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Cardiac rehabilitation (CR) improves health outcomes and quality of life for patients with cardiovascular disease, yet only a quarter of eligible patients enroll. A myriad of CR models that use either an alternative location (ie, home-based) and/or an alternative exercise have been developed to overcome known attendance and physical limitation barriers; however, patient experiences with these models have not been systematically reviewed. Our aim is to review patient experiences with these models of CR.We conducted a systematic review and thematic analysis of qualitative studies published between 2009 and January of 2022 from CINAHL, PubMed, Web of Science, and PsycINFO.Twenty-five studies were included, representing the perspectives of 487 individuals who participated in an alternative model of CR. Exercises included walking, tai chi, yoga, aquatic exercise, exergaming, chair-based exercises, aerobics, physical activity trackers, and individualized exercise plans. Nineteen of 25 studies used home-based models and two used live video. Twelve studies included patients with heart failure. Patient perspectives comprised three central themes: exercise benefits, exercise facilitators, and participation barriers. Some thematic categories were reported variably by particular model/study design (eg, home-based) than by others. All alternative models of CR were found to be physically, psychologically, and/or socially beneficial to patients. Participants described facilitators and barriers that were influential in the decision to initiate or continue exercise. These patient insights are critical for innovative delivery of CR that is appealing, accommodates physical limitations, and broadens access to improve health equity.

A qualitative descriptive approach examined perspectives of African Americans (AA) on their participation in health research despite historical research mistreatment. Nineteen AAs participated in semistructured interviews that provided data that were analyzed using thematic analysis. Salient themes included race concordance, being respected and valued by the researcher, research participation motivators, and cultural experiences of racism in health care. This study challenges dominant ideology that AAs are unwilling to participate in research and offers solutions to promote research inclusive of their perceptions. Therefore, researchers need to design research with inclusiveness and transparency that openly displays how research will impact future generations.

Purpose Youth in foster care are at greater risk for engaging in sexual behaviors that increase their odds of experiencing negative sexual and reproductive health (SRH) outcomes. The purpose of this qualitative study was to describe challenges faced by female African American adolescents in foster care as they tried to protect themselves from SRH risks and protective beliefs and behaviors to avoid these risks. Design and methods Semi-structured interviews were conducted with 16 female African American adolescents, ages 18–20 years, with a history of foster care placement during adolescence. Purposive sampling was done to recruit participants from a metropolitan area in Virginia. Transcribed interviews underwent inductive thematic analysis. This paper focuses on the theme of protection from SRH risks and its subthemes of challenges that made it difficult to avoid sexual risks and protective beliefs and behaviors that facilitated avoidance of those risks. Results Participants reported yearning for connection, partners' desire to not use condoms, and judgmental caregivers as challenges. Protective beliefs and behaviors included open communication with their caregivers about SRH, abstinence, contraceptive use, and participants' desire to be healthy. Conclusions Study findings shed light on protective beliefs and behaviors female youth in foster care used to safeguard themselves from negative SRH outcomes. Youth at times lacked agency in sexual decision-making and contraceptive use. Practice implications Findings highlight the importance of sexual relationships and partner communication related to contraceptive use, and offering trauma-informed interventions, including culturally sensitive counseling regarding long acting reversible contraception.

Introduction: Adolescents and young women become increasingly aware of their bodies through images presented to them through social structures during their developmental stage. These images may drive them toward unhealthy behaviors including overeating, starving, and skin bleaching. This paper is part of a study that examined the Older Adolescent Banyankole Girl’s Response to the socio-cultural constructions of body image in The Ankole Region, Uganda. It aimed to understand the self-perceptions of adolescent girls of their body image within Ankole society. Methods: The study collected narrative interviews of 30 adolescent and young adult females (16–24) recruited from various institutions of learning as well as the Ankole community of southwestern Uganda. Results: Adolescent girls’ perceptions of beauty were influenced by pull and push factors that included beauty expectations, beauty comparisons, relationships, and dietary habits that keep them oscillating between traditional and contemporary beauty ideals. Findings suggest that young women could benefit from social shifting of focus from physical appearance to other valuable developmental assets. Conclusion: Government-sponsored programs that provide education and positive media messages may be beneficial to building the self-esteem of young women.

Nursing education programs faced multiple challenges to increase the size, diversity, and skill set of the nursing workforce while contending with shortage of clinical placement sites and retiring faculty. A program that is unable to be resilient in the face of crisis will fail in its mission to graduate resilient nurses. The purpose of this paper is to describe how nursing programs can respond to the challenge of creating a resilient program poised to graduate a diverse, inclusive, and resilient workforce. Utilizing resilience-oriented strategies to impact educational services solidified program relevancy, promoted student belonging, and enhanced student recruitment/retention. While programs have become accustomed to doing more with fewer resources, many of these programs may not survive these unprecedented times without incorporating a holistic approach for organizational well-being that promotes resilience through inclusivity.

