bluuebunny/crossref_metadata_2025 huggingface dataset:
Grounded spaces: deictic -self anaphors in the poetry of Emily Dickinson
Authors: Freeman Margaret H.
Published: October 2007

Ungrammaticality in poetry, when it is considered 'acceptable' by literary critics, has been characteristically dismissed as 'poetic licence', as though poets are somehow exempt from the constraints on linguistic usage. Autonomous (traditional or transformational) grammar has no explanation for the occurrence of forms such as Emily Dickinson's -self anaphor pronouns. On the contrary, under a cognitive linguistic account, her apparently ungrammatical -self anaphors are perfectly grammatical. Dickinson's -self anaphors, grounded in mental spaces, are triggered by the subject/agent of their originating space. That the grounding of these -self anaphors makes them deictic is attested by the existence of 'crossover' spaces. Dickinson's use of the -self anaphor in projected mental spaces makes the self deictically present in that space: not any self, but the self as agent in the originating space. By using the principle of -self anaphor projection from the subject/agent in one mental space into another, Dickinson creates for us a world of possibilities : a world in which things can happen and be made to happen through the agencies of the self.
Rewriting rights: a relevance theoretical analysis of press constructions of sexual harassment and the responses of readers
Authors: Christie Christine
Published: October 2007

In this article I report on one aspect of a research project which explores the ways in which the meaning of the term 'sexual harassment' is contested in the British press, and which is based on a survey of all uses of the term in the Daily Afail and The Guardian during 1996, and a study of readers' responses to selected reports. This research has indicated that the term, which was coined by feminists, is being redefined from an anti-feminist perspective, and the aim of this article is to demonstrate how Sperber and Wilson's (1986/1995) relevance theory can provide a useful theoretical framework for exploring this phenomenon. I begin by considering why this issue is of significance to feminism; in section 2, I provide a context for my study by considering two distinct ways of conceptualizing sexual harassment; in section 3, I outline my methodology before demonstrating its application in section 4.
The European Union Structural Fund Allocations
Authors: Greenwood Justin , Levy Roger , Stewart Rachel
Published: October 2007

The growth of European Union territorial policy competencies has brought with it significant budget ary changes and heralded ambitions of a 'Europe of the Regions'. Regional policy funding now commands around 30 per cent of all European Union expendi ture. In the recent (1994-99) round of structural fund allocations there were more 'winners' than 'losers'. Over 60 per cent of the European territory is now covered by the funds. A number of local authori ties, justifiably pleased with the award of funds to their territories, are full of 'campaign lessons' of 'successful lobbying in Brussels'. Yet structural fund application procedures dictate that individual regions cannot enter into negotiations with the EU to obtain funds; rather, they can only seek to influence member states, the 'gatekeepers' for applications made to the EU for structural funding. The real 'winners' of struc tural fund awards are the member states themselves. This is because the spending of structural funds is diffcult to audit with any certainty, enabling member states to use European money as substitute territorial funding, rather than meeting EU rules designed to ensure that European funds are additional to national spending on the regions. Detailed insights are pro vided into the processes of applying for, spending, and auditing EU structural funds, demonstrating how it is possible for member states to draw benefit for central government spending programmes from funds intended for territorial initiatives. Rather than a 'Eur ope of the Regions' it would appear that EU spending can be recycled back to national governments, reinforcing centralization rather than creating decen tralization. The absence of strong regional 'policy net works' of public and private players in centralized unitary member states to monitor additionality exacerbates the problem. Case study material from Grampian, Scotland, is presented to illustrate these processes.
Urban Policy, Local Administration and Land Use Planning in Lille
Authors: Green Howard , Booth Philip
Published: October 2007

Urban policy initiatives are a characteristic of most European countries. These initiatives have developed within the context of existing legislative frameworks, particularly relating to public administration and land use. The Contrat de Ville, recently introduced as a mechanism for urban policy coordination and im plementation, has developed within an administrative structure based on 36,000 communes, Schémas Dir ecteur and Plans d'Occupation des Sols. This article outlines the development of urban policy and de scribes the existing structures before questioning the constraints which these may pose for urban policy development. Using the case of the Contrat de Ville for Lille, it then assesses how far these structures have constrained the development of the Contrat.
Restructuring of the European Production System
Authors: Nilsson Jan-Evert , Schamp Eike W.
Published: October 2007

In this paper we argue that the primary forces behind change in the European urban and regional system are those in the social organization of pro duction of goods and services. After reviewing on going transformations in the production system, we reflect on the legacy of Europe's earlier spatially frag mented order. Then we consider the significance of a changing regulatory environment and the strategies of large corporations for the geography of produc tion. Finally, we explore the likely economic and pol itical consequences of emergent patterns of European regional imbalance.
European Economic Restructuring
Authors: Blotevogel Hans H. , King Russell
Published: October 2007

