NINR Director's Lecture - Dr. Eun-Ok Im

NINR Director's Lecture - Dr. Eun-Ok Im

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I'm Ann, Cashion I'm the Acting, Director for. Ninr. And i would like to welcome you to the ninr, director's lectures. Lectures. Bring the nation's, top scientists. To nih campus. To share their work with a transdisciplinary. Audience. These. Lectures. Are opportunities, for an exchange, of ideas across. Nursing, science and the entire, NIH, research, community, this. Is the second, lecture, for. 2019. And today's. Lecture, is being videocast. Live, and an archived, version will. Be made available on, ninr. S youtube. Channel, ninr. Strives, to accelerate, nursing science in areas, where the health needs are greatest and in, which ninr. Supported, science, can have the largest impact, our. Mission, to promote and improve the lifelong, health of individuals, families and communities across. All care settings brings science and evidence-based, health care into, people's daily lives, ninr. Supported. Research provides. Serves. A pivotal. Role integrating. Biological. And behavioral sciences. To investigate. Symptom, science wellness. Self management and. End-of-life. And palliative care a particular. Importance, to the science, of wellness is research. Addressing, sex and gender differences, health. Disparities. And social, determinants of health a theme, of today's presentation. Innovative. Technologies, play a critical, role in advancing health care nursing. Science can foster the development of, novel, culturally. Sensitive interventions. That, deliver, tailored, care and real-time health, information, to, patients, families, clinicians. And communities. Ninr. Is committed, to supporting the development, of these innovative, health technologies. To, reach diverse, and underserved, populations and. Promote. Health prevent illness. And improve, health-related quality. Of life across, the. Lifespan. Today's. Speaker dr., u. Nuke M has. Combined, the areas of wellness and technology, in her innovative, research program she. Is the Mary T Champaign, professor, and associate dean for research development and, regulatory. Affairs, at the Duke University School of Nursing it sounds like you have a lot of jobs. She's. Also a member of the Duke Cancer, Institute. Dr.. M is a pioneer. In the adoption, of internet, computer. And mobile technologies. To, address gender. And ethnic, diversity Zinn healthcare, she, has incorporated, these, approaches, into several research, topics, including, breast cancer survivorship, cancer. Pain menopausal. Symptoms, and, physical, activity. Dr.. M has served on several NIH, research, review, panels, as well as review panels for, picori and the, American Heart Association. She's, an active, mentor for early stage investigators. Which we certainly appreciate and, want to promote, dr.. M has received, numerous national, and, international. Honors including, the 2014. International. Nurse, researchers. Hall of Fame Award from the Sigma Theta tall, international. Dr.. Elms lecture, is entitled, midlife. Women's health using, technology, to enhance research, and eliminate. Disparities. After. About 30 minutes dr.. M will moderate a question-and-answer. Session. Help, me welcome dr. M. Thank. You so much for your kind, and thoughtful, introduction, that location and it is my greatest honor, and, pleasure to be here culture is colorful. Culture. Is elegant. Culture. Is in our daily life and. Culture. Is embedded, in our beliefs, and attitudes. And, culture. Is actually everywhere. So. As you can guess from these, pictures my. Research, is related. To culture, and miserably, means health I started. To work on my first research, on menopausal, symptoms because. Of my mom's menopausal, transition, although. She was obviously, in her menopausal. Transition she. Never shared, it with her own daughter who. Was a nurse I, witnessed. Her to go to the bathroom, so frequently, because, of a man regia and urinary, symptoms, but. She never. Talked. About her symptoms with, me but then I was, thinking why, she was suffering, from all, the symptoms although, these, symptoms, could be easily menís, in various, ways which, was the third point of my research program my. Answer was culture, Korean, culture, death devalues. Women's, body experience, including. Health experience. At. The same time I worked as a nurse in a special oncology, unit at Seoul National University Hospital, which. Was one of the top hospitals. In Asian countries at, the time I had. A pancreatic, cancer, patient with the bone Mehta we. Knew that he was in great pain but. He never complained, about his pain or request, to pain medication, at. The time in South Korea we are actually, using cloth diapers for, pain medication. But. We never gave cluster birth to him because we knew that he was in great pain but. One day he wanted to move to a single special, suite that, is usually, offered for the high, officials, of South Korea and. In. Other words. Room was very expensive, for, his family and we, rarely provide, the room to our layperson.

