Experiences of Pediatric Cancer Survivors

Experiences of Pediatric Cancer Survivors Exploring the experiences of pediatric cancer survivors in Karachi, Pakistan. Muhammad Tahir Saleem This chapter presents the study design, its setting, the sampling technique, the data collection process and the details of data analysis. In addition, the ethical considerations and study limitations are also discussed in the chapter. Methodology Qualitative methods are utilized to generate knowledge about a new area of interest. Qualitative research methods are mostly descriptive in nature to bring out the subjective meaning of behaviors and attitudes (Polit Beck, 2008). As there is no documented evidence for the issues encountered by cancer survivors in Pakistan, the researcher felt that the question about the experiences of cancer patients and their needs for care could be best upraised by following a naturalistic inquiry using a qualitative methodology. Study Design The descriptive explorative qualitative design was used in this study to explore the experiences of survivors of pediatric malignancies. In the process of developing new knowledge one or more characteristics of a specific population can be examined by utilizing descriptive designs whereas, exploratory designs are used when an in-depth exploration of a single process, variable or concept is required (Wood and Ross-Kerr, 2011). Hence, in order to delineate the characteristics and conduct an in-depth exploration of the phenomenon of survivorship, the descriptive exploratory design was employed for the study. This design offers flexibility to generate knowledge by ensuring less control of the researcher over the variable and allowing the manifestation of subjective experience of the cancer survivors. Study Setting There is substantial amount of evidence that over the past decade the incidence of lymphoma is on the increase in Karachi, (Bhurgri, 2004), and this is equally applicable to all pediatric cancers. Karachi is a metropolitan city with a population, representative of diverse cultural, socioeconomic and educational backgrounds from all over Pakistan. The study site, the Aga Khan University Hospital (AKUH) is located in Karachi and it receives patients from diverse financial and geographical backgrounds from all over Pakistan. These characteristics make AKUH suitable as the study setting. Study population The pediatric oncology follow-up clinics of AKUH were identified as suitable places to study a variety of individuals who had survived pediatric cancers. All pediatric patients registered with the department of pediatric oncology AKUH were the study population. The study participants were the follow-up patients in the remission period who survived pediatric cancer and were discharged from the oncology clinic after completion of their anti-cancer treatment. Sampling Technique The purposive sampling technique is used in the present study. Despite the fact that a non-probability sample is less likely to be a representative of each individual of the population, in order to develop a rich and holistic understanding of survivorship, the sampling decision would be based on the informational and theoretical needs of the phenomenon of interest (Polit Beck, 2008). Therefore, based on the researcher’s prior knowledge about the population, participants who were particularly knowledgeable about the issue under study were chosen purposefully. Purposive sampling that deliberately reduces variation and permits a more focused inquiry for typical cases (Polit Beck, 2008), such as previously treated pediatric cancer patients (in remission), would bring qualitative information enriched with their lived experiences about cancer and its treatment. Sample Size Recruitment of the participants continued until theoretical saturation became apparent. Theoretical saturation is a point in time achieved in data collection process when no new relevant concepts are recognized in comparison with the data already produced; and researcher may only find repetition of previously collected data (Burns Grove, 2009; Gerrish Lacey, 2010). Male and female participants were randomly chosen at the pediatric oncology follow up clinics. Eight participants, four male and four female were interviewed after taking informed consent at pediatric oncology follow-up clinics. Ages of the patients ranged between 08-25 years. The length of time since completion of chemotherapy and radiation therapy was one year. The selected patients were in remission after having completed anticancer treatment for at least one year so that research would reveal the rich experience of the individuals who were treated and were disease free after the treatment regimen. Patients were cogni zant about their diagnosis and the treatment and subsequent after the treatment. Inclusion Criteria: Both male and females cancer survivors Children Age 08-16 years Diagnosed as having had Pediatric Cancer Have had completed anti-cancer treatment regimen In remission for at least one year after treatment Exclusion Criteria: Children who are on active treatment or relapsed after completion of treatment Children who did not sign voluntary informed consent Data Collection In-depth interviews are used when the researcher has a list of topics that are needed to be explored. Interview Guides are the list of areas or questions to be covered with each participant. These guides may be pilot tested before embarking upon the actual data