The role of empathic nursing telephone interventions with advanced cancer patients: A qualitative study

PURPOSE

Effective symptom management and provider-patient communication are critical components of quality palliative cancer care. Studies suggest nurse-telephone-interventions are feasible, acceptable and may improve the provision and satisfaction with care. However, little is known about what specific elements of nurse-telephone-interventions are most beneficial. The study's purpose was to describe the nature and key elements of therapeutic calls made by nurses to advanced cancer patients to understand what may have previously contributed to improvement in patients who received the intervention.

METHODS

As part of a larger study on methylphenidate and/or a nurse-telephone-intervention for fatigue in advanced cancer patients from a tertiary hospital, nurse calls were made to 95 patients. This qualitative descriptive study used thematic analysis of transcribed telephone calls between nurses and advanced cancer patients.

RESULTS

The overarching theme of these calls was supporting patients with empathy. Empathy in these conversations included nurses' efforts to understand patients' experiences, nurses communicating their understanding back to patients and nurses taking action in response to their understanding of patients' experiences. While humor and validation were used to communicate empathy, problem solving and providing support constituted the content of empathic communication.

CONCLUSIONS

This study illustrates a nurse-telephone-interventions that embraced multiple components of clinical empathy. Nurse-telephone-interventions are feasible and acceptable with diverse, advanced cancer patients. The growing evidence base underscoring the numerous benefits of medical empathy may serve as a basis for adopting simple, feasible and accessible approaches such as empathic nurse-telephone-interventions in both research and clinical practice.

The lived experience of adults with heart failure: a phenomenological study

BACKGROUND

Although a number of studies have been conducted on patients with Heart Failure (HF), they have not given a rigorous comprehensive description of what it is like to live with HF. The objective of this study was to describe the lived experience of adults with HF.

STUDY DESIGN

A hermeneutic phenomenological design was used.

METHODS

Cohen's method was used to conduct the study. Thirty HF patients were enrolled between February and July 2014 from an outpatient cardiovascular clinic in Tuscany, Italy. Phenomenological interviews took place at patients' homes, and the investigators analyzed verbatim transcripts. Once data saturation was achieved, to ensure data trustworthiness, participants were asked to confirm all the extracted themes. Atals.ti vers.7 was used for data analysis.

RESULTS

The patients were mostly male (67%) with a mean age of 71 (SD 9.15) and an age range of 48-86. Seven themes emerged from the phenomenological analysis: 1) important life changes; 2) social isolation caused by the illness; 3) anger and resignation associated with the disease; 4) relief from spirituality; 5) will to live; 6) uncertainty about the future and 7) the inescapability of disease and death.

CONCLUSIONS

The meaning that patients attribute to their lived experience helps to create their needs, which are important to direct care. Family support and religious beliefs are an important source for HF patients to better manage their fears and cope with the future. Findings of this study provide nurses with a comprehensive description of what it is like to live with HF, which can be useful in helping to meet patients' needs more effectively and in tailoring interventions.

Validation of the M. D. Anderson symptom inventory (MDASI-BT)

1546

Background: The occurrence of symptoms has been shown to predict treatment course and survival in a number of solid tumor patients. Primary brain tumor patients are unique in the neurologic symptoms that occur. Currently, no instrument exists that measures both neurologic and cancer-related symptoms. Methods: Patients diagnosed with Primary Brain Tumors (PBT) participated in this study. Data collection tools included a patient completed demographic data sheet, an investigator completed clinician checklist, and the core M.D. Anderson Symptom Inventory to which 18 neurologic symptoms were added (M.D. Anderson Symptom Inventory-Brain Tumor Module, MDASI-BT). The study evaluated the reliability and validity of the MDASI-BT in primary brain tumor patients. Results: 201 patients participated in this study. Mean symptom severity of items as well as cluster analysis was used to reduce the number of total items to 22. Regression analysis showed more than half (56%) of the variability in symptom severity was explained by the 9 remaining brain tumor items. Factor analysis was then performed to determine the underlying constructs being evaluated by the remaining items. The 22 item MDASI-BT measures six underlying constructs including affective, cognitive, focal neurologic deficit, constitutional, generalized symptom, and a gastrointestinal related factor. The internal consistency (reliability) of the sets of items comprising the six factors and also the interference scale were .87, .82, .72, .81, .69, .67 and .91 respectively). Test-retest reliability was good in a subset of 19 patients completing the instrument at two points in time. The MDASI-BT was sensitive to disease severity based on Karnofsky performance status (KPS) based on mean symptom severity (1.7 versus 3.8, p < .001) and mean symptom interference (2.2 versus 6.1, p < .001). Conclusions: The 22 item MDASI-BT demonstrated validity and reliability in patients with PBT. This instrument can be used to describe symptom occurrence throughout the disease trajectory and to evaluate interventions designed for symptom management.

