Tai Chi as a Complementary Therapy for Depression and Anxiety Among U.S. Veterans in a Mental Health Inpatient Setting

BACKGROUND

Depression and anxiety are two of the top five mental illnesses veterans report. Treatment for depression and anxiety includes medications and psychiatric treatment in inpatient, outpatient, and residential treatment programs; the use of complementary and alternative medicine (CAM) can have beneficial results by decreasing symptoms, recognize patients' preference for CAM, and be cost-effective.

AIM

This study aimed to evaluate the effects of Tai Chi on depression and anxiety symptoms on inpatient psychosocial or substance use disorder (SUD) rehabilitation treatment program residents since little evidence exists regarding the effectiveness of Tai Chi on participants in residential mental health treatment programs. METHOD: A mixed-method, cohort design with 88 participants (41 usual treatment without Tai Chi, 47 intervention) used a demographic survey, Hamilton Anxiety Scale, Quick Inventory of Depressive Symptomatology, self-report, and the Patient Health Questionnaire-9 at Weeks 1 and 4 of the treatment program. After Week 4, the intervention group responded to six open-ended questions about Tai Chi's effects on their overall depression and anxiety.

RESULTS

The anxiety level of the intervention group was significantly decreased, as evidenced by the Hamilton Anxiety Scale scores (p = .02). However, the measures of depression did not differ between the groups. Two themes, mindfulness and satisfaction, were identified from the written responses regarding the Tai Chi intervention.

CONCLUSION

Tai Chi effectively reduced symptoms of anxiety that varied by age and ethnicity. This study increased the insight regarding the benefit of including Tai Chi as a complementary therapy for those participating in residential treatment programs.

The Experience of Frontline Nurses during the COVID-19 Pandemic: A Phenomenological Study

The purpose of this phenomenological study was to describe the experience of frontline nurses working during the COVID-19 pandemic. The first author conducted two individual audiotaped interviews with 23 qualified staff nurses. All the authors analyzed the professionally transcribed data according to hermeneutic principles. The researchers identified five major themes: (a) we are family; (b) heroes work here; (c) fear of contagion; (d) mental health and well-being; and (e) new reality. Given the uncertainties of working during the COVID-19 pandemic, findings revealed the value of supportive collegial relationships and the need to support the mental health and well-being needs of frontline nurses during the pandemic. Nurses need supportive environments to help ease the challenges associated with serving on the frontline during times of crisis. Findings have implications for future public health preparedness and response efforts.

Comparison of Recertification Methods on CPR Quality

BACKGROUND

High-quality cardiopulmonary resuscitation (CPR) is vital to improving survival from cardiac arrest. This study compared participant performance of CPR with three American Heart Association (AHA)-approved CPR recertification programs because current literature does not show which method is superior. Our goal is to investigate the best training methods to deliver high-quality CPR.

METHOD

Participants were within 90 days of recertification in face-to-face, Heart Code, or Resuscitation Quality Improvement (RQI).

RESULTS

No statistically significant differences were found among training modalities or demographic characteristics. The only significant difference was among those who had performed CPR on a human.

CONCLUSION

Mean scores for the three modalities did not reach the passing requirement for AHA, suggesting that one method of CPR training is not better than the others. Recommendations for translating these findings into clinical practice include mock codes with the ability to measure CPR metrics and simulations of cardiac responses to provide vicarious CPR experience. [J Contin Educ Nurs. 2022;53(1):43-48.].

Clinical Nurses Research Priorities in Hospital Settings: A Delphi Survey

This study aimed to identify the research priorities of clinical nurses to develop a research program at a health care services system that includes three hospitals. A Delphi survey was emailed to all clinical nurses in two rounds. The Delphi method was used to collect data from the nurses in regards to their priority research themes, and the data were analyzed using descriptive and comparative statistics. A total of 933 clinical nurses returned the first round of the Delphi survey and 543 nurses answered the second round. Clinical nurses identified 89 potential research themes. Patient safety and ethical challenges were the two highest ranked research priorities. The 40 highest ranked priority research themes were closely associated with issues concerning patient care and ethics. However, the nurses also gave high ratings to issues relating to the work environment, questions about technology implementation, and patient involvement in clinical care decisions.