collection (Polit Beck, 2008). For the study under discussion, the researcher has prepared a written interview guide with Urdu translations that are attached as Appendix A. While preparing the interview guides a previously developed questionnaire for oncology was referred to (FACIT, 2010). The prepared interview guides were sent to the committee members for their opinion. The interviews allowed the researcher to explore the research topic in a broader way. The venue for the interview was an allocated room at pediatric oncology clinic at AKUH. In addition, the technique of interview permitted the researcher to probe on the issues which needed further exploration and clarification more in detail at the same time of interaction with the participant. Immerging ideas were also incorporated in the future session of data collection to enhance the richness of the data. It allowed the respondents to recall their memories and bring out the rich experiences in detail. The respondents expressed their feelings and perceptions in the context of the topic under discussion. These first hand reports of the participants, probing of the researcher during interview and researchers own reflections for nonverbal clues helped in collecting enriched data from the survivors of pediatric cancers. Each interview took about 30 to 45 minutes. A female moderator conducted the interviews for female pediatric cancer survivors. Interviews were recorded on an audio recorder with pseudo names. The pseudo names were used at transcription process to certify confidentiality. Demographic information e.g. age, gender, native area, history of ailment like diagnosis and treatment, length of treatment and treatment modalities used during the treatment process were also recorded at the beginning of the interview. The interviews were transcribed verbatim in Udru Language and translated by the researcher in such a way that no meaning was sacrificed. Data Analysis The audio-taped interviews in Urdu were transcribed word by word and analyzed manually. The interview generated codes, categories and/or sub categories and then themes, which in qualitative research are said to be broad units of information that consist of several codes aggregated to form a common idea (Creswell, 2013).The researcher listened to the recordings several times in order to assimilate the data to generate accurate transcription. To analyze the collected material during data collection, the recorded interviews were transcribed in the form of a formatted document for manual thematic analysis. The researcher then reverberated in the data to take similarities and differences of ideas. By doing this various specific ideas were identified which were labeled as codes. The codes were put under the sub categories and categories. The ideas or codes were marked very carefully in a way that prevented the researchers own frame of mind from affecting the interpretation of the collected data to reduce bias and ensure bracketing (Tufford Newman, 2012). Careful reflections were made to keep researchers own thoughts and understandings from affecting the analysis (internal validity). Various identified ideas were then grouped together by axial coding in order to make tentative categories of themes. As the process of analysis proceeded, these tentative codes or categories were merged to form common themes under the guidance of the research supervisor to avoid gaps in qualitative inference of the data. The valuable input of the research supervisor also shielded the analyses process form the personal reflexivity (biases in analysis due to personal assumptions, values and beliefs) of the novice researcher. To ensure the credibility and consistency of the analysis, constant input from the external supervisors (committee members) were also incorporated. A chronological record of all the activities of the study was made by the investigator in order to ensure the dependabili ty/audibility of the study. To safeguard the transferability of the research, the study settings, context of the study and demographics of the patients with their diagnosis and treatment modalities were noted to enable the future investigators to replicate the study (Polit and Beck, 2008). Ensuring trustworthiness and quality of the study Rigour in the qualitative researches is defined as the means by which the researcher shows integrity and competence (Aroni et al., as cited in Holloway Wheeler, 2010). Trustworthiness to maintain rigour in the study was maintained ensuring credibility, dependability, conformability and transferability (Lincon Guba, 1985). Credibility Credibility is the extent to which the data and interpretation of the research are grounded in the events rather than the inquirers personal construct (Lincoln Guba, as cited in Polit Beck, 2008). In other words credibility of a study is ensured when it presents such faithful interpretations of participants’ experiences that they are able to recognize them as their own (Hall Stevens as cited in Long, Johnson, 2000). A conscious attempt was made by the researcher to maintain credibility during the study. The researcher tried his best to remain involved with the participants during interviews rather than being with them only to ask questions and record the answers. It was done by helping participants to elaborate their lived experiences and allowing them to recall the events that occurred during the diagnosis and treatment. Triangulation was done by taking