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Biomedical subjects

M I Fitch

Publications and source records attributed to M I Fitch.

At least 37 records · Page 2Linked to original sources
PubMed1998

Exploring the barriers to cervical screening in an urban Canadian setting.

Cervical cancer is potentially one of the most preventable cancers. The benefits of cervical screening come to those who are actually screened. Despite the known value of cervical screening, a significant number of women do not avail themselves of the procedure. This study examined the barriers to cervical screening in an urban Canadian setting. Focus group methodology was used to explore the perspectives of socioeconomically disadvantaged women regarding their access to health care. The sessions were tape-recorded, and subsequent content analysis revealed four broad themes: being able to talk with doctors is important; being treated as a person is important; finding answers to many questions about cancer is important; and having a Pap test is uncomfortable. Implications for practice and program design were highlighted.

Adult↗
PubMed1998

The 1997 Schering Lecture. Quality of life in oncology: nurses' perceptions, values and behaviours.

Quality of life is an important dimension of cancer care. Yet, within our current environment of fiscal restraint, restructuring and cancer care system reform, pressures exist which may make it difficult to provide care which attends to issues of quality of life. Oncology nurses are key providers of cancer care and their perspectives on quality of life for cancer patients are very important. In addition, much of the satisfaction oncology nurses experience in their practice emerges from matters related to attending to quality of life issues. Are oncology nurses currently able to incorporate quality of life issues into their daily care of patients? How are they doing so? The purpose of this qualitative study is to identify major themes and dimensions of nurses' perceptions and values related to quality of life and create a profile of the oncology nurse's role in integrating quality of life in nursing practice. A total of 25 oncology nurses in regional cancer centres across Ontario were interviewed. Each semistructured interview was taperecorded and transcribed. Analysis was completed to identify the major themes and dimensions. This presentation will report the findings from the study and will focus on understanding the existing values oncology nurses hold surrounding quality of life, how quality of life is conceptualized, and the patterns of practice and decision-making regarding quality of life.

Attitude of Health Personnel↗
PubMed1998

Information needs of nurses regarding breast disease.

The purpose of this study was to identify the information needs of nurses regarding benign breast conditions and breast cancer. One hundred and five Ontario nurses who are directly involved in providing information to women were interviewed. The majority of nurses indicated feeling either somewhat or very comfortable during their discussions with women and perceived their knowledge was sufficient for answering women's questions. Nurses rated existing information concerning discovery of breast abnormalities and the diagnostic phases the highest in terms of quality, quantity and accessibility. Overall, a large proportion of nurses did not perceive gaps in information for nurses about breast disease. This work raises interesting practice questions for nursing in light of the reports by patients that they experience difficulties obtaining information.

Breast Neoplasms↗
PubMed1998

Communication needs of patients receiving mechanical ventilation: a pilot study.

Patients experiencing mechanical ventilation are unable to speak while being dependent on others for their physical needs. The purpose of this work is to describe the communication needs of individuals who are mechanically ventilated. This article reports the findings of a pilot study to assess communication needs of ventilated patients and to compare patients' perceptions of their needs with their nurses' perceptions of their needs. Twenty-seven nurse-patient comparisons were generated. The only statistically significant correlation was observed for the needs concerning social stimulation. Nurses and patients did not agree on the patients' communication needs in areas of information-seeking, information-sharing or request for assistance. Further research is needed to verify these findings.

Adult↗
PubMed1998

Living at home on a ventilator.

This study was undertaken to explore the perspectives of patients living at home on a ventilator. Understanding their perspectives could be helpful for planning education programs to prepare them for discharge as well as supporting them once they are at home. Analysis of audiotaped interviews with eight individuals revealed themes concerning skill in managing equipment, need for organization and planning, variations in necessary assistance, experiencing an emotional roller coaster, struggles with changing lifestyle, holding a positive attitude, the ventilator as an extension of self and preferences for the home environment.

Activities of Daily Living↗
PubMed1997

Health promotion and early detection of cancer in older adults: needs assessment for program development.

