Valerie S. Eschiti

Lesson from comparison of CAM use by women with female-specific cancers to others: it's time to focus on interaction risks with CAM therapies.

There has been no examination as to whether the prevalence of complementary and alternative medicine (CAM) use, as well as personal factors associated with CAM use and predictive of CAM use for women with female-specific cancers, is similar to those in other diagnostic groups. The purpose of this review is to compare CAM use and personal factors associated with and predictive of CAM use by women with female-specific cancers to samples of other diagnostic groups. If it is the case that CAM use is similar across various types of samples, then it may be unnecessary to continue to study detailed CAM use by those in separate diagnostic groups and instead focus energies on the examination of CAM therapies that may have risks for interaction with conventional therapies, such as biologically based therapies. The researcher concludes that we are now in an era in which we need to use our restricted time, human resources, and finances to examine biologically based CAM use that may carry high risks for interactions or toxicities for specific groups under examination, rather than examine global CAM use, unless the situation warrants such all-inclusive study.

Differences between weekend and weekday nurse work environments and patient outcomes: a focus group approach to model testing.

Design This focus group study was exploratory and descriptive. Purpose To identify differences between weekend and weekday nurse work environments that might explain higher rates of neonatal mortality among babies born on weekends. Sample The convenience sample consisted of 14 nurses from labor and delivery and neonatal intensive care units in 4 hospitals in 3 Texas cities. Methodology Focus group sessions were audiotaped and then transcribed verbatim. Responses were analyzed inductively and then compared to the model of Organizational Support of Nursing Care presented by Aiken, Clarke, and Sloane. Results The focus group responses fit the model moderately well. However, there were additional constructs found in the data that went beyond the model. Additional constructs included patient need/demand, nurse characteristics/skill level, and external motivating and inhibiting factors. Conclusions Nurses identified significant differences between weekend and weekday work environments such as less direct supervision and problems getting physician backup for emergencies on weekends. They gave examples where they felt weekend work environments resulted in both negative and positive patient outcomes. The nurses made no real distinction between night shift and weekend environments. The knowledge gained can be used to design effective strategies to improve the process of care and patient outcomes on weekends.

The Experience of Indigenous Traditional Healing and Cancer

Indigenous traditional healing is an ancient, deeply rooted, complex holistic health care system practiced by indigenous people worldwide. However, scant information exists to explain the phenomenon of indigenous medicine and indigenous health. Even less is known about how indigenous healing takes place. The purpose of this study is to describe the meaning and essence of the lived experience of 4 indigenous people who have been diagnosed with cancer and have used indigenous traditional healing during their healing journey. The researcher used a qualitative phenomenological methodology to collect and analyze interview data. Interviews were conducted with 4 self-identified indigenous people, ages 49 to 61, from diverse tribes. Time since cancer diagnosis varied from 2 to 20 years; types of cancer included lung, prostate, sarcoma of the leg, and breast. Four themes and 2 subthemes emerged (1) receiving the cancer diagnosis (with subthemes of knowing something was wrong and hearing something was wrong), (2) seeking healing, (3) connecting to indigenous culture, and (4) contemplating life’s future. This study demonstrates that 4 individuals with cancer integrated Western medicine and traditional healing to treat their cancer. This knowledge provides necessary data about the phenomena of being healed by indigenous healers. Such data may serve as an initial guide for health care professionals while interacting with indigenous people diagnosed with cancer. Accordingly, traditional healing may be used to decrease health disparities.

Healing Touch: a low-tech intervention in high-tech settings.

Healing Touch is a complementary therapy that can be used as a nursing intervention for patients in critical care settings. Use of healing touch may facilitate positive patient outcomes. However, further research is needed to adequately evaluate the effectiveness of healing touch in the critical care setting. The use of Healing Touch in critically ill patients is explored in this article.

Preparing faculty and students for an international nursing education experience.

As society becomes increasingly globalized, it is imperative to include international educational perspectives in the nursing profession. This article shares experiences of a university and hospital in facilitating education of students of nursing from India. It includes implementing partnerships, student selection process, and transcultural considerations. These considerations include faculty preparation for receiving students from India. In addition, ways to prepare Indian and U.S. students are examined.

