Describing the work of nursing: the case of postsurgical nursing interventions for men with prostate cancer

Psychosocial Concerns in the Postoperative Oncology Patient

OBJECTIVES

To describe psychosocial concerns associated with the postoperative cancer patient and to discuss current psychosocial evidence-based approaches to manage these psychosocial concerns.

DATA SOURCES

Published peer-reviewed literature.

CONCLUSION

The postoperative phase of cancer care may be associated with a range of overlapping acute and chronic psychosocial concerns related to the surgery itself, the cancer diagnosis, and the need for ongoing cancer treatments. The postoperative period of cancer care represents an essential time to detect unmet psychosocial concerns and begin timely interventions for these concerns.

IMPLICATIONS FOR NURSING PRACTICE

Nurses are in a key position to detect, triage, refer, or manage psychosocial concerns in the postoperative patient with cancer. Current psychosocial evidence-based approaches may be used by surgical oncology nurses or other nurses who care for cancer patients during postoperative recovery.

Nursing informatics: two foundational developments

Health informatics technologies exist to support the work of the health professionals. As successful healthcare outcomes increasingly rest on the active participation of patients and lay persons, these technologies must also directly support the important contributions of patients as they engage in self-help, self-care, and disease management activities. The unique role of nursing in the healthcare system is to attend to those aspects of the person that constitute the human response to disease and development, and to deliver interventions that help to compensate for, restore, or improve patients’ abilities to manage health status. This uniqueness is reflected in the terms used by nurses to characterize patient problems, which are operationally distinct from those used in medicine, and also in the nature of homecare technologies needed by nurses. Nurses provide an important but distinct contribution to patient care, and the informatics technologies needed to support nurses and their patients are complementary but distinctly different from those that support the medical aspect of care. Two developments in health informatics, formal languages and telehealth, serve as the core foundations of technological support for healthcare in the twenty-first century. Nurses contribute to and benefit from advances in language development and telehealth innovations.

Psychological Distress during Ovarian Cancer Treatment: Improving Quality by Examining Patient Problems and Advanced Practice Nursing Interventions

Background/Significance. Ovarian cancer patients are prone to psychological distress. The clinical significance and best practices for distress among this population are poorly understood. Method. Secondary analysis of research records from a six month randomized control trial included 32 women with primary ovarian cancer. All received 18 advanced practice nurse (APN) visits over six months. Three sub-samples were determined by distress level (high/low) and mental health service consent for high distress. Demographic, clinical factors, patient problems and APN interventions obtained through content analysis and categorized via the Omaha System were compared. Results. Clinically-significant psychiatric conditions were identified in 8/18 (44%) high distress subjects consenting to mental health intervention. High distress subjects who refused mental health intervention had more income and housing problems than the other subjects, received the fewest interventions at baseline, and progressively more throughout the study, exceeding the other sub-samples by study completion. Conclusions. Highly-distressed women not psychologically ready to work through emotional consequences of cancer at treatment onset may obtain support from APNs to manage cancer problems as they arise. Additional studies may identify best practices for all highly-distressed women with cancer, particularly those who do not accept mental health services for distress, but suffer from its effects.

Intervenções de enfermagem para alta de paciente prostatectomizado: revisão integrativa

Este estudo objetivou identificar o conhecimento que se tem produzido sobre intervenções de enfermagem, na literatura científica da enfermagem, com vistas ao preparo do paciente prostatectomizado para alta hospitalar. Trata-se de uma revisão integrativa da literatura em que foram consultados artigos das bases de dados LILACS, MEDLINE, CINAHL e Biblioteca Cochrane. A amostra da revisão constituiu-se de 25 artigos. A possibilidade de incontinência urinária constitui um dos focos mais frequentes abordados, assim como intervenções relativas à informação dos pacientes, especialmente, sobre cuidados com o cateter Foley. Destaca-se a importância da realização de estudos experimentais e quase experimentais sobre a eficácia da informação para o autocuidado aos pacientes e suas famílias, melhores cuidados de enfermagem na incontinência urinária e disfunção erétil e diagnósticos de enfermagem específicos para orientar planos de cuidados de enfermagem a esses pacientes.

Describing a Nurse Case Manager Intervention to Empower Low-Income Men With Prostate Cancer

PURPOSE/OBJECTIVES

Describe and categorize nurse case manager (NCM) interventions for low-income, uninsured men with prostate cancer.

RESEARCH APPROACH

Descriptive, retrospective record review.

SETTING

Statewide free prostate cancer treatment program in which each patient is assigned an NCM.

PARTICIPANTS

7 NCMs who developed interventions based on empowerment through increasing self-efficacy.

METHODOLOGIC APPROACH

NCM entries were extracted and coded from 10 electronic patient records, line by line, to reveal initial themes. Themes were grouped under categories. Investigators then reviewed and expanded these categories and their descriptions and postulated linkages. Linkages and relationships among categories were empirically verified with the original data. NCM entries from another 20 records were prepared in the same manner as the original records. Modifications were made until the categories contained all of the data and no new categories emerged. Categories were verified for content validity with the NCMs and reviewed for completeness and representation.