notes during the interview, recording of the demographics and cross checking of the data by the research supervisor. Dependability Dependability refers to the reliability of the collected data over time and over conditions in which the research is done (Lincoln Guba as cited in Polit Beck, 2008). It determines whether the process of study was consistent and reasonably stable over time. The researcher attained this by working on the research plan with the research supervisors and committee members, by taking approval from the ethical review committee of the institute and by submitting the updates of the research process to the supervisor and the committee members. The researchers’ personal record, notes during the interview and transcription records were kept chronologically so that the process of the study can be traceable. Conformability Conformability refers to objectivity to verify the quality and adequacy of the results and interpretation. The accuracy, relevance and meaning of the data are appraised by two or more independent people for congruence (Polit Beck, 2008). Conformability is achieved by having the input of the supervisor and the committee members at every step of the research. All the interviews and their transcript were cross checked by the supervisor. The thematic analysis by the researcher was cross checked by the supervisor for congruency and objectivity of the outcome. The researcher also maintained the records of unrefined data, transcriptions of the interviews, and also the records for synthesis and analysis of data. Transferability Transferability refers to the generalizability of the data and the results that came out as a result of subsequent analysis ((Polit Beck, 2008). In order to make the result applicable to other settings, the researcher interviewed male and female cancer survivors at the follow up clinic of the pediatric oncology. The demographics of the participants, who had different socio-economic status showed that they were from different backgrounds as they belonged to the provinces of Khyber Pakhtoon Khwa, Sindh, Baluchistan and lower Punjab. To maintain homogeneity, four male and female were interviewed. Therefore, the consumers of this research can use the results at different places in similar context. Ethical Consideration World Medical Association has put forward a statement of ethical principal as Declaration of Helsinki to guide medical research involving human subjects (World Medical Association, 2014). To fulfil the requirement of the article 22 and 23 of recently revised document of Declaration of Helsinki, a research proposal was made and submitted to the Ethical Review Committee (ERC) of AKUH. Approval from the Director of Nursing Services (DNS) and also from the Medical Director (MD) of AKUH was taken to conduct the study and was submitted to the ERC with the research proposal. Approvals from the DNS and the MD are attached as Appendix C and Appendix D respectively. The participants’ right of autonomy was maintained by having a consent form signed by the participant and the parent of each participant after giving complete information about the study and its significance. Ascent form with Urdu translations is attached as Appendix B and Appendix D respectively. A confidential ID number fo r further identification was assigned to each participant and to the corresponding data. As research thesis is one of the requirements of MScN program for Aga Khan School of Nursing and Midwifery the fund for the study was already allocated in the Master’s program budget. The thesis budget is attached as Appendix G. A formal approval was granted to conduct the study by ERC of Aga Khan University. Summary of the chapter This chapter presented the methodology for the study, giving a brief description of the study design, study setting, and sampling technique. The chapter also included the data collection and data analysis plan. Ethical considerations for conducting the study are discussed in the end. Reference Bhurgri, Y. (2004). Karachi Cancer Registry Dataimplications for the National Cancer Control Program of Pakistan. Asian Pac J Cancer Prev, 5(1), 77-82. Burns, N., Grove, S. K. (2010). Understanding nursing research: Building an evidence-based practice. Elsevier Health Sciences Creswell, J. W. (2013). Research design: Qualitative, quantitative, and mixed methods approaches. Sage Publications, Incorporated. FACIT (2010). Functional Assessment of Cancer Therapy General (constitutes the core of all subscales; the FACT-G can be used with patients of any tumor type), 2007. Retrieved on 11-11-2013Retrieved from http://www.facit.org/FACITOrg/Questionnaires Gerrish, K., Lacey, A. (2010). The research process in nursing. John Wiley Sons Holloway, I. S, Wheeler (2010). Qualitative research in nursing and healthcare. Wiley Blackwel. com. Tufford, L., Newman, P. (2012). Bracketing in qualitative research.Qualitative Social Work,11(1), 80-96. Long, T., Johnson, M. (2000). Rigour, reliability and validity in qualitative research.Clinical effectiveness in nursing,4(1), 30-37. Polit, D. F., Beck, C. T. (2008). Essentials of nursing research: Appraising evidence for nursing practice. Wolters Kluwer Health World Medical Association (2014). Declaration of Helsinki. Retrieved June 30, 2014, from http://www.wma.net/en/30publications/10policies/b3/ Wood, M. J., Ross-Kerr, J. (2010).Basic steps in planning nursing research: From question to proposal. Jones Bartlett Publishers.

