Carolee Polek - Academia.edu (original) (raw)
Papers by Carolee Polek
Handbook of fluid, electrolyte, and acid-base imbalances
Oncology Nursing Forum, 2010
Purpose/Objectives: To explore the association between lesbians' knowledge of human papillomaviru... more Purpose/Objectives: To explore the association between lesbians' knowledge of human papillomavirus (HPV) cancer risk with age, education, and openness with a woman's healthcare provider; and to explore the relationship between lesbians' knowledge of female-to-female HPV transmission with age, education, and openness with one's physician. Design: A descriptive correlational survey. Setting: Surveys were distributed at lesbian and gay community events such as Bingo AGo Go ; Rainbow Support Group meetings; Lesbian, Gay, and Bisexual Student Union of the University of Delaware meetings; and the Second Annual Women's Conference of the Women's Project of CAMP (Create a More Positive) Rehoboth. Sample: 96 women who self-identified as lesbian, bisexual, or transgender and lived in the state of Delaware.
Journal of Transcultural Nursing, 2004
The purpose of this study was to examine the impact of race on length of hospital stay (LOS) and ... more The purpose of this study was to examine the impact of race on length of hospital stay (LOS) and number of procedures on elderly persons hospitalized with chronic heart failure (CHF). Secondary data analysis was used to obtain data on 99,543 hospitalized Medicare patients with CHF age 65 years or older. MANOVA was utilized to examine the effects of race, age, and total hospital charges on LOS, number of procedures, and diagnosis. Asian American Pacific Islanders had significantly higher number of procedures and LOS compared to Whites. The combined dependent variables were significantly affected by race, F( 9, 99,543) = 121.95, p = .000; the covariates of age, F( 3, 99,543) = 720.65, p = .000; and total charges F( 3, 99,543) = 38,962.95, p = .000. LOS accounted for 50% of the variance. Studies that examine cultural variables and their effect on LOS and number of procedures are needed.
Lesbians' Disclosure of Sexual Orientation and Satisfaction With Care
Journal of Transcultural Nursing, 2008
The overarching aim of this study was to explore demographic variables and their association with... more The overarching aim of this study was to explore demographic variables and their association with a woman's disclosure of sexual orientation to a health care provider (HCP). This descriptive correlation study used a convenience sample of 96 women recruited at gay and lesbian community events held in Delaware. A self-report survey of 35 questions was used to obtain the data. None of the women identified themselves as exclusively heterosexual. The results indicate that a woman's self-identified sexual orientation is significant in predicting whether she has shared her orientation with her HCP. The more a woman's self-reported orientation moves toward the heterosexual end of the preference scale, the less likely she is to share her orientation with her HCP. Culturally competent care and a nondiscriminatory atmosphere will provide this population with the trust needed to enable open rapport with their HCPs.
Drinks per Day in Women of Mexican Origin
Journal of Addictions Nursing, 2013
Historically, Mexican-born women who immigrate to the United States (U.S.) have lower levels of a... more Historically, Mexican-born women who immigrate to the United States (U.S.) have lower levels of alcohol use and higher rates of abstinence compared with Mexican American women born in the U.S. and other racial groups in the U.S. As such, immigrant women's alcohol use has received limited attention by the research community. Gaps in knowledge of their alcohol use patterns, changes in healthy drinking recommendation for women, and projections of population growth in both Mexican immigrant and Mexican American populations support the need for the study. Data from the Center for Disease Control's National Health Interview Survey were used to explore alcohol use differences in women of Mexican origin born in and outside of the U.S. In addition, the relationship between years in the U.S. and drinks per day was explored in Mexican immigrant women. The results indicated that Mexican immigrant women who drink are drinking above recommended levels and the younger…
Characterising emergency department high-frequency users in a rural hospital
Emergency Medicine Journal, 2013
Patients who are frequent users (≥4 visits/year) comprise ∼10% of patients, but account for ∼34% ... more Patients who are frequent users (≥4 visits/year) comprise ∼10% of patients, but account for ∼34% of total yearly emergency department (ED) visits. Non-emergent care provided to frequent ED users affects operating costs and usage. The majority of reports characterising frequent ED use are from urban teaching centres. This study describes frequent users of ED services in a rural community setting and the association between counts of patient's visits and discrete diagnoses. Retrospective study of 1652 frequent ED adult patients from a rural US hospital over a one-year period. Descriptive statistics and Poisson regression were used to explore the characteristics of frequent users and their patterns of diagnoses. Frequent user visits ranged from 4 to 66 per patient. Frequent users were 9.41% of patient volume accounting for 33.94% of the total visits and were younger compared with patients with <4 visits. Approximately 36% of frequent user visits were generated by 20 diagnoses when the diagnoses were concatenated into domains which covered ∼76% of the visits. There was a high correlation between the number of visits and discrete diagnoses in frequent users. These findings suggest a more complex picture of rural ED services and their relationship with primary care and dental services, which needs to be defined before policy development to reduce ED use.
