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Biomedical subjects

B R Ferrell

Publications and source records attributed to B R Ferrell.

At least 37 records · Page 2Linked to original sources
PubMed1997

Nurses' knowledge of pain assessment and management: how much progress have we made?

Undertreatment of pain and lack of knowledge about pain management have been evident for approximately two decades. Because nurses are often the cornerstone of pain management, nurses' knowledge in this area is especially important. This paper explores indications of progress in the level of nursing knowledge about basic aspects of pain management. The literature is reviewed and findings from recent (1995) surveys of nurses' knowledge are compared with results of similar surveys conducted beginning in 1988. Improvements in nurses' knowledge of pain assessment, opioid dosing, and likelihood of addiction seem to have occurred. However, knowledge deficits continue. Fewer than one-half of the nurses surveyed understand that the patient's self report of pain is the single most reliable indicator of pain and that the nurse should increase a previously safe but ineffective dose of opioid. Findings from surveys on addiction reveal that the longer the patient receives opioids the more concerned nurses become about causing addiction. Nevertheless, results of current knowledge surveys of nurses suggest that educational efforts probably have been beneficial and should continue. To maximize the impact of educational efforts, content in basic and continuing education courses should be prioritized and critically evaluated for relevance and accuracy, especially content related to addiction. Early in the education of nurses, responsibility for pain assessment and use of analgesics must be instilled.

Evaluation Studies as Topic↗
PubMed1997

Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy.

Quality of life (QOL) is an important consideration as patients survive longer with cancer and is an area of increasing interest in patients with thyroid cancer who undergo long-term cancer surveillance. However, there are few disease-specific QOL tools available to evaluate QOL in patients with thyroid cancer. The purposes of this longitudinal, repeated-measures study were to: (1) test a new instrument, the QOL-Thyroid Scale, during thyroid hormone withdrawal; and (2) to evaluate the impact of thyroid hormone withdrawal on patients' perceived changes in quality of life. The sample included 34 subjects (mean age 40 years) undergoing thyroid hormone withdrawal in preparation for scanning procedures. Subjects completed three instruments (demographic data tool, the QOL-Thyroid, and the FACT-G) at four specific time points in relationship to scanning. The results demonstrated that the QOL-Thyroid tool is a reliable and valid measure of QOL. Cronbach's alpha coefficient of r = .78 between QOL-Thyroid and FACT-G indicated good concurrent validity. Second, the impact of thyroid hormone withdrawal on QOL showed significant changes in physical, psychological, and social well-being across the four testing points. The greatest changes occurred between peak hormone withdrawal and thyroxine (T4) therapy. While it is generally known that patients suffer troublesome physical symptoms relating to thyroid hormone withdrawal, the negative psychological, family, and work sequelae are less apparent. In conclusion, the QOL-Thyroid is a reliable and valid measure for use in evaluating patients undergoing scanning procedures and may be used to identify and target teaching and support for high-risk areas in patients lives that are negatively affected by hormone withdrawal.

Adult↗
PubMed1997

Nurses' knowledge about equianalgesia and opioid dosing.

Nurses are recognized as the cornerstone of palliative care. Yet, surveys of nurses' knowledge of cancer pain management reveal serious knowledge deficits that could adversely affect the care of patients with cancer pain. Previous research has explored basic pain management issues such as pain assessment and myths and misconceptions surrounding pain, and principles of analgesic use. Advances in recent years have increased the demand for continuing education that will extend scientific advances in pain to clinical practice. The purpose of this article is to share results from a study which evaluated nurses knowledge regarding three methods of analgesic delivery that have become common in clinical practice: intravenous morphine, extended release morphine, and transdermal fentanyl. Several resources are provided to assist clinicians in the appropriate use of these analgesic methods.

Administration, Cutaneous↗
PubMed1997

Quality of life in breast cancer. Part I: Physical and social well-being.

Almost 2 million breast cancer survivors reside in the United States. An increase in consumer advocacy and media attention to this disease has helped bring breast cancer survivorship to the forefront of public attention. This has led to increased attention on quality of life (QOL) issues for these survivors of breast cancer. This two-part article presents the results of a qualitative, descriptive study evaluating the QOL of 21 breast cancer survivors. This study is based on our conceptual model of QOL including physical, psychological, social, and spiritual well-being. Part I of this article describes the impact of breast cancer on the physical and social domains of QOL based on in-depth interviews with breast cancer survivors.

