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This article describes a pilot test of a community engaged, culturally relevant, arts-based intervention. The purpose was to increase children’s personal protective buffering resources. Protective buffering resources help children cope with stressful stimuli, reduce activation of their systemic stress response, mitigate allostatic load, and promote optimal health. The “Learning a Healthy Rhythm” intervention included a stress management component and an ongoing Afro-Latino percussion program for 18 children ages 9–11. The stress management component included educational content about stress, self-assessment of stress symptoms, and stress management techniques. A mixed-method intervention evaluation design was used. Qualitative data, quantitative data, and biometrics including hair cortisol were collected. Six intervention parameters were evaluated: effectiveness, fidelity, feasibility, acceptability, necessity, and safety. Positive results were obtained for all parameters. Reduction in physiological and subjective measures of stress was evident. This stress management intervention was well-received and supported by participants.

Background Colic is defined as periods of inconsolable crying, fussing, or irritability that have no apparent cause and present in healthy infants under 5 months of age. Although colic is a benign and self-limiting condition, it can be distressing to parents and there are few robust treatment interventions. This systematic review explored the evidence for administration of probiotics to prevent or decrease symptoms of colic. Methods Literature searches were conducted in PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, and Web of Science. Sample Twenty articles were included: 15 randomized controlled trials and 5 meta-analyses. Results Based on the evidence in this systematic review, the oral administration of probiotics to breastfed infants with colic resulted in at least a 50% reduction in crying time compared with placebo. Efficacy of probiotics to reduce colic symptoms in formula-fed infants needs further study. In this review, we did not find evidence to support or refute efficacy of probiotics to prevent infantile colic. Clinical Implication: Probiotics (especially the strain Lactobacillus reuteri DSM 17938) can safely be recommended if parents desire a treatment option for their infants with colic.

Adolescents do not have adequate safe traffic behaviors. This cross-sectional study investigated safe traffic behaviors of 414 male high school students of Hamadan, Iran, randomly selected using the multistage sampling method in 2020. This study used a researcher-made questionnaire based on the theory of planned behavior about safe traffic behaviors with Cronbach’s alpha coefficient of 0.95, content validity ratio of 0.70, and content validity index of 0.85. There was a strong positive correlation between safe traffic behaviors with perceived behavioral control and intention. Adolescents can be influenced to internalize behavioral safety precursors that can lead to a sustained increase in safe traffic behaviors and the prevention of road traffic injuries.

Road traffic injuries are public health challenges with heavy economic and social burdens. Road traffic injuries are common in developing countries and occur disproportionately with adolescents. This study aimed to elicit beliefs about traffic behaviors based on the theory of planned behavior among male high school students in Hamadan, Iran. We used a constructivist-interpretive qualitative design with directional content analysis. Interviews were conducted with 19 adolescent males in Hamadan, Iran. Analysis revealed that theory of planned behavior fit well to explain how perceptions, attitudes, and beliefs influenced traffic behaviors. Perceived subjective norms in the forms of parental encouragement, traffic rules and policies, and media advertising influenced the pursuit of safe traffic behaviors. Control belief factors that impeded safe behaviors included aggressive and/or drunk driving and bad road conditions, distance to bridge crossings, and improper seat belt position. Our results provided a deeper understanding of attitudes, experiences, and intentions that precede adolescents’ traffic behaviors. Understanding precursors to behaviors is necessary for effective intervention. Further exploration of factors that lead youth to engage in unsafe behaviors despite education, knowledge, and presence of influential people that promote safe traffic behaviors is needed.

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.

West Nile neuroinvasive disease (WNND) is a rare and severe manifestation of West Nile virus (WNV) infection that occurs in less than 1% of infected persons. It should be considered in patients who present with fever, neurological symptoms, and a history of recent outdoor activity where mosquitoes were active. This article highlights a case of a 55-year-old man whose history and symptoms of WNND were confounded with an alternate diagnosis, acute alcohol withdrawal. An overview of WNV infections, and important historical clues and objective findings characteristic of neuroinvasive disease, is discussed to increase readers' knowledge of WNV and awareness of when to consider WNND in the diagnostic differential.