[Table: see text]

Validation of the M.D. Anderson Symptom Inventory Brain Tumor Module (MDASI-BT)

BACKGROUND

Symptom occurrence has been shown to predict treatment course and survival in patients with solid tumors. Primary brain tumor (PBT) patients are unique in the occurrence of neurologic symptoms. Currently, no instrument exists that measures both neurologic and cancer-related symptoms.

METHODS

Patients diagnosed with PBT participated in this study. Data was collected at one point in time and included demographic and clinical factors, and the M.D. Anderson Symptom Inventory-Brain Tumor Module (MDASI-BT). The study evaluated the reliability and validity of the MDASI-BT in primary brain tumor patients.

RESULTS

Two hundred and one patients participated in this study. Mean symptom severity of items as well as cluster analysis was used to reduce the number of total items to 22 (13 core, 9 brain tumor items). Regression analysis showed more than half (56%) of the variability in symptom severity was explained by brain module items. The MDASI-BT measures six underlying constructs including affective, cognitive, focal neurologic deficit, constitutional, generalized symptom, and a gastrointestinal related factor. The internal consistency (reliability) of the instrument was 0.91. The MDASI-BT was sensitive to disease severity based on performance status (P<0.001), tumor recurrence (P<0.01), and mean symptom interference (P<0.001).

CONCLUSIONS

The 22 item MDASI-BT demonstrated validity and reliability in patients with PBT. This instrument can be used to identify symptom occurrence throughout the disease trajectory and to evaluate interventions designed for symptom management.

Isolation in blood and marrow transplantation

This phenomenological study explored the perceptions of 20 patients who had undergone an autologous bone marrow transplantation (ABMT). Transcripts from interviews were analyzed for themes. Three themes emerged related to the experience of isolation during and after ABMT: physical isolation (protecting self and others), emotional isolation (protecting self and others), and physical and emotional isolation (supporting self and others). During physical isolation, participants were protected from infection and tried to protect family and friends from emotional burden. However, physical isolation often led to emotional isolation, which the physical presence of others ameliorated, particularly when an emotional presence was coexistent. Emotional presence was a main source of social support. Participants felt family and friends needed more guidance on ways to provide effective support. An important implication for health care professionals is that emotional support in the form of positive presencing should accompany providing information to both patients and family members.

Qualitative research with diverse populations

OBJECTIVES

To describe the benefits of conducting qualitative research with members of diverse cultures.

DATA SOURCES

Research studies, articles and books on philosophy of science.

CONCLUSIONS

Qualitative research with diverse populations is useful when little research exists on a topic, when there are no reliable and valid instruments for the groups, and when the appropriate language to use or the appropriate concepts and questions to ask are unclear. Participating in research that includes discussing your experiences has also been found to be valuable to those participating.

IMPLICATIONS FOR NURSING PRACTICE

Qualitative studies with diverse groups are needed to understand the concepts that are important to members of these groups, and to guide us in asking the correct questions using correct language.

Culturally competent care

OBJECTIVES

To define key concepts and summarize available guidelines that are important resources to assist nurses to provide culturally competent care.

DATA SOURCES

Medline, anthropologic and epidemiologic literature, and National Institutes of Health documents.

CONCLUSIONS

Controversy remains about the most appropriate language to use to describe features of diverse populations.

