Comparison of good days and sick days of school-age children with cancer reflected through their drawings

Hospital classroom experiences of hospitalized school-age pediatric oncology patients: A qualitative study

PURPOSE

In this study, it was aimed to examine the hospital classroom experiences of school-age children who received treatment and care at a pediatric oncology-hematology clinic in Turkey.

METHODS

The study was conducted using the in-depth interview method with the participation of 17 children who were hospitalized in the pediatric oncology-hematology clinic of a research and training hospital in the Ankara province of Turkey. The data were collected using a "Semi-Structured Interview Form". The interviews started with the question "How do you perform the assignments given by your teacher while you are hospitalized?", and the interviews were recorded as audio with the consent of the children and their parents.

RESULTS

As a result of the interviews, three main themes, (1) Learning, (2) Maintaining normalcy, and (3) Expectations, and 9 subthemes (teacher, continuation of learning, learning through play, feeling good, continuation of routines, peer interaction, communication with the school-teacher, basic sport activity, and tablet/internet access) were generated from the data.

CONCLUSIONS

Hospital classrooms had a significant role in increasing the children's adaptation to hospital conditions and ensuring the continuation of school/learning.

PRACTICE IMPLICATIONS

Pediatric nurses can refer children with long and repeated hospitalizations (e.g., pediatric oncology patients and children with chronic diseases) to hospital classrooms. Thus, children can adapt more easily to the procedures performed in the hospital.

Drawing a River: Utilizing the Power of Metaphors in Interviews With Children and Young People

In the field of qualitative health research on children, scholars have called for the inclusion of children's perspectives. Still, health care research on children appears to be characterized by an exclusionary approach that stems from a conception of disability and sickness as equivalent to a lack of agency. This article responds to the call to include children's perspectives. It presents the Double-view (Dovi)-river interview, which is a drawing- and metaphor-based interview method that enables ambiguous and multi-layered life course narratives. Based on two steps - (1) a life course interview conducted while drawing a river of the child's life and (2) revisiting and unfolding the child's stories - the method allows for an arts-based, joint exploration of life experiences. Inspired by childhood studies as well as a poststructuralist epistemology, the article discusses and proposes ways to challenge power relations between the adult interviewer and the child interviewee. It is argued that the method can also challenge the predominant deficit view and the dichotomous understanding of children's experiences of their life and capabilities that characterize much health care practice and health research, by focusing both on challenges and opportunities. Doing so enables a more nuanced and appreciative approach to children. We draw on empirical examples from a study with children with disabilities. However, we suggest that the method's potential for enabling articulation of the complex and ambiguous can inspire qualitative research and health care practice more broadly.

Art Unfolds Words: Expressing Hope Through Creative Art Among Adolescents and Young Adults Who Have Advanced Cancer

Hope's role in the care of adolescents and young adults (AYAs) who have advanced cancer (AC) is not well understood. This study aimed to conceptualize the essence of hope among AYAs who have AC based on their lived experiences and illustrate hope through verbal and artistic depictions of the AYA's lived experiences. Fifteen AYAs, aged 12 to 21 years, diagnosed with AC completed two semistructured interviews to share their lived experiences of hope perspectives in the form of a descriptive narrative and a creative-art outcome. Participants who chose to draw pictures narrated the conceptual meanings based on elements of each picture. A board-certified art therapist performed a post hoc analysis of the drawings and participants' verbatim descriptions of their meanings. Five of the 15 AYA participants created drawings depicting their lived experiences of hope. The artistic process of mapping their cancer journey revealed distinct views of hope through nature landscapes and metaphors. Participants provided titles for their drawings such as "Over the Rainbow," "Growth in the Valley," and "The Light at the End of the Tunnel." The pictures embodied the AYAs' thoughts, perceptions, and lived experiences related to hope and its role during their cancer journey. Drawing is one simple art form that can facilitate an AYA's expression of well-being (including hope) beyond what may be verbally articulated. Creative art should be further researched as a screening tool to assess how AYAs with AC cope with an uncertain future and psychological and/or existential distress symptoms.

Symptoms and daily experiences reported by children with cancer using a game-based app

PURPOSE

Mobile health (mHealth) resources, including apps, are emerging as resources to support children in tracking symptoms and other health-related data. The purpose of this study was to describe symptoms and daily experiences reported by elementary school-age children receiving treatment for cancer using the newly developed Color Me Healthy app.

