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Biomedical subjects

M H Mishel

Publications and source records attributed to M H Mishel.

At least 19 recordsLinked to original sources
PubMed2001

Depression burden, self-help interventions, and side effect experience in women receiving treatment for breast cancer.

PURPOSE/OBJECTIVES: To describe effects of a set of Self-Help Intervention Project (SHIP) interventions with self-reported depression burden on the side effect experience of women receiving treatment for breast cancer. DESIGN: Repeated measures, experimental design. SETTING: Outpatient sites at a regional cancer center, private practices, and health maintenance organizations. SAMPLE: 169 women who completed data at all three data-collection points were used to answer the research questions. METHODS: Following random assignment, individuals in the treatment group participated in five different, but complementary, self-help interventions for six weeks. The control group received the usual care. Variables were measured at baseline after radiation, chemotherapy, or hormone therapies were started to allow for the side effects to emerge at six to eight weeks after treatment and three months following time 2. MAIN VARIABLES: Depression burden, fatigue burden, pain burden, nausea burden, difficulty concentrating burden, anxiety burden, number of side effects, severity of side effects, and participation in the interventions. FINDINGS: Self-reported depression burden was found to significantly influence severity of side effects, number of side effects, and the burdens of fatigue, difficulty concentrating, and anxiety. Depression burden did not significantly influence the side effect burdens of nausea or pain. Depression burden interacted with the self-help interventions over time for the side effect of fatigue, but the intervention effect on pain burden and nausea burden was not influenced by depression burden over time. No significant intervention effects were found for the burden of difficulty concentrating or anxiety, the number of side effects, or perceived severity of side effects. The interventions significantly reduced the fatigue, pain, and nausea burden in women with breast cancer. CONCLUSIONS: The interventions were particularly helpful, relative to their fatigue experience, for women reporting a high level of depression burden. Findings also contribute to conceptual clarification of essential aspects of the side effect experience and provide a basis for measure and intervention refinement. IMPLICATIONS FOR NURSING PRACTICE: Every woman who is undergoing cancer treatment should be assessed for depression and depression burden. Self-help interventions are effective and convenient treatments that reduce side effects and promote quality of life in women with breast cancer.

Adaptation, Psychological↗
PubMed2000

Uncertainty in childhood illness: a synthesis of the parent and child literature.

Uncertainty has increasingly been identified as an important construct in the clinical and empirical literature on families' responses to serious childhood illnesses. Most of the work has focused on parents' perceptions of uncertainty, but several recent studies have demonstrated that children are also affected by uncertainties inherent in the illness experience. Findings from 44 reports of parental uncertainty and 12 reports of children's uncertainty were reviewed to determine what is currently known about uncertainty in the context of acute and chronic childhood illness. Pertinent conceptual and methodological issues are identified and directions for future research are suggested.

Acute Disease↗
PubMed1999

Side-effects burden, psychological adjustment, and life quality in women with breast cancer: pattern of association over time.

PURPOSE/OBJECTIVES: To describe the side-effects burden experienced over time by 53 women who were receiving treatment for breast cancer and to describe the association of side-effects burden with psychological adjustment and life quality. DESIGN: Data were drawn from the Self-Help Intervention Project (SHIP), an intervention study designed to test the effectiveness of nursing interventions for women receiving treatment for breast cancer. SETTING: Subjects were interviewed in their homes or treatment locations three times over a period of four to five months. SAMPLE: 53 women randomly assigned to the control group of the SHIP. METHODS: The researchers collected data after treatment was initiated, six to eight weeks later, and three months after that. MAIN RESEARCH VARIABLES: Side-effects burden, psychological adjustment, and life quality. FINDINGS: Fatigue was the most problematic side effect over time. Other problematic side effects included sore arm(s), difficulty sleeping, hair loss, and skin irritation. Significant associations were evident for psychological adjustment with symptom extension and number of side effects at Time 2 and Time 3. Depression burden and anxiety burden were associated significantly with psychological adjustment at all three times. Overall life quality and present life quality was associated negatively with symptom extension and number of side effects at all three times. Fatigue burden was associated negatively with life quality at Time 2 and Time 3 with depression burden and anxiety burden negatively associated with life quality at all three times. CONCLUSIONS: Over time, evidence showed that negative feelings, in particular depression burden and anxiety burden, persist. Depression burden and anxiety burden each were negatively associated with overall and present life quality at all three times. IMPLICATIONS FOR NURSING PRACTICE: A need exists for clinically individualized nursing interventions that will reduce the side effects burden of women receiving treatment for breast cancer. Interventions can do much to reduce the perception of illness severity so that psychological adjustment and life quality can be maintained.

Adaptation, Psychological↗
PubMed1999

Uncertainty in chronic illness.

In this chapter, the research on uncertainty in chronic illness is reviewed and critiqued. Two theoretical perspectives of uncertainty that can be applied across the range of chronic illness are presented. Research on the causes and consequences of uncertainty in chronic illness are considered and critiqued. The review addresses research on adults and on parents of chronically ill children. Conclusions include the areas requiring further investigation.

Adaptation, Psychological↗
PubMed1997

Uncertainty in acute illness.

In this chapter, the research on uncertainty in acute illness is reviewed and critiqued. Both qualitative and quantitative studies are included. The review considers the cause and consequences of uncertainty from research on adults and from research on parents of acutely ill children.

Acute Disease↗
PubMed1997

Pattern of association over time of side-effects burden, self-help, and self-care in women with breast cancer.