This paper seeks to comprehend the nature of the relationship between economic restructuring and various processes of demographic change in Europe. The analysis reveals a broad set of complex inter relations between the economic and population systems. Population cannot be taken as a single de pendent variable acting in response to economic change. Demographic processes such as ageing and fertility decline can also act as independent variables providing feedback and input into socio-economic restructuring, and they can also be regarded as a kind of background system, reacting rather inertly compared to the short-term cycles and transform ations in the economy. Therefore demographic changes are often underestimated in their medium and long-term feedback effects. The labour market is taken as the main field of interplay between the sys tems of economy and population and thus this paper takes a close look at some important changes within the European labour market and submarkets. Changing employment conditions - the growth of the secondary labour market, the flexibilization of labour demand and increasingly also of supply, grow ing female labour force participation rates, generally high ethnic minority unemployment - reflect differ ent aspects of the transition from the Fordist to the postFordist regime as well as changing demographic and life-style influences. Together they have deeply transformed the European landscape of employment and unemployment The specific role of international migration is also analysed and it is seen to have fun damentally altered between the Fordist and postFordist eras. Less clear to interpret are changing internal migration patterns: has counterur banization stopped in response to restructuring and integration and is a new postFordist population map unfolding? The paper concludes by evaluating the nature of the relationship between economic restructuring and population trends and identifying pointers for future research.
Changing Cities
Authors: Bailly Antoine , Jensen-Butler Chris , Leontidou Lila
Published: October 2007

This paper outlines the main trends of urban change in contemporary Europe and indicates theoretical approaches which can be used to analyse and under stand them. Three main questions are considered: the link between economic restructuring and urban and regional change; the interactions between urban policy responses and restructuring; and the conse quences of these changes for patterns of marginality in Europe.
Psychological Assessment of the Adolescent with Cancer
Authors: Blotcky Alan D. , Cohen Debra G.
Published: October 2007

Pediatric oncology nurses are often faced with the difficult task of assessing the psychological symptoms of adolescents with cancer and determining when referral to a mental health specialist is needed. Such professionals are called upon to determine whether a teenager's difficulties reflect transient turmoil associated with adaptation to the illness which would respond to support and reassurance, or whether psychological disturbance is present which demands more intensive intervention. In making this decision, the health provider must carry out an evaluation which takes into account the adolescent's special psychological concerns as well as the nature of the presenting symptoms. This paper presents a conceptual framework to be used by the nurse clinician in evaluating the psychological functioning of adolescents with cancer.
Relaxation Techniques in Children with Cancer: The Nurse's Role
Authors: Hockenberry Marilyn J.
Published: October 2007

Relaxation techniques used to decrease the deleterious side effects of cancer therapy are now accepted approaches at most institutions. Utilization of these methods by nurses can offer effective coping strategies for children with cancer. Those individuals most intimately involved in the care of the child can provide a trusting relationship that will facilitate more effective use of relaxation techniques. Involvement of parents with these methods can enhance the utilization of these techniques while increasing their involvement in the child's care.
Establishing Pediatric Cancer Nursing Research Priorities: A Delphi Study
Authors: Hinds Pamela S. , Norville Robbie , Anthony Lori K. , Briscoe Beverly W. , Gattuso Jami S. , Quargnenti Alice , Riggins Melinda S. , Walters Lisa A. , Wentz Lori J. , Scarbrough Karen E. , Fairclough Diane C.
Published: October 2007

The purpose of this study was to have pediatric oncology nurses identify and rate topic priorities for clinical nursing research in the specialty and to determine if nurses in a pediatric cancer center identified different priorities than did nursing colleagues in other settings. The sample consisted of 44 nurses from a comprehensive pediatric cancer center and 43 nurses attending the 12th Annual APON Conference. A decision-making method, the classical Delphi technique, was used. Three rounds of soliciting opinions by questionnaires were completed. and data from each round were reviewed and categorized by a research team of six nurses until group consensus was achieved. The majority of priorities identified by both groups concerned nursing procedures, the pediatric oncology patient, and the specialty itself. The least number of priorities were in the categories of care delivery systems and families. One difference between the two groups was that professional issues dominated the cancer center sample, whereas psychosocial issues were more prominent in the APON sample.
Rationale and Development of an Institutional Pediatric Chemotherapy Certification Course
Authors: Alley Stam Mary Alice
Published: October 2007

In a large pediatric teaching hospital located in the southwestern part of the United States, few nurses had participated in a formal program that taught the knowledge and skills required for the nurse to care for the patient receiving chemotherapy. In order to enhance the necessary clinical competency of the nursing staff, a Chemotherapy Certification Course was developed for this institution. In reviewing the literature there was minimal information on how to develop such a program. The purpose of this article is to describe the development of this course with the intent that it can serve as a guide in facilitating and implementing such a course in other institutions. As more hospitals adopt institutional certification as a form of continuing education in cancer nursing, perhaps the gap between knowledge and practice will decrease. The institutional certification course will be a significant step toward improving the level of practice of nurses caring for patients receiving chemotherapy. The goal of promoting professional competence will benefit the nurse, the institution, and patients and their families.
Transition From Hospital to Home for Children With Complex Medical Care
Authors: Wong Donna L.
Published: October 2007