DESIGN AND METHODS

Participants in this descriptive study were children 6-12 years of age, who were receiving cancer treatment at a free-standing children's hospital in the Intermountain West of the United States. Children were requested to use the app for at least five days between clinical visits. Children's app-reported data were extracted from individual user accounts for analysis. Quantitative data were summarized descriptively. Qualitative data were summarized using qualitative content analysis.

RESULTS

Nineteen children (6-12 years; median 8 years; 7 females) completed 107 days of app use. All children reported symptoms at least once, and 14 reported at least one day with a symptom of moderate or greater severity. Daily experiences reported through the app reflected children's engagement in usual childhood experiences while also describing life with cancer, including symptoms.

CONCLUSIONS

Elementary school-age children are capable of self-reporting symptoms using a symptom reporting app, providing preliminary evidence for the potential benefits and clinical relevance of mHealth resources to support health outcomes within this population.

PRACTICE IMPLICATIONS

Clinicians should anticipate and support ongoing symptom management needs between clinical visits. Children's self-reported data can promote a person-centered approach to symptom assessment and management.

Does Creative Arts Therapy Improve Distressing Symptoms in Children with Cancer? A Synthesis of Extant Literature

Introduction: Children with cancer experience symptom distress which has been correlated with decreased quality of life (QOL). Creative arts therapy (CAT) encompasses the therapeutic use of creative arts which may improve QOL among children with cancer by affecting symptoms. Therefore, the research question was asked: Does CAT affect symptoms of pain, nausea, fatigue, anxiety, and mood in children with cancer? Methods: Based on the study question, a comprehensive literature search of PubMed, CINAHL, PsycINFO, and Embase was completed. Inclusion criteria limited articles to specific symptom outcomes in two-group intervention studies in the English language. Selected articles were confirmed for inclusion by the study team, followed by group discussion to develop matrices with levels of evidence based on the Grading of Recommendations Assessment, Development, and Evaluation (Grade) guidelines. Results: Initial searches revealed 1,391 articles, screened to 44 for systematic review. Based on the inclusion criteria, 11 articles remained. Four studies had evidence levels graded as low, three were low to moderate, and four were moderate. Outcomes of mood and anxiety were measured in five studies, pain in four, fatigue in two, and nausea in one study. Discussion: Psychological outcomes were measured more commonly than physical outcomes. Evidence reached a moderate grade in four studies. Summary: Through this synthesis of intervention studies with CAT in children with cancer, improvement in distressing symptoms has potential, but the state of the science for symptom management with CAT could be strengthened for nurses to promote CAT to improve QOL among children with cancer.

The Experiences of Chinese Children 5- to 7-year-old during cancer Treatment Reflected Through Interviews and Drawings

Background: For children with cancer, the experience during treatment can be challenging. There is a limited number of studies on self-reported treatment experiences of younger Chinese children with cancer using qualitative methods. Objectives: This study aimed at exploring the experience of Chinese children aged 5 to 7 years during cancer treatment reflected through interviews and drawings. Methods: This study used a descriptive qualitative design with the technique of "draw-and-tell." Participants were enrolled from the pediatric oncology inpatient department of one national children's medical center in China. They were asked to draw a picture of "your feelings in the hospital." An inductive content analysis approach was used. Results: Twelve participants were enrolled (8 male, mean age 5.7 years). Four themes were established: (1) suffering from adverse treatment effects; (2) perceiving changed relationships; (3) being thankful for others; and (4) trying out coping strategies. Conclusion: Chinese children aged 5 to 7 years expressed multiple cancer treatment impacts. They appreciated others' support and had their own way to cope with treatment demands. The authors also extended the dynamic nature of using the "draw-and-tell" methodology. Study findings highlight the importance of inviting and hearing the voice of young children during their cancer treatment, with particular consideration of the influence of disease, treatment, child development, family dynamics, and culture.

