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Purpose The aim of this paper is to examine complementary and alternative medicine (CAM) use among racially and ethnically diverse adolescents. Greater understanding of CAM use among this group is warranted to better inform health care providers in delivering a culturally relevant health promotion approach. Design and methods A secondary data analysis was conducted using the 2012 Child Complementary and Alternative Medicine Supplement of the National Health Interview Survey (CAM-NHIS) data, which was collected from a national sample of adolescents aged 12–17 years. A logistic regression test was employed to investigate the predictors associated with CAM use among racially and ethnically diverse adolescents. Results While Black and Hispanic adolescents were the least likely to use CAM compared to their White counterparts, families with higher incomes, higher education attainment, and adolescents who experienced pain were more likely to use CAM. Conclusions Findings suggest the need for future research to gain a greater understanding of CAM use among racially and ethnically diverse adolescents, and insights into how health disparities impact CAM use. Greater understanding of how CAM use intersects with health beliefs and outcomes is also warranted. Practice implications Based on the CAM-NHIS survey, few racially and ethnically diverse adolescents have reported use of CAM. Development of culturally appropriate instruments and methods to assess CAM use among racially and ethnically diverse adolescents may yield specific data for this population. Informed health care providers can advocate for improved access to CAM for minority adolescents and alter disparate use.

The experiences of pediatric oncology nurses with prognosis-related communication (PRC) remain largely unknown. The purpose of this article is to report results of focus groups wherein 15 pediatric oncology nurses from three Midwestern pediatric cancer programs provided descriptions of PRC and how they experience PRC within their daily practice. Data from focus groups were analyzed via an interpretive descriptive approach, which resulted in three themes: (1) nurses’ operational definition of PRC, (2) nurses’ roles in PRC, and (3) nurses’ preparation for engagement in PRC. From discussions within the focus groups, nurses recognized that PRC occurs across a continuum. Nurses distinguished that the definition of PRC expands beyond simply reporting life expectancy to describing the consequences of cancer- and treatment-related toxicities and effects. When nurses are not actively invited by their physician partners to participate in PRC, nurses will often develop workarounds to ensure that they understand what was said to patients and families. This allows them to function more effectively as supporters, advocates, and informants. Nurses described little preparation to participate in such challenging conversations. Pediatric oncology nurses need to acknowledge and embrace that they are an integral part of PRC. Interprofessional communication training is necessary to enhance the comfort and confidence of nurses engaging in PRC.

Spirituality is considered a universal phenomenon, but research addressing the spiritual needs of adolescents in the context of health and illness is limited. The aim of this article is to provide a description of how the spiritual development framework (SDF) was used in conducting research with adolescents. An exemplar of a qualitative descriptive study is provided to demonstrate applicability of the SDF. The SDF was used as a guiding theoretical framework in conducting research with adolescents living with sickle cell disease. The SDF is culturally applicable and methodologically appropriate. Additional research applying the SDF is warranted.

Road traffic crashes and sequelae are reaching pandemic proportions globally and have currently achieved disproportionately high levels in Nigeria. Quantitative studies are accumulating in the peer-reviewed literature, but there is a paucity of qualitative research in Nigeria. Data for this study of structural and behavioral factors of road traffic crashes and injuries in Federal Capital Territory were collected in semi-structured interviews with crash survivors at National Hospital Abuja. Interviews were analyzed via qualitative content analysis, revealing crash location and participant beliefs about crash etiologies. Units of analysis were developed from participant statements and were structured within four a priori etiologic categories using Haddon’s (1980) matrix: human-, vehicle-, physical environment-, and socioeconomic environment-related. Subcategories were generated. Human-related subcategories included reckless behavior and drivers, limited technical knowledge and skill. Vehicle-related subcategories included vehicular disrepair and lack of safety equipment. Physical environment-related subcategories included road disrepair, infrastructural inadequacy, and weather. Socioeconomic environment-related subcategories included government, prehospital care, money, and prayer. Subcategories were organized temporally by pre-event, event, and post-event phases, with most units of analysis allocated in the pre-event phase. These qualitative results can be utilized to guide future research along community-aligned priorities, and to structure community-engaged preventative and interventional efforts.

