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Biomedical subjects

B R Ferrell

Publications and source records attributed to B R Ferrell.

At least 55 records · Page 3Linked to original sources
PubMed1995

Unscheduled readmissions for uncontrolled symptoms. A health care challenge for nurses.

The purpose of this study was to measure the impact of nursing strategies to improve cancer pain management on hospital readmission for uncontrolled pain. Strategies include implementing a pain resource nurse program (PRN), making pain management a focus in the continuous quality improvement process of the institution and creating a supportive care service. Admissions were compared before and after implementation of the strategies. Results for 1989 to 1990 revealed 5772 total admission with 4.4% (255) admissions for uncontrolled pain; results for 1992 to 1993 revealed 4066 total admissions with 3.0% (121) admissions for uncontrolled pain. Findings indicate that strategies were effective in reducing the number of readmissions for uncontrolled pain.

Adolescent↗
PubMed1995

Quality of life in long-term cancer survivors.

PURPOSE/OBJECTIVES: To describe the quality of life (QOL) of long-term cancer survivors. DESIGN: Descriptive, mailed survey. SETTING: Membership of the National Coalition for Cancer Survivorship (NCCS), which is a nonprofit, peer-support network for people living with cancer. SAMPLE: 687 (57%) of the 1,200 members of NCCS completed the survey. The mean age of the sample was 49.6 years; 81% were female. The predominant cancer diagnoses were breast (43%), lymphoma (9%), ovarian (8%), and Hodgkin's disease (8%). METHODS: Mailed survey using three instruments: a demographic tool, the Quality of Life-Cancer Survivors (QOL-CS) tool, and the Functional Assessment of Cancer Therapy-General (FACT-G) tool. MAIN RESEARCH VARIABLES: Subscale and individual items of QOL including physical, psychological, social, and spiritual well-being. FINDINGS: Results include areas of positive effects for cancer survivors and continued demands of survivorship. Based on scoring of 0 (worst outcome) to 10 (best outcome), cancer survivors' mean QOL-CS subscores were 5.88 for psychological well-being, 6.59 for spiritual well-being, 6.62 for social well-being, and 7.78 for physical well-being. Several demographic factors (e.g., evidence of active disease; female gender; presence of spouse/partner or children; length of time since diagnosis; income) had significant influence on QOL. CONCLUSIONS: Cancer survivors experienced altered lives and had needs related to fear of recurrence and facing the spiritual aspects of having survived a life-threatening illness. IMPLICATIONS FOR NURSING PRACTICE: The growing population of cancer survivors has long-term needs for nursing care that address multidimensional aspects of QOL.

Adaptation, Psychological↗
PubMed1995

Priority ethical issues in oncology nursing: current approaches and future directions.

PURPOSE/OBJECTIVES: To describe ethical issues determined to be highly important to oncology nurses and to discuss strategies by which the Oncology Nursing Society (ONS) can address these priority concerns. DATA SOURCES: Survey on oncology nurses regarding ethical issues; nursing literature. DATA SYNTHESIS: Nine priority ethical issues of oncology nurses are identified. Past, current, and future ONS activities that address these priority issues are discussed. IMPLICATIONS FOR NURSING PRACTICE: ONS must support activities to increase the knowledge, confidence, and involvement of oncology nurses in discussions and decision making related to the ethical issues. CONCLUSIONS: The top three priority ethical issues for oncology nurses are assisted suicide, end-of-life decisions, and pain management. Efforts should be made to increase ethics expertise among the ONS membership.

Bioethical Issues↗
PubMed1995

Nurses' perceptions of the meaning of quality of life for bone marrow transplant survivors.

Nurses play an integral role in the care of bone marrow transplant (BMT) patients from pre-transplant to posttransplant. The purpose of this study was to explore the nurses' perceptions of the impact of transplant on the quality of life (QOL) of survivors. The conceptual framework for the study was the model of QOL developed by Ferrell, Grant, Schmidt, Rhiner, Whitehead, and Forman (1992). It depicts the QOL domains of physical well-being, psychological well-being, social concerns, and spiritual well-being. One hundred fifty nurses responded to a mailed survey. The items were based on the Quality of Life-BMT Survey used previously with patients. Nurses' and patients' responses to the same item were compared. Results reflect that transplant nurses generally perceived patients as having a poorer QOL than they actually reported. Nurses described transplant as having both positive and negative consequences. Transplant was seen as providing patients with a second chance at life and an opportunity to increase their QOL. Nurses described negative consequences as resulting from physical losses, psychological distress, financial distress, and loss of relationships. The findings of the study have implications for training future transplant nurses and for improving nursing care for transplant patients.