But. Since we knew that he was at, the end of his life we moved him to the city us special. Singles suite, at a time and then. Once he was moved. To the special single suite he, asked, his wife for grocery shopping, there. Once he was left alone he. Threw a big chair in the room to break the window and he, jumped, out of the 12th floor and his, body crashed, on the ground, so. As a nurse, who was in charge of him I got frustrated, and, depressed and all, the nurses are felt, the same thing and then, we had a number, of seminars and workshops to, discuss, about the case and then, our conclusion was, it, was Korean culture. Because. Of Korean, cultural beliefs and attitudes, related to pain management, and, cancer. He committed, suicide, so. That. Was the start point that I begin to work on oncology our, area, as well so, my research occasion has been on. Sorry. About. What. Gender, and ethnic, disparities, due to cultural. Influences. And. My, program of research includes. Two, branches, so, healthy mizerock women's health and cancer, survivorship. Especially. Breast cancer survivorship, and the, focus has been on gender, and ethnic disparities, due, to cultural, influences. Methodologically. I have used technology. Theoretically. I have used a situation, specific theories. Why. Technology, because, we can, easily incorporate, diversity, and complexities. By, gender, and race ethnicity while. Considering, multiple contextual. Factors using, computer, technologies. Also, we can access racial, and ethnic minorities, across the, nation, without, time or geographical. Limitations. Why. Is situation, specific theories maybe, are, those not in Nursing, does not know about this, specific, type of theories, briefly. Speaking in nursing, we had three, major types, of our theories grand. Theories, mid-range theories. And situation. Specific theories so. When I was conducting my doctoral, dissertation, there was no situation specific, Theory, situation. Specific, theories focus, on specific, phenomenon, there are limited, to a special, population, or a particular, field, of practice. But. Uh so. When I was doing my doctoral. Dissertation I, used, the middle range theory, of transition. But, I had, many difficulties, in, using the theory because, I, needed, a specificity, to. Explain my phenomenon. And my population, of Korean. Immigrant, women in their, menopausal transition. So. I proposed, a situation, specific, theory as the, first, there's. A new type of theory with, my doctoral dissertation chair, dr., families. Who, was a former dean Lu pan then, it became actually one of the major theories, in nursing by the liberal wealthtrack, so, if you do a google search you can find a number of articles. And a number of websites, related to. Situations respect, theories in these days. And. This was the first refereed, journal article, or situation, specific theories there, was published, in 1999. And. This. Picture shows my, research, journey, through, over 50 funded studies, including. Tory studies, as P I I, studied. My, research program from, my master's, thesis on. Menopausal. Symptoms, of, Korean, women in South Korea, then. Through. My doctoral dissertation I, extended. The population. To, Korean immigrant, women in the US then. At the completion of doctoral dissertation, because. Of my clinical, experience with. The cancer patient, that I mentioned, I deterred. My area, to include areas, in a way through, six pilot studies. Then. At the completion of six. Pilot studies I. My. First arrow and then, I have funded by the ninr, the. First. Terrorist study, was about, development. Of a decision, support system for. Cancer pain management that. Considers, gender, and ethnic differences in, cancer, pain and at, the time we, didn't know that we are using machine, learning method. But actually, reused, machine. Learning method. Using. The fuzzy logic and genetic, algorithms, the, reason that we didn't know it was because, there is no Tom of machine, learning at the time and then.