A graphic elicitation technique to represent patient rights

BACKGROUND

A patient charter is an explicit declaration of the rights of patients within a particular health care setting. In early 2020 the Save the Children Emergency Health Unit deployed to Cox's Bazar Bangladesh to support the establishment of a severe acute respiratory infection isolation and treatment centre as part of the COVID-19 response. We developed a charter of patient rights and had it translated into Bangla and Burmese; however, the charter remained inaccessible to Rohingya and members of the host community with low literacy.

METHODS

To both visualise and contextualise the patient charter we undertook a graphic elicitation method involving both the Rohingya and host communities. We carried out two focus group discussions during which we discussed the charter and agreed how best to illustrate the individual rights contained therein.

RESULTS

Logistical constraints and infection prevention and control procedures limited our ability to follow up with the original focus group participants and to engage in back-translation as we had planned; however, we were able to elicit rich descriptions of each right. Reflecting on our method we were able to identify several key learnings relating to: 1) our technique for eliciting feedback on the charter verbatim versus a broader discussion of concepts referenced within each right, 2) our decision to include both men and women in the same focus group, 3) our decision to ask focus group participants to describe specific features of each illustration and how this benefited the inclusivity of our illustrations, and 4) the potential of the focus groups to act as a means to introduce the charter to communities.

CONCLUSIONS

Though executing our method was operationally challenging we were able to create culturally appropriate illustrations to accompany our patient charter. In contexts of limited literacy it is possible to enable access to critical clinical governance and accountability tools.

Paediatric oncology patients' definitions of a good physician and good nurse

BACKGROUND

It is stated that the communication and disease experiences of paediatric patients, especially paediatric oncology patients, with healthcare professionals are completely different from those of adults.

OBJECTIVE

The aim of this study was to determine the definitions of a good physician and good nurse provided by elementary school-age oncology patients.

RESEARCH DESIGN

In this qualitative research, data were collected through semi-structured individual interviews. The data were evaluated thorough thematic analysis.

PARTICIPANTS AND RESEARCH CONTEXT

Eighteen children hospitalised due to cancer in paediatric oncology and haematology clinics of a university hospital in Turkey.

ETHICAL CONSIDERATIONS

Permission to conduct the study was obtained from the Institution's Ethics Committee. The objectives of this study were explained to the participants and families, and written consent was obtained from them. Also, participants were assured that necessary measures would be taken to protect their anonymity and confidentiality.

FINDINGS

The definitions of children were based on five main themes: interpersonal relationships, virtues, professional responsibility, security and individual characteristics.

CONCLUSION

Children conveyed important messages to health professionals. They emphasised that a good physician and good nurse should communicate well, not only with themselves but also with their family. In addition, children were sensitive about health professionals who played with them and actively participated in the treatment by informing them about the disease. Meeting the expectations of children can be possible by improving the communication skills of physicians and nurses and by adding games and activities to the treatment and care plan.

Economic Strain Deteriorates While Education Fails to Protect Black Older Adults Against Depressive Symptoms, Pain, Self-rated Health, Chronic Disease, and Sick Days

Background

A large body of empirical evidence on Minorities' Diminished Returns (MDRs) suggests that educational attainment shows smaller health effects for Blacks compared to Whites. At the same time, economic strain may operate as a risk factor for a wide range of undesired mental and physical health outcomes in Black communities.

Aim

The current study investigated the combined effects of education and economic strain on the following five health outcomes in Black older adults in underserved areas of South Los Angeles: depressive symptoms, number of chronic diseases, pain intensity, self-rated health, and sick days.

Methods

This cross-sectional study included 619 Black older adults residing in South Los Angeles. Data on demographic factors (age and gender), socioeconomic characteristics, economic strain, health insurance, living arrangement, marital status, health behaviors, depressive symptoms, pain intensity, number of chronic diseases, sick days, and self-rated health were collected. Five linear regressions were used to analyze the data.

Results

Although high education was associated with less economic strain, it was the economic strain, not educational attainment, which was universally associated with depressive symptoms, pain intensity, self-rated health, chronic diseases, and sick days, independent of covariates. Similar patterns emerged for all health outcomes suggesting that the risk associated with economic strain and lack of health gain due to educational attainment are both robust and independent of type of health outcome.

Conclusion

In economically constrained urban environments, economic strain is a more salient social determinant of health of Black older adults than educational attainment. While education loses some of its protective effects, economic strain deteriorates health of Black population across domains. There is a need for bold economic and social policies that increase access of Black communities to cash at times of emergency. There is also a need to improve the education quality in the Black communities.