The greatest risk factor for developing cancer is age, yet little is known about the cancer-related knowledge, attitudes and beliefs of the older adult (age > 55 years). A community-based needs assessment was conducted to understand these dimensions in a large metropolitan community. Ten focus groups (n = 158 older adults) and 9 individuals were interviewed. Content analysis for the audiotaped sessions was completed. The study participants focused on "being active" and living a healthy lifestyle. Many worried about illness interfering with their ability to do what they wanted to do. Many had had exposure to cancer through family members or friends, but still had many unanswered questions about cancer. Age was not seen as a risk factor for cancer, and a range of attitudes existed regarding cancer prevention and early detection. Overall, despite fearing cancer, participants thought older adults needed to know about cancer and suggested a wide range of approaches to disseminate information effectively to older adults.

Aged↗
PubMed1997

Patient preferences for oral versus intravenous palliative chemotherapy.

PURPOSE: To assess patient preference for oral versus intravenous (i.v.) palliative chemotherapy (CT). A strong preference would be an important quality-of-life issue. PATIENTS AND METHODS: A structured interviewer-administered scenario-based questionnaire evaluated incurable cancer patients who would be likely to receive palliative CT in the future. Using probability trade-offs, the preference for route of administration was evaluated against diminishing treatment response. RESULTS: Of 103 assessable patients, 92 preferred oral CT, 10 preferred i.v. CT, and one had no preference. Patient preferences were not associated with age, sex, site of primary cancer, or previous CT experiences. Major reasons for preferring oral CT were convenience, problems with i.v. access or needles, and a better CT-taking environment (outside of the clinic). Regardless of initial preference, 70% of patients were not willing to accept a lower response rate and 74% were not willing to accept a shorter duration of response to retain their initial preference. Although 99% of patients had a preference, 39% wanted the specific treatment decision made primarily by their physicians, 38% primarily by themselves, and 22% shared equally. CONCLUSION: Patients with incurable cancer have a clear preference for oral CT, but are generally not willing to sacrifice efficacy for their preference. Almost 40% of patients did not want to make final treatment decisions themselves.

Administration, Oral↗
PubMed1996

Creating a research agenda with relevance to cancer nursing practice.

To be clinically relevant, a research program must seek to answer questions considered significant and meaningful by front-line clinicians. This article describes the process used by one Nursing Department to identify significant clinical questions in cancer nursing that could form the basis for a clinical research agenda. Priorities for cancer nursing research were identified in the literature and through interviews with all nursing staff. The interview data were subjected to a content analysis in which seven overall themes were identified. Patient and family themes formed the basis for the research agenda, together with the identified priorities from the literature. The primary topic themes for the research program include (a) Coping at Home, (b) Information Needs, (c) Symptom Distress, (d) Evaluating Care Delivery, and (e) Instrument Development. The article will be of interest to nurses wishing to develop a program of clinically relevant research.

Clinical Nursing Research↗
PubMed1996

Fostering the growth of research-based oncology nursing practice.

PURPOSE/OBJECTIVES: To describe the initial stages involved in fostering a research-based oncology nursing practice in a comprehensive cancer program, including planning the initial implementation strategies to stimulate research awareness and create a program of research studies in clinical oncology nursing. DATA SOURCES: Literature searches; published articles, abstracts, and books; interviews with staff nurses; departmental, committee, and task force meetings; nursing grand rounds and workshops. DATA SYNTHESIS: Review and use of the available information facilitated the design of implementation strategies that addressed issues identified in the literature and in clinical practice. CONCLUSIONS: The nursing department was able to plan, introduce, and evaluate a series of activities directed toward integrating research and clinical practice and building a series of research studies in oncology nursing. Introducing both goals was challenging but facilitated staff learning about research, participating in research-related activities, and seeing results from research studies relevant to their clinical practice. IMPLICATIONS FOR NURSING PRACTICE: Research can be introduced successfully into the clinical setting if staff are involved in the planning and design of research-related activities and if research expertise is available to foster and support their participation.

Clinical Nursing Research↗
PubMed1996

Needs of family caregivers of patients receiving home hospice care for cancer.