Cancer as Communal: Understanding Communication and Relationships from the Perspectives of Survivors, Family Caregivers, and Health Care Providers

With cancer increasing in prevalence and high priorities placed on concurrent oncological and palliative care to help meet the familial, spiritual, and individual needs of stakeholders in cancer, research is needed that assesses the factors that facilitate coping across stakeholders in cancer care. We were interested in synthesizing our understanding of communication and relationships among patients, caregivers, and providers based on the reasoning that illness is relational, but often conceptualized and researched from the individual perspectives of various stakeholders. The current study examined the experiences of relational and communication opportunities and challenges during cancer for current and former family caregivers, cancer survivors, and palliative and oncology health care practitioners. The thematic analysis of 30 semi-structured interviews revealed an overarching theme on the benefits of orienting toward cancer as communal, which was, in turn, facilitated or impeded by four additional themes/sets of behaviors: support, presence, perspective-taking, and reframing hope. Results of a cross-case data matrix analysis reveal that stakeholders in different roles experience qualitative differences in their experience of cancer as communal, isolated, or ambivalent. Implications for education, palliative care, and interventions are discussed.

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.

Cancer-related Fatigue Reported in Online Discussion Groups

Fatigue is a prevalent cancer-related symptom that is difficult to communicate, define, and treat. To obtain robust descriptions of symptoms, participants were recruited into two online groups that consisted of their dialoguing together in an asynchronous, threaded discussion forum. Participants dialogued for 5 months and completed pre- and post-participation demographic data and symptom ratings. Survey data were described, and change scores were calculated. Excerpts from the dialogue were analyzed using phenomenological techniques. The 28 participants reported low symptoms that did not change significantly from pre- to post-participation. Phenomenological analysis revealed three themes: descriptions of "bone-sucking fatigue," a search for meaning or answers about the fatigue, and attempted remedies. Online support groups provide a venue for sharing symptom experiences, adding to existing knowledge about symptoms in survivors. These descriptions provide information that will aid in developing patient-centered interventions.

Self-efficacy for symptom management in the acute phase of hematopoietic stem cell transplant: A pilot study

PURPOSE

Hematopoietic stem cell transplant (HSCT) is an intensive treatment associated with distressing treatment and disease-related symptoms that affect patient outcomes such as functional status and quality of life. Self-efficacy for symptom management (SESM) is a person's belief in their ability to perform behaviors to prevent and relieve symptoms. Presence of SESM can impact symptom distress and functional status. This study describes the changes over time and relationships among SESM, symptom distress, and physical functional status in adults during the acute phase of HSCT.

METHODS

Patients (n = 40) completed measures of symptom distress, SESM, and physical function at time points prior to and at days 7, 15 and 30 post-transplant. Clinical outcomes were length of stay and number of readmissions.

RESULTS

Symptom distress, physical function, and SESM changed significantly over time. There was a significant negative relationship between symptom distress and physical function and between symptom distress and SESM at all points. The lowest levels of SESM and physical function were at day 7 when symptom distress was highest. Symptom distress was a moderator for the relationship between physical function and SESM at day 15.

CONCLUSION

This was the first study to examine SESM in the acute phase of HSCT. Higher SESM was associated with fewer symptoms and increased physical function. Less symptom distress was associated with higher physical function and confidence to manage symptoms. These findings provide the basis for development of patient-centered interventions to enhance SESM when symptoms are at their highest immediately after HSCT.

Self-Efficacy for Management of Symptoms and Symptom Distress in Adults With Cancer: An Integrative Review

PROBLEM IDENTIFICATION

Self-efficacy for symptom management plays a key role in outcomes, such as quality of life (QOL), functional status, and symptom distress, for adults with cancer. This integrative review identified and assessed evidence regarding self-efficacy for management of symptoms and symptom distress in adults with cancer.

LITERATURE SEARCH

The authors performed a search of literature published from 2006-2018, and articles that examined the relationship among self-reported self-efficacy, symptom management, symptom distress or frequency, and severity in adults with cancer were selected for inclusion.

DATA EVALUATION

22 articles met the inclusion criteria. All articles were critically appraised and met standards for methodologic quality.

SYNTHESIS

Evidence from this review showed that high self-efficacy was associated with low symptom occurrence and symptom distress and higher general health and QOL. High self-efficacy predicted physical and emotional well-being. Low self-efficacy was associated with higher symptom severity, poorer outcomes, and better overall functioning.

IMPLICATIONS FOR RESEARCH

Self-efficacy can be assessed using developed instruments. Presence of a theoretical model and validated instruments to measure self-efficacy for symptom management have set the groundwork for ongoing research.