Most traditional land tenure practices among developing economies are opposed to protecting and promoting women's land ownership rights. In Uganda, land tenure practices are largely customary and patriarchal in nature, in most communities women's land tenure security is dependent on marriage. This paper builds a body of evidence on how gender biased land tenure negatively affects maternal healthcare decision-making for family planning, antenatal care services and skilled care during childbirth. A cross-sectional mixed methodology was used to collect household survey data. Qualitative data from individual and focus group interviews were analysed using thematic content analysis. Land was found to be an important household factor that shapes women's maternal healthcare decision-making, not only through land ownership, but also through land's role as a source of identity, gendered land use decision-making patterns, and the allocation of resources that accrue from work on land. Most of the land-owning households are headed by men. More women than men expressed insecurity of tenure, despite the household's land ownership status. Land use decision-making, including its sale was significantly associated with maternal healthcare decision- making. Feeling secure on land was significantly associated with maternal healthcare decisions for planned pregnancy and use of antenatal care. Land purchasing was found to significantly determine place and skill level of providers for childbirth. In conclusion, women involvement in land purchasing decisions demonstrates more control and agency in the number of children. Women's land insecurity undermines their prospects for positive maternal health behaviours.

During adolescence, the youth increasingly rely on peers for intimacy and support. Since traditional Korean values emphasize the centrality of the family, this shift in emotional attachment may be especially challenging for Korean American youth. However, it is not known whether adolescents who lack a supportive close friendship may be at greater risk for mental health problems. The aims of this study were to determine whether the quality of the adolescents’ closest friendship is associated with the mental health of Korean American adolescents, and whether specific personality traits of the youth may moderate any association between the quality of their friendships and their mental health problems. This cross-sectional study included 138 Korean American adolescents from community settings in California. A demographic questionnaire, the Relationship Quality Questionnaire, the NEO Five-Factor Inventory-3, and the Youth Self Report were completed by adolescents. Hierarchical regression analyses were used to examine the aims. Quality of the closest friendship was not a significant predictor of mental health problems for youth in general. However, the personality trait of agreeableness did predict better mental health. Agreeableness also showed a moderating effect, indicating that for youth who had less agreeable, more antagonistic personalities, a high quality relationship with their best friend was associated with fewer mental health problems. Longer residence in the U.S. was also related to better mental health. Findings suggest the need for early identification of youth who have poor relationships with close friends or a more antagonistic personality. It may be especially important to provide supportive mental health interventions for Korean American adolescents with these combined risks.

Existing literature suggests that acculturation and integration processes for immigrant youth from East Africa are complicated by family values, interaction styles, and social roles that are in conflict with those of the US host culture. The purpose of this study was to explore first-generation female Ugandan immigrant youth perceptions, beliefs and attitudes toward self-development and identify factors among their social contexts that impact their development and adjustment. This study utilized dimensional analysis, an approach to the generation of grounded theory. Data collection included over 100 h of community participatory observation and 28 interviews in total. Participants included 20 English speaking Ugandan females aged 16–25 years who immigrated to the US after age of eight. Participants’ adaptations and adjustments led to an altered developmental path, including their beliefs about gender, ethnic and racial identities, and how they balanced and integrated US culture into their existing understandings and cultural awareness. Conditions that impacted the identity development process include timing of their immigration, the contexts of reception, media, the Ugandan Community, the school social setting, the perceived value of Ugandan cultural maintenance vs. the value of adopting certain American traits, and experiences of prejudice and discrimination vs. new future opportunities. The findings represent an in-depth consideration of the cultural, linguistic, religious, racial, and social attributes of the female Ugandan immigrant youth population and can therefore be seen as an important step in the direction of developing an understanding of the developmental assets and risk/protective factors that characterize this young immigrant population.

Korean American adolescents are a population that may be particularly vulnerable to mental health problems because of the potential cultural conflicts they face during an important developmental period. Yet little is known about the prevalence of their mental health problems. The aims of this study were to determine the prevalence of various mental health problems in a sample of Korean American adolescents, and to identify whether gender or age of the youth are associated with the types or severity of their mental health problems. This cross-sectional study included 138 Korean American adolescents from community settings in California. A demographic questionnaire and the Youth Self Report (YSR) were completed by adolescents. Descriptive analyses and t-tests were used to examine the aims. Percent of the sample falling into “normal”, “borderline”, and “clinical” ranges for different mental health problems was also determined based on normative scores provided in the YSR manual. Results indicate that 18% of the Korean American adolescents experienced clinically significant mental health problems. Most problems were of the internalizing type such as anxiety and depression where almost 23% of the youth reached the cutoff for clinical significance. The youth also experienced high levels of social problems, thought problems, and attention problems. However, scores for somatic complaints, rule-breaking behavior, and aggressive behavior as well as the composite score for externalizing problems were in the “normal” range. Girls reported higher levels of anxiety/depression and somatic complaints than boys, contributing to their higher internalizing score as well. Boys and older adolescents reported higher levels of rule-breaking behavior. A substantial percent of Korean American adolescents in this sample reported symptoms of anxiety and depression, especially girls. Findings suggest the need to screen for these problems in pediatric care and for development of prevention and referral programs in Korean American communities.

