Vivian Gedaly-Duff

Differences in Symptom Occurrence, Frequency, Intensity, and Distress in Adolescents Prior to and One Week After the Administration of Chemotherapy

Purpose/objectives: The purpose of this study was to describe differences in occurrence, frequency, intensity, and distress of symptoms prior to (T1) and one week following (T2) the administration of intravenous chemotherapy. Design: Longitudinal, descriptive. Settings: Two regional children’s cancer centers in the Pacific Northwest. Sample: A total of 51 adolescents 10 to 19 years old receiving cancer chemotherapy. Methods: Memorial Symptom Assessment Scale (MSAS 7-12). Findings: No significant differences were found in symptom occurrence rates between T1 and T2. Fatigue was the only symptom with significantly greater frequency and intensity, and nausea was the only symptom with significantly greater distress at T2 compared with T1. Conclusions: Adolescents receiving chemotherapy experience multiple symptoms that persist over time. Implications for nursing: In monitoring for symptoms, nurses need to be aware of the extent to which symptoms are present throughout treatment, as evidenced by these findings that symptom occurrence was significant even prior to receiving a subsequent course of chemotherapy.

A Community‐Based Participatory Research Approach to Understanding Pap Testing Adherence Among Vietnamese American Immigrants

OBJECTIVE To explore factors potentially influencing Pap testing practices among Vietnamese American immigrant women (VIW, foreign-born) and describe their awareness of cervical cancer screening resources in their community. DESIGN Descriptive study guided by the ecological model and community-based participatory research principles. SETTING Portland, Oregon, metropolitan area. PARTICIPANTS Vietnamese American immigrant women (211) who were age 21 and older. METHODS We used descriptive statistics and logistic regression analyses to analyze a self-administered questionnaire that was pretested and translated using a team approach. RESULTS Approximately 74% of VIW who completed the survey reported at least one Pap test, and 69% reported Pap testing history adherent to national guidelines. The factor most strongly associated with Pap testing receipt was suggestion from a friend, followed by longer residency in the United States, lower perceived common barriers, and lower perceived cultural barriers, for example, lack of family support and use of Eastern/Asian medicine. The factor most strongly associated with guideline adherence was having health insurance, followed by a recommendation from a physician or nurse practitioner. Only 11% of VIW knew where to obtain a free or low-cost Pap tests. CONCLUSION Nurses can influence rates of Pap testing among VIW by providing health education through outreach programs targeted at lay health workers and their social networks, identifying at-risk patients such as recently immigrated women, reducing perceived common and cultural barriers to Pap testing, and helping women seek alternative payment options if they lack health insurance. Primary health care providers should be reminded of their essential role in increasing Pap testing adherence.

Reducing Children's Pain‐Distress Associated With Injections Using Cold: A Pilot Study

&NA; This study used an experimental design to test the question, “Does ice reduce the pain‐distress children experience with injections?” One half of the 38 preschool children had ice applied to the preimmunization site for 30 seconds. The remaining children received the injection without the extra intervention. Measures included the Global Mood Scale, pulse rate, Oucher scale, and Faces scale. The results failed to show that ice reduces childrens pain‐distress with injections. Reasons for the failure are discussed, with comments on the various measures and suggestions for further study in this area of child nursing care.

Contributing factors to colorectal cancer and hepatitis B screening among Vietnamese Americans.