Vicarious Experience to Affect Physical Activity in Women: A Randomized Control Trial

People compare themselves to others for self-evaluation, practical information, and motivation for healthy behaviors. The effect of active peer models on comparative thinking is unknown. The purpose of this 12-week, randomized, two-group pilot study was to evaluate the effect of a workplace peer modeling intervention on self-efficacy, motivation, and comparative thinking. The attention control group (ACG; n = 24) received general health information. The intervention group (n = 26) met with active peer models, received an exercise prescription and information. No significant group by time interaction effects were found. Comparisons on ability (how well am I doing), opinions (what should I think or believe), future self (think about my future), and modeling (be like someone else) all increased in the intervention group (n = 21) but decreased in the ACG (n = 22). Active peer models may support physical activity behavior change through specific lines of comparative thinking.

Delirium in Advanced Cancer Leading to Distress in Patients and Family Caregivers

Background: Information is limited about the experiences of delirium among patients with advanced cancer and their caregivers, which makes designing interventions to relieve delirium-related distress difficult. To better understand the experience and thus permit the design of effective interventions, we collected and analyzed data from patients with advanced cancer who had recovered from delirium and their family caregivers. Method: Phenomenolog-ical interviews were conducted separately with 37 caregivers and 34 patients. One investigator reviewed verbatim transcripts of the audio-taped interviews to identify themes, which the research team confirmed. Results: Most patients and all caregivers had vivid memories of the experience; their descriptions were consistent. Most also attributed the confusion to pain medication. Caregivers had concerns about how best to help patients, patients’ imminent deaths, and their own well-being. Conclusions: The main finding that delirium leads to distress for both patients and care-givers indicates the importance of recognizing, treating, and, if possible, preventing delirium in this population. Concerns about pain medications also indicate the need to educate patients and caregivers about symptom management. Caregivers also need emotional support.

Pearls and Pitfalls of Team Science

Formidable health problems are often best addressed by teams of scientists with varied expertise. This diversity among team members and complexities in managing teams can lead to challenges in designing, funding, conducting, and reporting research. Team science difficulties can be addressed by sophisticated planning, frequent reassessment and realignment of team strategies with goals, and consistent transparent communication. This article addresses specific strategies to build and sustain research teams, manage team meetings, strategically develop publications and grants, thrive in the midst of disciplinary and individual team member differences, embrace new ideas and change to maintain creativity, and build future team scientists and projects. The potential value in team science justifies the effort required to build and maintain efficient and effective research teams.

Perceptions of a Peer Modeling Workplace Physical Activity Intervention for Women

A workplace physical activity (PA) study tested a novel use of peers to deliver the intervention. Peer models provided vicarious experience for living physically active lifestyles to a group of inactive women. The purpose of this study was to describe participants' perceptions of the peer modeling intervention. Nine women from the intervention group ( n = 26) participated in a 90-minute focus group. Qualitative description using thematic analysis was used to identify themes from the focus group transcript. Two themes about the intervention were "I am left wanting more" and "focus on food." Two themes about the peer models were "real people" and "it is doable." Focus group participants perceived the peer modeling PA intervention favorably; however, they desired more attention to healthy eating and more time with peer models. Replication of the study accounting for themes identified by focus group participants is needed to strengthen the peer modeling intervention.

Feasibility and Effect of a Peer Modeling Workplace Physical Activity Intervention for Women

Most working women do not meet current guidelines for physical activity (PA). A 12-week pilot study tested a workplace, peer modeling PA intervention. Inactive female employees from a health system were randomized to an attention control group (ACG; n = 26) or an intervention group (IG; n = 26). The ACG received health information. The IG participated in six group sessions with an active peer model and received an exercise prescription and PA information. Pre and post measures were PA (ActiGraph), Estimated VO2max (cycle ergometer), resting heart rate (HR), glucose and lipids, and cardiovascular risk. Using hierarchical linear modeling, no significant group by time effects were found. Although PA increased in both groups, F( df = 1) = 11.4, p = .002, the IG had greater improvements in fitness (VO2max, HR) and cardiovascular risk (total cholesterol, triglyceride, low density lipoprotein [LDL], calculated risk score) compared with ACG. Results support repeating this intervention in a fully powered study.