Adaptation to a new culture can be highly stressful, especially during challenging developmental stages such as adolescence. The ways in which adolescents adapt to a culture and their resulting well-being may be influenced substantially by their personality traits as well as the degree to which they are aligned with the values of the new culture. Korean Americans are one of the fastest growing immigrant groups in the US, including a burgeoning population of Korean youth. The purpose of this study was to determine whether specific personality traits of Korean American adolescents or their degree of acculturation would be associated with their mental health problems, and whether specific personality traits would moderate the association between acculturation and mental health problems. 138 Korean American adolescents completed a demographic questionnaire, the revised Stephenson Multigroup Acculturation Scale, the NEO Five-Factor Inventory-3, and Achenbach & Rescorla’s Youth Self Report. Hierarchical regression analyses indicated that acculturation played a minimal role in predicting mental health problems, while personality traits were strong predictors. Being more reactive to stress and less emotionally stable (greater “neuroticism”) and being less altruistic and cooperative (less “agreeableness”) predicted more mental health problems for Korean American adolescents. In addition, the trait of “openness to experience” played a moderating role. For youth who were more open to experience (curious and independent in their judgments), greater alignment with values of the American culture was a protective factor for their mental health. Findings indicate the need for further research to identify types of mental health problems that may be most affected by specific personality traits and the underlying mechanisms responsible for their effects. It will also be important to examine whether personality traits identified in this research influence mental health similarly across cultures and age groups or whether they are unique to Korean American youth.

Female African American adolescents experience high rates of sexually transmitted infections and unintended pregnancies. However, little is known about the sexual and reproductive health (SRH) needs of youth in foster care. This study explored the experiences of female African American/Black youth in foster care related to their SRH disparities and needs. The purposive sample was 16 female adolescents, ages 18–20 years old, with a history of foster care placement. Participants were recruited from a metropolitan area in Virginia. This study used a qualitative descriptive design with semi-structured in-depth interviews lasting an average of 1 h. The transcribed interviews underwent inductive thematic analysis, and four prominent themes emerged: caregiver barriers, facilitators, sources of information, and recommendations for caregivers. Results indicated that youth felt unsupported, relied on their strengths to seek information related to SRH, and provided their advice on communication about SRH with youth. The findings from this study will provide direction on how caregivers, health-care workers, social services staff, and community members can better support the SRH needs of young women in foster care.

There is increasing evidence that women are receiving a traumatic brain injury (TBI) during episodes of intimate partner violence (IPV), but little qualitative research exists around how surviving this experience impacts the lives of women. Primary and secondary data ( N = 19) were used with a constructivist grounded theory approach to explore the lives of women aged 18 to 44 years, who were living with a TBI from IPV. Women described multiple aspects of living in fear that shaped their daily lives and ability to seek help and access resources. The central process of prioritizing safety emerged, with salient dimensions of maintaining a present orientation, exhibiting hyperprotection of children, invoking isolation as protection, and calculating risk of death. These findings add to the growing body of knowledge that women living with IPV are at high risk for receiving a TBI and are therefore a subgroup in need of more prevention and treatment resources.

Background Sex before marriage among Muslim adolescents is becoming a serious issue in Muslim societies exemplified by an increasing incidence of teenage pregnancy. Sexual abstinence is an optimal goal for adolescent health from an Islamic perspective. Muslim adolescent girls’ perceptions have not been investigated, therefore, we lack understanding of their strengths and the risks that may contribute to outcomes such as pregnancy or sexually transmitted infections. Objective The purpose of this investigation was to characterize Muslim adolescent girls’ perceptions of sexual abstinence. Methodology This participatory action study was conducted at an Islamic school in southern Thailand. Twenty-five girls, ages 12–14 years old, were purposively selected to participate in the study. Content analysis was used for data analysis. Results Two salient themes were discovered that characterize Muslim adolescent girls’ perceptions about sexual abstinence: sexual abstinence is a means of self-protection and sex outside marriage is restricted by Islam, but it seems to be difficult to adhere to. Conclusions Religious values, family and peers play a central role in shaping thoughts and decisions about abstaining from sex. The integration of religious principles with building practical refusal skills, is needed to promote Muslim adolescent health.

Aim The aim of this study was to understand the social context of the lives of women who experienced a head injury from intimate partner violence. Background Sixty percent to 92% of survivors of intimate partner violence receive head trauma during the abuse. Little research exists regarding the episodes of abuse when women receive a head injury, or the reasons women might not seek medical care for the head injury or the abuse. Method Twenty-one interviews from nine women who self-reported passing out from being hit in the head were analyzed using thematic analysis. Findings Themes of extreme control and manipulation from abusers emerged, and women described living with instability from cycles of incarceration, drug and alcohol use, and fear of losing their children. Women did not receive medical care for head injury because the abusers often used forced sex immediately after the head injury to instill fear and authority. Implications for forensic nursing Hitting women in the head is not only about physical abuse, but also about exerting dominance and creating an environment of extreme control. Forensic nurses are uniquely positioned to screen for head injuries during initial assessments and follow-up visits and connect women with appropriate resources.

