus on how school nurse interventions impact health and educational outcomes. We need more research on the effectiveness of school nursing interventions to guide school nursing practice. As Dr. Maughan and colleagues pointed out, we also stressed the importance of developing and using a standardized national school data set that represents students and school nurses. We applaud NASN’s leadership with this critical effort. We also applaud the efforts of every school nurse who adds to the national school data set. This work is vital to moving school nursing research forward, thereby improving the health of school communities. We acknowledge that while the principles overlap and are nonhierarchical that all five principles should be considered as an integrated mindset for daily school nurse care to individual students and school populations. Furthermore, we also acknowledge that research is needed to investigate the collective impact or mindset that the integrated principles in the Framework illustrate. Ultimately, we found the Framework an effective lens to use in identifying school nurse interventions and outcome measures and agree with Dr. Maughan and colleagues that the Framework can be applied to all aspects of school nursing practice, policy, and research.

Making sense of loss through spirituality: Perspectives of African American family members who have experienced the death of a close family member to cancer

OBJECTIVE Among African Americans, spirituality is meaning or purpose in life and a faith in God who is in control of health and there to provide support and guidance in illness situations. Using qualitative methods, we explored the use of spirituality to make sense of the end-of-life and bereavement experiences among family members of a deceased cancer patient. METHOD Data in this report come from 19 African Americans who experienced the loss of a family member to cancer. A qualitative descriptive design was used with criterion sampling, open-ended semistructured interviews, and qualitative content analysis. RESULTS Participants made sense of the death of their loved one using the following five themes: Ready for life after death; I was there; I live to honor their memory; Gods wisdom is infinite; and God prepares you and brings you through. These five themes are grounded in conceptualizations of spirituality as connectedness to God, self, and others.Significance of resultsOur findings support the results that even during bereavement, spirituality is important in the lives of African Americans. African American family members might struggle with issues related to life after death, their ability to be physically present during end-of-life care, and disentangling beliefs around Gods control over the beginning and ending of life. The findings in this report can be used to inform healthcare providers to better support and address the needs for support of African American family members during end-of-life and bereavement experiences.