A test of the fit between the Corbin and Strauss Trajectory Model and care provided to older patients after cancer surgery

The promise of clinical interventions for hepatocellular carcinoma from the west to mainland China

OBJECTIVE

Hepatocellular carcinoma (HCC) presents a major health problem with its steadily increasing incidence in Western countries, and persistent high fatality rates worldwide. The well-recognized complexity and toxicity of its treatment as well as inadequate care and limited resources in mainland China exacerbate the difficulty of maintaining quality of remaining life of patients living with this illness. The goal of this comprehensive literature review was to identify promising clinical interventions for improving quality of life (QOL) of people with advanced HCC in mainland China.

METHOD

A comprehensive literature review was performed in China Academic Journals (CAJ), Cochrane, and PubMed databases. The review was confined to studies of randomized controlled trials (RCT) for adults, in Chinese and English, from 1980 to 2012.

RESULTS

A total of 676 studies in Chinese and 391 studies in English were identified. Eighteen RCTs were selected for the final review, among which three were conducted in mainland China.

SIGNIFICANCE OF RESULTS

Nurse-led home-based comprehensive interventions using a collaborative care approach addressing multiple dimensions of QOL show promise for enhancing clinical outcomes for people with advanced HCC in mainland China. Education and psychosocial support combined with symptom management early in the illness trajectory and ongoing close attention to physical symptoms, emotional distress, as well as spiritual well-being are crucial for maintaining QOL of people with advanced HCC. Telephone monitoring appears to be a feasible way in rural as well as urban areas. Families are advised to be part of overall interventions. It is warranted that promising interventions aiming at improving QOL for advanced cancer patients reported in Western literature be further tested in mainland China.

Information behaviour of parents of children admitted to a neonatal intensive care unit: Constructing a conceptual framework

This article explores the concepts 'information behaviour' and 'illness trajectory' at the neonatal intensive care unit (NICU). On the basis of literature review and exploratory interviews with neonatologists and head nurses of Belgian NICUs a conceptual framework is presented. The 'information behaviour' of parents of infants admitted to a NICU is analytically divided into five dimensions: ways of getting information; interpersonal information sources; time-related issues; location of information transfer; and content of information. The conceptual framework equally takes the 'illness trajectory' into account. Following Corbin and Strauss the illness trajectory at a NICU is analysed in three sub-trajectories: disease course; healthcare trajectory; and sickness trajectory. By combining the respective categories of information behaviour and illness trajectory, an analytical tool is presented under the form of a classification matrix for scrutinizing the mediating role of the illness trajectory on the information behaviour of parents of infants admitted to a NICU.

End-of-life caregiving trajectories

The purpose of this study is to illustrate variations in caregiving trajectories as described by informal family caregivers providing end-of-life care. Instrumental case study methodology is used to contrast the nature, course, and duration of the phases of caregiving across three distinct end-of-life trajectories: expected death trajectory, mixed death trajectory, and unexpected death trajectory. The sample includes informal family caregivers (n = 46) providing unpaid end-of-life care to others suffering varied conditions (e.g., cancer, organ failure, amyotrophic lateral sclerosis). The unifying theme of end-of-life caregiving is “seeking normal” as family caregivers worked toward achieving a steady state, or sense of normal during their caregiving experiences. Distinct variations in the caregiving experience correspond to the death trajectory. Understanding caregiving trajectories that are manifest in typical cases encountered in clinical practice will guide nurses to better support informal caregivers as they traverse complex trajectories of end-of-life care.

Quality-of-life trajectories in epilepsy: a review of the literature

The potential psychosocial sequelae of epilepsy are well-documented, but it cannot be assumed that trajectories for quality of life (QOL) of people with epilepsy will inevitably follow its clinical course. In this article, we draw on available literature to suggest likely QOL trajectories associated with epilepsy and the broad range of disease-, patient-, and other-focused factors that appear important in determining them. We conclude that both the likely shape and time frame for QOL trajectories associated with particular clinical scenarios can be delineated, but that their shape can be altered by a much wider range of factors than those represented as epilepsy disease progression. We identify contributory factors currently relatively unexplored and highlight implications for treatment and areas for future research.