After Completion of the, first. Our own study I conducted. Three, pilot, studies, related. To ethnic. Differences, in menopausal, symptoms and, physical. Activity, so, actually, I it was a direct extension of my doctoral dissertation so. As I mentioned, I had two branches, of research going on and then. I got lucky to get my second arrow and study on ethnic, differences, in menopausal. Symptoms among. Four major racial. And ethnic groups of midlife, women in, the u.s. so, this was actually linked, to my lecture dissertation. Then. I got lucky to get my third our own study, funded which, was about, ethnic. Differences, in miserable women's attitude. Toward, physical, activity, so, at the time I was thinking about using. Physical activity, promotion for. Management of menopausal, symptoms and, enhancement. Of breast cancer survivorship. Then. I had a really, a landmark, moment because. At the completion of the third era studies, I was, thinking about two, directions. To go one was intervention. Studies because. I already have all the data about, gender, and ethnic differences, then, I feel like I should, move forward to help people using. The data but, at the same time I was also more interested. In gender and ethnic differences using. Genetic, factors and at the time my program. Officer at the NIH which. Is actually, a doctor, eben, Brian she, gave a really, wise and. Great, otherwise for me she actually pushed, me a little bit to move to the behavioral, intervention, studies so, I changed, it actually, they told my direction of research to, intervention, studies, after, that so, to. Change. To. The intervention, studies I needed, of course more. Parallel, studies, so, I have conducted six, pilot, grant studies, about. Technology, based interventions. Then, I stopped my, first our own application. Then I got funded, for my fourth, our own study to. Test efficacy. Of a, technology-based coaching. And support program, for Asian, American breast cancer survivors. So. Going back to my first Iran study this. Study aim to identify gender. And ethnic differences in, cancer pain experience, among, four major. Racial and ethnic groups of cancer patient, and developed. For decision, support system, using, machine learning method. So, of course my, experience, with a cancer, patient that I mentioned, at the beginning was. Actually. Motivation. For this study. And. Actually. The literature, was also clear that the situation, of cancer, patients in the u.s. especially, ethnic. Minority, cancer patients, was, not positive, as well the, literature, said over, 50% of, cancer, patients having. Antistick, cancer, treatment and two-thirds. Of those with, advanced, metastatic cancer. Report pain and I, think minorities, are more likely, to experience only lived cancer, pain so, definitely, as in minority, cancer patients, need help so, I collected the data first, to identify the, racial. And ethnic differences and move, toward the decision, support system. And. The findings, indicated, a statistically. Significant, differences, in cancer, pain experienced by, race and ethnicity, but. Not by gender and, at, the time Lyra was known about gender and, differences, in case of pain so. I intentionally, included, multiple, instruments. To, confirm, the Arkansas, pain measurement, and across. The instruments. I found, statistically. Significant. Differences, as you can see, here. And. Also I try to identify, significant. Factors influencing, cancer pain and as. You can see across the instrument, less than ethnicity, or just significant, factor, influencing, cancer, pain. And. We all studied across town delicious by cancer pain experience, and we considered our symptoms, pain. And, functional. Status and as, you can see we had a low, pain. And, moderate, pain and severe, pain clusters. And interestingly. We. Found, significant. Racial and ethnic, differences only. In the moderate, and severe, pain, grow. The. Qualitative, findings also. Supported, commonalities. And differences among. Ethnic, groups so, across the racial and ethnic, group all the, patients, talk about communication. Breakdown, with, their health care providers. During. Their cancer pain management and all, the participants. Also, reported. Changes in, their perspective after the, diagnosis, of cancer and, they, wanted, to live to the fullest, and although. The quantitative, findings indicated. No, gender, difference, the Collett area finding, strongly, support, gender, differences, in cancer, pain experience, for. Instance across. The leisure and ethnic, groups women, thought their, pain tended. To be easily ignored, by, health care providers and family, members. Differences. Why, patients.

Try To control, their pain as passive as they could the ethnic minorities, try to minimize, their, pain and try, to be stoic and, why, patient, try to use diverse, strategies. Including. The. Complementary. And alternative medicine, but. Ethnic minorities, try, to normalize their, pain. Because. They, feel like pain is natural, when they have cancer, and white. Asians perceived, their pain experience, as highly, individualized. Experience, ethnic. Minorities, thought pain, experience, was, family-orientated. Experience, so, most of them included, their family, members, in cancer, pain management and they, tried to be stoic because, they, didn't want their, family, members worried about them. And. The, uniqueness of, this study is. This. Was one of the first internet-based, studies. So. I, needed, to go through so many challenges and, practical, issues that. I never expected because, I was the first, one and my Institute. So. For instance when, I submit, that I'll be a proposal. I needed. To attend, for, IRB. Board. Meeting actually, I wouldn't, expect that for the internet so they were, online forums in these days but at the time everybody, was worried, because we. Don't know what, will be the impact of using the internet in there a collection process, and also, we had many practical. Issues involved, there so, he published, many of the, methodological, articles. Related. To our internet research methodology. And this, was one of the first papers on issues. In protection, of human subjects, in internet. Research and we. Also had as I mentioned, multiple. Methodology. Papers, related. To internal research methodology. Here. And here. And. Also I, had 22. Publication. From this study including. The two. Major papers, on the quantitative. And qualitative findings and. We. Also had ethnic, specific finding, papers and, these. Papers, on the ethnic specific findings, became. The basis, for cultural, tailoring, rather, in the intervention development and, also, we had a paper on decision, support, system as well. And. We also developed, out to situation, specific theories based on this study and these became, the audiological. Basis, for, later in, and development. My. Stake on our own study is about ethnic. Differences, in menopausal, symptoms among, four major racial. And ethnic groups of midlife women in, the US and as, I, mentioned, it was a direct, extension, of my doctoral, dissertation and.