IntroductionIn many developing countries, children with CHD are now receiving surgical repair or palliation for their complex medical condition. Consequently, parents require more in-depth discharge education programmes to enable them to recognise complications and manage their children’s care after hospital discharge. This investigation evaluated the effectiveness of a structured nurse-led parent discharge teaching programme on nurse, parent, and child outcomes in India.Materials and methodsA quasi-experimental investigation compared nurse and parent home care knowledge before and at two time points after the parent education discharge instruction program’s implementation. Child surgical-site infections and hospital costs were compared for 6 months before and after the discharge programme’s implementation.ResultsBoth nurses (n=63) and parents (n=68) participated in this study. Records of 195 children who had undergone cardiac surgery were reviewed. Nurses had a high-level baseline home care knowledge that increased immediately after the discharge programme’s implementation (T1=24.4±2.89; T2=27.4±1.55; p0.05) after the programme’s implementation.ConclusionNurse, parent, and child outcomes were improved after implementation of the structured nurse-led parent discharge programme for parents in India. Structured nurse-led parent discharge programmes may help prepare parents to provide better home care for their children after cardiac surgery. Further investigation of causality and influencing factors is warranted.

Cancer in adolescence presents unique challenges to patients and families due to the dramatic physical and psychological vulnerabilities that occur during a time of identity development. Additionally, adolescents who experience progression of their cancer, or failure of first-line therapies, represent an understudied group within pediatric oncology. Illness blogs offer a unique opportunity to understand the experience of a chronic or serious illness through a naturalistic and longitudinal perspective that is inherently patient centered. The purpose of this exploratory qualitative study was to describe the experiences of adolescents with cancer who experienced disease progression through analysis of their online illness blogs. Seven illness blogs written by adolescents with cancer diagnosed between the ages of 13 and 18 years were analyzed using thematic analysis. Several key themes were described among the adolescents, including normalizing the news, facing treatment failure, and reconciling chronos—the finite concept of time. These findings provide vital descriptive evidence for the experience of disease progression as described by adolescents, as well as identifying key points of further study and intervention development for nurse researchers and nurses who care for this vulnerable patient population.

IntroductionParents of children with CHD require home care knowledge in order to ensure their child’s health and safety, but there has been no research on how to achieve this in a resource-constrained environment. The aim of this investigation was to compare parent and nurse perceptions of parent readiness for discharge after a structured nurse-led parent discharge teaching programme in India.Materials and methodsA pre-post design was used to compare parent and nurse perceptions of parental uncertainty and readiness for hospital discharge before and after introduction of the parent education discharge instruction programme in a paediatric cardiac surgery unit.ResultsParents (n=68) and nurses (n=63) participated in this study. After the discharge programme implementation, parents had less uncertainty (M=93.3 SD=10.7 versus M=83.6 SD=4.9, p=0.001) and ambiguity (M=40.8 SD=6.8 versus M=33.4 SD=3.7, p=0.001) about their child’s illness; however, they rated themselves as being less able to cope with the transition to home (M=24.3 SD=4.1 versus 23.1 SD=2.2, p=0.001) and as having less support at home than that required (M=31.5 SD=9.9 versus 30.9 SD=3.2, p=0.001). Parents’ and nurses’ perception of parental readiness for hospital discharge were more closely aligned after implementation of a nurse-led discharge programme (r=0.81, p=0.001).ConclusionThe results of this study suggest that the discharge programme had positive and negative effects on parental perceptions of uncertainty and readiness for discharge. Further examination is warranted to delineate these influences and to design methods for supporting parents during the transition to home care.

Nurses routinely provide care to patients in ethically challenging situations. To explore the continuum between conscientious objectors and designated staff in the provision of care to women seeking abortions, the aim of this study was to thickly describe decision-making, using abortion as the clinical context to elucidate how nurses approach ethically challenging work. A purposive sample of 25 nurses who worked in abortion clinics, emergency departments, intensive care units, labor, and delivery, operating rooms, and post anesthesia care units were interviewed. Qualitative description and thematic analysis were used to identify the cognitive, emotional, and behavioral processes in nurses' decisions to care for women needing abortions. Nurses developed and used multifaceted, real-time calculi when making decisions about their participation in emergent or routine abortion care. Nurses tacked back and forth between the personal and professional and/or held multiple contradictory positions simultaneously. Nurses weighed the role and opinion of others to determine if they know how to or know why they would provide abortion care to women, particularly in the elective abortion context. The parameters of the nurse-patient relationship were complex and specific to the experiences of both the nurse and patient. Findings from this study further develop the science of ethically challenging decision-making and expand our understanding of factors that influence how nurses develop relationships to ethically challenging work.