Adult↗
PubMed1995

The impact of cancer pain education on family caregivers of elderly patients.

PURPOSE/OBJECTIVES: To examine the impact of pain education on family members providing home care to elderly patients with cancer. DESIGN: Quasiexperimental. SETTING: Homes of selected patients from two California medical centers. SAMPLE: Fifty family caregivers of patients experiencing cancer-related pain. METHODS: The pain education program included three components: pain assessment, pharmacologic interventions, and nonpharmacologic interventions. Patients and their family caregivers were evaluated prior to initiation of the program and at one and three weeks following the interventions. MAIN RESEARCH VARIABLES: Quality of life (QOL); knowledge and attitudes about pain; and caregiver burden. FINDINGS: Findings based on measures of QOL and caregiver burden demonstrated the physical and psychological impact of family caregiving and pain management. Comparison between elderly patients with cancer and family caregivers revealed the pain experience's significant impact on family members caring for a loved one in pain. CONCLUSIONS: The pain education program was effective in improving knowledge and attitudes regarding pain management. IMPLICATIONS FOR NURSING PRACTICE: Pain management is a priority for nurses, and use of interventions such as structured pain education improves QOL outcomes for elderly patients and their family caregivers.

Adaptation, Psychological↗
PubMed1994

Pain management for elderly patients with cancer at home.

BACKGROUND: Pain is an important problem for patients with cancer and is particularly important for elderly patients with cancer and their family care givers. Increasingly, cancer is managed on an outpatient basis with pain management responsibility assumed by the family at home. This study evaluated a structured pain education program that included three components: basic pain management principles and assessment, pharmacologic interventions, and nondrug treatments. METHODS: The pain education intervention was implemented across three home visits with two points of follow-up evaluation. Outcomes of the 66 elderly patients with cancer completing the educational program included measures of quality of life, patient knowledge and attitudes regarding pain, and use of a self-care log to document drug and nondrug interventions and their effectiveness. RESULTS: Repeated measurement analysis was used to evaluate the outcomes of the three-part education intervention. Results indicate an improvement in knowledge and attitudes regarding pain as well as the use of drug and nondrug interventions. Outcomes of the quality of life instrument suggest significant effect of pain on all aspects of quality of life, including physical well being, psychological well being, social concerns, and spiritual well being. CONCLUSIONS: The investigators concluded that the pain education intervention provided important support to elderly patients with cancer and family members at home. Structured pain education based on an evolving science of pain relief should become a part of the standard health care for pain management. Improved pain management includes quality of life for the elderly patient with cancer as well as for family care givers.

Aged↗
PubMed1994

Ethical and professional issues in pain technology: a challenge to supportive care.

Pain management, a primary focus of oncology care, is undergoing a technological boom. This paper provides an overview of the ethical and professional issues facing health care providers in the use of pain technology. Ethical issues including the concepts of autonomy, beneficence, nonmaleficence, and justice are discussed in relation to pain management. The paper concludes with recommendations for clinical practice.

Clinical Protocols↗
PubMed1994

Cost issues related to pain management: report from the Cancer Pain Panel of the Agency for Health Care Policy and Research.

The clinical problem of unrelieved pain has received much attention over the previous decade with a major focus on cancer pain and acute postoperative pain. Organizations such as the World Health Organization (WHO), the National Cancer Institute, the American Pain Society (APS), and others have addressed the previously neglected areas of pain assessment, pharmacologic treatment, and the knowledge and attitudes of health-care providers. Health-policy issues related to pain, including areas of cost, access to care, regulatory perspectives, and ethical and legal issues, have likewise been neglected. To explore the costs associated with pain, the following framework has been developed through the Agency for Health Care Policy and Research (AHCPR) pain panel. This 13-point framework is an attempt to isolate specific cost issues, identify what is known in these areas, and address implications for future research. A brief synopsis of these 13 areas of cost analysis is provided including comments regarding work in progress by the panel and directions for future health-policy research related to pain management.

Cost-Benefit Analysis↗
PubMed1994

The experience of chronic nonmalignant pain.