Home care has become a well-accepted option for children with chronic illnesses, such as cancer, who require continued technological care for survival. Components of successful home care include assessment of the child and family for this option, assessment of the community's ability to provide the services the family needs, development of a comprehensive care plan, education of care givers, and ongoing evaluation of the plan. Nurses play a major role in the discharge planning for home care by educating care givers to perform the necessary care, by providing opportunites for care givers to demonstrate competence before assuming total responsibility, and by ensuring that the care givers and the home environment are ready for the child's discharge. Throughout this process, the principles of normalization are applied to provide the child with an optimum home environment. Establishing parent-professional partnerships is crucial to providing family support that empowers family members, especially parents, to assume the responsibilities of caring for their child.
Coping With Adolescent Cancer: It's a Matter of Adaptation
Authors: Ellis Jacqueline A.
Published: October 2007

Adolescents with cancer face many stresses that challenge their ability to cope. Using the framework of the Roy model, common adaptation problems and nursing interventions are discussed as they pertain to adolescents with cancer. © 1991 by Association of Pediatric Oncology Nurses.
"Lasting Impressions: Adolescents With Cancer Share How to Cope"—A Videotape Program
Authors: Heiney Sue P. , Wells Linda M. , Coleman Beth , Swygert Elaine
Published: October 2007

This article discusses the production of a videotape program for newly diagnosed adolescent cancer patients and their parents. The video was developed as a goal of the members of Lasting Impressions, a support program for adolescent cancer patients and their parents. The patients wanted to help other patients realistically understand the stesses they would encounter and learn ways to cope with them. The project is unique in that the patients developed the content, wrote the script, and starred in the production. This article details the various components of the project and describes the therapeutic goals achieved.
Validity and Reliability of a Pediatric Hematology Oncology Patient Acuity Tool
Authors: Lovett Ruth Busch , Wagner Leslie , McMillan Susan
Published: October 2007

Appropriate use of nursing resources in the pediatric hematology and oncology inpatient settings demands a patient acuity system that is easy to use and accurate, and that objectively measures nursing care needs of a specialized patient population. Structured survey of 13 comprehensive cancer centers and a review of the literature show no valid and reliable acuity tools for this pediatric population. The purpose of this project was to study the validity and reliability of a newly developed pediatric hematology and oncology acuity system designed to quantify patient care needs. A new acuity tool for this pediatric population was developed based on the patient classification tool used at Johns Hopkins Hospital Oncology Center (JHHOC). The levels of care from the JHHOC tool were adopted, with therapeutic indicators modified to reflect nursing diagnoses relevant to the pediatric inpatient. Nursing care hours required for each level of care were also identified. Validity was studied using a content validity index (CVI). Experts from the pediatric unit where the tool would be used were asked whether each therapeutic indicator was assigned to the correct level of care (1 thru 5) based on patient care hours. CVIs for items ranged from .5 to 1.0; the overall CVI for the tool was .93. Interrater reliability was studied using two raters from the unit. Data were collected for 150 patient observations on a 12-bed pediatric hematology and oncology inpatient and short-stay outpatient unit. The resulting Pearson correlation coefficient was r = .97 (P <.001). The resulting tool is nursing diagnoses based, interfaces with standard care plans, is easy to use, requires no calculation, and provides reliable quantification of nursing work load based on pediatric hematology and oncology patients care needs. Data from this acuity tool determine variable nursing hours per patient per day and assist with patient assignments, staffing and scheduling decisions, budgetary processes, establishing productivity, and will ultimately facilitate establishing charges for nursing services to patients. Currently, a quality assurance interrater reliability design audit system is used to maintain and monitor ongoing integrity and accuracy of the classification system. CVI and interrater reliability studies will occur at regular intervals to ensure the validity and reliability of the tool.
Meeting the Challenge of Infection: A Case Study
Authors: Walsh Betty A.
Published: October 2007

Infection is the most critical complication of cancer. A case study is presented that describes an adolescent with acute lymphocytic leukemia. He experienced multiple complications due to infection. Both new and standard therapies were required for the treatment and prevention of infections. A discussion of the rationale for various aspects of his care is presented.
The Use of Venous Access Devices in Pediatric Oncology Nursing Practice
Authors: Keegan-Wells Diane , Stewart Janet L.
Published: October 2007