Other. Our prior studies, that I have conducted. And. At. A time in the literature, there, was a growing, challenge to, universality. Or menopausal, symptoms and, most. Scenarios, about menopausal. Symptoms still. Came from studies. Of white women, so. Through, using the internet as a data collection medium, I try. To identify, racial. And ethnic differences using, a national, approach. With, an H K number of racial. And ethnic minority, women, and. As. You can see we found significant. Differences in the prevalence of, 48. Symptoms. The miserable women, experience, during, their menopausal, transition. I just, think loaded, about, 10 symptoms, here, but. We, intentionally included. A wide range, of symptoms because. At the time little, was known about, racial. And ethnic differences in, menopausal symptoms in, the literature. And. We also found, significant. Differences in, the severity, scores, of, menopausal. Symptoms by, race and SSK. And. We also try, to identify our. Significant. Factors, influencing. The total, numbers, of menopausal. Symptoms in, each racial and ethnic group and as. You can see there are differences, in significant. Factors, are by race and ethnicity and, we. Intentionally. Stacked, the factors. That we enter into the matter from the current literature of menopausal, symptoms, although. I didn't, include. The. R squared or square see here but the RS square score was, highest, among, white, women which. Means actually, the factors from the literature, reflect. White women's monopolist, symptom experience, better, than. Or other leisure and ethnic Grossman, approaches symptoms. And. We found out very similar findings, on the significant, factors influencing. The tourist, ability, scores of menopausal, symptoms and of. Course, our. Scale score was. The highest, among white women. And. Also we did the closet analysis, and we found three, distinct. Clusters. Low. Symptom, group moderate income group and highest income group interestingly. We, found, significant. Racial and ethnic, differences, only. In the lowest income group which, was contrast. To the cancer pain study where, we found, significant.

Racial And ethnic. Differences only, in the moderate and severe pain and. I. Suspect that the. Difference, came from the differences, in the condition, so, in the Arkansas pain study we, study the, life threatening, condition, and here. We studied, the Newmar development. Our condition, so this needs to be a further study though, and. We all studied the path analysis, and here, the solid line means significant. Association, that, it align means non significant. Association. And as, you can see there are differences in the past and. Demography. Indexes. Were all satisfactory, inform. Others but. Actually the scared, multiple, correlation was, the highest, among. The white women which means the matter works better for, white women. Culturally. Findings, also supported, commonalities. And differences among, ethnic, groups so across the leisure and ethnic group although, women, told me, no further symptoms are, just a part of their life they are so they try to be optimistic but. They need more information and differences. Why, women, try to be open about their menopausal symptoms, ethnic. Minorities. Try, to tend. To be closed, about. Their menopausal symptoms, and. White, women perceived, menopause, a symptom experience, as a universal. Experience there, although women, experience, in the same way personal. Mile route is perceived. With a symptom experience, as unique, due, to their unique cultural, attitudes, and Billups and, also, our white women try to control, their symptoms, as possible, as they could but, ethnic. Minorities. Try, to minimize, their symptoms, while, expecting. That their symptoms would, eventually. Go, away because, this is numa aging, process, so. We, had 22. Or 24, puffs from the study including, the two major papers, and an. Especially, finding. Papers, and these. Ethnic, specific, findings, also became, the basis. For a radar cultural, tailoring, in our. Intervention, development. And. This. Study was specifically. Mentioned, in the famous, women's. Self-help, book. Called, our bodies, in our steps, by, the Boston women's health or collective. And as, a feminist, researcher, it was a quite, an honor to, be highlighted. In the book because, the book is actually being used by, women themselves for. Information. On their health. And. Also this study was cited, by the American, Psychological Association. But. Page on mapping. Menopause, and my. Paulo study was also mentioned there. And. Since. This was also one of the only internet-based, studies. I had me, on multiple. Methodologies. Related. To the internal research, methodology. And. We, developed, a situation, specific theory of Asian, immigrant, woman's menopausal, symptoms experience, in the US and this, became the author ethical, basis for later intervention. Development. And. My third our own study was about ethnic, differences, in madera pyramids, attitude. For the physical, activity, as I mentioned, I was thinking about using physical, activity, promotion for, management of menopausal, symptoms and, enhancement. Of cancer. Survivorship, and the. Literature, was actually, clear that Midwife as. Human, eye increased. Risk of chronic diseases, partially. Due to such, high. Inaccurate. Rates, so. Many, researchers, are actually, developed, the intervention to, increase their, physical, activity but, they have failed, one.