BACKGROUND: Despite the high rate of work-related injuries among hospital nurses, there is limited understanding of factors that serve to motivate or hinder nurses return to work following injury. OBJECTIVES: Perspectives of nurses with work related injuries, as they relate to obstacles and motivations to return to work, consequences of injury, and influences of work climate were documented. METHODS: This was a sub-study of nurses taken from a larger investigation of hospital workers. A purposive sample of 16 nurses was interviewed. Analysis was carried out using grounded theory as the research method. RESULTS: Nurses' responses fell into four concepts: organizational influences, personal conditions, costs and losses, and employee health as influenced by workers' compensation systems. Conceptualization of these concepts resulted in key categories: injury as an expected consequence of hospital work; nursing alone versus nursing together; the impact of injury on professional, family, and social roles; and nurses' understanding of and involvement with the workers' compensation system. DISCUSSION: The findings provide new perspective into features that support or hinder nurses' with injuries return to work and corroborate existing occupational health research. Consideration of these findings by hospital and employee health managers may help promote more effective return to work programs within the hospital setting. Language: en

Maltreated youth have a high prevalence of acute and chronic mental and physical health problems, but it is not clear whether these problems are related to maltreatment or to a disadvantaged environment. To compare health status and health care use of maltreated youth who had an open case with child protective services to comparison youth living in the same community, we conducted a secondary analysis of caregiver reports for 207 maltreated adolescents (mean age 11.9 years) and 142 comparison adolescents (mean age 12.3 years) living in urban Los Angeles, using questionnaire data from a larger longitudinal study framed in a socio-ecological model. Caregivers included biological parents, relatives, and unrelated caregivers. Analyses included t-test, MANOVA, chi-square, and multivariable logistic regression. Caregivers reported similar rates of physical health problems but more mental health problems and psychotropic medicine use in maltreated youth than in the comparison youth, suggesting that maltreated youths' higher rates of mental health problems could not be attributed to the disadvantaged environment. Although there were no differences in health insurance coverage, maltreated youth received preventive medical care more often than comparison youth. For all youth, having Medicaid improved their odds of receiving preventive health and dental care. Attention to mental health issues in maltreated adolescents remains important. Acceptance of Medicaid by neighborhood-based and/or school-based services in low-income communities may reduce barriers to preventive care.

Background: In developing countries, more children with complex cardiac defects now receive treatment for their condition. For successful long-term outcomes, children also need skilled care at home after discharge. The Parent Education Discharge Instruction (PEDI) program was developed to educate nurses on the importance of discharge teaching and to provide them with a structured process for conducting parent teaching for home care of children after cardiac surgery. The aim of this pilot study was to generate preliminary data on the feasibility and acceptability of the nurse-led structured discharge program on an Indian pediatric cardiac surgery unit. Methods: A pre-/post-design was used. Questionnaires were used to evaluate role acceptability, nurse and parent knowledge of discharge content, and utility of training materials with 40 nurses and 20 parents. Retrospective audits of 50 patient medical records (25 pre and 25 post) were performed to evaluate discharge teaching documentation. Results: Nurses’ discharge knowledge increased from a mean of 81% to 96% ( P = .001) after participation in the training. Nurses and parents reported high levels of satisfaction with the education materials (3.75-4 on a 4.00-point scale). Evidence of discharge teaching documentation in patient medical records improved from 48% (12 of 25 medical records) to 96% (24 of 25 medical records) six months after the implementation of the PEDI program. Conclusion: The structured nurse-led parent discharge teaching program demonstrated feasibility, acceptability, utility, and sustainability in the cardiac unit. Future studies are needed to examine nurse, parent, child, and organizational outcomes related to this expanded nursing role in resource-constrained environments.

Population health needs in developing countries are great and countries are scaling up health professional education to meet these needs. Marginalized populations, in particular, are vulnerable to poor health and health care. This paper presents a culturally appropriate diversity training program delivered to Global Health Fellows who are educators and leaders in health professions in Malawi and Zambia. The purpose of this interprofessional education experience was to promote culturally competent and humble care for marginalized populations.

The purpose of this paper is to describe health profiles of adolescents in foster care. The Child Health and Illness Profile-Adolescent Edition clustered adolescents in foster care into 13 mutually exclusive health profiles using dimensions of satisfaction with health, risks, resilience, and discomfort. Health profiles were further characterized into four health status rankings from best to worst health status. Many reported best health status (39%); nearly equal numbers (30.6%) had profiles indicating poor or worst health status, particularly girls and those with high risk behaviors, aggression, sexual abuse, or suicidality. It is valuable to identify health characteristics of the most vulnerable subgroups of foster youth to tailor specific interventions.

Problem Adolescents in out-of-home placement have a high prevalence of mental health distress, and their vulnerability to poor mental health outcomes continues during placement. Risk and protective factors may influence mental health outcomes; however, little is known about their relationship to mental health distress in this population. Methods Using data from a population-based survey conducted in schools, mental health distress, along with other risk and protective factors, was evaluated in young people who reported living in out-of-home placements (n = 5,516) and a comparison group (n = 5,500). Multivariate analysis was used to determine the strength of association between risk and protective factors and mental health distress in the youth reporting out-of-home placement. Findings Comparisons of risk and protective factors indicated that out-of-home youth had greater risks (suicidal risk, mental health distress) and fewer protective factors (feeling parents care about them, other adults care, and school connectedness) than those in the comparison group. Multivariate analyses showed significant associations (38% explained variance) between mental health distress and the risk and protective factors, with the exception of other adult connectedness. Conclusions Findings from this population-based school survey of young people reiterate that youth in out-of-home placements have higher levels of mental health distress and lower levels of protective factors compared to other youth. These results offer insights for those working with out-of-home or precariously housed young people.