Venous access devices have been in use since 1973 and have made a tremendous impact on care of children with malignancies to facilitate the delivery of complex medical care and minimize the trauma associated with cancer therapy. During the past 20 years the variety and complexity of available devices has resulted in an increased demand for technical knowledge and expertise to prevent complications and assure safe use. This article reviews the various devices, complications and implications for nursing practice, and recommendations for pediatric nursing regarding patient/parent self-care and developmental safety issues.
The Roy Adaptation Model Used As a Guide for the Nursing Care of an 8-Year-Old Child With Leukemia
Authors: Wright Penelope S. , Holcombe Judy , Foote Anne , Piazza Dianne
Published: October 2007

Roy's Adaptation Model provides a framework for holistic oncology nursing practice. In this article, an overview of Roy's model is provided. It is used to assess the behaviors and stimuli influencing the behaviors of an 8-year-old boy with acute lymphocytic leukemia. Planning and evaluating the nursing care of this child is based on the model. A comprehensive list of nursing diagnoses is categorized according to Roy's four adaptive modes, and a nursing care plan for two of these diagnoses is presented.
Perceived Sources of Stress Among Pediatric Oncology Nurses
Authors: Evans Emery Janet
Published: October 2007

This study examined the stressors most commonly experienced by pediatric oncology nurses. A descriptive, correlational design was used, and Selye's stress theory served as the theoretical framework. The final sample consisted of 155 members of the Association of Pediatric Oncology Nurses who completed and returned the Spielberger State-Trait Anxiety Inventory, and the Pediatric Oncology Nurse Stressor Questionnaire (PONSQ). The participants reported that relapse or sudden death of a favorite patient was their greatest source of stress. The second most common stressor was a workload perceived as too great to give quality patient care. The participants reported no more state or trait anxiety than the reference group. Statistics for white-collar working women were used as the reference group by Spielberger. The PONSQ shows that pediatric oncology nursing is a stressful profession. Additional research is needed to identify positive strategies for reducing this stress.
A Delphi Study of Pediatric Oncology Nurses' Facilitative Behaviors
Authors: Walker Carolyn , Wright Penelope , Curry Diane , Panzarella Cheryl , Adams Jeanette , Gleason-Morgan Debbie , Kramer Robin , Vogel Ralph , Weekes DeLois
Published: October 2007

Using a classic Delphi methodology, this study identified the nursing behaviors and interventions that oncology nurses rated as most important in facilitating the patient's, parents', and siblings' coping efforts with the effects of disease and treatment. Random selection of 300 pediatric oncology nurses resulted in a final sample of 69 nurses who completed all 3 rounds of the Delphi. The majority of the nurses were younger than 35 years of age, had less than 10 years of experience, were educated with at least a bachelor's degree, and practiced in an all-oncology setting. Twenty-eight facilitative behaviors were identified for the child with cancer, 25 for the parents, and 25 for the siblings. Results of this study support previous research on patient, parent, and sibling coping.
A Trajectory Approach for Education of the Child/Adolescent With Cancer
Authors: Baysinger Mary , Heiney Sue P. , Creed Joan M. , Ettinger Robert S.
Published: October 2007

Survival in childhood cancer has improved, but the child's learning capability and psychosocial adjustment are affected by intense therapy, the side effects, and psychosocial issues. The resulting problems of school attendance and performance need to be addressed by pediatric oncology nurses. This article describes an education intervention program that is based on a treatment trajectory with interventions that occur from diagnosis through long-term survival and are directed toward the patient/parent, school personnel, and classmates. Both anecdotal and empirical evaluations of the program are being completed. This program provides pediatric oncology nurses with a model for program development and resource materials.
Parents' Perceptions of Their Quality of Life
Authors: Wright Penelope S.
Published: October 2007

The purpose of this study was to assess parents' perceptions of their quality of life after the diagnosis and treatment of cancer in their child. The following questions were addressed: (1) How do parents of children with cancer perceive their quality of life; (2) How do parents of children with cancer perceive their quality of life compared with before their child was diagnosed; and (3) Is there a statistically significant difference in parents' quality of life perceptions now as compared with before their child had cancer? Using Roy's Adaptation Model as a theoretical framework, a descriptive study research design was used with a convenience sample of 30 parents. Data collection involved parental completion of the Varricchio-Wright Impact of Cancer Questionnaire-Parents, a 17-item instrument measuring parental quality of life in each of Roy's domains, and a Demographic Information Form. Measures of central tendency were used to describe the sample and to answer the first two research questions; student's t-test was used to answer the third. Results indicated that this sample of parents perceived their quality of life now as good, but not as good as before their child was diagnosed with cancer. There was a statistically significant difference in parents' perceptions of their quality of life now and before their child was diagnosed with cancer. The significance of this study related to nursing practice and research is discussed and recommendations for future research are given.
A Comparison of Three Theories of Nursing Used as a Guide for the Nursing Care of an 8-Year-Old Child With Leukemia
Authors: Wright Penelope S. , Piazza Dianne , Holcombe Judy , Foote Anne
Published: October 2007