Reason May be that the intervention, have not been designed with women's, values, and beliefs related. To physical activity in mind and really. Incorporate women's, cultural, attitudes, in the intervention so. I thought maybe, figuring, out estimate differences in, women's, cultural, attitude, should. Be done as the, first step of development, of the intervention, for them. And. We found statistically. Significant, differences, in the perceived, barriers, self-efficacy. Cultural. Attitudes, and occupational. Physical activity. By race and ethnicity. And. Also, I try to identify, significant. Factors influencing, physical activity, as, you can see there are differences in the significant, factors but, I didn't, find any clear, pattern, that we found in demented a symptom study. And. Also. We did close tunnel issues and we, identified. Our three distinct, clusters and, on, unique, cluster, among miserable women compared. With other age group was the high household. Caregiving. And occupational. Activity, group interests. Me in the tulle bottom groups, we found significant. Racial, and ethnic differences but. Not in the top group with a high household. Caregiving. And occupational, activity, their. Activities, were actually, strongly. Correlated. With, socioeconomic, status. Rather, than race or. Ethnicity. And. Also our we did the pest analysis, and we try to identify how. Multiple. Factors influence physical activity, scores in each racial and ethnic group as you, can see there are differences. There but, all the modified, indexes, was the respective across, the groups and we. Didn't find any clear, pattern, that we found in the menopause study. Qualitative. Findings also. Supported. Commonalities. And differences among. Ethnic, groups so, across the leisure and a circle, although women, toughest collectively is ago for their health but they are not as active as they could because of their busy schedules, and from. Their childhood a, physical activity was not increased to them because, of their gender and, but. They wanted, to increase their physical activity because. Their. Family, history, of chronic, diseases such as diabetes stroke. And heart diseases and, all. Of them talked about lack of accessibility, to physical activity because. Of dangerous. Neighborhood. Or. No, exercise, of exercise, facilities. Near their home. Differences. Why. Women, perceived physical, activity, as a necessity, in, their daily life, ethnic. Minorities, perceived, physical, activity, as a luxury, so, could they have a time or, money they. Would not do physical activity, later they would do something else for other family, members and. White women preferred, organized, physical, activity, such, as yoga, sessions, or aerobic, exercise, ethnic. Minorities, preferred, natural, physical activity, such, as walking or, learning, and, why, women perceive the physical activity, experience, as individualized. The experience, as the, minorities. Tend to perceive, physical. Activity, experience, as family oriented, experience, so, if a day on earth Oh physical activity they, wanna do it with their family, members and, interestingly. White, women, and Asian women, wanted. To increase their physical activity for. Their beauty idea. So-called slim, body but. African American, and Hispanic, women only, to their own physical, activity just, for their health, while. Perceiving. Out their coverages, body is culturally. Acceptable, by the appearance, so. We actually used, these cultural, examples, as the basis, for our physical, activity, promotion program. Later. And. We had 22, publication. For this study. As. In, other studies, we had the two main papers, and, multiple. Ethnic, specific, finding. Papers, and. Again. As these specific findings were, used for, cultural, tailoring, later. And. This. Study was specifically. Mentioned, in the famous, I should. Say famous right, bonds and groves our nursing research textbook. And she. Also mentioned, me as a nurse, leader in internet, research at the time and. Then. We had the two situation, specific theories from this study and these theories, became, that your ethical basis, for later intervention. Development. And. During, the same time my theoretical works, begin, to recognized. By the community so, I was, highlighted. In the unearthing. Theory books nursing, theories honors and blogs and, media. Out there. Then. There was a question, on how can, I incorporate all, these findings, on leisure and ethnic differences and contextual. Factors, for healthcare. My. Answer, was of course technology-based the intervention. Why. Because, we can easily incorporate diversity, and complexities. In leisure and ethnic minority, women's health using, computer, technologies. And we can reach, racial, and ethnic minorities, living, across the nation, through the internet, technologies. And we, can provide, 24-hour. Access to the intervention across. Time and geographical. Areas, using, the Internet and also, we can overcome cultural, stigma, and cultural, headstones, using.