There are increasing numbers of mothers as well as fathers who engage in long-term migration to support their children and other family members in their home countries. In this article, the current state of the literature about children and adolescents left at home in these transnational families is surveyed and reviewed. The article reviews the effects on children of the process of separation from parents, the impact of gifts and remittances home, communication with distant parents and the quality of life with their substitute caregivers. The effects of immigration in late childhood or adolescence on these separated children are examined, as well as what is known about the processes of adaptation and family reunification, including migration traumas, impact of gender, and educational outcomes. Suggestions are given for pediatric clinicians working with reunifying families. Gaps in the literature are highlighted and the need for research into factors that promote successful family re-engagement and overall adaptation upon reunification. © 2013 Mosby, Inc.

Spirituality is important to holistic health, yet little is known about its impact on young people with HIV. To address this knowledge deficit, a grounded theory study used semi-structured interviews of 20 Christian-identified adolescent and emerging adult gay males and one perinatally infected male. This study revealed that, to cope with HIV health issues, participants used a process of reconnecting with their spirituality. In order to successfully reconnect with their spirituality, study participants reported a need to re-embrace and re-engage in spiritual practices, hold onto hope, believe they are normal, and commit to beliefs and practices despite rejection from the church.

Using a constructivist grounded theory approach, we explored the development of father identity among boys involved in the juvenile justice system. Youth were recruited from a juvenile detention center and school district in a northern California county with a high teen birth rate. The participants were expecting a child or parenting an infant and had been arrested, incarcerated, or had committed a crime. We collected data through observations and individual interviews. Using constant comparative and dimensional analysis, we found that expectant adolescent fathers hoped for a boy and envisioned their central role as father to be making their son a man. This article contributes to greater understanding of father identity development for youth involved in the justice system. We suggest that teen parenting policies and programs include interventions sensitized by gender, accounting for the influence masculine ideals of manhood have on the development of father identity and the father–child relationship.

TOPIC: Little is known about teen fathers though they are found to be disproportionately represented among incarcerated youth. SOURCE USED: This article is developed from a qualitative pilot study of adolescent fathers in the justice system. PURPOSE: The authors theorize about teen fathers and the process by which they accept, reject, or are “barriered” from a father identity and role. CONCLUSIONS: Adolescence as a developmental period during which an identity is forming is viewed in concert with the concept of hegemonic masculinity and the concept of intersectionality. Risk factors in childhood and adolescence complete the conceptual model through which incarcerated adolescent fathers can be examined.

The need for kidney transplantation among Asian Americans is increasing owing to hypertension, diabetes mellitus, and the shortage of available organs. This need is likely to increase as the relatively young Asian population ages. However, knowledge about organ donation and transplantation in this population has been little investigated. The objectives of this study was to develop an Organ Donation and Transplantation Knowledge Survey for use in Asian Americans and to examine its psychometric properties. Internal consistency (Cronbach alpha) and factor analyses were used to determine the reliability and validity of the survey in 121 Asian American adolescents residing on the Big Island of Hawaii. Our results indicate that the survey had adequate reliability and was psychometrically valid for evaluating knowledge about organ donation and transplantation. More studies are needed to validate the usefulness and psychometric properties of the Organ Donation and Transplantation Knowledge Survey in other groups.

Problem Adolescent health problems are predominantly caused by risk behavior. Foster adolescents have disproportionately poor health; therefore identification of risk behavior is critical.

SUMMARY Research indicates that lesbians who frequent bars are more likely to drink and that lesbians drink more than their heterosexual counterparts. We explored in detail the consequences of lesbians' bar attendance. We conducted 35 in-person, semi-structured interviews and analyzed the data using qualitative methods. The findings are organized into the following categories: safety and support over the life course; lesbian identity development; reduction of stress; and social networks and intimate relationships. In each category, participants' stories are presented to highlight the health tradeoffs associated with bar patronage, the psychosocial importance of the bar, and the relationship between minority stress and alcohol use. Public health implications are discussed.

Acquiring HIV in adolescence and young adulthood, when development of self-identity, personal values, and life purpose are central, is challenging. The purpose of our study was to explore the spiritual needs of young people with HIV, learning strategies they used to cope with the disease. A constructivist grounded theory study was conducted. A purposive sample of 21 Christian-identified HIV-infected males was interviewed. The iterative coding phases of grounded theory, including open, axial, selective, and theoretical, were used to analyze data, and a theory of claiming normalcy with HIV was generated. We present the salient theme "I am normal," describing young people's attempts to function the same as peers despite requiring daily treatment. Conditions associated with feelings of normalcy included disclosure status, stigma experiences, support, and health status. Participants sought meaning in the disease, ongoing social engagement, and self-belief. Reinforcing feelings of normalcy may help young people cope with HIV.

When parents apply religious or cultural beliefs concerning spiritual healing, faith healing, or preference for prayer over traditional health care for children, concerns develop. Medical care is considered one of the most basic of all human needs, and yet parents may elect to apply religious or cultural beliefs in place of traditional Western medical care for their children. Because memberships in religious groups that have beliefs concerning prayer and health care for children are increasing, the topic is of great importance for pediatric health professionals. This article describes parental refusal of medical care, and it discusses the legal, ethical, and clinical implications.