This article evaluates three nursing theories that can be used to provide a framework for holistic pediatric oncology nursing practice: the Roy Adaptation Model, the Neuman Systems Model, and the Orem General Theory of Nursing. Each theory is compared in terms of its view of man, health, environment, nursing, and the nursing process. Critique of each theory is presented. The decision of which theorist to use as a basis for practice is left to the individual nurse. This article explicates the similarities and differences in the three theories.
Behavioral Training of Motion Control in Young Children Undergoing Radiation Treatment Without Sedation
Authors: Slifer Keith J. , Bucholtz Jennifer D. , Cataldo Marilyn D.
Published: October 2007

Preschool-age children undergoing radiation treatment for malignancies often require daily sedation or general anesthesia to assure adequate motion control. A few older children with severe anxiety reactions, a history of behavior problems, or developmental handicaps have similar problems with radiotherapy. The use of sedation or anesthesia adds risk and expense to a procedure that does not require their administration for pain management. This report describes an altemative approach using behavior analysis to teach cooperation and motion control to preschoolers and older children with special needs. Outcome data are presented for 10 children between the ages of 3 and 7. Eight of the 10 appeared to benefit from the behavioral program. These eight cooperated with radiation treatments without the need for repeated sedation or anesthesia. The benefits and limitations of this approach are discussed along with the need for additional research.
Measuring Pain in Pediatric Oncology ICU Patients
Authors: West Nancy , Oakes Linda , Hinds Pamela S. , Sanders Lori , Holden Robin , Williams Sharon , Fairclough Diane , Bozeman Paula
Published: October 2007

Thirty patients (ages 5 to 13) hospitalized In a pediatric oncology intensive care unit (ICU) rated the presence and severity of their pain on the Faces Pain Scale (FPS) and the Poker Chip Tool (PCT). Parents independently rated the child's pain on these scales and each patient's nurse completed the Objective Pain Scale (OPS). Patients' ratings on the FPS correlated significantly with parents' ratings on this scale (τ = .48, P = .002) but not on the PCT (τ = .23, P = .16). Nurses' ratings on the OPS were moderately correlated with patients' FPS ratings (τ = .37, P = .02) but were only weakly associated with PCT ratings (τ = .27, P = .09). The majority of patients, parents, and nurses eacpressed a preference for the FPS over the PCT. The FPS appears to be a clinically useful and accurate approach for measuring the pain of pediatric oncology patients in an ICU but is limited to those who can participate in a self-report measurement. © 1994 by Association of Pediatric Oncology Nurses.
Measurement of Behavioral, Affective, and Somatic Responses to Pediatric Bone Marrow Transplantation: Development of the BASES Scale
Authors: Phipps Sean , Hinds Pamela S. , Channell Susan , Bell Gay L.
Published: October 2007

A new measure to assess behavioral, affective and somatic outcomes in the acute phase of bone marrow transplant is described. The Behavioral Affective and Somatic Experiences Scale (BASES) is a 38 item nurse-report instrument, with five subscales labeled Somatic distress, Compliance, Mood/Behavior, Interactions, and Activity. A series of pilot studies were conducted to refine the content of the BASES scale and to establish its psychometric properties in terms of internal consistency, inter-rater reliability, and validity. Internal consistency (Chronbach's α) for the subscales ranged from .742 to .902. Inter-rater reliability was good, with a median correlation between paired nurse observations of .866. A parent report version of the BASES scale has also been developed, and the finding of significant parent-nurse correlations provides preliminary evidence of the validity of the measure. Potential uses of the BASES scale in the pediatric BMT setting are discussed.
Developing and Producing a Patient Education Video on Care of the Permanent Right Atrial Catheter
Authors: Akcasu Nur , Bodenmiller Sara
Published: October 2007

Because of current trends in health care, nurses must find efficient, cost-effective, and innovative ways to provide quality patient education. In working with the pediatric oncology population, it is necessary to teach several family members how to care for the patient. One of the skills families must learn is care of the permanent right atrial catheter (PRAC). Although nurses and families together agreed a videotape would be extremely helpful in learning PRAC care, there was no videotape available to meet these needs. We developed and produced a patient education video on care of the permanent right atrial catheter. This article discusses identifying and organizing resources and finances, steps involved in writing and editing a script, and the producing/videotaping process. By sharing our experience, we hope to enable other nurses to create their own patient education materials.
The Effects of a Support Group on Selected Psychosocial Outcomes of Bereaved Parents Whose Child Died From Cancer
Authors: Heiney Sue P. , Ruffin Julian , Goon-Johnson Karen
Published: October 2007