This article reports the results of a survey of 204 persons with chronic nonmalignant pain who were members of a national self-help organization. The survey evaluated the organization, explored the perceived effect of pain on quality of life, and assessed experiences with and perceptions of health-care providers. Response rate was 40%. Of survey respondents, 50% reported inadequate pain relief. Respondents identified depression as one of the worst problems caused by their chronic pain: 50% reported that they had considered suicide due to feelings of hopelessness associated with their pain, 51% reported taking only as much medication as prescribed, and 44% reported taking less medication than prescribed. Further investigation is needed to describe the personal impact of chronic nonmalignant pain.

Adult↗
PubMed1994

Quality of life in adult bone marrow transplant patients: beyond the first year.

Currently, there are more than 2,000 marrow transplant patients surviving between 5 and 20 years. Thus, increased attention is focusing on information about the nature of posttransplant survival and quality of life (QOL). Assessment of the survivor's QOL and rehabilitation needs should consider the domains of physical well-being and symptoms as well as psychological, social, and spiritual well-being. An analysis of the QOL reported in 780 adult survivors from 15 separate studies provides a perspective on the adult BMT survivor beyond the 1-year milestone.

Adult↗
PubMed1994

Nurses' assessment of pain intensity and choice of analgesic dose.

Under-treatment of all types of pain has been identified in many countries throughout the world. For example, the World Health Organization states that unrelieved cancer pain is an international problem. Lack of education of health care professionals, including nurses, is frequently cited as a major reason for under-treatment of pain. This survey of 517 Australian nurses suggests that they have some of the same educational needs as nurses in North America, such as how to assess pain intensity and how to select a dose of an opioid analgesic that is appropriate for the individual patient.

Education, Nursing, Continuing↗
PubMed1994

Providing relief from cancer pain by assisting in the search for meaning.

Pain is a common, distressing symptom experienced by cancer patients and their family caregivers. An important aspect of coping with cancer pain is the ability to make meaning of the experience. This paper provides an overview of the literature related to meaning-making processes utilized by people experiencing cancer. It also presents an integrated approach to assisting patients and their family caregivers with the meaning-making process associated with cancer pain. Approaches to intervening are integrated within a model developed through previous research.

Aged↗
PubMed1994

The experience of pediatric cancer pain, Part I: Impact of pain on the family.

This two-part article reports on the results of qualitative data derived from the study on the impact of pediatric cancer pain on the family. Part I of this two-part article explores the family caregivers' description of a child with cancer, the helplessness experienced in the management of the child's pain, and the impact of pain on the entire family. Study findings support existing literature identifying inadequate assessment and management of pediatric cancer pain. Parents identified the benefits of pain management teams for the child and for themselves. Family caregivers also identified the stresses associated with managing pain at home. Part II will describe the role of the parents in managing their child's pain. This study provided valuable information that can enable health care professionals with an opportunity to intervene not only with the child but also with the family.

Adaptation, Psychological↗
PubMed1994

The experience of pediatric cancer pain, Part II: Management of pain.

This paper reports on the results of qualitative data derived from a study on the impact of pediatric cancer pain on the family. Part I of this two-part article reported on the family caregivers' description of a child with cancer, the helplessness experienced in the management of the child's pain, and the impact of pain on the entire family. This article will describe the role of the parents in managing their child's pain, including use of pharmacological and nondrug interventions, family caregivers' perspectives on what physicians and nurses could do to improve the care of patients in pain, and family caregivers' advice to other families when placed in a similar situation of trying to manage pediatric pain. Five major themes were identified related to the role of family caregivers in managing the child's pain. Parents also identified six major ways in which physicians and nurses could help to improve care related to pain management. Although some parents were unable to identify information that may be useful for other parents in similar situations, nine major themes were identified. Study data demonstrates the experience of family caregivers in caring for a child with cancer pain and provides health care professionals with information that can promote effective pain relief for the pediatric cancer patient with pain as well as address issues affecting the family.

Adolescent↗
PubMed1994

Ethical issues in pain management at home.

This review of several studies from the authors' program of research supports the notion that the experience of pain, particularly in the home, has a profound effect not only on the patient, but on family and health care providers as well. Family caregivers revealed their private grief and burden when describing the physical suffering they witnessed. They faced the daily responsibility of making decisions regarding a loved one's pain, and the decisions often resulted in ethical conflicts. Caregivers generally felt ill-prepared for the administration of pain medication. They struggled to balance the need for medications to relieve pain against the perceived unwanted side effects and fear of addiction. These studies also demonstrate that a concerted effort must be made by health care providers to support the pain management role of family caregivers. By listening, being available, making pain management a priority, and reinforcing appropriate pain management principles, health care professionals help sustain family caregivers in carrying out their anguishing and unrelenting task.

Caregivers↗