Pictographic Representations of the Word "Nature" in Preschool Education Children

The relevance of preschool children's understanding of nature, its elements, how it affects the behavior of human beings, and how human beings influence it, is a two-purpose task. First, it helps to identify the necessary elements for the design of programs that have a significant impact in the development of environmental identity. Second, it also assists in the implementation of environmental education in the school curriculum in Mexico, in order to develop attitudes to preserve the environment from an early age. Based on this logic, the objective of this study was to identify the components of the concept of nature and its relationship with environmental identity, from drawings made by preschool children in a desert environment through a visual discursive analysis. The sample consisted of 118 preschool students whose ages ranged between 5 and 6 years. Participants were selected from four different schools in Hermosillo, Mexico: three located in the urban area and one on the coastal area of the State of Sonora. Participants were asked to draw the first thing that came to their minds when they heard the word nature. As a result, all the drawings presented categories such as plants, animals, waterbodies, celestial bodies, abiotic factors, natural locations, locations made by man, and others. Finally, the analysis showed that a general idea of what nature represents to children includes elements of known flora and fauna; however, they did not capture elements of the desert region in which they live. In addition, most participants' self-definition contained environmental identity.

Mental and Physical Health Correlates of Financial Difficulties Among African-American Older Adults in Low-Income Areas of Los Angeles

Background: While financial difficulties correlate with mental and physical health status, less is known about these associations among economically disadvantaged African-American (AA) older adults. Objective: This study explored mental and physical health correlates of financial difficulties among AA older adults in low-income areas of south Los Angeles. Methods: A cross-sectional study on 740 AA older adults (age ≥ 55 years) conducted in South Los Angeles between 2015 and 2018. Independent variable was financial difficulties. Outcomes were depressive symptoms, chronic pain, chronic medical conditions, self-reported health, and sick days. Age, gender, educational attainment, living alone, marital status, smoking, and drinking were also measured. Zero order (unadjusted) and partial (adjusted) correlates of financial difficulties were calculated for data analysis. Adjusted (partial) bivariate correlations controlled for age, gender, education, marital status, living alone, and health insurance. Results: In adjusted analyses, financial difficulties were positively associated with chronic pain, chronic medical conditions, self-rated health, sick days, and depressive symptoms. Conclusion: Financial difficulties seem to be linked to chronic pain, chronic medical conditions, self-rated health, sick days, and depressive symptoms. The results advocate for evaluation of social determinants of health in providing health care of AA older adults. Addressing financial difficulties may help with the health promotion of low-income AA older adults in urban areas.

How Does Creative Arts Therapy Reduce Distress for Children With Cancer? A Metasynthesis of Extant Qualitative Literature [Formula: see text]

Introduction: As more children survive cancer, attention must be paid to their quality of life (QOL). Integrative therapies are an ideal modality for nurses to advocate for reducing distress and improving QOL for children with cancer. Creative arts therapy is a type of integrative health that may improve QOL in this population. Therefore, the research question was asked, "For children with cancer, what opportunities exist for creative arts therapy to reduce distress?" Method: A metasynthesis of the extant qualitative research was conducted to answer the research question. Seven qualitative studies were identified, which included 162 participants. New themes were identified through rigorous analyzation by the study team of each study as individual data. Results: Four derived analytic themes emerged through the analysis: (a) connection is established through creative expression, (b) coping is facilitated by creative arts, (c) communication is enabled by creative arts interventions, and (d) continuance (the concept of time) is experienced through creative arts. Examples of each theme with subthemes are delineated, including expressive quotes. Summary: Through this qualitative synthesis of studies with creative arts therapy, evocative opportunities to reduce the distress associated with the disease experience are revealed. Nurses are called now to promote creative arts therapy to improve the symptoms in children with cancer.