PURPOSE/OBJECTIVES: To identify needs of family caregivers of home hospice patients with cancer. DESIGN: Exploratory, descriptive. SETTING: Six nonprofit homecare hospices in Canada. SAMPLE: Twenty Caucasian family caregivers of 20 patients with cancer enrolled in home hospice. METHODS: Subjects were recruited on admission to hospice and completed the Home Caregiver Need Survey in the home. MAIN RESEARCH VARIABLES: Family caregivers' assessment of their poorly satisfied informational, household, patient care, personal, spiritual, and psychological needs. FINDINGS: Family caregivers needed time for themselves away from the house and for their personal needs. They also lacked sufficient time to rest and did not experience adequate sleep. Caregivers needed to learn ways to help patients maintain some independence. A 24-hour hotline can be an important resource for caregivers. CONCLUSIONS: Family caregivers need social, volunteer, and professional support while caring for a family member at home so that their own physical and emotional health does not suffer. IMPLICATIONS FOR NURSING PRACTICE: To provide guidance and support to family caregivers, nurses should assess the needs of caregivers and tailor interventions to meet those needs. Nurses also should facilitate the development of a social, volunteer, and professional support network.

Adaptation, Psychological↗
PubMed1996

Coping strategies of family caregivers of home hospice patients with cancer.

PURPOSE/OBJECTIVE: To identify the use and effectiveness of coping strategies identified by family caregivers of patients with terminal cancer. DESIGN: Exploratory, descriptive. SETTING: Six nonprofit home hospices in Canada. SAMPLE: Twenty Caucasian family caregivers of 20 patients with terminal cancer who were enrolled in home hospice. METHODS: Subjects were recruited on admission to hospice and completed the revised Jalowiec Coping Scale. MAIN RESEARCH VARIABLES: Family caregivers' assessment of their use of 60 possible coping strategies and the extent to which those strategies were effective. FINDINGS: In this study, the problem was defined as caring for the patient in the two weeks prior to the interview. Family caregivers of patients with cancer receiving home hospice care found that keeping busy, thinking positively, and learning more about the problem were effective coping strategies. Talking the problem over with family and friends also was found to be an effective strategy. CONCLUSIONS: Family caregivers need encouragement to maintain hope and a positive attitude so that they can continue caregiving. Social, volunteer, and professional support are important for caregivers. IMPLICATIONS FOR NURSING PRACTICE: To provide guidance and support to family caregivers, nurses need to explore the meanings that caregivers attach to the caregiving experience and assist caregivers in reframing these meanings in a positive light.

Adaptation, Psychological↗
PubMed1995

Guidelines for the optimal management of chemotherapy-induced nausea and vomiting: a consensus.

Nausea and vomiting are the most frequently reported adverse effects of cancer chemotherapy and have a significant impact on patients' daily functioning, quality of life and compliance with chemotherapy. Summarized in this article are the recommendations for the optimal management of nausea and vomiting developed by a multidisciplinary group of health care professionals. Issues relating to chemotherapy-induced nausea and vomiting are discussed; general principles of treatment are reviewed; treatment algorithms based on emetogenicity and types of chemotherapy are presented; and the importance of issues including non-pharmacological approaches, patient education and pharmacoeconomic perspectives are considered. The goal of antiemetic therapy should be no episodes of vomiting or retching and minimal or no nausea. Data from clinical trials support the clear superiority of 5-HT3 receptor antagonists in a variety of clinical situations. Their cost must be considered not only as an isolated item from the institutional perspective, but also from the perspective of the impact of successful therapy on the patient.

Algorithms↗
PubMed1994

How much should I say to whom?

During the past several decades, attitudes in North America have shifted with regards to disclosing information to patients about their own diagnosis. There is still debate, however, about the extent of the information that should be shared regarding treatment and prognosis. Families have their own set of needs in the face of coping with life-threatening illness and supporting the patient. Receiving clear honest information about the patient's condition, prognosis, and comfort are important to family caregivers. Resolving the issue of disclosing patient information to families demands that health care professionals engage in sensitive communication and achieve a delicate balance between the patient's right to confidentiality and meeting the family members' needs for information.

Adaptation, Psychological↗
PubMed1992

Managing treatment-induced emesis: a nursing perspective.