PURPOSE/OBJECTIVES: To describe the side-effects burden experienced over time by 53 women who were receiving treatment for breast cancer, and to describe the association of side-effects burden with self-help and self-care. DESIGN: Data were drawn from the Self-Help Intervention Project (SHIP), an intervention study designed to test the effectiveness of nursing interventions for women who were receiving treatment for breast cancer. SETTING: Subjects were interviewed in their homes or treatment locations three times over a period of four to five months. SAMPLE: 53 women randomly assigned to the SHIP control group. METHODS: The researchers collected data at a designated period of time after treatment was initiated (Time 1), six to eight weeks later (Time 2), and three months after that (Time 3). MAIN RESEARCH VARIABLES: Side-effects burden, as measured by items from the Symptom Transition Scale and the Side Effects Checklist; self-help, as measured by the Inventory of Adult Role Behavior; and self-care, as measured by the Inventory of Adult Self-Care Behaviors and the Self-Care Inventory-Wellness Promotion subscale. FINDINGS: Fatigue was the most frequent and problematic side effect over time. Other frequent and problematic side effects over time included sore arm(s), difficulty sleeping, and skin irritation. Significant correlations were evident for self-help with symptom extension, number of side effects, depression, difficulty concentrating, and pain. No significant relationships were evident between self-care and an increase in side effects. Small relationships existed for self-care between symptom extension at Time 2 and Time 3. CONCLUSIONS: Over time, side effects interfered with patients' ability to perform adult role activities. For the most part, problematic side-effects burden was not associated with self-care at any point in time. The scattered associations that did exist were in the negative direction. IMPLICATIONS FOR NURSING PRACTICE: A need exists for clinically individualized nursing interventions to reduce the side-effects burden of women receiving treatment for breast cancer. Interventions can do much to reduce the perception of illness severity so that self-help and self-care can be maintained.

Activities of Daily Living↗
PubMed1992

Uncertainty, appraisal and quality of life.

This study evaluates the influence of different factors in the adaptation process activated by uncertainty in illness on health-related quality of life. The sample included 100 women (mean age = 52.1 years) receiving treatment for newly diagnosed (M = 5.1 months) gynaecological cancer (38 cervical, 26 ovarian, 24 endometrial, 7 uterine, 4 vulvar, and 1 vaginal). Stepwise regression analyses identified mood states, ambiguity about illness-wellness state, danger-focused appraisal and mastery as key predictors of four health-related quality of life scores. The variance accounted for by those variables is reflected in cumulative multiple R2 of 0.56 for total quality of life score, 0.57 for psychosocial well-being, 0.235 for physical well-being and 0.25 for disease/symptom distress. These variances do not reflect the contribution of age, time since diagnosis, metastasis and stage of cancer which were forced to enter the regression equation first. The latter set of variables accounted for a smaller portion of the variance in health-related quality of life (R2 = 0.03-0.195). Coping strategy did not predict health-related quality of life. These findings provide beginning support for conceptualizing health-related quality of life as the outcome of an adaptation process explained by the uncertainty in illness theory. However, uncertainty in illness theory may not be sufficient to predict quality of life outcomes. Future research should consider the addition of discrepancy theory to guide the selection or development of a health-related quality of life measure, to account for the perceived discrepancy between actual experience and expected well-being.

Adaptation, Psychological↗
PubMed1991

Depression assessment and management: evaluating a community-based mental health training program for nurses.

This mental health training program was designed to increase primary care nurses' knowledge and skills about depression. The program emphasized criteria for assessing depression, presented psychopharmacologic and psychotherapeutic content, discussed care coordination among several agencies and providers, and addressed referral resources. Cultural and developmental issues were highlighted. The 237 participants had significant knowledge gains after the program on comparison of pretest and posttest measures. Client record audit found significant increases in the assessment of and intervention with depression. The training program successfully increased primary care nurses' abilities to use knowledge about depression in clinical practice.

Adult↗
PubMed1990

Assessment and management of depression: an imperative for community-based practice.

The purpose of this mental health training program was to increase primary care nurses' knowledge and skills about depression. The program emphasized criteria for assessing depression, presented psychopharmacological and psychotherapeutic content, discussed care coordination among multiple agencies and providers, and addressed referral resources. Highlighted were cultural and developmental issues for Native Americans, Mexican-Americans, the elderly, and adolescents. The training program successfully increased primary care nurses' knowledge about depression and their abilities to use this knowledge in clinical practice.

Adult↗
PubMed1990

Reconceptualization of the uncertainty in illness theory.

The theory of uncertainty in illness has its strongest support among subjects who are experiencing the acute phase of illness or are in a downward illness trajectory (mishel, 1988a). The theory has not addressed the experience of living with continual, constant uncertainty in either a chronic illness or in an illness with a treatable acute phase and possible eventual recurrence. Since uncertainty characterizes many, most prevalent, long-term illness conditions, there is a need to reconceptualize the theory of uncertainty to include the experience of living with continual uncertainty. A close examination of the theoretical statements and the empirical data reported by Mishel resulted in the identification of areas of the theory that could be expanded and reconceptualized. The reconceptualization effort was primarily fueled by questions about the outcome portion of the uncertainty theory. To provide a contest for the expansion and reconceptualization of uncertainty, applicable parts of the theory are summarized below.

Adaptation, Psychological↗
PubMed1984

Perceived uncertainty and stress in illness.

A structural model was proposed to explain the stress resulting from hospitalization for a medical problem. Perceived uncertainty about symptoms, treatment, and outcome was examined as a major predictor of stress. Other variables proposed in the model included seriousness of illness, age, education, and recency of rehospitalization. Testing of the model with hospitalized medical patients indicated support for the relationship of uncertainty to stress. Uncertainty also had the predicted mediating role between seriousness of illness and stress. The only other variable supporting the proposed model was age which related inversely to stress. Much of the unexplained variance in the model is attributed to the heterogeneity of diagnoses in the sample. Suggestions for future testing of the model are presented.

Adult↗