IMPLICATIONS FOR NURSING PRACTICE

Becoming culturally competent begins by understanding terms and concepts that are essential in developing cultural awareness, knowledge, and skills. Sensitivity to language and the history of the development of some labels are important.

African American women's experiences with breast cancer screening

PURPOSE

To describe the experience and meaning of breast cancer screening for African American women. Breast cancer screening offers the greatest hope of reducing breast cancer mortality and improving breast cancer outcomes. Despite the proliferation of initiatives targeting African American women, they continue to be first diagnosed only when they have late-stage disease.

DESIGN AND METHODS

Using hermeneutic phenomenological research methods, 23 low- and middle-income African American women were interviewed to gain an understanding of their experiences with breast cancer screening.

FINDINGS

Participants varied in their experiences with breast cancer screening. Women spoke of a desire for a holistic approach to health that did not separate the breast from the rest of the body. This desire is indicated in the theme of minding the body, self, and spirit, along with themes of relationships and spreading the word about breast health issues.

CONCLUSIONS

Interventions for African American women should include a focus on minding the body, self, and spirit to promote breast cancer screening, and should indicate the importance of relationships and spreading the word about breast cancer screening.

Bone marrow transplantation: the battle for hope in the face of fear

PURPOSE/OBJECTIVES

To describe patients' experience of having an autologous bone marrow transplantation (BMT).

DESIGN

Hermeneutic phenomenologic, descriptive, and interpretive.

SETTING

Outpatient treatment area of a comprehensive cancer center in the Southwest.

SAMPLE

20 adult survivors of autologous BMT, 15 women and 5 men, with a mean age of 46 years.

METHODS

Content analysis of verbatim transcriptions of open-ended interviews using hermeneutic phenomenology, which combines descriptive and interpretive phenomenology.

CONCLUSIONS

These patients illustrate that fear, a predominant reality when undergoing autologous BMT, is balanced with hope for survival. The overarching fear, fear of death, often was related to the unknown, including cancer recurrence. The fear of the unknown also came from being unprepared physically and emotionally. Losses were intertwined with these fears and included loss of both control and trust in one's body. Patients discussed fear of leaving the hospital and not having someone "constantly looking at you to make sure that the cancer isn't back." These fears and losses changed patients' view of life and led to a need for help in bringing closure to the experience.

IMPLICATIONS FOR NURSING PRACTICE

Specific nursing actions to help allay fear include providing information about both feelings and procedures, giving opportunities to discuss fears and losses, arranging meetings with others who have had a BMT or suggesting an appropriate support group, and including family in all interventions, as appropriate. Reducing fears with these interventions helped patients maintain hope. By understanding the relationship between hope and fear, nurses caring for people having BMT can use specific strategies to decrease fear, hence increasing hope in patients. Nursing education can emphasize the need to adequately prepare patients. Further research is indicated to explore the effectiveness of interventions to prepare patients for BMT and the interplay between hope and fear.

Breast cancer screening and African American women: fear, fatalism, and silence

PURPOSE/OBJECTIVES

To explore the beliefs, attitudes, and practices related to breast cancer and breast cancer screening among low- and middle-income African American women.

DESIGN

Qualitative study using focus group methodology.

SAMPLE/SETTING

26 African American women, age 40-65, selected from three employment groups, recruited from a community-based center and a local teacher's union in a moderate-sized urban area.

METHODS

Three 90-minute focus group discussions exploring breast cancer beliefs, attitudes, and practices were audiotaped, transcribed verbatim, and analyzed using thematic context analysis techniques.

FINDINGS

When breast cancer was discussed, fear was the predominant feeling expressed in all groups. This fear was a primary reason not to engage in breast cancer screening. Unemployed women and service workers emphasized the role of violence in causing breast cancer, whereas teachers discussed injury and sex as causing breast cancer. All participants stressed that breast cancer is seldom discussed within the African American community. Teachers added that this secrecy within the African American community leads to breast cancer being viewed as a white woman's disease.