Rehabilitation Nursing, 2012
This study's aims were to evaluate patient knowledge of safe warfarin practices early in treatmen... more This study's aims were to evaluate patient knowledge of safe warfarin practices early in treatment, and to pilot a nursing telephone follow-up enhancement to a pharmacy-facilitated discharge. Method: Forty-two randomized patients in either "enhanced follow-up" or "treatment as usual" groups completed the study. Results: Enhanced treatment resulted in significant improvement in warfarin knowledge (86% versus 71%). In critical safety related knowledge questions even larger improvements were present ($ 96% compared to $ 77%). Discussion: The hypothesis that non-adherence generating rehospitalization is a function of poorer knowledge was not supported as there were no warfarin-related readmissions during the study. Conclusion: The study supports the use of enhanced follow up and the need for larger studies to delineate what patient knowledge prevents rehospitalization and cost effective educational efforts. Statement of the Problem The number of patients on anticoagulation therapy has increased dramatically, and is projected to increase with the aging population and changes in preventive care (Melnikova, 2009). Preventive antithrombotic agents can reduce morbidity and mortality associated with a variety of complex health conditions. The most commonly prescribed antithrombotic agent is warfarin with more than 3.8 million Americans taking the drug in 2005 at an estimated cost of $963 million (Agency for Healthcare Research and Quality, 2008). Warfarin accounts for 17.3% of medication-related adverse events seen in emergency rooms in the elderly (Budnitz & Layde, 2007). Rehabilitation nurses are ideally positioned to reinforce hospital discharge education which is the cornerstone in improving patient safety.
Oncology Nursing Forum, 2004
B reast cancer is the most frequent cancer diagnosis for women in the United States. Incidence re... more B reast cancer is the most frequent cancer diagnosis for women in the United States. Incidence remained relatively unchanged during the 1990s. Even so, an estimated 217,440 women will be diagnosed and 40,580 will die of the disease in 2004 (Jemal et al., 2004). More Caucasians are diagnosed with breast cancer than other groups. However, the five-year relative survival rate in other races and ethnic minorities is substantially lower than that for Caucasians (Jemal et al.). The term Asian American signifies a diverse population in the United States. The federal government defines Asian Americans as a minority population originating in the Far East, Asia, and Southeast Asia (Intercultural Cancer Council, 2001). According to the 2000 U.S. Census, Asian/Pacific Islander Americans (APIAs) are the fastest-growing ethnic group in the United States, with the population increasing by 72% since the 1990 U.S. Census (U.S. Census Bureau, 2000). The number of APIAs in the United States has grown from 1.5 million in 1970 to more than 11.2 million in 2000 (U.S. Census Bureau, 2000). Rates of breast cancer generally are lower in Asia than in the United States (Kagawa-Singer & Pourat, 2000). According to Jemal et al. (2004), the incidence of breast cancer in APIA women is 97.2 (per 100,000 women) compared to 140.8 for Caucasian women in the United States. The mortality rate is 12.5 (per 100,000) compared to 27.2 for Caucasians (Jemal et al.). Evidence suggests that exposure to the Western lifestyle increases breast cancer risk among immigrants from Asia (Ziegler et al., 1993). The longer that foreign-born Asian/Pacific Islander women reside in the United States, the more likely that their risk for developing breast cancer will approach that of American-born women. Disease rates among APIA women vary depending on ethnicity. In general, however, these women
Delaware Lesbian Health Survey
Declining HPV Vaccination Rates in Delaware: Cause for Concern and Action
Delaware Journal of Public Health
From 2010 to 2013, Delaware’s rates of HPV vaccination of females ranked among the highest in the... more From 2010 to 2013, Delaware’s rates of HPV vaccination of females ranked among the highest in the nation.1 Recently, the rate of completion has declined to one resembling the reported national rate.1 This paper provides a brief background on HPV vaccination, a description of the efforts within Delaware which may have generated the promising earlier results, potential reasons for the decline in rates, and recommendations to increase vaccination rates in the future.