In this paper, we discuss how we cultivated a sustainable community-academic partnership and describe how our community-based participatory research project, Bembé Drum and Dance, contributed to youth development. Bembé Drum and Dance is an Afro-Latino performing arts program based on the positive youth development theory. Thirteen children ages 9–13 participated in the ensemble. We used a multimethod descriptive design. Data were gathered using surveys, participant observation, and interviews. Increases in the Five Cs (competence, confidence, connection, character, and caring) were noted among youth, most notably in competence and confidence. Recognizing that the project belonged to the community and supporting this sense of ownership were imperative to the project’s success. Forging and sustaining a community-academic partnership was a challenging and rewarding way to directly exchange knowledge and expertise among youth, adult community members, and academic partners and to contribute to the flourishing of young people.

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.

Road traffic crashes are rapidly becoming one of the leading causes of injury and death globally. It is predicted that by 2030 crashes will become the fourth leading cause of disability-adjusted li...

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.]

Purpose To explore inpatient pediatric nurses' current experiences and perspectives on medication teaching. Design and Methods A descriptive qualitative study was conducted at a Midwest pediatric hospital. Using convenience sampling, 26 nurses participated in six focus groups. Data were analyzed in an iterative group coding process. Results Three themes emerged. 1) Medication teaching is an opportunity. 2) Medication teaching is challenging. Nurses experienced structural and process challenges to deliver medication teaching. Structural challenges included the physical hospital environment, electronic health record, and institutional discharge workflow while process challenges included knowledge, relationships and interactions with caregivers, and available resources. 3) Medication teaching is amenable to improvement. Conclusion Effective medication teaching with caregivers is critical to ensure safe, quality care for children after discharge. Nursing teaching practices have not changed, despite advances in technology and major changes in hospital care. Nurses face many challenges to conduct effective medication teaching. Improving current teaching practices is imperative in order to provide the best and safest care. Practice Implications This study generated knowledge regarding pediatric nurses' teaching practices, values and beliefs that influence teaching, barriers, and ideas for how to improve medication teaching. Results will guide the development of targeted interventions to promote successful medication teaching practices.

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.

Nurse practitioners at a primary care clinic established a weight loss program to address high obesity rates among their African American patients. Interviews and a retrospective chart review were used to evaluate the weight loss program. Number of appointments was the only significant predictor of weight loss, and there was a strong positive correlation between total number of appointments and weight loss. The overall view of the program was positive. This description and evaluation of the program may be useful to nurse practitioners seeking to develop an individualized effective weight loss intervention for African Americans within a primary care setting.

Purpose: Sickle cell disease (SCD) is a serious debilitating chronic illness, affecting approximately 90,000 Americans and millions globally. Spirituality and religiosity (S/R) may ease the burden faced by persons living with SCD. The purpose of this study was to examine the role of S/R in adolescents and adults living with SCD in the research literature. Method: The electronic databases Cumulative Index to Nursing and Allied Health Literature, Health Source Nursing/Academic, ProQuest Health Module, PsycINFO, Medline, PubMed, and the American Theological Library Association were searched from January 1995 to December 2014. Findings: Of the 89 studies retrieved, 11 articles between 2001 and 2013 met the inclusion criteria and were reviewed. Four themes emerged. The themes included (a) S/R as sources of coping, (b) S/R enhance pain management, (c) S/R influence health care utilization, and (d) S/R improve quality of life. Discussion: Use of S/R may be significant in coping with SCD, managing pain, affecting hospitalizations, and affecting quality of life. This review can direct researchers exploring S/R in adolescents and adults living with SCD.

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.

Objectives The purpose of this study was to understand the influences of heart failure (HF) self-care among low income, African Americans. Background Compared to all other racial groups, African Americans have the highest risk of developing HF, coupled with high mortality and morbidity rates. Methods Using the photovoice method, participants related important lifestyle factors through photography. The participants and researcher met for reflection and discussion 2 h per week for six weeks. Results Four themes emerged: family support gives me the push I need, social interaction lifts me up, improving my mind to lift depression can improve my heart, and it is important but challenging to follow the HF diet. Conclusion The findings from this study may assist policy makers, health care professionals, patients, and support systems in understanding the complexity of engaging in HF self-care. This understanding may lead to the development of appropriate patient-centered assessments and interventions.

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.