CONCLUSIONS

Despite initiatives promoting breast cancer awareness. African American women still hold misconceptions regarding the etiology of breast cancer and fatalistic perspectives regarding breast cancer outcomes, perhaps because breast cancer is discussed infrequently. Because pain, fear, and fatalism were discussed in all groups, future research should address the influence of these factors to increase screening behaviors.

IMPLICATIONS FOR NURSING PRACTICE

Because unemployed women, service workers, and teachers differed in their beliefs about breast cancer and breast cancer screening, nurses must be mindful of the need to tailor Interventions to address the needs of both low- and middle-income African American women.

Autologous bone marrow transplantation: the patient's perspective of information needs

Phenomenologic inquiry was used to explore patients' experiences with autologous bone marrow transplantation (ABMT). Interviews were conducted before and after implementation of a clinical pathway that included a teaching protocol for ABMT. Texts were analyzed individually, compared for pre- and postpathway patients to determine if different themes emerged from these two groups, and then combined. Themes common to both groups included (a) a range of needs for information, (b) everybody's different: a fine balance (the challenge of finding a balance when giving information to patients who vary in the amount of information they desire), (c) someone who has been there (the value of talking to someone who has survived an ABMT), (d) and the burden of ABMT patients teaching family. One theme that reflected different experiences of pre- and postpathway patients was that of the need to know detailed information about the ABMT and the fear of knowing too much. Whereas postpathway patients reflected more on the burden of knowing too much, prepathway patients expressed more dissatisfaction about not being told enough about procedures and symptoms to be expected. Suggestions for teaching patients about ABMT include being generally realistic while focusing on the positive, and viewing patient education as a process individualized according to each patient's needs.

Multimeasure pain assessment in an ethnically diverse group of patients with cancer

The purposes of this study were (a) to describe the relationship between pain perception and ethnic identity and socioeconomic status, (b) to evaluate the intercorrelations between pain measures in different ethnic groups, and (c) to determine whether ethnicity or socioeconomic status influences patient's pain control beliefs and satisfaction with the pain management provided. The sample consisted of 51 English-, Korean-, or Spanish-speaking participants experiencing cancer pain who were 18 years and older and were having a Karnofsky score of no less than 30. The Visual Analogue Scale (VAS), Memorial Pain Scale (MPS), and Face Scale (FS) were used to measure pain perception. In all pain analyses, Hispanics, African Americans, and Anglos did not differ significantly. The data suggest that the pain scales used in this study are appropriate for use in a multicultural population.

Healthcare reform. Its effects on nurses

Healthcare reform has been a major economic and political focus throughout the 1990s. In a national survey of registered nurses about work life and health, many narrative comments addressed changes in the healthcare system. This qualitative study an analysis of these comments, identified themes related to nurses' perceptions of changes and the effect of healthcare reform on the practice of nursing.

Beyond body image: the experience of breast cancer

PURPOSE/OBJECTIVES

To describe the mental and emotional impact of treatment for breast cancer with a focus on the ways the body is experienced.

DESIGN

Phenomenologic, descriptive, and interpretive.

SETTING

An outpatient treatment area of a comprehensive cancer center in the southwestern United States.

SAMPLE

20 women, ages 20-68 (mean = 50 years), who had mastectomies (including both modified radical mastectomies and lumpectomies, with some having reconstruction) for breast cancer.

METHODS

Content analysis of verbatim transcriptions of open-ended interviews using hermeneutic phenomenology and descriptive and interpretive presentation of a paradigm case.

MAIN RESEARCH VARIABLES

Reaction to breast cancer and its treatment.

FINDINGS

Informants' descriptions demonstrate that the body can be viewed as having three aspects: (a) the body as symbol or social expression (i.e., how bodies make a social statement and tell others who you are); (b) the body as a way of being in the world, including sensations and symptoms such as nausea, fatigue, and pain; and (c) the existential sense that one needs a body to be in the world (i.e., the body expresses existence), which led to more awareness of the possibility of death.

CONCLUSIONS

Women treated for breast cancer view their bodies in ways that go beyond what is suggested by the literature on body image and breast cancer, encompassing a wide range of responses.