MAIN RESEARCH VARIABLES

NCM interventions.

FINDINGS

Categories of NCM interventions emerged as assessment, coordination, advocacy, facilitation, teaching, support, collaborative problem solving, and keeping track. Categories overlapped and supported each other. NCMs tailored interventions by combining categories for each patient.

CONCLUSIONS

The skillful tailoring and execution of intervention strategies depended on the knowledge, experience, and skill that each NCM brought to the clinical situation. NCM categories were consistent with the tenets of the self-efficacy theory.

INTERPRETATION

The model, based on NCM interventions, provides a guide for the care of underserved men with prostate cancer. Components of the model need to be tested.

Longitudinal analyses of nurse staffing and patient outcomes: more about failure to rescue

BACKGROUND

Numerous studies have examined cross-sectional data to determine the relationships between nurse staffing and patient outcomes. Questions have been raised about some of the studies now in the literature regarding the use of the hospital as the unit of analysis and the cross-sectional design of the studies. Additionally, there is a concern that the primary outcomes being studied are negative.

OBJECTIVE

Objectives of this study are to (1) compare the relationships between nurse staffing and positive patient outcomes for 3 adult medical-surgical nursing units in one university teaching hospital across 4 years (16 fiscal quarters); and (2) explore the use of 2 new failure-to-rescue (FTR) rates as outcomes, specifically FTR from medication errors and FTR from decubitus ulcers.

DESIGN

This study uses secondary analyses of data viewed retrospectively with a longitudinal repeated-measures design to estimate the relationships between nurse staffing and the outcomes of interest.

RESULTS

Accounting for total dollars and case mix, all patient satisfaction measures increased as total hours of care per patient day increased, and as the skill mix became richer (more RN hours/total hours) there was a higher satisfaction with pain management and physical care requests. There was an increase in FTR from medication error as the non-RN (Other) hours of care per patient day increased and there was an increase in FTR from decubitus ulcers as patient severity increased.

CONCLUSION

The overall conclusion is that it will likely be necessary to vary staffing hours and staffing mix depending on which positive patient outcome or outcomes you wish to achieve.

Mixed models incorporating intra-familial correlation through spatial autoregression

Family researchers are challenged by the need to account for the special forms of statistical dependence that can exist in family data. To address this issue, mixed modeling methods were adapted to account for dependence of continuous outcomes measured across multiple family members. This was accomplished using a spatial autoregressive approach that accounts for dependence on direction as well as on distance apart. For family data, the dimensions underlying direction can correspond to different family members, thereby accounting for different correlations between family members. When the data are also longitudinal, a dimension representing distance apart in time also can be included to account for temporal correlation. Fixed effects involving general linear models can be included as well. Example analyses were conducted to demonstrate the use of the spatial autoregressive approach for modeling intra-familial correlation.

Advanced practice nursing outcomes: a review of selected empirical literature

PURPOSE/OBJECTIVES

To review selected empirical literature examining outcomes of advanced practice nursing with a specific focus on the work of oncology advanced practice nurses (APNs).

DATA SOURCES

Published articles (descriptive and data-based) and books.

DATA SYNTHESIS

Well-designed, methodologically sound investigations offer clear and compelling evidence that APNs are effective in improving outcomes in diverse populations and settings. Data on outcomes of oncology APNs are more limited but do demonstrate statistically significant improvements in clinical outcomes in the homecare and ambulatory settings. The increase in oncology APNs and the evolution of viable roles for oncology APNs across cancer practice settings offer opportunities to further assess the outcomes of advanced practice nursing.

CONCLUSIONS

Understanding the effects of oncology advanced practice nursing on clinical, cost, and satisfaction outcomes is critical. These data will help to explain how APNs can be used most effectively in the healthcare system to ensure the delivery of quality cancer care.

IMPLICATIONS FOR NURSING

Assessing the outcomes of advanced practice nursing care has been identified as a priority by the Oncology Nursing Society. Expansion of APN roles in oncology creates myriad opportunities to investigate this issue. APNs should be cognizant of the work that has been done in this area and use this knowledge as a foundation from which to launch further investigations.

Advanced practice nursing in the care of frail older adults

Models of care for frail older adults have increasingly used advanced practice nurses (APNs) to achieve outcomes. Knowledge of the common APN functions and skills that contribute to the success of these models could better inform education and evidence-based practice and guide further research, but published investigations associated with models of gerontologic care neither describe fully these functions and skills nor link the activities of the APN with specific outcomes. Using examples primarily from the University of Pennsylvania School of Nursing, this paper identifies, describes, and analyzes common functions and skills of APNs in published gerontologic care models; examines the strength of the evidence for the effect of APNs on outcomes of care; and identifies areas for further study.