Breast Neoplasms↗
PubMed1997

Quality of life in women with ovarian cancer.

Despite growing interest in quality of life (QOL) as an important variable in nursing and health care, little research focuses on QOL in women with ovarian cancer (OVCA). The purpose of this study was to examine QOL in OVCA survivors. The convenience sample consisted of 152 women in all disease stages. Quantitative data were collected using the QOL-Cancer Survivors tool and a demographic sheet. Qualitative data were collected by asking participants to write their definitions and experiences of QOL since their diagnosis. Reliability and validity of all data and findings were established. Findings reveal that QOL is moderately high for this group of cancer survivors, despite some specific negative facets of the illness and treatment experience. Qualitative analysis elaborates the four domains of Ferrell's QOL model: physical, psychological, social, and spiritual well-being. Qualitative data also reflect the complexity of the cancer experience.

Adult↗
PubMed1996

An evaluation of the quality of life among long-term survivors of breast cancer.

UNLABELLED: Attention to the quality of life (QOL) among long-term of breast cancer is long overdue. Modest improvements in overall survival have led to a greater emphasis on how women are living with the disease. The purpose of this paper is to report the results of a descriptive study that evaluated the quality of life of 294 breast cancer survivors, and to review the continuum of positive and negative QOL outcomes in this population. Members of the National Coalition for Cancer Survivorship (NCCS) were surveyed and received two QOL instruments: the Quality of Life-Cancer Survivors Tool (QOL-CS) and the Functional Assessment of Cancer Therapy (FACT-G), and a demographic data tool. The main research variables were the subscales (Physical, Psychological, Social, and Spiritual Well-being) and individual items of the QOL-CS and the FACT-G. Results indicated that: a) fatigue, aches and pains, and sleep problems were persistent after treatment ended; b) psychological distress from cancer diagnosis and treatment, and fear of recurrent, metastatic, and recurrent disease were problematic over time; c) family distress, sexuality, and family burden issues were of greatest social concern; and d) uncertainty over the future plagued breast cancer survivors long-term. Breast cancer survivors also reported good outcomes in hopefulness, having a life purpose, and having a positive change after the treatment. CONCLUSIONS: breast cancer survivors experienced long-term changes after completion of treatment which affected overall quality of life. However, many positive benefits were also gained which helped to balance the worse outcomes.

Adult↗
PubMed1996

Informed consent: process and clinical issues.

PURPOSE/OBJECTIVES: To review the issues related to informed consent in a clinical cancer care setting and suggest strategies to improve the informed consent process. DATA SOURCES: Published books, journal articles, and clinical research experience. DATA SYNTHESIS: Clinicians and researchers are ethically obligated to maintain the informed consent process when treating participants in clinical cancer research. Nurse clinicians, clinical trial nurses, and nurse researchers often encounter dilemmas while ensuring proper informed consent. Nurses involved in pediatric cancer care must address specific consent issues relevant to children and youth. CONCLUSIONS: Informed consent does not end with a patient's signature on a form. Establishing and maintaining informed consent is a multidisciplinary effort in cancer clinical trials. Nurses can improve the informed consent process by ensuring adequate time for patient consideration and understanding and by reassessing consent during the study. IMPLICATIONS FOR NURSING PRACTICE: Clinical trial nurses and nurse investigators in both adult and pediatric oncology have a duty and obligation to maintain continued informed consent throughout a study and to be involved in all aspects of study planning and implementation.

Adolescent↗
PubMed1996

Family and caregiver involvement in pain management.

Pain management is a common concern of elderly patients with chronic cancer pain as well as many nonmalignant chronic illnesses. Family caregivers are central to pain management efforts, particularly in the home-care environment. Pain management is cited as an aspect of caregiving with both physical and emotional demands. Comfort for elderly patients in pain is enhanced by support from family caregivers. Education is necessary to dispel common misconceptions regarding pain and use of analgesics, and also to address the emotional aspects of relieving pain. This family education must be preceded by the education of professionals in geriatric care and to the extension of recent advances in pain management into the geriatric population. These advances can provide comfort to elderly patients as well as to the family members who care for them.