IMPLICATIONS FOR NURSING PRACTICE

The contribution of this study is the documentation of the complexity of the meaning of "body" for women with breast cancer. Appropriate interventions differ for each aspect of the body: for the body as social symbol, programs such as Look Good ... Feel Better or image centers; for the body's sensations and symptoms, information about what to expect and about symptom prevention and management; for the existential body, active listening to fears and concerns and providing assistance as needed.

Using qualitative research in advanced practice

Although using research in nursing has become increasingly valued, some incorrectly believe that only the findings of quantitative research can be applied. While there are distinct differences between qualitative and quantitative research, both paradigms have an important role to play in nursing. This article explores the topic of research utilization and discusses qualitative research and its evaluation and use. The discussion, and examples from qualitative research, emphasize how useful qualitative research can be to advanced practice nurses.

The meaning of cancer and oncology nursing: link to effective care

A better understanding of the meaning of cancer and oncology nursing may yield insights that will help identify ways in which nurses can obtain the resources they need to meet their own needs and to provide effective care. This article briefly reviews literature on job stress, burnout, coping, and job satisfaction and summarizes our research on nurses' descriptions of the meaning and nature of their work with cancer patients. Nurses described having three important roles: maintaining the goals and values of health care; participating in the patients' experiences; and reconciling the health care values and the patients' experiences (ie, the other two roles). Aspects that are rewarding are also difficult and individual experiences and perceptions changed the meaning of work, the needs nurses have, and the care they provide. The work of nursing may be most satisfying when nurses can articulate the meaning of their work and most effective when they understand how these meanings affect patient care.

Cultivating expertise in oncology nursing: methods, mentors, and memories

PURPOSE

To explore the development of clinical expertise and the role of mentoring experiences in this process for oncology nurses involved in direct patient care.

DESIGN

Multi-institutional, descriptive, qualitative.

SETTING

Six sites in different regions of the United States; rural and urban cancer and noncancer centers.

SAMPLE

38 oncology nurses (mean age = 35 years; average time in nursing = 10 years and in oncology = 7 years; 47% bachelor of science in nursing, 29% diploma, 13% associate degree in nursing, and 11% master's prepared).

METHODS

Phenomenological; content analysis of interviews.

FINDINGS

Development of clinical expertise and professional commitment requires a combination of protégée- and mentor-initiated behaviors. Protégée learning included reading, watching, attending, doing, asking questions, seeking peer support, seeking new opportunities, and associating with others. Mentor contributions included modeling standards and beliefs, coping effectively, explaining knowledge, and believing in, challenging, and supporting the protégée personally and professionally. The absence of mentoring also was of concern to nurses. True mentoring required on interpersonal connection and commitment between the protégée and mentor.

IMPLICATIONS FOR NURSING PRACTICE

Mentoring enhances the development of expert nurses who combine competent clinical practice with strong interpersonal commitment to their patients and the oncology nursing profession. The benefits of mentoring outcomes for individual oncology nurses, their patients, the institutional setting, and the profession need further exploration, especially given the focus on advanced practice and healthcare reform.

The meaning of oncology nursing: a phenomenological investigation

PURPOSE

To describe the method used in a multisite study of the meaning of oncology nursing from the oncology nurses' perspectives.

DESIGN

Multi-institutional, descriptive, qualitative.

SETTING

Six sites in different regions of the United States; rural and urban cancer and noncancer centers.

SAMPLE

38 oncology nurses (mean age = 35 years; average time in nursing = 10 years and in oncology = 7 years; 47% bachelor's degree in nursing, 29% diploma, 13% associate degree in nursing, and 11% master's prepared).

METHODS

Phenomenological; content analysis of interviews.

FINDINGS

Nurses' experiences in caring for people with cancer have many similarities despite the differences among these nurses or their work settings. These similarities are described in this supplement.

IMPLICATIONS FOR NURSING PRACTICE

Many nurses said they had not described their experiences to interested listeners before. Providing these descriptions helped the nurses to see their work in new ways and led some of them to make changes in their personal and professional lives.