Special Olympics of Delaware and Sigma Theta Tau International ? Beta Xi
Engagement of the Next Generation of Nurses Through Obstetric Research
Journal of Obstetric, Gynecologic, & Neonatal Nursing, 2018
Declining HPV Vaccination Rates in Delaware: Cause for Concern and Action
Delaware Journal of Public Health, 2016
From 2010 to 2013, Delaware’s rates of HPV vaccination of females ranked among the highest in the... more From 2010 to 2013, Delaware’s rates of HPV vaccination of females ranked among the highest in the nation.1 Recently, the rate of completion has declined to one resembling the reported national rate.1 This paper provides a brief background on HPV vaccination, a description of the efforts within Delaware which may have generated the promising earlier results, potential reasons for the decline in rates, and recommendations to increase vaccination rates in the future.
Objective: Cancer can evoke long-held cultural beliefs which either facilitate or impede efforts ... more Objective: Cancer can evoke long-held cultural beliefs which either facilitate or impede efforts to expand the health literacy of families. Among these beliefs is fatalism which holds that controlling ones′ outcome is not possible, and that ones′ outcome is predestined. Some fatalistic beliefs are broadly held within the Asian American (AA) community and may be challenged or reinforced by the experience of having a family member diagnosed with cancer. This study evaluated the relationship between having a family member diagnosed with cancer and selected demographics in AAs on fatalistic beliefs. Methods: Data from 519 AA subjects from the Centers for Disease Control and Prevention Health Information Trends Survey were used to complete a secondary analysis. Descriptive statistics characterize fatalistic beliefs. Four models using four questions assessed fatalistic beliefs as dependent variables and independent variables of having or not having a family member diagnosed with cancer, c...
Beyond the Research Grant: Supporting Nursing Research Through Collaborative Partnerships
Experiences of Asian Women Who Live in Urban Environments and Are Breast Cancer Survivors
Journal of Transcultural Nursing
Introduction Despite expanding interest in cancer survivorship, little is known about urban Asian... more Introduction Despite expanding interest in cancer survivorship, little is known about urban Asian breast cancer survivors whose experience may differ from those in suburban and rural locations. This study explores survivors’ challenges to maximize outcomes and identify common and unique themes among urban Asian survivors. Information was obtained from the survivors and outreach workers from their community. Methodology Descriptive qualitative methods including semistructured interview guides were used to plan, conduct, and analyze both individual interviews of Asian women ( n = 6) and a focus group ( n = 7) composed of community outreach workers. Results The interview and focus group findings, endorsed themes of communication/language, trust, and privacy, with generational differences. Poor health literacy in both survivors and providers was identified. Discussion Nurses are in a unique position to use the themes identified to both assist survivors expand their health literacy and l...
Cancer Screening and Prevention in Lesbian, Gay, Bisexual, and Transgendered Community and Asian Lesbian, Gay, Bisexual, and Transgendered Members
Asia-Pacific Journal of Oncology Nursing
Participation in cancer screening and prevention (cessation of or reduction in modifiable health ... more Participation in cancer screening and prevention (cessation of or reduction in modifiable health risk behaviors) are the most effective methods of reducing cancer morbidity and mortality. Some members of the lesbian, gay, bisexual, and transgendered (LGBT) communities have not participated in screening for a variety of reasons which have been explored in the literature. Common and unique behavioral risks are also reviewed. Knowledge about Asian members of the LGBT community participation in cancer screening and prevention is limited. This paper reviews the current literature on participation and barriers to cancer screening and prevention for the LGBT community and provides some insights for the Asian LGBT subcommunity. Potential interventions that have been demonstrated to be effective are presented for potential implementation within nursing practice and practice settings. Suggestions for future research are also provided to enhance the care of the LGBT community.