Substance Use among Economically Disadvantaged African American Older Adults; Objective and Subjective Socioeconomic Status

Purpose. This study investigated the effects of objective and subjective socioeconomic status (SES) indicators on two health behaviors, cigarette smoking and alcohol drinking, among African American older adults. Methods. This community-based study recruited 619 economically disadvantaged African American older adults (age ≥ 65 years) residing in South Los Angeles. Structured face-to-face interviews were conducted to collect data. Data on demographic factors (age and gender), subjective SES (financial difficulties), objective SES (educational attainment), living arrangement, marital status, healthcare access (insurance), and health (number of chronic medical conditions, self-rated health, sick days, depression, and chronic pain) and health behaviors (cigarette smoking and alcohol drinking) were collected from participants. Logistic regressions were used to analyze the data. Results. High financial difficulties were associated with higher odds of smoking cigarettes and drinking alcohol, independent of covariates. Educational attainment did not correlate with our outcomes. Similar patterns emerged for cigarette smoking and alcohol drinking. Conclusion. Subjective SES indicators such as financial difficulties may be more relevant than objective SES indicators such as educational attainment to health risk behaviors such as cigarette smoking and alcohol drinking among African American older adults in economically constrain urban environments. Smoking and drinking may serve as coping mechanisms with financial difficulty, especially among African American older adults. In line with the minorities' diminished returns (MDR) theory, and probably due to discrimination against racial minorities, educational attainment has a smaller protective effect among economically disadvantaged African American individuals against health risk behaviors.

Staff Perceptions of Symptoms, Approaches to Assessment, and Challenges to Assessment Among Children With Cancer

Nurses are often the first to recognize and respond to children's symptoms. This descriptive, exploratory study characterized how pediatric oncology health care providers characterize and assess children's cancer-related symptoms. The study also explored challenges associated with symptom assessment and information perceived as helpful in planning interventions. The setting was a Children's Oncology Group-affiliated hospital in the Intermountain West of the United States. Twenty-two pediatric oncology health care providers (95% female; 68% nurses) participated in one of four focus group sessions. Sessions were facilitated by two individuals and included six open-ended questions addressing participants' perspectives of cancer-related symptoms, approaches to symptom assessment, challenges and frustrations encountered when assessing symptoms, and information needed to plan interventions. Participants identified 75 physical and psychosocial responses that included both subjectively experienced symptoms and other consequences of the cancer experience. Qualitative content analysis procedures organized other responses into categories and subcategories. Participants most frequently reported using observational approaches including physical assessment findings and observation of the child's behavior to identify symptoms. Strategies that sought the child's input such as the use of a rating scale or seeking the child's verbal description were less frequently named. Participants related discerning and interpreting the child's behaviors as a challenge to symptom assessment. They also reported attention to symptom characteristics as important to planning interventions. Future directions include building capacity to support child-centric symptom assessment. Development of reliable and valid resources for use in clinical settings may support a more child-centric approach to symptom assessment.

Children with ADHD draw-and-tell about what makes their life really good

PURPOSE

The purpose of this study was to engage children with attention deficit hyperactivity disorder (ADHD) in a developmentally sensitive way to explore the children's subjective well-being. Explicitly, their life satisfaction, or what makes their life "really good." To date, little is known about the subjective life experience of children with ADHD or how incorporating children's views separate from the purview of adults and pathology might enhance our understanding or change our approach to evaluation and/or intervention.

DESIGN AND METHODS

A parallel convergent mixed-methods design was used to collect data from a convenience sample of children with ADHD (N = 20) ages 7 to 11 years old. This article focuses solely on the qualitative data obtained through semi-structured interviews using the art-based approach draw-and-tell conversation (DTC). The DTC data were analyzed using qualitative content analysis. In addition, each parent (N = 20) independently completed demographic and health-related forms to provide descriptive and contextual variables.

RESULTS

Three themes were discerned in the DTC analysis-activity, nature, and connections. Most children (90%) described engaging in some form of activity, often outdoors, and with others; though the focus of activity was varied. Nature was evidenced directly and indirectly in many of the children's (85%) stories. Over half (65%) of the children described some variation in relational connection across a continuum that contributed to, or detracted from, their sense of well-being/life satisfaction.

PRACTICE IMPLICATIONS

Children shared that doing things, outdoors, with others, [emphasis added] made their life "really good". Children's stories yielded insightful and actionable information that is relevant to each individual child/family, and to nursing assessment, intervention, and advocacy. These child-granted insights also extend our attention beyond pharmacological and behavioral focused interventions, to include the children's own innate health promoting interests that help to make their life really good.