An analysis of critical incidents describing the essence of oncology nursing

PURPOSE

To describe oncology nurses' perceptions of the meaning of their work using particularly relevant anecdotes.

DESIGN

Multi-institutional, descriptive, qualitative.

SETTING

Six sites in different regions of the United States; rural and urban cancer and noncancer centers.

SAMPLE

38 oncology nurses (mean age = 35 years; average time in nursing = 10 years and in oncology = 7 years; 47% bachelor's degrees in nursing, 29% diploma, 13% associate degree in nursing, and 11% master's prepared).

METHODS

Phenomenological; content analysis of interviews.

FINDINGS

Nurses described three roles, each characterized by a set of activities: (a) maintaining the values of the healthcare establishment as characterized by monitoring, acting on patients' behalf, protecting patients, and bringing patients into line, (b) participating in patients' experiences as characterized by "being there" for patients, being with dying patients, and, in a sense, becoming part of patients' families, and (c) reconciling healthcare values and the experiences of patients as characterized by teaching and telling the truth.

CONCLUSIONS

Nurses not only demonstrated self-confidence, courage, emotional strength, and a desire to be empathetic but also displayed an unexamined belief that they understood their patients' experiences, were isolated in their work, and experienced difficulty dealing with suffering.

IMPLICATIONS FOR NURSING PRACTICE

Future research should establish whether nurses' understanding of their patients' experiences correlates with patients' accounts of those experiences and whether nurses' sense of isolation is indicative of a pattern of inadequate supportive resources.

Rewards and difficulties of oncology nursing

PURPOSE

To describe oncology nurses' perceptions of the rewards and difficulties of their work.

DESIGN

Multi-institutional, descriptive, qualitative.

SETTING

Six sites in different regions of the United States; rural and urban cancer and noncancer centers.

SAMPLE

38 oncology nurses (mean age = 35 years; average time in nursing = 10 years and in oncology = 7 years; 47% bachelor's degree in nursing, 29% diploma, 13% associate degree in nursing, and 11% master's prepared).

METHODS

Phenomenological; content analysis of interviews.

FINDINGS

Nurses described sources and origins of both job stress and satisfaction. The three most important sources of rewards were patients, co-workers, and new skills. These sources of rewards also were described as sources of difficulties. Additional sources of difficulties include lack of competent administrators, lack of time, and life stresses.

IMPLICATIONS FOR NURSING PRACTICE

Nurses' experiences with work are shaped by both common and very individual and personal realities. Aspects that are rewarding also are difficult, and individual experiences and perceptions change the meaning of work and the needs that nurses have. Considering the findings in the context of nurses' lives may yield more fruitful approaches to providing support and resources that nurses need to be able to provide effective care for patients and their families.

Knowledge and presence: accountability as described by nurses and surgical patients

Accountability was an integral part of phenomenological descriptions of 24 patients' experience of having surgery and 24 nurses' understanding of their experiences. Patients and nurses discussed two major elements, knowledge and presence, although the emphasis on categories within these elements differed. Within the element of knowledge, nurses emphasized lacking knowledge, using professional knowledge, teaching, and leadership. Patients talked most about receiving teaching and individualized knowledge. Nurses also emphasized structure and process, and patients emphasized outcomes. Within the element of presence, nurses talked most about environmental barriers and interaction, and patients emphasized attentive attitude. This view of accountability may help restructure work environments to allow nurses to meet the needs that patients perceive themselves as having.

Explanatory models of diabetes: patient practitioner variation

Most cases of diabetes, a complex disorder that requires many lifestyle changes, can be controlled if persons adhere to their prescribed regimen. However, compliance is difficult to attain. Differences in explanatory models between client and practitioner have been suggested as one reason for non-compliance in several disorders. In this ethnographic investigation, individual explanatory models were elicited from persons with diabetes and from health professionals working with these patients. Professionals described models of diabetes in general and their model of a particular patient's diabetes. A composite professional model was constructed and compared with each of the patients' models. The models were most congruent regarding treatment. Etiology, pathophysiology, and severity had less congruence, and time and mode of symptom onset were least congruent. The Spearman correlation coefficient showed a positive but non-significant association of explanatory model congruence between professionals and patients with normal glycosylated hemoglobin levels. Patients and professionals seem to emphasize different domains; patients emphasized difficulties in the social domain and the impact of diabetes on their lives while staff saw diabetes primarily as a pathophysiological problem with impact on patients' physical bodies. This study's importance rests on its clear articulation of significant differences between patients' and staffs' models even when they are similar in demographic characteristics.