Langston Hughes Essay examples -- essays research papers

Langston Hughes James Langston Hughes was born on February 1, 1902, in Joplin, Missouri. He was named after his father, but it was later shortened to just Langston Hughes. He was the only child of James and Carrie Hughes. His family was never happy so he was a lonely youth. The reasons for their unhappiness had as much to do with the color of their skin and the society into which they had been born as they did with their opposite personalities. They were victims of white attitudes and discriminatory laws. They moved to Oklahoma in the late 1890s. Although the institution of slavery was officially abolished racial discrimination and segregation persisted. Langston Hughes parents then separated. Since his mother moved from city to city in search of work he lived in Lawrence, Kansas, with his grandmother named Mary Hughes. She fiercely opposed to racial discrimination. While growing up, Langston also stayed with friends of the family, James and Mary Reed. Living with his grandmother and the Reeds in all-white neighborhoods, he felt even more isolated. When Langston was ready to start school in 1908, his mother was told that because her son was black, he could not attend a nearby, mostly white school in Topeka, Kansas. Carrie, his mother, fought with the school over their decision. She won her fight and Langston was finally admitted to the school. He dealed with his loneliness by writing poetry. After Langston’s grandmother died in 1915, he went to live with his mother, her second husband, Homer Clark, and Clark’s two-year-old son, Gwyn. They went from Lawrence, Kansas to Kansas City, Missouri to Lincoln, Illinois. They moved to Cleveland, Ohio in 1916. Clark moved to Chicago, Illinois. Langston’s mother followed him and Langston was left alone in Cleveland. He devoted himself to his class work and other interests. He was on the editorial staff, on the student council, one the track team, an officer in the drill corps, and acted in school plays. When Langston Hughes attended Central High, the student body was very ethnically diverse. Langston’s Jewish friends were the ones who first opened his eyes to the ideals of socialism. Socialism is the doctrine that all property in a society is public property. Claude McKay, a black writer whose articles and poems appeared in the Liberator, became a favorite of Langston’s. Langston started to use Negro (African-American... ...es spent the early part of the 1940’s working on his autobiography, The Big Sea, which tells in brilliantly clear language the story of his life up to the year 1931.He explored the expressing validity of black vernacular in urban and rural black lifestyles. He graduated from Lincoln University in 1930. He wrote playwrights and created major Broadway successes as Scottsboro Limited (1932) and Mulatto (1935). In first collections of short stories, The Ways Of White Folks, published in 1934.He was recognized as Simple a humorist through the creation of a character named Jessie B. Semple who, Simple States A Claim (1957), makes commentary on social issues confronting the black community in a vernacular style which strikes a common chord in its simplicity. In 1957, Semple was brought to Broadway in the musical Simply Heavenly. In May 22, 1967 Langston Hughes in died in New York City. The reason why I picked Langston Hughes as my famous African American was because his poems are my favorites. The other reason is that he was always trying to improve the life of African Americans. So, as in conclusion, I would like to say Langston Hughes is an American hero.   Ã‚  Ã‚  Ã‚  Ã‚  

Designing a Reward System

Detailing the methods of determining what aspects of the work should be monitored and rewarded is what I plan to focus on when designing my reward system. Designing a well-integrated motivation and reward is arguably one of the most important functions of management in its quest to achieve excellence in organizational performance, according to University of Phoenix Achieving Excellence in the Management of Human Services Organizations (2002). I want to focus on getting my workers to work hard to the best of their ability and be as productive as possible, providing high quality and effective services. I have to follow the basic functions of a human service organization to meet the expectations of the organizations mission. These functions have much to do with my workers and not the management. How do I get my workers to be all they can be in this organization, to accomplish the organizations mission. The designing of a successful reward system should be the answer to that question.The re are many theories of motivation and has been explored from many perspectives. According to Montana and Charnov (1993), drawing on the work of previous studies, identified twenty-five factors that motivate employees. Out of those twenty-five factors, only nine factors by its respondents in all the studies were reviewed. The nine factors of motivation selected:1. Respect for me as a person 2. Good pay 3. Chance to turn out quality work 4. Chance for promotion 5. Opportunity to do interesting work 6. Feeling my job is important 7. Boss acknowledgment of my work 8. Opportunity for self-development and improvement 9. Large amount of freedom on the job The ways in which I will address the nine factors of motivation would be equally and reviewed individually among each employee. Respect; each employee being treated equally and this will help build a strong bond within the staff and organization. Good Pay; if paid more than originally expected, this automatically becomes a motivator. Cha nce to turn out quality of work; if an employee is given a chance to complete a certain task and show their creativeness, they are providing independency and earn recognition, leading to job satisfaction. Chance for promotion; an employee works hard and completes all asked and beyond their duties. Opportunity to do