Aged↗
PubMed1996

Ethical issues in pain management.

The elderly are a vulnerable group and many will face several chronic illnesses, with cancer being likely among them. Each year approximately one million elderly are abused, with the most vulnerable being those who rely on family members for their care. Humphrey stated that old age "is sufficient cause to give up" even when the individual is not suffering. Humphrey's statement exemplifies how much our society has come to devalue the elderly. Opponents of euthanasia and assisted suicide as alternatives to effective palliative care contend that we are degrading not only the sanctity of life for the elderly, but we are also undermining the goals of medicine.

Aged↗
PubMed1995

Measurement of the quality of life in cancer survivors.

A QOL instrument was developed to measure the specific concerns of long term cancer survivors. The QOL-CS is based on previous versions of the QOL instrument developed by researchers at the City of Hope National Medical Centre (Grant, Padilla, and Ferrell). This instrument was revised over a one year pilot by Hassey-Dow and Ferrell. The revised instrument included 41 items representing the four domains of quality of life incorporating physical, psychological, social, and spiritual well being. The present study was conducted as a mail survey to the membership (n = 1,200) of the National Coalition for Cancer Survivorship with 686 subjects responding to the survey. This survey included a Demographic tool, QOL-CS and the FACT-G tool developed by Cella. Psychometric analysis, performed on 686 respondents, included measures of reliability and validity. Two measures of reliability included test-retest and internal consistency. The overall QOL-CS tool test-retest reliability was 0.89 with subscales of Physical r = 0.88, Psychological r = 0.88, Social r = 0.81, and Spiritual, r = 0.90. The second measure of reliability was computation of internal consistency using Cronbach's alpha coefficient as a measure of agreement between items and subscales. Analysis revealed an overall r = 0.93. Subscale alphas average ranged from r = 0.71 for spiritual well being, r = 0.77 for physical, r = 0.81 for social, and r = 0.89 for psychological. Several measures of validity were used to determine the extent to which the instrument measured the concept of QOL in cancer survivors. The first method of content validity was based on a panel of QOL researchers and nurses with expertise in oncology. The second measure used stepwise multiple regression to determine factors most predictive of overall QOL in cancer survivors. Seventeen variables were found to be statistically significant accounting for 91% of the variance in overall QOL. The fourth measure of validity used Pearson's correlations to estimate the relationships between the subscales of QOL-CS and the subscales of the established FACT-G tool. There was moderate to strong correlation between associated subscales including QOL-CS physical to FACT physical (r = 0.74), QOL-CS Psych to FACT Emotional (r = 0.65), QOL Social to FACT Social (r = 0.44). The overall QOL-CS correlation with the FACT-G was 0.78. Additional measures of validity included correlations of individual items of the QOL-CS tool, factor analysis, and construct validity discriminating known groups of cancer survivors. Findings demonstrated that the QOL-CS and its subscales adequately measured QOL in this growing population of cancer survivors.

Adult↗
PubMed1995

Nurses' knowledge about cancer pain: a survey of five countries.

Surveys of nurses' knowledge of cancer pain management were conducted in five countries: Australia, Canada, Japan, Spain, and the United States. The results reveal that, in all countries, serious knowledge deficits exist that could adversely affect the care of patients with cancer pain. It appears, however, that the longer a country has been engaged in efforts to educate health-care professionals and the public and to establish palliative care programs, the more likely are nurses from that country to possess correct information about cancer pain. Nevertheless, survey results in all countries strongly suggested the need to continue aggressive measures to educate nurses, who are the cornerstone of palliative care.

Health Knowledge, Attitudes, Practice↗
PubMed1995

Pain in cognitively impaired nursing home patients.