Autism spectrum disorder and genetic testing: Parental perceptions and decision-making

PURPOSE

Advances in genomic technology and research have led to genetic testing being recognized as an essential component of the etiological workup for children with autism spectrum disorder (ASD). Chromosomal microarray analysis (CMA) is a first-tier diagnostic test for patients with ASD, as recommended by the American College of Medical Genetics and other professional societies. An accurate underlying medical diagnosis for ASD has many potential benefits, including appropriate medical management, detailed therapeutic recommendations, and accurate recurrence risk. Genetic testing is relatively complicated, expensive, and, currently, in the majority of the cases, does not provide any organic improvement in the management of symptoms.

DESIGN AND METHODS

We conducted semistructured interviews with 20 parents to explore the decision-making process of genetic testing from the perspectives and experiences of parents of children with ASD. Data were analyzed using qualitative content analysis.

RESULTS

Parents had limited knowledge of genetic testing for ASD prior to a genetics clinic visit. The majority of the participants thought genetic testing would be beneficial for their child, their reproductive choices, and potential future generations.

PRACTICE IMPLICATIONS

Various stakeholders (geneticists, primary care providers, nurses, and families) would benefit from future establishment of educational strategies to inform parental decision-making regarding genetic testing for children with ASD.

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.

Measuring Resilience in Two Generations: Psychometric Properties of Available Instruments

BACKGROUND AND PURPOSE

This study examines measures of resilience to identify the best available measure for future research to assess efficacy of a low-cost intervention that enhances resilience of older adults and youth (i.e., intergenerational transfer of ethnic culture).

METHODS

Scanning the literature produced no obvious choice; 3 measures showed promise: the Wagnild-Young Resilience Scale, Windle-Markland-Woods Psychological Resilience Scale, and the Connor-Davidson Resilience Scale (CD-RISC); 200 ethnicityalike older adults and 192 youths completed all three scales.

RESULTS

Factor analyses interpreted in consultation with a panel of community advisers showed no measure was statistically robust. The CD-RISC had acceptable reliability and a conceptually interpretable structure.

CONCLUSIONS

Results suggest the CD-RISC, supplemented by qualitative input, provides a way forward for research on efficacy of intergenerational interventions.

Launching Successful Beginnings for Early Career Faculty Researchers

Junior faculty follow a research path replete with challenges as they strive to create knowledge in their area of interest while balancing new responsibilities. Unlike graduate school, where students focus inward on personal development, junior faculty must add responsibilities in ways that hold them accountable as members of a university. This special article deals with three themes of interest to new junior faulty launching research programs: personal development, collaboration and team development within university settings, and funding advice. Strategies in these areas provide guidance on navigating early careers and finding success in the academic setting.

Strategies to Build Authorship Competence Among PhD Students

Publication in refereed journals is an important responsibility of PhD-prepared nurses. Specialized writing skills are crucial for effective professional publication. The capacity to develop and publish articles is best learned during doctoral education. This Western Journal of Nursing Research Editorial Board Special Article addresses multi-dimensional strategies to develop authorship competence among doctoral students. The article outlines structured PhD program experiences to provide the context for students to develop authorship capacity. The authors identify multi-faceted faculty endeavors and student activities that are essential to foster authorship competence. Students who embrace opportunities to acquire authorship qualifications will be well prepared for their post-graduation role as stewards of the nursing discipline.

Distinguishing Features and Similarities Between Descriptive Phenomenological and Qualitative Description Research

Scholars who research phenomena of concern to the discipline of nursing are challenged with making wise choices about different qualitative research approaches. Ultimately, they want to choose an approach that is best suited to answer their research questions. Such choices are predicated on having made distinctions between qualitative methodology, methods, and analytic frames. In this article, we distinguish two qualitative research approaches widely used for descriptive studies: descriptive phenomenological and qualitative description. Providing a clear basis that highlights the distinguishing features and similarities between descriptive phenomenological and qualitative description research will help students and researchers make more informed choices in deciding upon the most appropriate methodology in qualitative research. We orient the reader to distinguishing features and similarities associated with each approach and the kinds of research questions descriptive phenomenological and qualitative description research address.

Evaluation of two instruments of perceived symptom intensity in palliative care patients in an outpatient clinic

AIMS AND OBJECTIVES

To evaluate the test-retest stability in assessments of perceived symptom intensity on the Edmonton Symptom Assessment System-revised and the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative. The possible interchangeability between the instruments and the patients' experiences of completing the instruments were also studied.

BACKGROUND

The two instruments assess the same symptoms, but the symptom intensity is assessed on 11-point numerical scales on the Edmonton Symptom Assessment System-revised and on four-point verbal descriptive scales on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative. Both instruments are commonly used; however, uncertainty exists about which instrument should be recommended and about the interchangeability of the instruments.