PROBLEM Caretaker knowledge and understanding of adolescent development and its application to clinical practice with severely emotionally disturbed adolescents in residential treatment. METHODS Twenty child-care workers and registered nurses participated in semistructured interviews analyzed using dimensional analysis, a grounded theory method. FINDINGS Three distinct categories of caregivers were identified based on level of expertise and engagement in developmentally appropriate treatment practices: inexperienced, party-liners, and transcenders. Developmental issues identified included lack of resident preparation for puberty and staff discomfort with adolescent sexuality. CONCLUSIONS Caregiver, institutional, and social barriers to developmentally sensitive practice were identified. Practice recommendations include direct preparation of children and adolescents in residential treatment for pubertal changes and sexual development, and carefkl discernment of age-appropriate and psycho-pathological adolescent behaviors.

PURPOSE: To understand and document children's stated experiences and beliefs about television and to elicit their suggestions for alternative activities. DESIGN AND METHODS: Eleven focus groups were conducted with 51 Anglo and Latino children, ages 7-10, in a large Northern California city. Philosophical underpinnings of developmental psychology were the basis for multiphase thematic analysis. Data were collected in 1998-1999. RESULTS: Themes were identified in five conceptual categories. Findings showed that children did not perceive many parental rules related to TV watching, rather daily routines are associated with TV viewing. Children revealed both covert and overt motivations for watching. Nearly all participants spoke of the deception of advertising, but they were unclear about the role of commercial sponsors in payment for TV shows. Children perceived both negative physical and behavioral health effects of TV and they had great difficulty imagining life without a TV. CONCLUSIONS: Children perceived television as providing educational and relational needs. Although they preferred alternatives to TV, they had difficulty articulating and getting those needs met. Clinicians and researchers can utilize these findings to design health interventions that attenuate the health-impairing effects of habitual sedentary activity in childhood. Language: en

Because little is known about adolescent pain, in particular pain after blunt traumatic injury, a descriptive exploratory approach was used to examine the pain experience of adolescents after acute blunt traumatic injury in three contexts: at the scene of the accident, in the emergency department, and in the hospital setting. For the 13 adolescents (11-17 years) who experienced multiple sites of blunt unintentional injury, the majority recalled their worst pain at the scene and in the emergency department, with high, intense pain persisting into the hospital setting. Regardless of the context, adolescents recalled multiple aspects of their pain experience. Study findings have implications for the understanding and management of adolescent pain resulting from blunt traumatic injury.

OBJECTIVE: The purpose of the study was to examine caregiver understanding of the impact of child sexual abuse and the management of abused children in residential treatment. METHODS: A purposive sample of 20 registered nurses and child care workers were interviewed about their experiences working in residential treatment and their knowledge about child development and child sexual abuse and its application to practice. Data from interviews and field notes were analysed using dimensional analysis. FINDINGS: Caregivers had limited knowledge of the sequelae of child sexual abuse. Developmentally appropriate behaviour of sexually abused children, as well as behavioural manifestations of child sexual abuse, were often misinterpreted and mismanaged. CONCLUSION: Residential care of sexually abused children should be based on sound developmental principles and caregiver sensitivity. Language: en

• Background Despite increasing survival for adults with congenital heart disease, little is known about hospitalization for young adult patients with this disease and for their families. Because of the complexity of the disease and its management during the life span, young adults are often hospitalized on both pediatric and adult units during a stay in the hospital. • Objectives To explore the experience of hospitalization of young adults with congenital heart disease, the experience of their families, and the views of the nurses who cared for these patients and to generate substantive theory on interactions between patients, patients’ families, and nurses. • Methods Semistructured interviews and naturalistic observations were conducted with young adults with congenital heart disease (mean age, 28.6 years), their family members, and nurses who cared for the patients during hospitalization (N = 34). Dimensional analysis was used to analyze interviews and field notes from observations. • Results A grounded theory was derived, explaining how the hospital context and relationships between patients, patients’ families, and nurses affect patients’ hospital experiences. Expectations differed among the groups, leading to dissonance in care, as exemplified by role confusion and power struggles over control of care. This dissonance resulted in interpersonal conflict, distrust, anxiety, and dissatisfaction with the care and caring experiences. • Conclusions Changes in hospital units, a better understanding of the healthcare needs of young adults with congenital heart disease, and acknowledgment of the expertise of patients and patients’ families are needed to improve nursing care for these patients and their families.

Maltreated youth have a high prevalence of acute and chronic mental and physical health problems, but it is not clear whether these problems are related to maltreatment or to a disadvantaged environment. To compare health status and health care use of maltreated youth receiving child protective services to comparison youth living in the same community, we conducted a secondary analysis of caregiver reports for 207 maltreated adolescents (mean age 11.9 years) and 142 comparison adolescents (mean age 12.3 years) living in urban Los Angeles, using questionnaire data from a larger longitudinal study framed in a socio-ecological model. Caregivers included biological parents, relatives, and unrelated caregivers. Analyses included t-test, MANOVA, chi-square, and multivariable logistic regression. Caregivers reported similar rates of physical health problems but more mental health problems and psychotropic medicine use in maltreated youth than in the comparison youth, suggesting that maltreated youths’ higher rates of mental health problems could not be attributed to the disadvantaged environment. Although there were no differences in health insurance coverage, maltreated youth received preventive medical care more often than comparison youth. For all youth, having Medicaid improved their odds of receiving preventive health and dental care. Attention to mental health issues in adolescents receiving child welfare services remains important. Acceptance of Medicaid by neighborhood-based and/or school-based services in low-income communities may reduce barriers to preventive care.