Off-peak nurse staffing: critical-care nurses speak.

The off-peak work environment is important to understand because the risk for mortality increases for patients at night and on the weekend in hospitals. Because critical-care nurses are on duty in hospitals 24 hours a day, 7 days a week, they are excellent sources of information regarding what happens on a unit during off-peak times. Inadequate nurse staffing on off-peak shifts was described as a major problem by the nurses we interviewed. The study reported here contributes the type of information needed to better understand the organization of nursing units and nurse staffing on outcomes.

Use of the talking circle for Comanche women's breast health education.

Background: As breast cancer screening is critical to early detection and treatment, it is imperative to furnish health care providers with effective educational materials for the populations they serve. To do so for Comanche American Indian women requires understanding the cultural constructs that influence the use of screening and treatment recommendations. Purpose: The purpose of this article is to describe the health—illness beliefs and barriers to breast health for a group of Comanche women. Design: This was a descriptive, qualitative study guided by the principles of community-based participatory research. Seven community health representatives serving Comanche women participated in a “Talking Circle,” an indigenous method of making decisions and conducting group process among American Indian people. Findings: Themes were Barriers to Information, Barriers to Screening, Economic Barriers, Barriers to Follow-up, and Protecting Our Women. Discussion/Conclusion: This study provided insight into barriers to breast health for women in the Comanche Nation. These findings contribute to a foundation for enhancements needed to make breast health education and interventions culturally appropriate. These findings also add to the cultural knowledge of nurses for use in the practice area to improve understanding and communication with American Indian patients.

Native Cancer Navigation: The State of the Science

The purpose of this literature review is to determine the current state of the science for the effectiveness of patient navigation on improving outcomes of cancer care across the continuum among Native Americans. The research will help healthcare professionals ascertain potential evidence-based practice guidelines and gaps in knowledge, which may provide direction for future research. Data synthesis included the use of Native navigation for cancer care, which has been demonstrated in limited, nonrandomized studies to improve cancer knowledge, access to care, and quality of life for Native Americans. Those studies had limitations, including small sample size, self-report of outcome measures, and lack of randomization. Evidence is insufficient to conclude that the use of Native navigation is superior to usual cancer care for Native American patients. Oncology nurses have a role in training personnel to serve as cancer navigators. Nurses need to be supportive of culturally appropriate navigation programs and know about services provided by navigators. In addition, nurse educators need to encourage Native Americans in their communities to consider choosing nursing as a profession. If an oncology nurse has an interest in research, opportunities exist to assist with or conduct research projects regarding Native cancer navigation. A particular need exists for addressing the gaps in research identified in this article.

Managing chronic pain in patients with cancer who have a history of substance abuse.

Oncology nurses may encounter patients recovering from substance abuse who will need acute or chronic pain management. Knowing how to assess, treat, and manage that pain is a benefit to the nurse and patient. In addition, understanding and overcoming bias toward patients with a history of substance abuse can lead to a trusting relationship and more effective pain management. A thorough assessment and documentation of the patients pain during each visit provide a solid basis for prescribing opioids to patients with a history of substance abuse. The use of long-acting and higher-dose opioids in this population will be discussed. Functional improvement versus absence of pain may be a more realistic goal for patients recovering from substance abuse, and complementary and alternative therapy may be considered. Setting standards to deal with lost prescriptions or medication, missed appointments, and the use of contracts for all patients receiving opioids establishes unbiased treatment.

Holistic approach to resolving American Indian/Alaska Native health care disparities.

There is increasing public attention on the health care disparities that exist among minority populations. Recent focus is on the need to identify ways health disparities can be reduced. The American Indian/Alaska Native (AI/AN) populations areminorities experiencing grave health care disparities. From a Native view, what adversely affects 1 part of society ultimately impacts the rest of it. It is necessary to keep the Native population as healthy as possible for the United States to maintain its health as a nation. Holistic nursing, with its core value of cultural diversity, is an ideal framework in which to foster promotion and maintenance of health for AI/AN people. The purpose of this article is to describe some of the health care disparities experienced by Native people and holistic approaches for resolution. These approaches include providing culturally appropriate health education, promoting educational opportunities in nursing for AI/AN people, and mentoring Native nursing students and new nurses.