The purpose of this systematic review was to explore the association between timing of introduction of potentially allergenic foods to infants and development of food allergies. CINAHL, Medline, PubMed, Science Direct, and Web of Science were searched using the terms solid food, complementary food, or infant feeding combined with allergy or hypersensitivity for articles published in English in 2000 or later. Inclusion criteria were 1) primary research articles with 2) a focus on association between introduction of complementary foods including potentially allergenic foods into diets of infants less than 12 months of age and development of food allergies. Articles were excluded if they were 1) not primary research, 2) about complementary foods only (without specificity of allergenic foods), or 3) on allergic conditions other than food allergy (such as asthma or eczema). The initial literature search yielded 533 articles; 14 articles met inclusion criteria. Level of evidence of each study was determined with the SORT criteria. Results found that delayed introduction of solid foods in general and allergenic foods in particular was not associated with decreased risk for allergic diseases among high and low-risk infants. Later introduction was associated with increased risk for allergy development. For infants at low risk for development of food allergies, providers should advise caregivers to introduce potentially allergenic foods with other solid foods between 4 and 6 months of age when children show an interest in eating solids. Infants at high risk for peanut allergy, should be evaluated by an allergy specialist prior to introduction of peanuts and work with providers to create an individualized plan for introduction of peanuts and other allergenic foods as needed.

Purpose To explore parents’ experiences of the transition from hospital to home and complex chronic illness management following their children's solid organ transplant (SOT). Design and Methods Qualitative component of a larger mixed methods longitudinal study. Parents of SOT recipients were interviewed three times following hospital discharge from five major pediatric transplant hospitals in the United States. Results Analysis of parent interviews (N = 48) resulted in three themes that characterized the phases of transition to home and complex chronic illness care. Three themes, corresponding to the three time periods of data collection, included “getting back to normal” at 3 weeks, “becoming routine” at 3 months, and “facing a future” at 6 months. Challenges families experienced over the course of their transition are also described. Practice Implications The transition from hospital to home and complex chronic condition care is challenging and changes over time. Nurses are called upon to prepare parents to become knowledgeable and confident to care for the child after hospital discharge. Nurses can best support families in transition after SOT by anticipating and understanding their dynamic challenging complex care needs.

Purpose: This study fills a gap regarding the perspectives of Mexican American female adolescents on dating relationships and dating violence (DV). Methods: This was a qualitative descriptive study. Focus groups included 20 Mexican American young women, primarily first and second generation, mean age 14.5 years (SD= 2.5). Data were analyzed with categorical analysis. Findings: Participants described key components of DV and identified cultural aspects that may serve to promote healthy dating relationships. Conclusions: Family-based interventions to promote exploration of gender roles and parent-child communication may foster biculturalism as well as promote healthy dating relationships and prevent violence within this cultural group. Clinical Relevance: In the United States, 10% to 40% of teens experience DV. Hispanic females experience more physical DV than their White peers. Language: en

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.

Objective Test a novel intervention to help sexually experienced girls increase abstinence behaviors and attitudes. Design A quasi-experimental repeated measures design using qualitative and quantitative data. Setting Two alternative public schools. Participants Thirty-three females whose mean age was 16 and who were 79% African American participated. Most (79%) had experienced a pregnancy. Intervention A 6 session, weekly, interactive intervention was delivered. Data were collected at baseline, last session, and at 5 and 7 month follow-ups. Main Outcome Measures Measured outcomes related to abstinence included participants' reasons, behaviors, stages of change, and attitudes. Results The most common reason for abstinence was not wanting to have sex. At each postintervention data collection point, most participants (greater than or equal to 74%) reported that they had purposefully avoided sex. Duration of consecutive days of abstinence increased although only significantly at 5 month follow-up. Abstinence behaviors increased with the largest change from first to last session. Stage of change advanced from preparation to action by 7 month follow-up. Attitudes toward abstinence became more favorable. Conclusion Effective sexual risk reduction interventions are critically needed to promote safety. Nurses may assist young women to decrease their sexual risks by teaching them to practice periodic abstinence.

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.

African Americans have a higher risk of developing heart failure (HF) than persons from other ethnic groups. Once diagnosed, they have lower rates of HF self-care and poorer health outcomes. Promoting engagement in HF self-care is amenable to change and represents an important way to improve the health of African Americans with HF. This study used a community-based participatory action research methodology called photovoice to explore the practice of HF self-care among low-income, urban, community dwelling African Americans. Using the photovoice methodology, themes emerged regarding self-care management and self-care maintenance.