Clinical Journal of Oncology Nursing
Adherence to procedures in cancer clinical trials is essential to the validity of outcomes. Altho... more Adherence to procedures in cancer clinical trials is essential to the validity of outcomes. Although extensive efforts are made to ensure that each clinical trial adheres to the study procedure, breaks in study protocols are not uncommon. The rates of protocol violations are difficult to fully ascertain because they are not commonly reported in the literature (Sweetman & Doig, 2011). Post-marketing studies completed for the U.S. Food and Drug Administration (FDA) indicated that 15%-24% of trials contained protocol violations, but that finding was based on a narrow definition of nonadherence (Dodd, White, & Williamson, 2012; Macias et al., 2004; Sprung, Finch, Thijs, & Glauser, 1996). The complexities of clinical trials, the number of clinicians involved, and a variety of patient and environmental issues contribute to protocol violations. A dearth of knowledge exists about the rates and sources of protocol violations observed by research nurses. The expansion of oral agent trials has increased the risk of patient-based nonadherence because dose administration is probably a patient's responsibility outside the healthcare setting. Unobserved patients are more likely to not adhere than those who are observed or administered study drugs (Agoritsas, Deom, & Perneger, 2011). Invariably, this will affect the quality of the data reported to establish drug efficacy and render judgment on clinical significance. With nonadherence to study medication and requirements of the protocol, the integrity of the data becomes questionable and the validity and reliability of the study potentially compromised. Clinical trial nurses are in a unique position to provide insight into common sources of protocol violations. The current study characterized groups and sources responsible for protocol breaks as a first step in seeking to mitigate them.
Patterns of Alcohol Abstinence in Mexican Women Residing in the United States: Effects of Nativity and Duration in the United States
Hispanic Health Care International
Objectives:Explore changes in abstinence rates in Mexican women (MW) residing in the United State... more Objectives:Explore changes in abstinence rates in Mexican women (MW) residing in the United States based on nativity and time in the United States as an indicator risks for future alcohol-related disorders.Design:A secondary analysis of data from the National Health Interview Survey evaluated rates of abstinence between 2000 and 2017. A logistic regression was completed to address the impact of age, years in the United States, sample years.Sample:A total of 29,860 MW surveyed over an 18-year period that included those born in and outside the United States.Primary Research Variables:Dependent variable was abstinence status; independent variables included nativity, year of survey, age, years in the United States (if immigrant).Results:Immigrant MW showed higher rates of alcohol abstinence than U.S.-born MW across all years, but regardless of place of birth, fewer MW are abstaining over time. Among immigrant MW, those only in the United States greater than 15 years had a greater risk o...
Breast Cancer Survivorship Experiences of Urban Hispanic Women
Journal of Cancer Education
The purpose of this study was to explore determinates of health that impact survivorship of urban... more The purpose of this study was to explore determinates of health that impact survivorship of urban Hispanic breast cancer survivors who are at risk for experiencing poorer outcomes than others. Some challenges have been characterized, but gaps in our knowledge of the impact of some of the social determinates of health remain. Challenges likely exist prior to a diagnosis of cancer and may amplify in intensity during survivorship, potentially shortening survival and quality of life of these women. A narrative, focus group was conducted with a group of urban Hispanic breast cancer survivors. A series of linked vignettes describing survivorship challenges and late effects of breast cancer pathology and treatment were used to stimulate discussion. Three themes impacting survivorship were identified. The themes included communication (health literacy), isolation, and social support and financial cost. Communication issues resulted in delays in treatment denial of services. While these themes in cancer survivors are independent of residence (rural, suburban, or urban) and across ethnic groups, some unique issues were identified in urban Hispanic breast cancer survivors. Members of the healthcare team are in a unique position to enhance survivor’s health literacy, advocate for programmatic efforts to enhance navigation roles in the hospital and communities, decrease delays in initiating care, and decrease the rate of patients lost.