Pain is an understudied problem in frail elderly patients, especially those with cognitive impairment, delirium, or dementia. The focus of this study was to describe the pain experienced by patients in skilled nursing homes, which have a high prevalence of cognitive impairment. A random sample of 325 subjects was selected from ten community skilled nursing homes. Subjects underwent a cross-sectional interview and chart review for the prevalence of pain complaints, etiology, and pain management strategies. Pain was assessed using the McGill Pain Questionnaire and four unidimensional scales previously utilized in younger adults. Thirty-three percent (33%) of subjects were excluded because they were either comatose (21%), non-English speaking (3.7%), temporarily away (sick in hospital) (4.3%), or refused to participate (3.7%). Of 217 subjects in the final analysis, the mean age was 84.9 years, 85% were women, and most were dependent in all activities of daily living. Subjects demonstrated substantial cognitive impairment (mean Folstein Mini-Mental State exam score was 12.1 +/- 7.9), typically having deficits in memory, orientation, and visual spatial skills. Sixty-two percent reported pain complaints, mostly related to musculoskeletal and neuropathic causes. Pain was not consistently documented in records, and pain management strategies appeared to be limited in scope and only partially successful in controlling pain. None of the four unidimensional pain-intensity scales studied in this investigation had a higher completion rate than the Present Pain Intensity Scale of the McGill Pain Questionnaire (65% completion rate). However, 83% of subjects who had pain could complete at least one of the scales. We conclude that cognitive impairment among elderly nursing home residents present a substantial barrier to pain assessment and management. Nonetheless, most patients with mild to moderate cognitive impairment can be assessed using at least one of the available bedside assessment scales.

Aged↗
PubMed1995

The meaning of cancer pain.

Pain is a common symptom in cancer and one experienced both by patients and family caregivers. A neglected area of pain management is enhancing the individual's ability to derive the meaning from pain and suffering associated with illness. Because pain is often a metaphor for impending death, the meaning derived from pain may contribute to the ultimate meaning of death for the individual. This article provides case examples and analysis of the search for meaning in cancer pain.

Adult↗
PubMed1995

Issues of control in patients with cancer pain.

The enhancement of patient control is frequently cited in nursing literature as an important area of nursing intervention. In this article, the concept of control, from the perspective of the patient with cancer pain, the primary family caregiver, and the home-care nurse, is discussed. Lewis identified five types of control: processual control, contingency control, cognitive control, behavioral control, and existential control. Lewis's typology of control was used as an organizing analytical framework, in this study, for interpreting the interview responses of each member of the triad. Similarities and differences in the perspectives of each member are discussed and examples of interventions that may be used to increase control in the management of pain are presented.

Community Health Nursing↗
PubMed1995

An institutional commitment to pain management.

PURPOSE: To share the development, implementation, and evaluation of a program called "An Institutional Commitment to Pain Management," which is based on the philosophy of organizational influence on pain management. METHODS: A tested pain education model was disseminated to 32 physician/nurse teams in settings throughout California, after which the 64 professionals returned to their institutions to serve as role models and catalysts to change the practice of pain management. Each team member completed a 39-item survey about knowledge and attitudes related to pain, which was developed by B.R.F. and colleagues, and also identified three goals for the implementation of course information. Precourse data also included administration of the knowledge and attitudes survey to participating physicians' and nurses' colleagues (10 physicians and 20 nurses per institution). Each team completed five chart audits using the pain audit tool (PAT), which was developed by B.R.F. and colleagues at the City of Hope National Medical Center. The PAT identifies how pain is managed currently at the institutional level. Final course evaluation 8 months after course completion included a summary of activities implemented by the teams as well as the factors that served as barriers and benefits to improve the quality of pain management. RESULTS: Two hundred seventy-two physicians and 629 nurses completed the survey about knowledge and attitudes related to pain, and 154 PATs were submitted. These results, as well as evaluation at the completion of the course, are discussed. CONCLUSION: The Institutional Commitment to Pain Management program is an evolving model that was developed to overcome barriers to pain relief by obtaining the commitment from institutions to improve the management of pain for their patients.

Adult↗
PubMed1995

The impact of pain on quality of life. A decade of research.

Pain and the quality of life are closely related. This article summarizes a series of studies conducted over the last decade contributing to the understanding of the pain and quality of life relationship. Details about the meaning of pain, the experience of pain in children, and the impact of pain on the family are presented. Information obtained from research studies led to the development of pain education programs that strengthen direct nursing care of patients and families experiencing cancer pain.

Adult↗