DESIGN

This study used a test-retest design with inter-scale comparisons.

METHODS

Data from 54 patients with cancer who were receiving palliative care in an oncology outpatient clinic were self-reported by the patients in the clinic, at home and when patients returned to the clinic.

RESULTS

The assessments on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative verbal rating scales showed a higher level of test-retest stability than the assessments on the Edmonton Symptom Assessment System-revised numerical scoring scales, indicating higher reliability. The correspondence between the verbal categories and the numerical scores of symptom intensity were low because different verbal categories were used by patients who assessed the same numerical score.

CONCLUSIONS

The test-retest stability in the assessments was higher on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative and the results show that assessments on the two instruments could not be used interchangeably. Therefore, the symptom instrument chosen must be specified and unchanged within a patient to improve efficacy in clinical practice.

RELEVANCE TO CLINICAL PRACTICE

The Edmonton Symptom Assessment System-revised or the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative can be used for initial assessments of patients, but should not be compared or used interchangeably. It is vitally important to have individual follow-up for all patients who score an instrument.

Symptom profiles in children with advanced cancer: Patient, family caregiver, and oncologist ratings

BACKGROUND

Systematic symptom assessment is not routinely performed in pediatric oncology. The objectives of the current study were to characterize the symptoms of pediatric oncology outpatients and evaluate agreement between patient and proxy reports and the association between children's ratings and oncologists' treatment recommendations.

METHODS

Two versions of the pediatric Memorial Symptom Assessment Scale (pMSAS) were translated into Spanish. An age-appropriate and language-appropriate pMSAS was administered independently before visits to the oncologist to patients and family caregivers (caregivers) and after visits to consenting oncologists. Statistical analysis included Spearman correlation coefficients and weighted kappa values.

RESULTS

English and Spanish results were similar and were combined. A total of 60 children and their caregivers completed the pMSAS. The children had a median age of 10 years (range, 7-18 years); approximately 62% were male and 33% were Spanish-speaking. Fourteen oncologists completed the pMSAS for 25 patients. Nine patients (15%) had no symptoms and 38 patients (63%) reported ≥2 symptoms. The most common symptoms were fatigue (12 patients; 40%) and itch (9 patients; 30%) for the younger children and pain (15 patients; 50%) and lack of energy (13 patients; 45%) among the older children. Total and subscale score agreement varied by proxy type and subscale, ranging from fair to good for most comparisons. Agreement for individual symptoms between the patient and proxy ranged from a kappa of -0.30 (95% confidence interval, -0.43 to -0.01) to 0.91 (95% confidence interval, 0.75 to 1.00). Three of 51 symptomatic patients (6%) had treatment recommendations documented in the electronic health record.

CONCLUSIONS

Symptoms are common and cross several functional domains. Proxy and child reports are often not congruent, possibly explaining apparent undertreatment among this group of patients.

Normalizing Rejection

Getting turned down for grant funding or having a manuscript rejected is an uncomfortable but not unusual occurrence during the course of a nurse researcher's professional life. Rejection can evoke an emotional response akin to the grieving process that can slow or even undermine productivity. Only by "normalizing" rejection, that is, by accepting it as an integral part of the scientific process, can researchers more quickly overcome negative emotions and instead use rejection to refine and advance their scientific programs. This article provides practical advice for coming to emotional terms with rejection and delineates methods for working constructively to address reviewer comments.

Implementing common data elements across studies to advance research

Challenges arise in building the knowledge needed for evidence-based practice partially because obtaining clinical research data is expensive and complicated, and many studies have small sample sizes. Combining data from several studies may have the advantage of increasing the impact of the findings or expanding the population to which findings may be generalized. The use of common data elements will allow this combining and, in turn, create big data, which is an important approach that may accelerate knowledge development. This article discusses the philosophy of using common data elements across research studies and illustrates their use by the processes in a developmental center grant funded by the National Institutes of Health. The researchers identified a set of data elements and used them across several pilot studies. Issues that need to be considered in the adoption and implementation of common data elements across pilot studies include theoretical framework, purpose of the common measures, respondent burden, teamwork, managing large data sets, grant writing, and unintended consequences. We describe these challenges and solutions that can be implemented to manage them.