Introduction The purpose of this study was to explore communication with health care providers from the perceptions of parents before their child's diagnosis of autism spectrum disorder and provide some examples of how communication may contribute to the autism diagnosis. Method This study used a qualitative descriptive design with multiple individual structured in-person interviews. Results Three themes captured parents’ (n = 8) descriptions of the phases of communication during their children's diagnoses including, (1) anguished questioning, (2) urgently seeking help, and (3) expecting a diagnosis. In addition, three themes characterized the communication style that parents needed, although not always received, in each of the periods of diagnosis including (1) compassionate curiosity, (2) acknowledgment and affirmation, and (3) engagement with parents. Discussion Results point to opportunities for pediatric providers to use a more empathic and engaging communication style during the diagnostic process with better identification of education and support needed by parents and families.

In the United States, teen dating violence (TDV) is a concern across ethnic groups. Attitudes and correlates of violence differ by gender, culture, and acculturation. This study used a qualitative interpretive approach. Data were obtained in focus groups with 23 Latino male adolescents. Themes reflected contexts of participants' lives, and definitions and nature of dating relationships and TDV. Participants described the importance of respecting dating partners, the destructive effects of TDV, and the pressure to display masculinity that can lead some young men to perpetrate TDV. These results may advance culturally relevant interventions to promote healthy relationships and prevent dating violence.

The purpose of the current article is to describe the use of photovoice with individuals from vulnerable population groups. Ten African American men and women ages 66 to 72 with heart failure from three different low income public housing facilities were recruited for participation in a qualitative photovoice project. Participants were given 5 weeks to take photographs of images that represented facilitators of and barriers to engaging in self-care behaviors. Each week, participants met as a group to discuss the photographs and their meanings to other participants. The photovoice method was empowering to participants, easy to use, and shown to be appropriate within African American older adults with heart failure. The photovoice method assisted in providing the opportunity for this vulnerable population to share their personal beliefs and perspectives. Use of this method assisted in identification of themes that represented facilitators of and barriers to engaging in self-care and was effective in meeting the specific aims of the research project. Findings from the current study support photovoice as a valuable method to use with vulnerable individuals with chronic conditions. [ Journal of Gerontological Nursing, 44 (7), 43–49.]

Introduction: Due to advances in disease management, mortality rates in children with sickle cell disease (SCD) have decreased. However, mortality rates for young adults (YA) increased, and understanding of social and psychological factors is critical. The aim of this study was to explore factors associated with health care transition experiences for YA with SCD. Method: This was a qualitative descriptive study. A 45-minute semistructured interview was conducted with 13 YA ( M = 21.5 years, SD = 1.73). Results: Results suggest that social and psychological factors and self-management experiences influence health care transition. Eight themes emerged: “need for accessible support”; “early assistance with goal setting”; “incongruence among expectations, experiences, and preparation”; “spiritual distress”; “stigma”; “need for collaboration”; “appreciation for caring providers”; and “feeling isolated.” Discussion: Consideration of cultural contexts will guide nurses in supporting health care transition. Designing culturally relevant interventions that address unique needs for YA living with SCD is warranted.

Excessive alcohol use is a significant health issue. Underage drinking is one expression of excessive alcohol use. Researchers have identified a trajectory of alcohol involvement. Gaps exist in understanding the influences that delay and promote the trajectory of alcohol use among young people. The purpose of this study was to explore the contexts and influences that limited and contributed to the trajectory of alcohol use among young people. A qualitative descriptive design was used. Eight youth workers from a city in Northern England participated in individual audio-recorded semistructured interviews. Transcriptions were coded. Data were analyzed within, and across, codes to identify themes. The theme "Alcohol is an Expected Part of Life" characterized a hypothetical trajectory of alcohol involvement. "Fostering Community in Youth Centers" characterized how participants' perceptions informed their work. The results increase understanding of how contexts may influence initiation, promotion, and prevention of alcohol use among young people.