Group support for bereaved parents whose child died from cancer has been suggested as a means of helping parents express emotions about their loss and improve their coping. Using a quasi-experimental design, we sought to determine the selected psychosocial effects of participation in a support group for bereaved parents whose child died from cancer. Five bereaved parents completed the Emotions Profile Index, the Family Adaptability and Cohesion Evaluation Scales, and the Social Adjustment Scale Self-Report before and after the seven group sessions. No statistically significant differences were found. Descriptive data were analyzed from the co-therapists' process log and the participants' evaluation forms. The group process log revealed intense pain and grief over the loss of the child and the parents' conscious struggle to adapt to the present and prepare for the future. The discussions poignantly indicated the great extent to which the child's death had changed their lives. Using the group evaluation form parents reported high satisfaction with the group sessions. Tentative conclusions support the value of such a group in providing a forum for some bereaved parents to ventilate feelings and thoughts and validate the normalcy of their reactions.
Social Support for Siblings of Children with Cancer
Authors: Murray John S.
Published: October 2007

This descriptive study investigated nursing interventions used by pediatric oncology nurses to provide social support to siblings of children with cancer. The study was guided by House's conceptualization of social support which includes components of emotional, instrumental, informational, and appraisal support. A sample of 250 randomly selected pediatric oncology nurses were mailed the Sibling Social Support Questionnaire (SSSQ), developed by the researcher, to determine what interventions they use in clinical practice to provide social support to siblings of children with cancer. With 134 nurse respondents, the SSSQ demonstrated high internal consistency (Cronbach's alpha of .95). Results indicated that the two most frequently used nursing interventions to provide social support to siblings are: ( I ) encouraging parents to spend time with their other children and (2) providing honest responses to questions asked by siblings. © 1995 by Association of Pediatric Oncology Nurses.
The Relationship of Illness Longevity and Relapse With Self-Perception, Cancer Stressors, Anxiety, and Coping Strategies in Children with Cancer
Authors: Hockenberry-Eaton Marilyn , Dilorio Colleen , Kemp Virginia
Published: October 2007

A descriptive, correlational design was used to investigate the relationship of the longevity of the cancer experience and the presence of a relapse to the child's self-perception, cancer stressors, anxiety, and use of coping strategies. The 44 children included in this study were 6½ to 13½ years of age. Fifteen of the children had experienced a relapse of the disease either on or off therapy. The longevity of the cancer treatment and the presence of a relapse were negatively associated with the child's self-perception. Trait anxiety was positively associated with duration of the cancer experience and with the presence of a relapse. Longevity of the cancer experience and the presence of a relapse may be factors that signal the need for interventions designed to enhance the child's self-perception throughout treatment. Because children in this study who reported lower self-perception and higher trait anxiety levels also reported experiencing more cancer stressors, nursing efforts to develop Innovative strategies designed to enhance patients' feelings of self-worth and decrease their anxiety may prove to be important contributions to the care of children receiving treatment for cancer.
The Parent-Nurse Relationship From the Perspective of Parents of Children with Cancer
Authors: Romaniuk Daria K. , Kristjanson Linda J.
Published: October 2007

Research to date has overlooked the specific relationship between parents and nurses, particularly in the context of family-centered care for a hospitalized child with cancer. The purpose of this study was to describe how parents perceive the relationship with the pediatric staff nurse necessitated by the hospitalization of their child with cancer. Using a symbolic interactionist framework and a modified grounded theory methodology, this study explored the parent-nurse relationship when a child with cancer is hospitalized. A purposive, theoretical quota sampling method was used to recruit 16 parents. Both parents' and nurses' care were examined from the parents' perspectives; mothers and fathers were interviewed separately. Analysis of the data led to the development of a substantive theory describing parent care (Making it Better), nursing care (Going Through the Motions, Caring Incompletely and Caring Completely), and the parent-nurse relationship (Working Together). Conditions influencing the care provided by parents and nurses and in turn the parent-nurse relationship were also identified. This research describes strategies nurses use to enhance the family-centered care they provide and reveals the effect nursing care has on parents' hospital experiences. Recommendations are made for nursing research, practice, and education.
Conscious Sedation: A Quality Management Project
Authors: Ross Paul J. , Fochtman Dianne
Published: October 2007

Conscious sedation provides effective pain control and can relieve anxiety associated with procedures. The increased use of this modality has prompted the American Academy of Pediatrics to develop national guidelines that emphasize the need for patient monitoring to ensure patient safety. A policy was developed that incorporated continuous monitoring of patients and frequent documentation of physiological measures before, during, and after procedures. All procedures over a 2-month period in the outpatient (n = 19) and inpatient (n = 24) pediatric oncology units that required midazolam and fentanyl were retrospectively analyzed. A nonrandom sample of one third of the inpatient procedures (n = 8) was also observed to assess the dynamics of monitoring and recording. Procedures, including recovery time, lasted an average of 69 minutes, with longer recovery periods recorded for the outpatient unit. Nurses. particularly on the inpatient unit, were not always able to provide continuous monitoring through recovery because of the demands of other patient assignments. This study suggests that to realistically meet the needs of the patients and the institution's responsibility, the current guidelines may need to be reconsidered to allow more nursing discretion in patient monitoring and/or the nurse's patient care assignment must be more flexible to allow for changing demands.
Developing, Implementing, and Evaluating a Handbook for Parents of Pediatric Hematology/Oncology Patients
Authors: Heiney Sue P. , Wells Linda M.
Published: October 2007