Couples' experiences with prostate cancer: focus group research

PURPOSE/OBJECTIVES

To explore the experiences of couples living with prostate cancer, the impact of the illness on their quality of life, their ability to manage symptoms, and their suggestions for interventions that would help them to improve their daily experiences.

DESIGN

Descriptive, qualitative.

SETTING

Six focus groups were used to obtain the data; two were patient-only groups, two were spouse-caregiver groups, and two were dyad groups. The focus groups were conducted at two comprehensive cancer centers in the midwestern region of the United States.

SAMPLE

42 participants: 22 men with prostate cancer and 20 spouse-caregivers.

METHODS

Focus group discussions were tape-recorded, and the content was analyzed.

MAIN RESEARCH VARIABLES

Quality of life, symptom experience, and areas for intervention.

FINDINGS

Four major themes emerged from the data: enduring uncertainty, living with treatment effects, coping with changes, and needing help.

CONCLUSIONS

Participants had a need for information and support. Both men and spouse-caregivers felt unprepared to manage treatment effects. Symptoms had a broad effect on couples, not just men. Positive effects of the illness, as well as negative effects, emerged from the themes.

IMPLICATIONS FOR NURSING

Attention needs to be given to methods of providing information and support to couples coping with prostate cancer. Both patients and partners need to be included in discussions about the effect of the illness and treatments so that both can feel more prepared to manage them.

Early quality of life in patients with localized prostate carcinoma: an examination of treatment-related, demographic, and psychosocial factors

BACKGROUND

Men with localized prostate carcinoma are faced with important treatment decisions, and quality of life (QoL) information has become a crucial element of decision making. The first objective of this study was to compare the early, health-related QoL (HRQoL) of men with localized prostate carcinoma who were treated with radical prostatectomy, external beam radiotherapy, or brachytherapy. A second objective was to identify demographic and psychosocial variables that predict HRQoL.

METHODS

Two-hundred fifty-six men with localized prostate carcinoma were interviewed within 7 weeks of treatment initiation. The interview included measures of prostate-specific HRQoL (the University of California-Los Angeles Prostate Cancer Index), general HRQoL (the SF-36), and psychosocial variables.

RESULTS

After adjusting for covariates, treatment group differences were found for both prostate specific HRQoL and general HRQoL. Men who underwent prostatectomy reported more urinary and sexual problems and more general physical dysfunction compared with men who were treated with either form of radiation therapy. Men who were treated with brachytherapy reported the fewest problems in sexual function and the least general physical dysfunction. Few treatment group differences were found in mental functioning. Both demographic factors and psychosocial factors predicted HRQoL. Older men and African-American men reported more physical problems than younger men and Caucasian men, respectively. A supportive social environment, high self-efficacy, and high self-esteem were predictive of better HRQoL.

CONCLUSIONS

Shortly after undergoing treatment for localized prostate carcinoma, men who underwent radical prostatectomy, older men, and African-American men are at heightened risk for experiencing prostate-specific and general deficits in HRQoL. Having psychosocial resources from which to draw may enhance HRQoL.

Sexual problems in men with prostate cancer in comparison with men with benign prostatic hyperplasia and men from the general population

In a questionnaire study, men with prostate cancer (n = 155) or benign prostatic hyperplasia (n = 131) identified more sexual problems than did men from the general population (n = 129). Sexual dysfunction was acknowledged regarding sexual pleasure and attraction, erectile function and sexual satisfaction and sexual performance. Lowered rates of sexual desire, pleasure and attraction were found when comparing their situation in recollection of pre-treatment situation to the current situation. Lower intercourse frequency and sexual satisfaction were also found. Medication, masturbation and artificial aids to achieve erection were not used as substitutes for shortcomings of erectile function either by men with prostate cancer and benign prostatic hyperplasia nor by their partners. There seemed to be a lack of information about the illness and treatment consequences for sexual life, including what physical dysfunction to expect after surgery and also what possible help to expect to compensate for the shortcomings.

Psychosocial and educational intervention trials in prostate cancer

OBJECTIVES

To describe the nature and focus of published educational intervention trials in prostate cancer in the last 10 years and to examine the state of the research in this particular area of knowledge.

DATA SOURCES

Health science and psychosocial electronic databases were searched for studies reporting trials of educational or psychosocial interventions for men with prostate cancer and for the partners or families of these men.

CONCLUSIONS

Interventions were characterized by the aspect of the illness trajectory that was targeted. The majority of the studies focused on managing the disease, treatments, and side effects.

IMPLICATIONS FOR NURSING PRACTICE

Psychosocial stressors and uncertainty are pervasive throughout the prostate cancer trajectory. Knowledge of psychosocial and educational interventions that have been tested is critical for nurses working with these patients and their families.

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.