Faculty at the School of Nursing of the University of Pennsylvania successfully responded to the National Center For Nursing Research Center grant initiative with a center focused on advancing care in serious illness. The faculty and campus resources available to the proposed center and the initial center research and training program are described.

Academies and Institutes↗

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Preparing clinical preceptors to teach master's-level students in oncology nursing.

This article reports the development of a structured program for clinical nurse specialists who served as clinical preceptors for graduate students in an oncology nursing program. A needs assessment of clinical preceptors was completed, and a program for the preceptors was developed based on the learning needs identified. In addition to the program, a Manual for Clinical Preceptors was developed. The benefits of this program include networking; positive working relationships among the preceptors, faculty, and students; potential job opportunities for students; potential applicants from the clinical agencies; and, ultimately, improved care for patients with cancer and their families. The authors conclude that administrators should support efforts to nurture and recognize the personnel in the clinical agencies.

Education, Nursing, Graduate↗

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Fatigue and quality of life outcomes of exercise during cancer treatment.

PURPOSE: Despite the recognition of fatigue as a common and distressing symptom during cancer treatment, there are few evidence-based interventions available to manage such fatigue. The purpose of this multi-institutional pilot study was to explore the effects of a home-based moderate walking exercise intervention on fatigue, physical functioning, emotional distress, and quality of life (QOL) during breast cancer treatment. DESCRIPTION OF STUDY: Fifty-two women were recruited from five university hospital outpatient departments for this pilot study with an experimental design. Subjects were randomly assigned to the walking program or to usual care during adjuvant chemotherapy or radiation therapy for breast cancer. Symptoms, physical functioning, and QOL were measured at baseline, midtreatment, and at the end of treatment. RESULTS: Women who exercised at least 90 minutes per week on 3 or more days reported significantly less fatigue and emotional distress as well as higher functional ability and QOL than women who were less active during treatment. CLINICAL IMPLICATIONS: A home-based walking exercise program is a potentially effective, low-cost, and safe intervention to manage fatigue and to improve QOL during adjuvant chemotherapy or radiation therapy for breast cancer. This health-promoting self-care activity needs further testing in large randomized clinical trials.

Activities of Daily Living↗

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Nurses' use of palliative care practices in the acute care setting.

This study examines the reported use of palliative care practices by nurses caring for terminally ill patients in the acute care setting. Randomly selected nurses (n = 180) from six randomly selected hospitals in Connecticut completed a self-administered questionnaire. Factors associated with use of palliative care practices were examined by using bivariate and multivariate analyses. Most nurses surveyed (88.5%) reported using palliative care practices when caring for their terminally ill patients. Factors associated with greater use included greater knowledge about hospice, having practiced nursing for less than 10 years, and having had hospice training in the past 5 years. A substantial proportion of nurses reported that they never discuss hospice (51.7 per cent of nurses) and prognosis (26.6 per cent of nurses) with their terminally ill patients. Educational preparation (bachelor's degree versus less education) was not associated with greater use of palliative care practices. Palliative care practices are commonly used by nurses in the acute care setting. However, many report having limited training and substantial gaps in knowledge about hospice among this group of nurses, suggesting greater attention to palliative care and hospice may be warranted in nursing educational programs.

Acute Disease↗

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A model of survivors' psychological responses following a residential fire.

Residential fires result in loss of life, property, and displacement from one's neighborhood. It would be expected that grief experienced in the aftermath of residential fires has a significant impact on survivor's recovery and reintegration into the community. Although there is some research on psychological responses to community-wide fires and large scale disasters, little is known about such responses among survivors of home fires that occur episodically. Appropriate interventions cannot be developed until more is learned about variables influencing survivors' psychological response to a residential fire. A theoretical model of survivors' psychological response post-fire is proposed.

Disasters↗

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The effects of home nursing care for patients during terminal illness on the bereaved's psychological distress.

BACKGROUND: Although some studies have examined the effects of terminal illness care models such as hospice care on survivor outcomes, no studies could be found that examined whether nursing care affected such outcomes. OBJECTIVE: To determine whether specialized oncology home care services provided to terminally ill patients with lung cancer positively influenced bereavement psychological distress among survivors, compared with other models of care. METHODS: A secondary analysis was performed to test the effects of home nursing care for terminally ill patients on spousal psychological distress during bereavement. Forty-six patient-spousal dyads were randomly assigned to either an oncology home care group (OHC), a standard home care group, or an office care control group. Patient-spousal dyads were entered into the study 2 months after the patient's diagnosis of lung cancer and received follow-up until the patient died. Bereaved spouses continued to receive follow-up for 25 months after the patient's death. RESULTS: Psychological distress was significantly lower initially among spouses of patients that received the OHC intervention compared with the other two groups. Significant mean group differences were found on the subscales of depression and paranoid ideation; marginal group differences were found on the subscales of hostility and psychoticism. There were no significant differences among the groups at 25 months. CONCLUSIONS: These results suggest that the bereaved's psychological distress can be positively influenced depending on how their loved one is cared for during the terminal phase of illness.

Bereavement↗

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Enhancing caregiver outcomes in palliative care.