Focus groups are a well-known qualitative approach to gathering data in health science research. The literature on focus groups, however, primarily discusses adults as subjects. Unfortunately, the scant reports of studies using children as participants in focus groups have not described their methods in detail. This article discusses the use of children (age 6-12) in focus groups, and highlights methodological considerations in this approach, with particular attention to the integration of developmental principles. Focus groups with children can capture their perspectives, original ideas, and insights, which are often neglected in more traditional pediatric research. Focus groups can also serve as an innovative approach to understanding children's experiences from a developmental perspective. Further, focus groups free children and investigator from the data-gathering limitations placed by literacy/reading levels that plague quantitative methods using self-report. By using relatively homogeneous groups, common cultural, emotional, and cognitive processes and responses are revealed that normally would not come to light in structured data collection. Focus groups offer a rich, interactive and developmentally effective approach to planning, content and evaluation in research with children.

With advances in medical and surgical management of congenital heart disease (CHD), it is becoming more common for patients to survive into adulthood. This article reviews family management of CHD over the life course of the disease and presents the findings of a study of the psychosocial needs of hospitalized adults with CHD and their families. Thirty-four patients, family members, and nurses were interviewed for their perceptions of the hospital experience. Hospitalization was characterized by differing expectations of care between participant groups, resulting in conflict, tension, and dissatisfaction. This dissonance in care had a negative impact on individual and family transitions in illness management. The data suggest that family-centered standards of nursing practice based on an understanding of both the physical and psychosocial effects of CHD on adults are needed.

Dimensional analysis has been proposed by Schatzman as an alternate method for the generation of grounded theory. The intent of this article is to trace the evolution of dimensional analysis and describe it in relation to traditional grounded theory method. Analytic processes that characterize dimensional analysis will be reviewed, and a research exemplar is presented to illustrate the application of the dimensional analysis method.

Hospital physicians care for most seriously ill patients in the United States. We employed dimensional analysis to describe communication about death and dying in audio-recorded admission encounters between seriously ill patients and hospitalists. Acknowledging or not acknowledging the possibility of dying emerged as a key process. Acknowledgment was rare, and depended on synergistic communication behaviors between patient and physician. Facilitators included patients cuing for information and disclosing emotional distress, and physicians exploring the patient’s understanding of his or her illness and emotional distress. When hospitalists focused on acute issues, stated that they were awaiting test results, and deferred to other physicians, discussion moved away from acknowledgment. Meaningful discussion of end-of-life issues, including goals and values, fears about death and dying, prognosis, and options for palliative care followed open acknowledgment. This acknowledgment process can serve as a guide for providers to sensitively and honestly discuss essential end-of-life issues.

The purpose of this qualitative study was to further the understanding of father identity and role development among adolescents involved in the justice system. Youth who were expecting a child or parenting an infant and who were incarcerated, arrested, or had admitted to criminal behavior participated in interviews and observations in a juvenile detention center and in the community. Data analysis revealed 4 patterns of fathering intentions: (a) embracing fatherhood, (b) being barred from fatherhood, (c) being ambivalent about fatherhood, or (d) rejecting fatherhood. Community health nurses can use this information to assess father identity status and address factors that interfere with father engagement.

Context— Despite the growing need for organ donation among Asian Americans, studies suggest that they are reluctant to donate. Objective— To examine the association of attitudes and knowledge about organ donation and transplantation with willingness to donate and willingness to engage in family discussion about organ donation among Asian American adolescents. Design— A cross-sectional study. Setting— The Big Island of Hawaii. Participants— Self-identified Asian American adolescents (Japanese, Chinese, Filipino, Korean), ages 16 to 17 years old, and each adolescent's parent or guardian. Main Outcome Measures— Asian American adolescents provided demographic information and completed the Modified Organ Donation Attitude Survey, the Organ Donation and Transplantation Knowledge Survey, and the Suinn-Lew Asian Self-Identity Acculturation Scale. A parent or guardian also provided demographic information. Linear regression analyses were used to examine the associations with willingness to donate and to engage in family discussion about organ discussion. Results— Willingness to donate was associated with positive knowledge related to general aspects about organ donation and cultural limitations in receiving an organ transplant, a high level of acculturation, and a low level of negative attitudes ( R2 = 0.402, F = 18.86, P = .005). Asian American adolescents with approving or positive attitudes were likely to engage in family discussion about organ donation ( R2 = 0.195, F =27.93, P = .005). To reinforce and maintain high levels of knowledge and positive attitudes, organ donation education is most likely needed in high schools.