Gero-Oncology Nursing Research

PURPOSE/OBJECTIVES

To analyze the development of gero-oncology research through a critical review of nursing and other relevant research as well as the present state of practice.

DATA SOURCES

Journal articles, book chapters, and personal experience.

DATA SYNTHESIS

Cancer in older adults is viewed through two investigative perspectives. The assumptions, questions, theoretical frames, and research design that follow from these investigative perspectives do not adequately meet the need to examine the interplay of responses to aging, cancer, and nursing practice. The mismatch of need, knowledge, and resources marks older adults with cancer as a special population in need of far more sophisticated research. With the synthesis of a new perspective, gero-oncology nursing research becomes age focused, more precisely shaping theoretical, methodologic, and analytic approaches.

CONCLUSIONS

Uniform attachment of chronologic age or other simple age-related variables to investigations, which is the primary consideration of age-related research, is irrelevant for older adults who are diagnosed with, treated for, live with, survive, and die from cancer. Shaping the next phase of gero-oncology research with a focus on age precisely integrates theoretical, methodologic, and analytic approaches through language specific to older adults and cancer.

IMPLICATIONS FOR NURSING

Shifting perspectives in gero-oncology nursing research will better inform future practice.

Describing an episode of home nursing care for elderly postsurgical cancer patients

BACKGROUND

While studies have documented the beneficial effect of home care for cancer patients, the actual interventions implemented during these studies have not been well described.

OBJECTIVES

Purposes of this study were to analyze interventions documented in narrative form by advanced practice nurses during a four-week episode of home care and describe intervention type, frequency, range, and variation over time in intervention emphasis and dose intensity.

METHODS

Chart audits were performed on records kept for 148 postsurgical cancer patients who were assigned to the experimental group in a randomized clinical trial to evaluate the effect of home care on quality of life outcomes (McCorkle et al., 2000). Interventions statements (N = 7,275) were analyzed using Grobe's (1996) Nursing Intervention Lexicon and Taxonomy.

RESULTS

Teaching accounted for the highest percentage of interventions documented, followed by provision of psychological support and reassurance, determination of patient needs and nursing care requirements, assessment of current status, and indirect care. Physical care and actions to promote self-care independence were documented least frequently. Differences in nursing care were found by cancer site with the greatest diversity of interventions documented for breast cancer patients. Intervention emphasis and dose intensity varied over time, suggesting that these nurses altered their care in response to the changing needs of their patients.

CONCLUSIONS

These nurses responded to complex problems and used a variety of interventions to assist patients and families in management of the illness experience. They also tailored their care to each patient's location along the illness trajectory. These findings provide beginning support for the clinical utility of Nursing Intervention Lexicon and Taxonomy as a way to quantify an episode of nursing care.

Re-thinking stroke rehabilitation: the Corbin and Strauss chronic illness trajectory framework

Re-thinking stroke rehabilitation: the Corbin and Strauss chronic illness trajectory framework The dramatic effects of a stroke can have far-reaching implications for patients and carers. Effective recovery involves a considerable array of coping strategies that facilitate and promote engagement in the social world. Their development is a long-term process that requires considerable effort, motivation and enterprise on the part of patients and their families. Traditional approaches to the provision of stroke rehabilitation services, however, appear to be underpinned by frameworks that are short-term in outlook. As a consequence, nursing interventions often focus on the progression of the patient through the care system, rather than on facilitating future recovery. Much of the work of stroke recovery is consequently done by patients and their families at home, with little provision of ongoing professional help and advice. This paper explores the application of the Corbin and Strauss Chronic Illness Trajectory Framework for stroke. In particular, the major concepts of the framework are applied to a vignette derived from a longitudinal study of patients' experiences of recovery. The trajectory framework is shown to be a useful structure that has the potential to enhance the appropriateness of nursing interventions for stroke patients. However, the validity of the framework can only be established through its application and evaluation in clinical practice. The purpose of this paper is to contribute to a debate that encourages consideration of the framework's utility for nurses to enhance the stroke rehabilitation experience.