Introduction The Institute of Medicine prioritizes active family and clinician participation in treatment decisions, known as shared decision making (SDM). In this article we report the decision-making experiences for parents of children who had a solid organ transplant. Method We performed a prospective longitudinal mixed methods study at five major U.S. children's medical centers. Qualitative interview data were obtained at 3 weeks, 3 months, and 6 months after hospital discharge following the child's transplant. Results Forty-eight parents participated in the study. Three themes were identified: (a) Parents expect to participate in SDM; (b) parents seek information to support their participation in SDM; and (c) attributes of providers' professional practice facilitates SDM. SDM was facilitated when providers were knowledgeable, transparent, approachable, accessible, dependable, and supportive. Conclusions Parents expect to participate in SDM with their transplant team. Health care providers can intentionally use the six key attributes to engage parents in SDM. The results provide a framework to consider enhancing SDM in other chronic illness populations.

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.

This study fills a gap regarding the perspectives of Mexican American female adolescents on dating relationships and dating violence (DV).This was a qualitative descriptive study. Focus groups included 20 Mexican American young women, primarily first and second generation, mean age 14.5 years (SD= 2.5). Data were analyzed with categorical analysis.Participants described key components of DV and identified cultural aspects that may serve to promote healthy dating relationships.Family-based interventions to promote exploration of gender roles and parent-child communication may foster biculturalism as well as promote healthy dating relationships and prevent violence within this cultural group.In the United States, 10% to 40% of teens experience DV. Hispanic females experience more physical DV than their White peers.

PURPOSE. Adolescents receive less primary care than other age groups. One reason may be the negative ways that providers sometimes interact with adolescents. The purpose was to develop knowledge regarding adolescents' preferences for provider interactions. DESIGN AND METHODS. Design was descriptive and mixed method. Donabedian's healthcare quality model guided the study. Data were collected via focus groups and a survey. RESULTS. Twenty-four adolescents participated. Four themes described their preferences: forming a relationship, supporting independence, assuring confidentiality, and conveying caring. PRACTICE IMPLICATIONS. Care that is congruent with adolescents' preferences may improve quality of, and access to, care and, ultimately, health outcomes.

Obesity is a complex disease state that has challenged the health of Americans and has become a main concentration in health care. The highest rates of obesity are observed among black women. The purpose of this evidence-based review was to find evidence that specifically examined black women to determine if participation in weight loss interventions led to successful weight loss compared with usual care and control groups. Twelve experimental studies and 4 systematic reviews revealed that interventions contributed to successful weight loss among black women with obesity. However, maintenance of weight loss is an ongoing challenge.

Objective To determine community support and identify appropriate learning methodologies, parameters of delivery, and intervention content. Design Qualitative descriptive study in which participants were interviewed in a semistructured format. Data were analyzed thematically. Setting An urban pediatric primary care clinic from which youths and parents were recruited. Participants Ten youths, 10 parents, and 10 community members. Community members included professional and laypersons who had experience in working with early adolescents or in working with children of any age on sexuality issues. Overall, most participants were female (67%) and African American (67%). Results Descriptions of early adolescents' knowledge of sexuality, participants' support for sexuality education for early adolescents, recommendations for education content, and preferred methods for education delivery. Conclusion The participants supported comprehensive sexuality education for early adolescents. They believed that it would help youths to be abstinent, would provide some protection from sexual abuse, and would prepare them to practice safer sex in the future. JOGNN, 35, 369‐375; 2006. DOI: 10.1111/J.1552‐6909.2006.00048.x

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.

This was a study of 102 adolescent females, 12-20 years of age, presenting to a central city clinic for medical care. Participants completed an oral questionnaire that included demographics, and questions regarding scholastic history, sexual behavior, and substance use. Each subject completed the Accuracy Level Test (ALT), a reading test. The subject's reading test grade level was subtracted from her appropriate grade in school to give a reading delay level (RDL). The mean reading grade level for all subjects was 6.7 +/- 2.6 and the average reading delay was 4.5 +/- 2.5 grades. Poor school attenders had greater reading delays (5.8 +/- 3.4 grades behind vs. 4.3 +/- 2.2 for good attenders p0.04), and those who repeated grades were also significantly delayed (5.5 +/- 2.4 grades behind vs. 3.7 +/- 2.3, p0.0007). Previously pregnant students had a greater delay in reading level than their nonpregnant peers (5.2 +/- 2.3 vs. 3.9 +/- 2.5 respectively p0.01). Delayed reading levels appear to correlate with some risk behaviors. The ALT may serve as a tool to identify high-risk patients who need more intensive clinical intervention.