This article details the development of a parent handbook for pediatric hematology and oncology patients. The planning and content development are discussed. Adult learning principles were incorporated throughout the handbook. Use of the handbook in a pediatric cancer center is described. Both subjective and objective methods were used to evaluate the handbook. Results from the evaluation verify the value of the handbook to parents and give direction for future revisions of the handbook.
Comparing Child-Rearing Practices in Parents of Children With Cancer and Parents of Healthy Children
Authors: Hillman Kimberly Anne
Published: October 2007

This nonexperimental, descriptive study identified parenting behaviors and differences in the reported child-rearing practices between parents of children diagnosed with cancer and parents of healthy children. Two groups of parents were included: 58 parents of children diagnosed with cancer at a large urban children's cancer center and 58 parents of healthy children. The total group of parents ranged from 22 to 58 years with 35.7 and 35.9 years as the mean ages of the two groups. A variety of races were included among the parents and educational backgrounds ranged from high school and vocational to graduate/ doctoral degrees. Each child with cancer selected a healthy friend of the same age, sex, and race who served as their healthy counterpart for this study. Each of these child's parents were then involved in the data collection process.

Data were collected over a 2-month period using the Child-Rearing Practices Report (CRPR) in the Q-sort format, in which the parent sorted 91 cards containing 91 items dealing with child-rearing. Items were compared between the two groups using two-tailed t-tests.

Using a significance level of alpha = .02, 11 significant differences were found between the two groups in the domains of parental expectations, discipline, expression of emotion, parental concern/worry, and overprotectiveness. In conclusion, the primary types of items that shared or demonstrated significant differences between the two groups of parents were those dealing with discipline and overprotectiveness issues. The items responded to most significantly different were, "I tend to spoil my child" and "I worry about the health of my child," with the parents of children with cancer consistently rating these as more descriptive of them than the parents of healthy children did. Finally, this study suggested that the time of the child's diagnosis with cancer also affected the parents' reported child-rearing practices.
An Analysis of the Concept of Hope in the Adolescent With Cancer
Authors: Hendricks-Ferguson Verna L.
Published: October 2007

Nursing application of the concept of hope in the pediatric oncology clinical setting is currently in its infancy. This article presents a systematic analysis of the concept of hope for use by the pediatric oncology nurse in the care of the pediatric adolescent oncology patient. The literature review addresses health and illness states as areas significant to the analysis and application of hope. This article defines critical attributes, antecedents, and consequences of hope; constructs case examples (a model, a borderline, and contrary cases); includes an operational definition of adolescent hopefulness; and summarizes empirical referents of hope. Through clinical assessment of hope in the pediatric adolescent oncology patient and ongoing research of hope in this population, evaluation of the potential benefits of hope to this population's adaptation to varying health states will be further demonstrated.
Symptom Distress in Children With Cancer: The Need to Adopt a Meaning-Centered Approach
Authors: Woodgate Roberta , McClement Susan
Published: October 2007

Children with cancer experience many symptoms during the course of their illness trajectory. However, to date, research capturing the total symptom experience in this population and the language used by children to express distress is lacking. This article reviews the theoretical and empirical underpinnings of symptom distress in children with cancer including discussion related to (1) medical procedures, (2) cancer treatment, and (3) children's adjustment to cancer. Recommendations for research and practice that will provide a foundation for understanding children's experience with symptom distress are also included. Most salient of those recommendations is to adopt a meaning-centered approach to guide research and practice. This includes capturing the meanings and feelings children assign to the symptoms they experience throughout the whole illness trajectory.
The Relationships Among Uncertainty, Social Support, and Psychological Distress in Adolescents Recently Diagnosed With Cancer
Authors: Neville Kathleen
Published: October 2007

Uncertainty in illness about diagnosis, symptoms, prognosis, treatments, and relationships with health professionals is a major psychosocial stressor for adolescents recently diagnosed with cancer. In this study, the theoretical linkages of the uncertainty in illness theory of perceived social support, uncertainty, and psychological distress were tested. Respondents consisted of 60 adolescents between the ages of 14 and 22 years who were recently diagnosed with cancer. Data were generated by three questionnaires and analyzed using Pearson product moment coefficients and multiple regressional analyses. Hypotheses tested were that among adolescents with cancer (1) there will be an inverse relationship between perceived social support and uncertainty; (2) there will be a positive relationship between uncertainty and psychological distress; (3) there will be an inverse relationship between perceived social support and psychological distress; and (4) there will be an inverse relationship between perceived social support and psychological distress when controlling for uncertainty. Findings were as follows: the first three hypotheses were supported; there was no relationship between perceived social support and psychological distress when controlling for uncertainty. An interaction effect of perceived social support and uncertainty explained 39% of the variance in psychological distress.
Patient Satisfaction After Limb-Sparing Surgery and Amputation for Pediatric Malignant Bone Tumors
Authors: Hudson Melissa M. , Tyc Vida L. , Cremer Lola K. , Xiaolong Luo  , Hao Li  , Rao Bhaskar N. , Meyer William H. , Crom Deborah B. , Pratt Charles B.
Published: October 2007