interesting work; motivation comes in to play when employees have more opportunities within the organization.Feeling my job is important; the more recognition and opportunities available, the more the employee feels motivated and the importance of their job. Being told by my boss when I do a good job; boss acknowledgment lets it employees feel more motivated and focused to do more. Opportunity for self-development and improvement; an employee takes steps to improve their skills and becomes more motivated. Large amounts of freedom on the job; leads to job satisfaction because providing independency and completing work tasks is a huge motivational factor. All these nine fac tors of motivation are important when designing a reward system.There are also several necessary reward system properties: Basic Needs Satisfied, Competitive Benefits, Equitable Distribution, and Employees as Individuals (Lawler, 1977). I can make sure the basic needs are met by trying to satisfy salary and job security within my organization. I can make sure the organization offers competitive benefits by trying to compare with other human services organizations between salaries and benefits. I can make sure benefits are equally distributed by ensuring the employees are aware of their performance levels and the rules. I can make sure all my employees are treated as individuals by taking into consideration each employee has different needs. All of these properties will help develop a  fair and successful reward system.Some benefits and incentives that will be offered to employees would be merit increases, lump-sum salary increases, paid time off, insurance and retirement benefits; just to name a few. Merit increases are increases in an employee’s wages based on their performance level. Lump-sum salary increases are merit payments that may be considered part of an employee’s normal pay. Paid time off is hours an employee can use for sick days, personal days or vacation days, which are paid hours. Insurance and retirement benefits can be a positive benefit for an employee. Healthy insurance is offered and retirement plans are offered after a certain amount of years. These benefits and incentives will help motivate its employees and keep a successful reward system.This is a performance review form for an employee to be evaluated by its employer. It evaluates the employee’s levels of performance and is a good tool to use, especially for designing a reward system for a human service organization. You can design this form to meet the basic needs and functions of the organizations standard requirements. This is just an example and I feel it is a functional form. By completing this form, the employer or manager as a better review of the employee and gets an idea of where they stand. This form may be filled out after an employee’s probation period, which is usually after 90 days from the time they were hired. A manager or supervisor may also complete a form every six months or yearly. This is also good when wanting to determine of the employee gets a raise or wants a different position within the organization. These can also be compared to other employees when making that determination. They may also be held in an employee’s file and compared to previous forms to see if they improved.

A Begining Of World War 1 - Free Essay Example

Sample details Pages: 1 Words: 382 Downloads: 8 Date added: 2019/05/16 Category History Essay Level High school Topics: War Essay World War 1 Essay Did you like this example? Ww1 was one of our biggest events in American history,many lives were lost during the war, the war did a lot of damage to both families and to the battlefield, the war lasted for about 4 years. The war actually ended up starting after Archduke Franz Ferdinand of Austria, Heir and his wife Sophie was shot to death on June 28, 1914, this event was the beginning of the first world war. The war was virtually unpredicted in the slaughter, carnage and destruction World War 1 was one of the great watershed of the 20th century political history. It led to the fall of four great imperial dynasties in Germany, Russia, Austria-Hungary, and Turkey, it resulted in the Bolshevik Revolution in Russia, and in its destabilization of European society, laid the groundwork for World War 2. Don’t waste time! Our writers will create an original "A Begining Of World War 1" essay for you Create order With Serbia already much aggrandized by two balkan wars 1912-1913, Serbian nationalists turned their attention back on the idea of liberating the south slavs of Austria- Hungary. Colonel Dragutin Dimitrijevic, head of Serbias military intelligence, was also, under the Alias Apis head of the secret society Union or Death, pledged the pursuit of the pan- Serbian ambition. Believing that the Serbs cause would be served by the death of Archduke Franz Ferdinand, Heir presumptive to the empire Franz Joseph, and learning that the Archduke was about to visit the Bosnia on a tour of military inspection, Apis planned his assassination. Nikola pasic, the Serbian prime minister and the enemy of Apsi, heard of the plan and warned the austrian government of it, but his message was too cautious to be understood. At 11:15 on June 28, 1914 in the Bosnasian capital, sarajevo, Franz Ferdinand and his wife, Sophie, duchess of Hohenberg, were shot dead by a Bonsasian Serb, Gavrilo Princip. The chief of Austrio- Hungarian general staff, Franz, Graf (Count) Conrad Von Hotzendorf, and the foreign minister Leopold Graf Von Berchtold saw the crime as the occasion for measures to humiliate Serbia and so to enhance Austria- Hungarys prestiege in the Balkans. Conrad had already ( October 1913) been assured By William the second of Germanys support if Austria-Hungary should start a preventive war against Serbia. This assurance was confirmed in the week following the assassination of Archduke Franz Ferdinand, before william, on July 6, set upon an annual cruise to the North Cape of Norway.