Background Disclosure of prognosis-related information is an essential aspect of communication with pediatric patients with cancer and their families. The nurse is believed to play an important role in this process, but nurse perceptions and experiences have not been well-described. Purpose Provide an exploration of pediatric oncology nurses’ experiences with prognosis-related communication (PRC). Method Mixed-methods, multiphase design. This paper highlights the qualitative portion of the study. Findings Three themes were identified: Importance of collaboration, impact of PRC, and delivery of prognostic information. Discussion Collaboration is a critical element of PRC. Nurses are often not included in the disclosure process, which limits the ability of nurses to fully function in their roles, compromising patient, family, and nurse outcomes. A paradigm shift is required to empower nurses to be more active participants. More education of physicians and nurses is necessary to consistently engage nurses in PRC and prepare nurses for critical conversations.

This study purports to address paucity in the literature regarding how adolescents with sickle cell disease (SCD) describe and experience spirituality and religiosity (S/R). This was a qualitative descriptive study. Two semi-structured interviews were conducted with nine adolescents ( Mage = 16.2 years). Data were analyzed using a template analysis style and a concurrent analysis process of data reduction. Three major themes encompassed the participants’ descriptions of the relationships between S/R, health and illness in their lives including S/R as sources for coping, influence of S/R beliefs on health and illness, and sharing S/R with Health Care Providers (HCPs). S/R as coping mechanisms included six threads: interconnecting with God, interconnecting with others, interconnecting with creative arts, scriptural metanarratives, transcendent experiences, and acceptance and finding meaning. Expectations of health providers included two threads: Religiosity is private/personal and sharing spiritual and religious beliefs is risky. S/R are particularly salient for adolescents with SCD.

The purpose of this case study was to describe compassion fatigue using one nurse's experience as an example and to present the process of Personal Reflective Debrief as an intervention to prevent compassion fatigue in emergency department (ED) nurses. Debriefing after adverse outcomes using a structured model has been used in health care as a nonthreatening and relatively low-cost way to discuss unanticipated outcomes, identify opportunities for improvement, and heal as a group. There are many methods of debrief tailored to specific timing around events, specific populations of health care workers, and amount of time for debriefing. Debrief with personal and group reflection will help develop insights that nurses may need to understand their own emotions and experiences, as well as to develop knowledge that can be used in subsequent situations. Regular engagement in a proactive scheduled Personal Reflective Debrief has been identified as a method of promoting resiliency in an environment where the realities of emergency nursing make compassion fatigue an imminent concern. Nurses working in the ED normally experience some level of stress because of high acuity patients and high patient volume; yet, repeated exposure puts them at risk for developing compassion fatigue. The Personal Reflective Debrief is one way emergency nurses can alleviate some of this caring-related stress and thereby become more resilient. Increasing nurses' resilience to workplace stress can counter compassion fatigue. The key is to provide planned, proactive resources to positively improve resiliency.

This study examined the association of religiosity, sexual education and family structure with risky sexual behaviors among adolescents and young adults. The nationally representative sample, from the 2002 National Survey of Family Growth, included 3,168 women and men ages 15-21 years. Those who viewed religion as very important, had frequent church attendance, and held religious sexual attitudes were 27-54% less likely to have had sex and had significantly fewer sex partners than peers. Participants whose formal and parental sexual education included abstinence and those from two-parent families were 15% less likely to have had sex and had fewer partners.

The purpose of this study was to determine the main and interactive effects of religiosity, gender, and language preference acculturation on sexual activity among 570 Latino/a adolescents from the 2002 National Survey of Family Growth. Results indicated that adolescents who viewed religion as very important, had frequent church attendance, and had more traditional attitudes on sexuality were less likely ever to have sex compared with adolescents who were less religious. Those with frequent church attendance and high traditional attitudes had fewer lifetime and recent sex partners. Unassimilated religious youth were less likely ever to have sex, had fewer lifetime and recent sexual partners, and a later age of sexual debut. Females were less likely to have had sex, had fewer recent and lifetime partners, and had a later age of coital debut than males. Religiosity had a healthy dampening of sexual activity among Latino/a adolescents and, in particular, among those who were less assimilated.