BACKGROUND: Families are increasingly replacing skilled health care workers in the delivery of unfamiliar complex care to their relatives with cancer, despite other obligations and responsibilities that characterize their lives. METHODS: The authors review the needs of cancer caregivers and describe intervention strategies not only presented in the literature, but also implemented in their own program of research to address those needs during the palliative phase of cancer. RESULTS: Research suggests that developing interventions that teach caregivers to become proficient in the physical and psychological aspects of patient care will benefit both patients and caregivers. CONCLUSIONS: Despite the fact that a cancer diagnosis can cause major changes in family roles and functioning,as well as increased responsibility for complex care being absorbed by family caregivers, data supporting the effectiveness of caregiver interventions have been limited.

Caregivers↗

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Causal attribution and life-threatening disease.

When individuals are confronted with a diagnosis of serious disease, they try to understand why it has happened to them. The degree to which any individual can control his or her susceptibility to disease is not clear, but different diseases carry with them varying degrees of implied personal responsibility. For example, certain diseases (heart attack, stroke, cancer) have associated risk factors. Presumably, avoiding these risk factors will have some effect on a person's chance of developing those diseases. The purpose of this secondary analysis was to describe patients' attributed causes for two groups of individuals recently diagnosed with either lung cancer or myocardial infarction. Content analysis was done on the responses to an open-ended question about the cause of their disease for 108 subjects at Interview 1 and for 100 subjects at Interview 2. The most frequent causal explanations given by post myocardial infarction subjects in this study were related to life style, which could be interpreted as self-blame or self responsibility for what had happened to them. In contrast, the subjects with lung cancer more consistently said that they did not know what caused their disease, or mentioned a combination of life style (smoking) and external factors (exposure to noxious fumes or asbestos).

Adult↗

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Demographic characteristics, fire experiences, and distress of residential fire survivors.

The United States has one of the highest per capita fire death rates in the world. Death rates alone, however, fail to reflect the breadth of loss experienced by residential fire survivors. Despite the frequency of home fires and the potential for loss, little is known about this vulnerable population. Interviews were conducted with 440 fire survivors 14 weeks after fires. Demographic characteristics of residential fire survivors, survivors' fire experiences, psychological distress after fires and the interrelationships among these variables were examined. This sample of urban fire survivors largely comprised poor, middle-aged African American women. Psychological distress was measured by the General Severity Index of the Brief Symptom Inventory, and the results showed that survivors were highly distressed, even in the absence of fire-related death or physical injury.

Adolescent↗

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Effects of touch on seriously ill patients.

Explore the source record for details and available documents.

Adult↗

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What certification is all about.

Explore the source record for details and available documents.

Certification↗

PubMedDate not supplied

What nurses need to know about home care.

Explore the source record for details and available documents.

Community Health Nursing↗

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Implementing a multidisciplinary cancer pain education program.

Cancer pain remains problematic for many patients. No standardized guidelines were available for the management of cancer pain until the early 1990s. In addition, many healthcare personnel have not been trained adequately in pain management, despite the abundance of literature. As a result, clinicians often manage patient's pain poorly. This article provides an overview of the process of development and implementation of a 5-year multidisciplinary cancer pain education program, begun in 1989 by the University of Pennsylvania School of Nursing, School of Medicine, and Cancer Center. The program was comprised of a multidisciplinary cancer pain consultation panel that sought to educate healthcare personnel in community hospitals and nursing homes in southeastern Pennsylvania about cancer pain. This was accomplished by providing consultations for agencies with patients experiencing uncontrolled and/or progressive cancer pain. The panel also provided education through lectures, newsletters, and symposia. A total of 1949 healthcare personnel attended 92 consultations, lectures, and symposia during the 5 years that the program has operated. With the linkage approach to innovation diffusion framework used in this consultation program, and the implementation of the guidelines now available, many healthcare personnel may be able to increase their skills and manage pain more effectively, thus reducing and/or eliminating needless suffering for patients. Developing role models in the area of pain management at community hospitals may be the most effective means of incorporating pain control guidelines and fostering innovation.

Diffusion of Innovation↗

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Development of a self-administered psychosocial cancer screening tool.

Among patients with cancer, psychosocial issues and problems are common, yet they often go unnoticed and thus untreated until they become severe and significantly interfere with the patient's comfort, quality of life, and potentially survival. Given the increasing complexity of cancer care, psychosocial support must assume a more prominent role in the care of individuals with cancer. Routine use of a screening tool for psychosocial assessment may help facilitate early identification and intervention for individuals who are at risk for psychosocial problems. Based on the prevalence of psychosocial problems described in the literature and the paucity of psychosocial screening instruments that can be applied practically in the clinical setting, the development of a new instrument to identify patients with cancer who have psychosocial problems in multiple domains and who thus are at risk for excessive psychosocial distress throughout the course of treatment is presented. This article provides background information, reviews the literature, including instruments that have been used to screen patients in the oncology setting for psychosocial problems, and presents a new instrument based on current deficiencies in this area. Pilot testing of the instrument demonstrates its feasibility for use in the clinical setting.

Humans↗