PURPOSE/OBJECTIVES To identify factors associated with screening for colorectal cancer (CRC) and hepatitis B, because hepatitis B can increase the risk of liver cancer. DATA SOURCES MEDLINE®, CINAHL®, and PsycINFO databases from January 1998 to April 2012. DATA SYNTHESIS The 23 reviewed studies included 15 descriptive, 2 intervention, 3 qualitative, 2 chart or medical record review, and 1 mixed method. Most studies used an investigator-developed instrument with no reported reliability. Inconsistent operational definitions for contributing factors to screening made it challenging to make comparisons. CONCLUSIONS CRC and hepatitis B screening are consistently low among Vietnamese Americans. Contributing factors included sociodemographics, knowledge, cultural beliefs, and external factors. External factors such as having a regular place of care and a healthcare provider were crucial because they influenced adherence to screening recommendations. Use of a public media education plus healthcare provider model and a culturally tailored intervention using Vietnamese lay advisors appeared to be promising for improving CRC screening. Additional intervention studies are needed to increase screening. IMPLICATIONS FOR NURSING Vietnamese is a fast-growing subgroup within the Asian American Pacific Islander (AAPI) group that may require targeted approaches to screening for disease. Future studies should focus on immigrants or those who were born in the United States (men and women) as disaggregated subgroups. Such research can inform culturally sensitive and appropriate interventions that may improve cancer screening rates. KNOWLEDGE TRANSLATION Although Vietnamese is the fourth largest racial-ethnic subgroup within the AAPI group, the literature about contributing factors to CRC and hepatitis B screening is limited among this subgroup. CRC and hepatitis B screening are consistently low among Vietnamese Americans. Use of public media education plus a healthcare provider model and a culturally tailored intervention using Vietnamese lay advisors appears promising for improving CRC screening.

Nocturnal Sleep–Wake Parameters of Adolescents at Home Following Cancer Chemotherapy

Purpose: The purpose of this descriptive, longitudinal study was to describe objective nocturnal sleep–wake parameters of adolescents at home after receiving chemotherapy in the hospital or outpatient clinic and explore differences in sleep variables by age, gender, and corticosteroid use. Methods: We collected 7 days of wrist actigraphy and sleep diary data from 48 adolescents (10–19 years) who were receiving cancer chemotherapy for a primary or secondary cancer or a relapse. The actigraphic sleep variables included rest interval (i.e., time in bed), sleep onset, sleep offset, sleep duration, total sleep time (TST), wake after sleep onset (WASO), and %WASO. Results: Of the 48 adolescents, 38 had at least five nights of scored actigraphy and were included in analyses. Older (13–18 years) adolescents went to bed later and had fewer minutes of TST than younger adolescents (10–12 years). Exploratory analyses revealed no differences between adolescents who were taking oral corticosteroids (i.e., prednisone, dexamethasone) and those who were not or between males and females. Conclusion: These adolescents had sleep durations that met or exceeded the recommended sleep duration for their age groups but experienced significant WASO. Further research is needed to estimate sleep needs of adolescents during chemotherapy and determine factors that contribute to nocturnal wake-time so that targeted interventions can be designed to improve sleep quality.

Sleep as an indicator for pain relief in an infant: A case study

Sleep was used as an indicator of pain relief for an 8-month-old female infant with meningococcemia who experienced nociceptive input from skin wounds and multiple noxious treatment procedures during her recovery. A sleep activity record documented total hours of sleep, awake/crying, awake/content, and longest hours of sleep after nonanalgesic and analgesic interventions to mediate the infants pain. Sleep appears to be a useful indicator of the efficacy of pain treatment for infants.

Adaptation and Testing of Instruments to Measure Cervical Cancer Screening Factors Among Vietnamese Immigrant Women

Purpose: Vietnamese American women diagnosed with cervical cancer are more likely to have advanced cancer than non-Hispanic White women. We sought to (a) develop a culturally sensitive Vietnamese translation of the Revised Susceptibility, Benefits, and Barriers Scale; Cultural Barriers to Screening Inventory; Confidentiality Issues Scale; and Quality of Care from the Health Care System Scale and (b) examine the psychometric properties. Design: Cross-sectional study with 201 Vietnamese immigrant women from the Portland, Oregon, metropolitan area. Method: We used a community-based participatory research approach and the U.S. Census Bureau’s team approach to translation. Results: Cronbach’s alpha ranged from .57 to .91. The incremental fit index ranged from .83 to .88. Discussion and Conclusions: The instruments demonstrated moderate to strong subscale internal consistency. Further research to assess structural validity is needed. Implications for Practice: Our approaches to translation and psychometric examination support use of the instruments in Vietnamese immigrant women.