We surveyed 65 patients age 13 years or older who had been treated for malignant bone tumors and were in remission at least 1 year after limb-sparing surgery (LS) or amputation (AMP) to assess general satisfaction with the surgical outcome and its impact on various areas of functioning. Of 130 eligible patients, 65 responded (61 treated for osteosarcoma, 3 for Ewing's sarcoma, and 1 for mesenchymoma). The median current age of the cohort was 25.8 years (range, 14.2 to 47.5 years). The median time from surgery was 14.2 years (range, 4.0 to 30.4 years) for the AMP group, and 5.5 years (range, 2.0 to 13.8 years) for the LS patients. Questionnaire responses of patients treated with AMP compared to those who had LS surgery showed no significant differences in the impact of the surgical procedure on educational and occupational status, functional limitations, pain intensity and degree of pain interference, emotional distress, interpersonal/social interactions and self-image, rehabilitation experience, and overall satisfaction with the surgical procedure. Functional limitation was significantly related to pain interference, as well as emotional distress, self-image, and interpersonal difficulties for the entire cohort. Our findings highlight procedure-related advantages and difficulties that may potentially enhance decision making regarding the selection of the surgical procedure for individual patients with malignant bone tumors of an extremity
Evaluation of a School Re-entry Nursing Intervention for Children With Cancer
Authors: McCarthy Ann Marie , Williams Janet , Plumer Christine
Published: October 2007

A retrospective qualitative design was used to identify and compare the concerns parents, teachers, and children have regarding school re-entry after a cancer diagnosis and to describe the impact of a school re-entry program on parents', teachers', and children's concerns. Audiotaped, semistructured interviews were obtained from a convenience sample of 10 children with cancer (ages 5 to 13 years), 10 mothers, and nine teachers. All participants were positive about the school re-entry nursing intervention, which is described. Results of content analyses indicate that before the intervention, mothers were concerned about their child's safety and peer teasing; teachers were concerned about their own knowledge and peers' adjustment, and children were concerned with keeping up with school activities. After the intervention, mothers were less concerned about peer teasing but continued to be worried about their child's safety in the school setting and began to have concerns about academic progress and physical stamina; teachers reported increased concerns for the child's safety and academic progress, and a desire to return to normal routines in the classroom; and the children continued to have concerns with maintaining academic and physical progress. Clinical and research implications are discussed.
Exploring the Lived-Experience of Childhood Cancer Survivors
Authors: Karian Victoria E. , Jankowski Stacey M. , Beal Judy A.
Published: October 2007

The purpose of this qualitative phenomenological study was to explore the lived-experience of childhood cancer survivors with regard to their patterns of interaction with family and the environment using Newman's theory of Health as Expanding Consciousness, which proposes that experiencing a devastating event promotes an expanded consciousness. The sample consisted of five young adults, ages 23 to 26 years, who had experienced childhood cancer and now are considered to be cured of their initial cancer. A hermeneutic dialectic approach was used, with each subject being asked to respond to one openended question, "What are the most meaningful events in your life?" The interviews were analyzed for evidence of expanded consciousness, changing relatedness, and other universal themes. Individual patterns emerged and themes were identified that supported Newman's theory, such as optimism and hope, stronger bonds to family and friends, increased capacity for empathy, a desire to help others, and deeper feelings for the value of life. The intensely personal and professional relationship that develops between pediatric oncology nurses and their patients can only be strengthened by the knowledge that these patients generally grew up to be caring and empathetic individuals, perhaps as a result of the nurses' loving care for them. This research also provided support for Newman's theory as a sound paradigm for nursing practice.
A Childhood Cancer Sibling's Oral History
Authors: Lehna Carlee R.
Published: October 2007

The diagnosis of childhood cancer in a family member alters a sibling's life, including exposing a sibling to the side effects of cancer therapy, feelings of being displaced, and a possible misunderstanding of what is happening. The purpose of this oral history was to gain a better understanding of the recall and long-term effects of a younger sister's diagnosis of cancer at age 6 on the child's sibling, who was then 8 years old. Data were gathered from a 22-year-old sibling of a leukemia survivor through three taped and transcribed semistructured interviews. Themes emerged through the process of content analysis. Six themes: closeness, activity, fearfulness, anger, worry, and spirituality, emerged and were supported by thick descriptions.