Evaluating depression among patients with cancer

The stress, diagnosis, and treatment of cancer cause substantial psychiatric morbidity that is treatable. Chemotherapy or other cancer treatments cause 40% to 60% of patients' emotional distress. Major depression develops in approximately 25% of patients with cancer, and less severe depressive symptoms develop in many patients, but fewer than half of the patients with symptoms are offered treatment. Alleviating major depression improves the quality of life for these patients with cancer. These patients, particularly during terminal illness, have an increased risk of suicide. Clinicians proficient in psychosocial assessment can detect subtle signs, monitor risk factors, reduce major depression with cognitive strategies, and prevent complications. Untreated major depression lowers life expectancy and treatment compliance and increases risk of suicide and cardiac disease. In this article, incidence of major depression among patients with cancer is discussed. Guidelines for diagnosis, correcting myths, and detecting major depression are suggested. Effective cognitive strategies for intervention are described; medical treatment is briefly reviewed. Detection and evaluation of suicide risk are discussed.

Experiences in children of critically ill parents: a time of emotional disruption and need for support

The purpose of this phenomenologic study was to describe effects of a parental critical care hospitalization on the family as viewed by children. Interviews were conducted with eleven male phenomenologic techniques and showed these four major themes: (1) emotional turmoil, (2) family disruption, (3) need for support, and (4) minor illnesses. These disruptions are strong and need to be treated through nursing interventions.

Grant writing for qualitative research

In order to broaden understanding of the quality of qualitative grant proposals, analysis of 19 summary statements from qualitative grant proposals was conducted. This analysis showed that reviewers determined quality of proposals in terms of four themes: scientific contribution of the research; conceptual framework guiding the work; methods; and knowledge, skills, and resources available to the proposal writers. Writers' responses to the evaluations were reflected in the theme: surviving the review. This analysis suggested that reviewers of qualitative proposals recognized salient issues and were able to respond in ways that writers perceived as helpful. Qualitative research proposals that are clearly written, internally consistent, meaningful and have potential impact for the discipline of nursing are well-received.

Love and work: oncology nurses' view of the meaning of their work

Phenomenological interviews with 23 nurses and more than 200 hours of participant observation on units of one cancer hospital were conducted to obtain a better understanding of how nurses caring for patients with cancer view their work. When asked to discuss a "critical incident" that captures the essence of oncology nursing for them, most nurses described acute physiologic emergencies. A few nurses described psychosocial needs and explained how they had helped or were unable to help patients and families deal with these needs. A major theme in these incidents was how they related to the nurses' own lives. These findings suggest the need to provide nurses with support and an opportunity to discuss their work. Oncology nurses appear to be motivated by a deep concern for patients and families that creates tremendous stress when conditions such as poor staffing, excessive use of registry nurses, and unexpected crises occur. The task orientation of these nurses also seems to be based on their fundamental concern for patient welfare.

Pain as a metaphor for illness. Part I: Impact of cancer pain on family caregivers

While previous research has focused on patients' or professional caregivers' perspective of pain, this study describes cancer pain from the family caregivers' perspective. Chronic pain, which is associated with malignant disease, produces an intense burden on the patient as well as on the entire family. This qualitative study included 85 family caregivers of patients with cancer pain. Data were collected using an interview guide, and verbatim responses were analyzed for themes. The results identified four themes surrounding family descriptions of pain (anatomic descriptions, hidden pain, family fear and suffering, and overwhelming/unendurable pain) and three themes surrounding family experience of pain (helplessness, coping by denying feelings, and a wish for death). This study documents the important role that family members play in cancer treatment. If the number of patients receiving care in the home from family members continues to grow, this role will become even more important. Part I of this two-part paper focuses on the impact that cancer pain has on family caregivers and concludes that pain does have a tremendous impact on the family because it is perceived as a metaphor of progressive illness and death.