Data validation and other strategies for data entry

Data entry can result in errors that cause analytic problems and delays in disseminating research. Invalid responses can lead to incorrect statistics and statistical conclusions. The purpose of this article is to provide researchers some basic strategies for avoiding out-of-range data entry errors and streamlining data collection. This article identifies some basic strategies using Microsoft® Excel, which is an inexpensive method of data entry that can be used when research budgets are constrained. Data files can be structured so that out-of-range values cannot be entered. When string variables are entered, researchers may be inconsistent in the way they code responses. Data validation can be accomplished through the use of restricting response options and skipping items can be avoided by using count functions to tabulate the number of valid responses. We also discuss advantages and disadvantages of several methods of data entry, including using web-based data entry and relational databases.

Managing Opportunities and Challenges of Co-Authorship

Research with the largest impact on practice and science is often conducted by teams with diverse substantive, clinical, and methodological expertise. Team and interdisciplinary research has created authorship groups with varied expertise and expectations. Co-authorship among team members presents many opportunities and challenges. Intentional planning, clear expectations, sensitivity to differing disciplinary perspectives, attention to power differentials, effective communication, timelines, attention to published guidelines, and documentation of progress will contribute to successful co-authorship. Both novice and seasoned authors will find the strategies identified by the Western Journal of Nursing Research Editorial Board useful for building positive co-authorship experiences.

Measuring functional recovery in older patients discharged from intensive care units: is advanced technology an option?

The purpose of this descriptive study was to determine if older patients discharged from intensive care units (ICU) would be willing to use mobile phone and sensor technology (aka "mobile monitoring") to measure their functional recovery in the posthospitalization period. Semistructured interviews were conducted with 22 older ICU patients and/or their surrogates 24 to 48 hr prior to hospital discharge. While 11 respondents reported they would agree to participate in a future study involving mobile monitoring, an equal number reported they would not participate. Numerous contextual factors were found to affect older adults' willingness to participate including the belief the research would ultimately benefit themselves or other older adults, concerns about loss of privacy, perception that the research is feasible and valuable, and lack of skills using the technology. Future studies using the mobile monitoring technique with older survivors of a serious illness will require substantial recruitment and educational efforts.

The experience of stroke survivors three months after being discharged home: A phenomenological investigation

BACKGROUND

Stroke is the leading cause of disability in adults, and has a significant impact on individuals, families, and society. Returning home after a stroke represents a challenging experience for patients who struggle to adapt to their new life conditions. Although many studies have been conducted on stroke survivors, few studies have focused on the lived experience of patients at three months after they came home after rehabilitation.

AIMS

The aim of this study was to describe the experience of stroke survivors three months after being discharged home from rehabilitation hospitals.

METHOD

A phenomenological methodology was used to conduct the study. Participants were enrolled from rehabilitation hospitals in the cities of Rome and Naples. Interviews were conducted at the patients' house and data were analysed with a phenomenological approach

FINDINGS

Fifteen stroke survivors were interviewed (mean age 70 years; 12 males). Five themes emerged from the phenomenological analysis of the interviews and the field notes: deeply changed life, vivid memory of the acute phase of the stroke, slowed lives, relief after recovering from stroke, being a burden for family members.

CONCLUSIONS

The results of this study give an overview of the experience of stroke survivors three months after being discharged home. From a clinical perspective, health care providers need to provide more interventions to help survivors to cope better with life changes and encourage them to adapt to daily life limitations caused by stroke. Also, health care providers should improve support provided to family members of stroke patients.

Strategies for a Successful PhD Program

Nursing doctoral programs prepare students for research-focused careers within academic settings. The purpose of this Editorial Board Special Article is to provide PhD students and advisors with suggestions for making the most of their doctoral experience. Editorial Board members provide their individual insights on the skills and attributes students must acquire during the course of their doctoral education in order to succeed. The authors provide practical tips and advice on how to excel in a PhD program, including how to select an advisor and a dissertation committee, the importance of attending conferences to increase visibility and develop a network of colleagues, presenting and publishing research while still a student, and balancing work and personal life. Students who take full advantage of the opportunities available to them during the course of their doctoral programs will graduate well prepared to take on the multiple responsibilities of research, teaching, and leadership.

Methylphenidate and/or a nursing telephone intervention for fatigue in patients with advanced cancer: a randomized, placebo-controlled, phase II trial

PURPOSE

Cancer-related-fatigue (CRF) is common in advanced cancer. The primary objective of the study was to compare the effects of methylphenidate (MP) with those of placebo (PL) on CRF as measured using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) fatigue subscale. The effect of a combined intervention including MP plus a nursing telephone intervention (NTI) was also assessed.