Non Face-to-face. Interactions. So. You. May remember my first Darwin study so, based, on the first hour one study on cancer, pain experienced, in the, situation-specific theory, we, developed, a culturally, tailored internet, cancer support group, for asian, american, breast cancer survivors, and then, we pilot, tested and, we, stormy rate for, our own grant, and then we go fund a for this study. And. Among, the are four, major leisure and ethnic groups that we included in the first town hall study we, specifically. Chose asian, american breast cancer survivors, because. They have a higher relative. Risk and lower five, years, above all AIDS and they, really, complain, about their symptoms delay. Seeking help and start, on a score get support and they, report, a lower quality, of life and fewer, sources. Of information and, support. Compared, with white. So. Those studies actually, are, still going once I cannot share the findings, yet, but I can always share the website, so. If for you go to the website you'll see the picture. Of beautiful. Asian women there and yura c5, language, selections. Because, we, specifically, chose three so birth Nichols of Asian Americans, including. Chinese, Korean. And Japanese. We. Use the five major languages. Among, those. Groups and then. Other website, includes all the information, in five different, languages, which, was possible. Because, of the computer technologies. And then. The website provides, the information on the study and informed, consent state, and project. Team information, then. Actually, being everything if you are interested. In joining the group then, you will be given five language, selections, again, and then, when you click one language you, are connected, to the redcap system in that specific language and then. You will be screened against. The inclusion, criteria and. For. Our requirement, at a time and when. You successfully. Goes to it you, will be connected, to the pretest, questionnaire. Then, at the completion of the pretest, questionnaire. You are automatically, randomized. Into intervention. And control, group, and. Because. The program, is still includes, the patient there are I cannot, share, the. Program itself, but briefly, speaking we, include, 15 educational. Modules, related, to, breast cancer survivorship. With, the some ethnic, specific, examples, from previous, studies, and we, also include, 85. On. And resources, related, to breast cancer there, are general in an ethnic specific, and we have, three, ethnic, specific, social, media, sites through, age group, and individual, coaching is being conducted. And. The. Program. Is actually available in, mobile apps mobile. Versions. And tablet. Versions and these, shows, the screenshots, of mobile. Buttons so, as you can see here and here the, basically, same information, in five, different languages. And. All. The participants of this study really, appreciate. All the support and, information that, we are providing, and also. The preliminary. Findings indicated. Positive. Changes, in their outcome, variables. And. This study was highlighted. In the NBC, News. And. Also, we had for, publication. From the studies of our and most of them are actually methodological, papers. And. During, the same time I was invited, as, keynote speakers, for international. Conferences, because of a research and. Theoretical. Walks that I have been doing. So. What's next, you. May remember my second era one and third our own study, I, developed. I mean based on those, two our own studies, and related, situation, specific theories we, developed, our technology. Based physical, activity, promotion, program, to, improvement. For the symptoms, among Asian Americans and. Also. We developed, culturally. Tailored web-based. The physical activity, promotion program, to, decrease, depressive. Symptoms, of asian-american. Miserable, women and then, we pilot tested post. Of them and we submitted, our ones so we, have a two other ones currently pending based. On the second and third our own studies, and. During. The same time we published, our several, methodology, a paper related. Web. Based intervention and, culturally. Tailored the technology, based interventions. And. Also. We have been accepted, to the Sprint program, by the see I they, could help refine, and commercialize, our technology-based the program, and so. We are hoping to translate, the findings from. The current study and, disseminate. This intervention, for, a larger, group of leisure. And ethnic minority, breast cancer, survivors, we. Are also thinking about, commercializing. Through SBIR, and, STTR, opportunities. So. As you can guess my journey, is still going on and to. Conclude this lecture I wanna thank you too many people including all, my, research, participants.