Pain as a metaphor for illness. Part II: Family caregivers' management of pain

Changes in the healthcare system have made the patient's home the primary site of cancer care. Family members, already burdened with the psychological impact of having a loved one with cancer, take on caregiving roles to meet the multiple and complex needs of the patient. Part I of this two-part article focused on family caregivers' descriptions of the patients' pain and the impact of this pain on caregivers. A model of the Caregiver Experience of Pain is provided along with implications for future inquiry and clinical practice. Themes identified in caregiver roles in medication administration included deciding what to give, deciding when to give, night duty, reminding/encouraging, keeping records, fear of addiction, and doing everything. Caregiver roles in nondrug interventions included positioning/mobility, massage, use of ointments/lotions, cold, heat, being there through touch, avoiding touch, and talk and other distractions. Caregiver perceptions of what doctors or nurses could do better included themes of being there, explain, be honest/listen, addiction concern, and giving medication. Caregiver questions included areas of future, understanding why, death, concern about medications, and fear about what to do at home. The study results offer important suggestions for oncology nurses in supporting family caregivers in the management of the patient in pain.

Cancer clinical trials. Companion studies

Nursing companion studies may accompany research in a variety of disciplines but most often are associated with medical research. Companion studies include "collaborative-companion" studies and "parallel-companion" studies and rely on a variety of methods. The majority of nursing companion studies have focused on the areas of treatment effects or symptoms, cancer control, and rehabilitation, however, there are many other areas that provide opportunity for independent nursing research.

Inductive methodology and a research team

Large teams of researchers using inductive methodologies are relatively rare and present unique challenges to team members. A team from the University of Iowa reports on what it experienced during a project to develop a taxonomy of nursing interventions.

Classification of nursing interventions for care of the integument

The Classification of Nursing Interventions research team at The University of Iowa, College of Nursing is building a taxonomy of nursing interventions that will include all of the direct care treatment activities that nurses perform on behalf of patients. This report describes the study in which 12 nursing interventions and their associated activities for care of the integument were extracted from a large database and validated through a two-round Delphi survey. Using an adaptation of Fehring's model for determining diagnostic content validity of nursing diagnoses, a definition, critical activities, and supporting activities were developed for each of the following interventions: Bathing, Bedrest Care, Hair Care, Nail Care, Oral Health Maintenance, Oral Health Promotion, Oral Health Restoration, Positioning, Pressure Management, Skin Care--Topical Treatments, Skin Surveillance, and Wound Care. Further research is needed to validate supporting activities and to continue classifying interventions and activities that nurses use in treating impaired skin integrity (potential and actual) and altered oral mucous membrane integrity (potential and actual).

Impact of adult critical care hospitalization: perceptions of patients, spouses, children, and nurses

This phenomenologic study describes the effects of adult hospitalization in a critical care setting on the family as perceived by patients, spouses, children in the family, and nurses. Tape-recorded interviews were completed with 12 spouses, 9 patients (2 mothers and 7 fathers), 11 children, and 12 nurses. Responses were analyzed by using systematic thematic content analysis. Themes that emerged with regard to how this event affected the family unit and individuals in the family included (1) lack of communication among family members; (2) protecting children from anxiety-provoking information; (3) overriding threat, exemplified by feelings of vulnerability, uncertainty, intense emotions, and physical illness in children; (4) disruption of normal home routines; (5) changes in relationships; and (6) role conflict. Nurses' perceptions of the impact of this event on parents, spouses, and children demonstrated some incongruences with perceptions of patients and family members. Practice implications from this study include the following nursing actions: (1) eliciting more comprehensive information about relationships among family members and the impact on the family; (2) developing mechanisms to promote communication among family members; (3) making referrals to community resources such as school nurses, counselors, and chaplains; and (4) teaching nurses and parents ways to help children cope with this event.