PATIENTS AND METHODS

Patients with advanced cancer with a fatigue score of ≥ 4 out of 10 on the Edmonton Symptom Assessment Scale (ESAS) were randomly assigned to one of the following four groups: MP+NTI, PL+NTI, MP + control telephone intervention (CTI), and PL+CTI. Methylphenidate dose was 5 mg every 2 hours as needed up to 20 mg per day. The primary end point was the median difference in FACIT-F fatigue at day 15. Secondary outcomes included anxiety, depression, and sleep.

RESULTS

One hundred forty-one patients were evaluable. Median FACIT-F fatigue scores improved from baseline to day 15 in all groups: MP+NTI (median score, 4.5; P = .005), PL+NTI (median score, 8.0; P < .001), MP+CTI (median score, 7.0; P = .004), and PL+CTI (median score, 5.0; P = .03). However, there were no significant differences in the median improvement in FACIT-F fatigue between the MP and PL groups (5.5 v 6.0, respectively; P = .69) and among all four groups (P = .16). Fatigue (P < .001), nausea (P = .01), depression (P = .02), anxiety (P = .01), drowsiness (P < .001), appetite (P = .009), sleep (P < .001), and feeling of well-being (P < .001), as measured by the ESAS, significantly improved in patients who received NTI. Grade ≥ 3 adverse events did not differ between MP and PL (40 of 93 patients v 29 of 97 patients, respectively; P = .06).

CONCLUSION

MP and NTI alone or combined were not superior to placebo in improving CRF.

Time management strategies for research productivity

Researchers function in a complex environment and carry multiple role responsibilities. This environment is prone to various distractions that can derail productivity and decrease efficiency. Effective time management allows researchers to maintain focus on their work, contributing to research productivity. Thus, improving time management skills is essential to developing and sustaining a successful program of research. This article presents time management strategies addressing behaviors surrounding time assessment, planning, and monitoring. Herein, the Western Journal of Nursing Research editorial board recommends strategies to enhance time management, including setting realistic goals, prioritizing, and optimizing planning. Involving a team, problem-solving barriers, and early management of potential distractions can facilitate maintaining focus on a research program. Continually evaluating the effectiveness of time management strategies allows researchers to identify areas of improvement and recognize progress.

Symptoms and quality of life in diverse patients undergoing hematopoietic stem cell transplantation

CONTEXT

Symptoms and quality of life (QOL) are critically important in hematopoietic stem cell transplantation (HSCT). However, few studies have examined these factors by transplant type among diverse cultures.

OBJECTIVES

To identify and compare QOL and symptom severity and prevalence by transplant type in a diverse population having HSCT.

METHODS

The M. D. Anderson Symptom Inventory Blood and Marrow Transplantation (MDASI-BMT) module measured symptom severity and its impact. The Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) measured QOL.

RESULTS

Symptom data were collected from 164 patients at eight points (pretransplant to 100 days post-transplant) and QOL data at four times. Over time, symptom severity was significantly correlated with QOL and patients who had allogeneic transplants with myeloablative regimens showed more severe sleep disturbance and poorer QOL than patients having autologous transplants. Male patients reported less fatigue than female patients. However, ethnicity was not significant. Patients whose functional status was good had fewer of the five worst symptoms and higher QOL than patients with a poor functional status. Patients with acute graft-versus-host disease had more severe symptoms than those who did not.

CONCLUSION

Type of transplant and preparative regimen are the most important aspects to consider when managing symptoms and QOL. This information is important for providing anticipatory guidance and support needed during the transplantation experience, to explore in future research the mechanisms involved in symptoms after HSCT, and to develop additional effective interventions.

Food or medicine: ethnic variations in perceptions of advanced cancer patients and their caregivers regarding artificial hydration during the last weeks of life

PURPOSE

To identify whether advanced cancer patients receiving home hospice care and their primary caregivers view artificial hydration (AH) as food or medicine, and the demographic and clinical factors influencing these perceptions.

METHODS

Participants were enrolled in a randomised, double-blind controlled trial examining the efficacy of AH in cancer hospice patients. In-depth interviews at days 1 and 4 of study enrolment explored the meanings attributed to AH at the end of life. Responses to the question, 'Are these fluids more like food or more like medicine?' were categorised as 'food', 'medicine', 'both' or 'other'. χ(2) analyses were conducted with data from 122 interviews (54 patients and 68 caregivers) to identify differences between patients and caregivers, and by gender, age, ethnicity and caregiver relationship. Predictors of perceptions were identified using logistic regression analysis.