Patients with cancer undergoing treatment with chemotherapy or radiation therapy may experience a range of treatment-related side effects. One of the most common and most distressing side effects is treatment-induced emesis. The severity of the symptom is great enough to cause some patients to refuse treatments, delay appointments or discontinue therapy entirely. Experiencing treatment-induced nausea and vomiting can create a spectrum of issues for patients and their families and seriously influence their quality of life. Managing nausea and vomiting induced by cancer therapy is of critical importance. A team approach, inclusive of the patient, can be most effective. Nurses play a pivotal role in assessing patterns of nausea and vomiting and the usefulness of anti-emetic therapy, evaluating and updating treatment/care plans and helping the patient and family to cope with the disease and its treatment.

Antiemetics↗
PubMedDate not supplied

Presurgery experiences of prostate cancer patients and their spouses.

PURPOSE: In this article, the authors describe the experiences of men with prostate cancer and their spouses between diagnosis and surgery. DESCRIPTION: As part of a longitudinal qualitative study, semistructured interviews were held with 34 prostate cancer patients who were waiting for surgery. Separate interviews were held with their spouses. RESULTS: Six main components of experience were evident from the analysis of transcripts related to the presurgery period: 1) the news of a diagnosis of prostate cancer came initially as a shock for both partners, the impact of which lessened over time; 2) the new reality of illness necessitated readdressing the marital relationship, most often resulting in a sense of renewed connection and commitment; 3) the illness crisis precipitated a search for information to guide decisions about treatment; 4) there was a need for couples to decide who to inform about the cancer diagnosis and how much to say about it; 5) couples attempted to seek a semblance of normality in their lives, especially after treatment decisions had been made; and 6) despite attempts to minimize the potential impact of upcoming surgery, anxiety was typically experienced at least intermittently by one or both partners. CLINICAL IMPLICATIONS: Physicians, nurses, social workers, and other health professionals need to facilitate attempts by the patient to gather and synthesize information. Cancer specialists can play a positive role in reducing distress in couples, and, thus, the attention of the specialists to communication issues is critical. The strain of waiting for surgery must be considered when treatment recommendations are made; watchful waiting protocols require further study from a psychological perspective. Clinicians need to be alert to the balance between being positive and carrying on as normal, and acknowledging and dealing with the distress that arises.

Activities of Daily Living↗
PubMedDate not supplied

Early postsurgery experience of prostate cancer patients and spouses.

PURPOSE: The authors describe the experience of men with prostate cancer and their spouses in the early recovery period after surgery. DESCRIPTION OF STUDY: As part of a longitudinal qualitative study, semistructured interviews were held with 34 patients who had prostate cancer and their spouses 8 to 10 weeks after surgery. RESULTS: Five components of experience emerged from the interviews: 1) hearing news about the extent of their cancer after surgery influenced how patients viewed their cancer experience and, in many cases, their recovery; 2) men placed great emphasis on recovering their physical capacity quickly; 3) couples connected with each other through working out care routines and managing periods of irritability; 4) couples described a range of responses to surgery side effects and complications; and 5) the meaning of cancer varied for couples, with most seeing the experience as a temporary disruption. CLINICAL IMPLICATIONS: Physicians, nurses, social workers, and other health professionals working with patients before and after prostatectomies may assist couples to prepare better for the early recovery period by being both sensitive to the men's need to recover physical capacity quickly while helping them to understand that recovery takes time. Accurate information about expected periods of irritability, side effects, and possible complications would diminish the likelihood of distress during this period.

Activities of Daily Living↗
PubMedDate not supplied

The generic research protocol: an innovative technique to facilitate research skills development and protocol preparation.

Hospitals are increasingly delegating responsibility for initiating nursing research to nursing staff whose knowledge of and experience in conducting research may be limited. As a result, nurses involved in continuing education and staff development are increasingly involved in helping staff develop their research skills and prepare research protocols. The generic research protocol (GRP) is a computerized learning package that assists nursing staff in preparing a scholarly research protocol through step-by-step instruction and guidance. When used in two unrelated nursing studies, research skills of participating nursing staff were developed and protocol preparation facilitated. The time and editorial effort required for protocol preparation were reduced, and novice researchers were familiarized with research terminology and issues related to study design.

Clinical Competence↗