Handbook of fluid, electrolyte, and acid-base imbalances
Oncology Nursing Forum, 2010
Purpose/Objectives: To explore the association between lesbians' knowledge of human papillomaviru... more Purpose/Objectives: To explore the association between lesbians' knowledge of human papillomavirus (HPV) cancer risk with age, education, and openness with a woman's healthcare provider; and to explore the relationship between lesbians' knowledge of female-to-female HPV transmission with age, education, and openness with one's physician. Design: A descriptive correlational survey. Setting: Surveys were distributed at lesbian and gay community events such as Bingo AGo Go ; Rainbow Support Group meetings; Lesbian, Gay, and Bisexual Student Union of the University of Delaware meetings; and the Second Annual Women's Conference of the Women's Project of CAMP (Create a More Positive) Rehoboth. Sample: 96 women who self-identified as lesbian, bisexual, or transgender and lived in the state of Delaware.
Journal of Transcultural Nursing, 2004
The purpose of this study was to examine the impact of race on length of hospital stay (LOS) and ... more The purpose of this study was to examine the impact of race on length of hospital stay (LOS) and number of procedures on elderly persons hospitalized with chronic heart failure (CHF). Secondary data analysis was used to obtain data on 99,543 hospitalized Medicare patients with CHF age 65 years or older. MANOVA was utilized to examine the effects of race, age, and total hospital charges on LOS, number of procedures, and diagnosis. Asian American Pacific Islanders had significantly higher number of procedures and LOS compared to Whites. The combined dependent variables were significantly affected by race, F( 9, 99,543) = 121.95, p = .000; the covariates of age, F( 3, 99,543) = 720.65, p = .000; and total charges F( 3, 99,543) = 38,962.95, p = .000. LOS accounted for 50% of the variance. Studies that examine cultural variables and their effect on LOS and number of procedures are needed.
Lesbians' Disclosure of Sexual Orientation and Satisfaction With Care
Journal of Transcultural Nursing, 2008
The overarching aim of this study was to explore demographic variables and their association with... more The overarching aim of this study was to explore demographic variables and their association with a woman's disclosure of sexual orientation to a health care provider (HCP). This descriptive correlation study used a convenience sample of 96 women recruited at gay and lesbian community events held in Delaware. A self-report survey of 35 questions was used to obtain the data. None of the women identified themselves as exclusively heterosexual. The results indicate that a woman's self-identified sexual orientation is significant in predicting whether she has shared her orientation with her HCP. The more a woman's self-reported orientation moves toward the heterosexual end of the preference scale, the less likely she is to share her orientation with her HCP. Culturally competent care and a nondiscriminatory atmosphere will provide this population with the trust needed to enable open rapport with their HCPs.
Drinks per Day in Women of Mexican Origin
Journal of Addictions Nursing, 2013
Historically, Mexican-born women who immigrate to the United States (U.S.) have lower levels of a... more Historically, Mexican-born women who immigrate to the United States (U.S.) have lower levels of alcohol use and higher rates of abstinence compared with Mexican American women born in the U.S. and other racial groups in the U.S. As such, immigrant women's alcohol use has received limited attention by the research community. Gaps in knowledge of their alcohol use patterns, changes in healthy drinking recommendation for women, and projections of population growth in both Mexican immigrant and Mexican American populations support the need for the study. Data from the Center for Disease Control's National Health Interview Survey were used to explore alcohol use differences in women of Mexican origin born in and outside of the U.S. In addition, the relationship between years in the U.S. and drinks per day was explored in Mexican immigrant women. The results indicated that Mexican immigrant women who drink are drinking above recommended levels and the younger…
Characterising emergency department high-frequency users in a rural hospital
Emergency Medicine Journal, 2013
Patients who are frequent users (≥4 visits/year) comprise ∼10% of patients, but account for ∼34% ... more Patients who are frequent users (≥4 visits/year) comprise ∼10% of patients, but account for ∼34% of total yearly emergency department (ED) visits. Non-emergent care provided to frequent ED users affects operating costs and usage. The majority of reports characterising frequent ED use are from urban teaching centres. This study describes frequent users of ED services in a rural community setting and the association between counts of patient's visits and discrete diagnoses. Retrospective study of 1652 frequent ED adult patients from a rural US hospital over a one-year period. Descriptive statistics and Poisson regression were used to explore the characteristics of frequent users and their patterns of diagnoses. Frequent user visits ranged from 4 to 66 per patient. Frequent users were 9.41% of patient volume accounting for 33.94% of the total visits and were younger compared with patients with <4 visits. Approximately 36% of frequent user visits were generated by 20 diagnoses when the diagnoses were concatenated into domains which covered ∼76% of the visits. There was a high correlation between the number of visits and discrete diagnoses in frequent users. These findings suggest a more complex picture of rural ED services and their relationship with primary care and dental services, which needs to be defined before policy development to reduce ED use.