Or My. Research team members, all. My, mentors, and collaborators. And, all. My funders, especially. My biggest funder, ni and I thank. You so much. Hi. There, um it, was a wonderful, lecture first of all I really really enjoyed it as. A student, right now I guess. My question was. Just thinking about the technology, and. I. See. That you're using technology, to kind of, send. Out, translations. For the language to bring. In more participants. In your research. What. Was the process that you needed to go through in terms of like. I arby's, like, how how. Is that like viewed, I guess. Institution. By institution and. As we're. Thinking about research, ourselves and, thinking. About where. We. Go like I'm. Just, trying to understand, the the process, and like where you would start and, if you're, gonna bring in a technology based something. To. Help you with that research, like. You. Know could you go over that process a little bit more well. When. I was studying, my, technology, based intervention. I mean the technology base the Internet today first, actually. There was nobody around me, especially, his, crew of Nursing, I was, the first one and then, when I move about 20, front university the situation was actually, same so. My strategy, was involving, the engineering. Team who knows the technology very, well so. I, just kind of consult, with them with my ideas, first and then, they have to. Go through the process and, since. I was the first one in terms of internal research there, was a tons, of issues to deal with but in these days you should be fine because, everybody. Knows about those, issues and we, became, more flexible. And more, generous. For the Internet research actually, so. For, instance as I mentioned, when I first, started. My internet research I should, go to the full board. Meeting so. They are asking tons of questions about what, would be done in pair of Internet they're a collection, master, or something like that but, nowadays with. The new common, rule changes, this, will be just exam, study so. Don't get scared because of what I talk I. Thank. You for your talk um I'm, Pamela Thomas I'm training director here at ninr, and I, saw your slide listing, all your collaborators. And mentors can. You and, because I'm interested in career developing good career development can, you give advice for. Students. And postdocs, on finding. Mentors like, what are the some of the first steps how do you find a good mentor and what what characteristics, do you look for Oh, actually. My. Mentors, are naturally, capone's I was kind of very lucky to have them so, whenever I have a new idea I thought, with my dissertation, chair, first, when I was studying my own research and she, connected, me to other people in, the area and then, whenever I reach, it out they are very cooperative and, very generous, to share their. Times and everything and my, strategy was, are targeting, the person, in that specific area so, I try to include I mean it's. Kind of Asian heritage, we would go and say I wanna learn from you then, usually. The mentors are very generous. To, share their time and brain. With, me. Hello. I monopolist. I loved. Your presentation it, was really interesting, and I know there wasn't a lot of time and, I, felt like the cultural. Factors, and the differences, between groups on, their. Views of how they might manage your symptoms differed. Obviously. But we can get into them very much but, from your perspective having, done this for a number of years how, much do you feel these interventions, have to be tailored for specific groups, and how much is generalizable. Across. Underserved. Groups, yeah, there, was actually, postmodern. Dilemma, for me because, I feel, like we. Should have some, specificity, but at the same time we should have of generalizability. So. Krong - my strategy is, just to choosing, several, specific ethnic. Group and try to incorporate. The cultural factors, related. To that specific growth, so that means I have a specificity, but, at the same time I could kind, of generalize. To, several groups at the same time. Can. You speak a little bit to what, works you could generalize, which groups can you lump together based, on your research, and what would a, little. Bit more thank, you so much for the question. For. Instance among Asian, Americans there. Are over 81. The. Leisure and ethnic, groups there and then, I lump the East Asian. Groups together that's, why I included, our Chinese, Korean. And Japanese as, a one group so a least I could kind of generalize, the findings, among them because. Their culture is basically, based, on very similar background, like Buddhism, Confucianism. So, like, that way I usually do that and in, terms of a cultural, tailoring, I used specific. Findings, for. The deep, cultural, tailoring, but, photos, papi shared cultural, tailoring, I adapted, the multiple, language versions, and I, try to have specific. Resources. In each ethnic, group. I. Thank. You for the great presentation.