Purpose: To describe sexual abstinence from the perspective of abstinent African American female adolescents. Design: Descriptive qualitative. Methods: Data were collected from 14 sexually abstinent, African American adolescent girls during two semi-structured interviews. Data were collected using the life history method and were analyzed in the style of narrative analysis. Findings: This analysis indicated four themes in descriptions of abstinence: limited information, categorization of sexual behaviors, activities that lead to intercourse, and abstinence as a self-determined choice. For most participants, “having sex” referred to heterosexual vaginal intercourse and being abstinent meant that one chose to refrain from intercourse. Conclusions: The participants' limited definition of abstinence might lead them to unknowingly put themselves at risk by engaging in other forms of genital sexual activities. They may think that they are protected because they believe that they are practicing abstinence.

This study describes a group of six African American grandmothers parenting their grandchildren secondary to cocaine abuse on the part of the parents. It explores the manner in which such parenting affected the grandmothers’ health. Data for this ethnography design were collected through participant observation, field notes, taped interviews, and supplementary data sources. The identification of cultural themes evolved from domain and taxonomic analyses. The themes—parenting a second time around, sacrifice, and God’s presence in daily life—expressed aspects of the grandmothers’ culture. The effects on health varied from none to exacerbation of chronic illnesses. The study results, and its picture of life from the grandmothers’ perspectives, suggest areas of nursing assessment and intervention that otherwise might be left unexplored.

Purpose: To test a theater intervention designed to raise awareness of the dynamics and consequences of teen dating violence (TDV) and to facilitate creation of nonviolent responses to TDV among Latino and Latina adolescents. The intervention was based on Theater of the Oppressed, which advocates the use of theater methods to explore social issues and to allow audiences to experiment with problem-solving, thereby promoting change. Methods: This study used a pretesteposttest, no control group, mixed-measures design to study 66 Mexican-American adolescents (mean age, 13.4 � 5 years). Two plays containing subtle and overt signs of control and abuse were written and performed. Scripts were based on data from prior studies of TDV among Latino and Latina adolescents. At baseline, we measured sociodemographics, personal safety, and ethnic identity. Preepost instruments measured acceptance of TDV, confidence to resolve conflicts nonviolently, and intentions to use nonviolent strategies to resolve conflict. We collected qualitative data via essay. Results: At posttest, participants had less acceptance of TDV (t ¼� 2.08; p < .05), increased confidence to resolve conflicts nonviolently (t ¼ 3.82; p < .001), and higher intentions to use nonviolent strategies (t ¼ 3.35; p ¼ .001). We analyzed 20 essays. Qualitative results provided context for understanding participants’ changes in attitude, confidence, and nonviolent behavioral intentions. Conclusions: This adaptation of Theater of the Oppressed was an effective way to interact with Latino adolescents. In a safe setting, participants vicariously experienced TDV, which facilitated self-reflection and cognitive rehearsal strategies to respond nonviolently to TDV.

The purpose was to explore the perspectives of teenage girls on how life contexts influenced sexuality and sexual abstinence. A qualitative descriptive study with a convenience sample of 14 sexually abstinent African American adolescent females who were interviewed to obtain their life histories. Narrative analysis was used to identify unique and common experiences and to develop themes. For these participants being abstinent was a way to demonstrate their emerging identities as adult women. They described themselves as faithful unique persons who defied negative stereotypes avoided risky situations wanted to be strong women like their mothers and grandmothers and were selective about their friends. The primary challenge to abstinence was their degree of vulnerability to sexual harassment romantic partner pressure and female peer pressure. Abstinence is a complex state of being that is influenced by a variety of contexts develops over time and is consciously chosen. Maintaining abstinence requires effort and a variety of skills. While these young women were cognitively familiar with reasons why they should refrain from sex nurses may still assist youth with being abstinent by providing ongoing teaching and specific dialogue on how to refrain from sex. (authors)

This article is a commentary on the life history approach, which specifically described aspects of and offered suggestions for conducting life history research with adolescents. The life history approach is well suited to a wide variety of types of health-related inquiry. In this article, the author used an exemplar study to show how well the life history approach was suited for questions regarding adolescent issues. This approach was also a good match for the developmental skills and needs of adolescents. The author uses the strengths and weaknesses of the approach and a detailed example of how she used the life history data to identify themes drawn from the exemplar study. She makes specific suggestions, including the development and implementation of an interview guide, planning and scheduling interviews, and the use of a lifehistory grid. She includes examples of each suggestion and a sample lifehistory grid.