Rehabilitation Nursing, 2012
This study's aims were to evaluate patient knowledge of safe warfarin practices early in treatmen... more This study's aims were to evaluate patient knowledge of safe warfarin practices early in treatment, and to pilot a nursing telephone follow-up enhancement to a pharmacy-facilitated discharge. Method: Forty-two randomized patients in either "enhanced follow-up" or "treatment as usual" groups completed the study. Results: Enhanced treatment resulted in significant improvement in warfarin knowledge (86% versus 71%). In critical safety related knowledge questions even larger improvements were present ($ 96% compared to $ 77%). Discussion: The hypothesis that non-adherence generating rehospitalization is a function of poorer knowledge was not supported as there were no warfarin-related readmissions during the study. Conclusion: The study supports the use of enhanced follow up and the need for larger studies to delineate what patient knowledge prevents rehospitalization and cost effective educational efforts. Statement of the Problem The number of patients on anticoagulation therapy has increased dramatically, and is projected to increase with the aging population and changes in preventive care (Melnikova, 2009). Preventive antithrombotic agents can reduce morbidity and mortality associated with a variety of complex health conditions. The most commonly prescribed antithrombotic agent is warfarin with more than 3.8 million Americans taking the drug in 2005 at an estimated cost of $963 million (Agency for Healthcare Research and Quality, 2008). Warfarin accounts for 17.3% of medication-related adverse events seen in emergency rooms in the elderly (Budnitz & Layde, 2007). Rehabilitation nurses are ideally positioned to reinforce hospital discharge education which is the cornerstone in improving patient safety.
Oncology Nursing Forum, 2004
B reast cancer is the most frequent cancer diagnosis for women in the United States. Incidence re... more B reast cancer is the most frequent cancer diagnosis for women in the United States. Incidence remained relatively unchanged during the 1990s. Even so, an estimated 217,440 women will be diagnosed and 40,580 will die of the disease in 2004 (Jemal et al., 2004). More Caucasians are diagnosed with breast cancer than other groups. However, the five-year relative survival rate in other races and ethnic minorities is substantially lower than that for Caucasians (Jemal et al.). The term Asian American signifies a diverse population in the United States. The federal government defines Asian Americans as a minority population originating in the Far East, Asia, and Southeast Asia (Intercultural Cancer Council, 2001). According to the 2000 U.S. Census, Asian/Pacific Islander Americans (APIAs) are the fastest-growing ethnic group in the United States, with the population increasing by 72% since the 1990 U.S. Census (U.S. Census Bureau, 2000). The number of APIAs in the United States has grown from 1.5 million in 1970 to more than 11.2 million in 2000 (U.S. Census Bureau, 2000). Rates of breast cancer generally are lower in Asia than in the United States (Kagawa-Singer & Pourat, 2000). According to Jemal et al. (2004), the incidence of breast cancer in APIA women is 97.2 (per 100,000 women) compared to 140.8 for Caucasian women in the United States. The mortality rate is 12.5 (per 100,000) compared to 27.2 for Caucasians (Jemal et al.). Evidence suggests that exposure to the Western lifestyle increases breast cancer risk among immigrants from Asia (Ziegler et al., 1993). The longer that foreign-born Asian/Pacific Islander women reside in the United States, the more likely that their risk for developing breast cancer will approach that of American-born women. Disease rates among APIA women vary depending on ethnicity. In general, however, these women
Delaware Lesbian Health Survey
Declining HPV Vaccination Rates in Delaware: Cause for Concern and Action
Delaware Journal of Public Health
From 2010 to 2013, Delaware’s rates of HPV vaccination of females ranked among the highest in the... more From 2010 to 2013, Delaware’s rates of HPV vaccination of females ranked among the highest in the nation.1 Recently, the rate of completion has declined to one resembling the reported national rate.1 This paper provides a brief background on HPV vaccination, a description of the efforts within Delaware which may have generated the promising earlier results, potential reasons for the decline in rates, and recommendations to increase vaccination rates in the future.