I As a Korean myself. And, someone, who's interested in health disparities, across. Ethnic. Minorities, including, including, Asian Americans I find, your presence I, find, your research is very interesting, my question is about. So. You have looked at agent. He's American Asian. Immigrants. Yeah. And I wonder if you took. Into consideration the. Degree to which. Asian. Americans. Simulated. Into, American, culture American life, in. Other words I guess I'm wondering if someone. Who's been. Born and raised in the States, Asian, American would feel that the. Same way. Well. Actually, there, are generational. Differences, and actually. There is, differences. By immigration. Generation, as well so, basically, in, my cultural, tailoring, studies we, include, all of them regardless, of their generation, but. In the data analysis process we. Actually counted. That as a one factor to try to see. The differences, like that and we. Didn't find any significant, differences. But. Thank you. So, I, just, another one follow-up on that in since. You're using Internet. To. Recruit. And. To. Get the data and, that. To me says that people globally. Could, respond, to your, study, are you finding, that to be the case or do you not. Include those, outside, of the US or how are you handling that that's, an excellent question actually because we. Intended, include, only those in the US because, we, cannot pay the, study reimbursement. For those outside the US but, what happened it was actually, I mean. The those in Canada. Where were those in Mexico or, those in Asian, countries. Like they're eligible, so, actually they came and filled out the questionnaire so. At the time of reimbursement, we got shocked so we got all the international, people here and how to deal with it so we need to individually. Contact them and say this is a US study now, for the outside the u.s. to study and then, we, put a lead, font, 810, tents on our project, website saying. We. Are in for the only tools in the US so. I mean, whenever we had an issue we need to put one more sentence, in red font and one more sentence in that font like that but, absolutely. Right because they, wanna actually, participate, in the study. I'm. Interested. In hearing a little more about your theories. Because, you said there weren't situation, specific, theories, when. You started, there. Are certainly lots of systems theories, there have been social. Interactions and other kind of things did you draw on were there things for you to draw on or you know how new was it what fields, were particularly helpful or. Relevant. To what you were trying. To do. Because. Those. Are not in nursing, may not know these are specific types of theories, because. I. Don't, know it may be it's kind of a nurse's nature, we try to categorize. Systematically. So, that happen in nursing, throughout the nursing history so. At first nurses. Tried to develop grand, theories, about. The nature and, missions, and goals of, Nursing, so they tend to be very broad, and they. Cannot be easily used in research, or practice, because, of the I, mean higher, level, of abstract, and then. Mid-range, theories, are more have more less self track so. That may be related, kind, of similar to the system theory outside. The nursing, or some, the. Theories that we are usually using in our research, but. What happened was when I did my. Research with, the mid range theory of transition. I needed. The most aspects, of concept, under, the major, concept, of Theory like, there, is a nature, of transition. Then, that is a concept, in the theory but what I need was more specificity, like. It, is a development, third transition. And you could be situational. Transitions, like that so, I tried, to most, specify. The theory, so, that became, the situation. Specific theories but, in I. Mean. Currently. In yeah in our literature, world actually we are developing the. Situation, specific, theories from the nurses, perspective. But we label it differently, I don't. Know if I answer your. Correctly. And we just have a few more minutes that, we could kind, of have two more questions okay. Thank you really. Appreciate the very wonderful, presentation. So, I saw you had. A lot. Of like a symptom, clustering. Thing in. Almost, every, of this for our studies. So. Particularly. Some symptoms, try, to cluster. Differently. Among, different the ratio and ethnicity. Groups, so. I wonder, have you tried, to explore, this, in further, why. This. Thing goes in. The different the clustering, so that, you. Can understand. More these.

Minority. People tend to have a different like. A symptom expression. Thanks. For the question actually, that's why I was, you know has done about two, directions, to go after, the completion of the third arrow and study I was, really, interested in, see those differences, using. Genetic, factors at the time but. That was the point the NIH, had, financial. Issues you may remember those years, so, I was, thinking, maybe are more, practical studies. Or to work better than, just to go defer for the racial and ethnic differences but I am still interested, in that thank. You. Dr.. M thank you so much for your a terrific presentation and, I also appreciate, your. Contribution. On studying. Underserved. Minority population. Especially Asian Americans, and, based. On your work, throughout. Maybe. Two decades or so I'm. Especially interested in, research in cancer survivors, but based on your research, what do you think is the most needed, future, area that you want to focus for Asian cancer survivors, well. Currently. I, feel, like there should be can other pain, and symptom, management because. Those who are without, pain, and symptoms, actually they. Don't need much support, so, I feel like there, may be the more our focus, the area that I should go for in the future and do you plan, to use technology. To do that yeah of course because, I am at Duke it's. In North, Carolina, one. Local area I couldn't find many my research. Participants, so, I try to across, the nation. To. Recruit. The participants, thank you. Thank. You very, much we, appreciate, you, presenting, here today and Ellis demonstrating. How nursing science is, really. Providing. Insight, and. And. Opportunities. To look at innovation, in patient centered care and. As. A small, gesture, of our, appreciation. To you here, coming, here today and presenting, this lecture, I would like to give you. And. It actually says, that we. Recognized, with grateful, appreciation. Who knew Kim M. For. The ninr director's lecture, on April the 25th thank, you.

2019-05-02 00:31

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