Special Olympics of Delaware and Sigma Theta Tau International ? Beta Xi
Engagement of the Next Generation of Nurses Through Obstetric Research
Journal of Obstetric, Gynecologic, & Neonatal Nursing, 2018
Declining HPV Vaccination Rates in Delaware: Cause for Concern and Action
Delaware Journal of Public Health, 2016
From 2010 to 2013, Delaware’s rates of HPV vaccination of females ranked among the highest in the... more From 2010 to 2013, Delaware’s rates of HPV vaccination of females ranked among the highest in the nation.1 Recently, the rate of completion has declined to one resembling the reported national rate.1 This paper provides a brief background on HPV vaccination, a description of the efforts within Delaware which may have generated the promising earlier results, potential reasons for the decline in rates, and recommendations to increase vaccination rates in the future.
Objective: Cancer can evoke long-held cultural beliefs which either facilitate or impede efforts ... more Objective: Cancer can evoke long-held cultural beliefs which either facilitate or impede efforts to expand the health literacy of families. Among these beliefs is fatalism which holds that controlling ones′ outcome is not possible, and that ones′ outcome is predestined. Some fatalistic beliefs are broadly held within the Asian American (AA) community and may be challenged or reinforced by the experience of having a family member diagnosed with cancer. This study evaluated the relationship between having a family member diagnosed with cancer and selected demographics in AAs on fatalistic beliefs. Methods: Data from 519 AA subjects from the Centers for Disease Control and Prevention Health Information Trends Survey were used to complete a secondary analysis. Descriptive statistics characterize fatalistic beliefs. Four models using four questions assessed fatalistic beliefs as dependent variables and independent variables of having or not having a family member diagnosed with cancer, c...
Beyond the Research Grant: Supporting Nursing Research Through Collaborative Partnerships
Experiences of Asian Women Who Live in Urban Environments and Are Breast Cancer Survivors
Journal of Transcultural Nursing
Introduction Despite expanding interest in cancer survivorship, little is known about urban Asian... more Introduction Despite expanding interest in cancer survivorship, little is known about urban Asian breast cancer survivors whose experience may differ from those in suburban and rural locations. This study explores survivors’ challenges to maximize outcomes and identify common and unique themes among urban Asian survivors. Information was obtained from the survivors and outreach workers from their community. Methodology Descriptive qualitative methods including semistructured interview guides were used to plan, conduct, and analyze both individual interviews of Asian women ( n = 6) and a focus group ( n = 7) composed of community outreach workers. Results The interview and focus group findings, endorsed themes of communication/language, trust, and privacy, with generational differences. Poor health literacy in both survivors and providers was identified. Discussion Nurses are in a unique position to use the themes identified to both assist survivors expand their health literacy and l...
Cancer Screening and Prevention in Lesbian, Gay, Bisexual, and Transgendered Community and Asian Lesbian, Gay, Bisexual, and Transgendered Members
Asia-Pacific Journal of Oncology Nursing
Participation in cancer screening and prevention (cessation of or reduction in modifiable health ... more Participation in cancer screening and prevention (cessation of or reduction in modifiable health risk behaviors) are the most effective methods of reducing cancer morbidity and mortality. Some members of the lesbian, gay, bisexual, and transgendered (LGBT) communities have not participated in screening for a variety of reasons which have been explored in the literature. Common and unique behavioral risks are also reviewed. Knowledge about Asian members of the LGBT community participation in cancer screening and prevention is limited. This paper reviews the current literature on participation and barriers to cancer screening and prevention for the LGBT community and provides some insights for the Asian LGBT subcommunity. Potential interventions that have been demonstrated to be effective are presented for potential implementation within nursing practice and practice settings. Suggestions for future research are also provided to enhance the care of the LGBT community.
Clinical Journal of Oncology Nursing
Adherence to procedures in cancer clinical trials is essential to the validity of outcomes. Altho... more Adherence to procedures in cancer clinical trials is essential to the validity of outcomes. Although extensive efforts are made to ensure that each clinical trial adheres to the study procedure, breaks in study protocols are not uncommon. The rates of protocol violations are difficult to fully ascertain because they are not commonly reported in the literature (Sweetman & Doig, 2011). Post-marketing studies completed for the U.S. Food and Drug Administration (FDA) indicated that 15%-24% of trials contained protocol violations, but that finding was based on a narrow definition of nonadherence (Dodd, White, & Williamson, 2012; Macias et al., 2004; Sprung, Finch, Thijs, & Glauser, 1996). The complexities of clinical trials, the number of clinicians involved, and a variety of patient and environmental issues contribute to protocol violations. A dearth of knowledge exists about the rates and sources of protocol violations observed by research nurses. The expansion of oral agent trials has increased the risk of patient-based nonadherence because dose administration is probably a patient's responsibility outside the healthcare setting. Unobserved patients are more likely to not adhere than those who are observed or administered study drugs (Agoritsas, Deom, & Perneger, 2011). Invariably, this will affect the quality of the data reported to establish drug efficacy and render judgment on clinical significance. With nonadherence to study medication and requirements of the protocol, the integrity of the data becomes questionable and the validity and reliability of the study potentially compromised. Clinical trial nurses are in a unique position to provide insight into common sources of protocol violations. The current study characterized groups and sources responsible for protocol breaks as a first step in seeking to mitigate them.
Patterns of Alcohol Abstinence in Mexican Women Residing in the United States: Effects of Nativity and Duration in the United States
Hispanic Health Care International
Objectives:Explore changes in abstinence rates in Mexican women (MW) residing in the United State... more Objectives:Explore changes in abstinence rates in Mexican women (MW) residing in the United States based on nativity and time in the United States as an indicator risks for future alcohol-related disorders.Design:A secondary analysis of data from the National Health Interview Survey evaluated rates of abstinence between 2000 and 2017. A logistic regression was completed to address the impact of age, years in the United States, sample years.Sample:A total of 29,860 MW surveyed over an 18-year period that included those born in and outside the United States.Primary Research Variables:Dependent variable was abstinence status; independent variables included nativity, year of survey, age, years in the United States (if immigrant).Results:Immigrant MW showed higher rates of alcohol abstinence than U.S.-born MW across all years, but regardless of place of birth, fewer MW are abstaining over time. Among immigrant MW, those only in the United States greater than 15 years had a greater risk o...
Breast Cancer Survivorship Experiences of Urban Hispanic Women
Journal of Cancer Education
The purpose of this study was to explore determinates of health that impact survivorship of urban... more The purpose of this study was to explore determinates of health that impact survivorship of urban Hispanic breast cancer survivors who are at risk for experiencing poorer outcomes than others. Some challenges have been characterized, but gaps in our knowledge of the impact of some of the social determinates of health remain. Challenges likely exist prior to a diagnosis of cancer and may amplify in intensity during survivorship, potentially shortening survival and quality of life of these women. A narrative, focus group was conducted with a group of urban Hispanic breast cancer survivors. A series of linked vignettes describing survivorship challenges and late effects of breast cancer pathology and treatment were used to stimulate discussion. Three themes impacting survivorship were identified. The themes included communication (health literacy), isolation, and social support and financial cost. Communication issues resulted in delays in treatment denial of services. While these themes in cancer survivors are independent of residence (rural, suburban, or urban) and across ethnic groups, some unique issues were identified in urban Hispanic breast cancer survivors. Members of the healthcare team are in a unique position to enhance survivor’s health literacy, advocate for programmatic efforts to enhance navigation roles in the hospital and communities, decrease delays in initiating care, and decrease the rate of patients lost.