RESULTS

Overall, 47 participants (38%) understood the fluids to be more like food, 41 (34%) as medicine, 17 (14%) as both, and 17 (14%) as 'other'. Ethnic minority participants (n=34, 66%) were significantly more likely than non-Hispanic European Americans (n=30, 42%) to view AH as food, or both as food and medicine (p=0.034). Ethnic differences persisted in the final regression model (OR 2.7; 95% CI 1.3 to 5.7, p=0.010). No significant differences were detected between patients and caregivers, or across gender, age, caregivers' relationship to the patients, group assignment, disease severity or cancer type.

CONCLUSIONS

AH was perceived as food/nutrition by many cancer patients and caregivers in the study, particularly among ethnic minorities. This perception may lead to greater distress if fluids are discontinued or withheld. Asking patients/caregivers about their AH perceptions may enhance patient/provider communication and culturally appropriate end-of-life care.

Symptoms (Sx) in English (E) and Spanish (S) speaking children with cancer

9096

Background: Sx in children receiving treatment for cancer are poorly described and often reported by proxies. Study aims were to 1. Characterize sx of pediatric oncology outpatients 2. Evaluate the agreement between patient (pt) and proxy reports 3. Report the association between pt assessed sx and treatments prescribed by physicians (MD). Methods: The pediatric Memorial Symptom Assessment Scale (pMSAS) is a validated tool that evaluates frequency, intensity and distress of 8 sx (version 7-12) or 30 sx (version 10-18) for pts of corresponding ages. Higher scores indicate greater sx burden. pMSAS was translated into S versions. Pt eligibility included ages 7-18, E or S speaking, advanced cancer, pediatric assent/parent consent and E or S speaking family caregiver (CG) with IRB approved consent for self participation. Pts and CG were administered age appropriate pMSAS in E or S independently just prior to MD visit and consenting MDs, the corresponding pMSAS after the visit. Subscale scores included total pMSAS score (TOTAL), psychological, physical and global distress index for older group (OG) and TOTAL for younger group (YG). Statistical analysis included Spearman correlation coefficients and weighted kappas. Results: E and S results were similar and combined. 60 children [age mean +SD 12 +.5, 62% male, 35 S] and their CG completed the pMSAS. 14 MD completed pMSAS for 20 pts. 9 pts (15%) had no sx and 38 (63%), ≥2. The most common sx for ages 7-10 were tired (N=12, 40%) and itch (N=9, 30%) and for ages 11-18, pain (15/30, 50%) and energy (13/29, 45%). Subscale score agreement varied by proxy type and subscale. For TOTAL, highest correlation was 0.6 (p<.001) for YG and 0.7 (p<.001) for OG. For individual sx, agreement between patient and proxy was highly variable (Table). Of symptomatic patients, 6% (3/51) received sx recommendations. Conclusions: Sx in children with cancer are common and undertreated. CG and MD ratings are often not congruent with pt reports which may explain the apparent under treatment of sx. [Table: see text]

The meaning of parenteral hydration to family caregivers and patients with advanced cancer receiving hospice care

CONTEXT

In the U.S., patients with advanced cancer who are dehydrated or have decreased oral intake almost always receive parenteral hydration in acute care facilities but rarely in the hospice setting.

OBJECTIVES

To describe the meaning of hydration for terminally ill cancer patients in home hospice care and for their primary caregivers.

METHODS

Phenomenological interviews were conducted at two time points with 85 patients and 84 caregivers enrolled in a randomized, double-blind, controlled trial examining the efficacy of parenteral hydration in patients with advanced cancer receiving hospice care in the southern U.S. Transcripts were analyzed hermeneutically by the interdisciplinary research team until consensus on the theme labels was reached.

RESULTS

Patients and their family caregivers saw hydration as meaning hope and comfort. Hope was the view that hydration might prolong a life of dignity and enhance quality of life by reducing symptoms such as fatigue and increasing patients' alertness. Patients and caregivers also described hydration as improving patients' comfort by reducing pain; enhancing the effectiveness of pain medication; and nourishing the body, mind, and spirit.

CONCLUSION

These findings differ from traditional hospice beliefs that dehydration enhances patient comfort, given that patients and their families in the study viewed fluids as enhancing comfort, dignity, and quality of life. Discussion with patients and families about their preferences for hydration may help tailor care plans to meet specific patient needs.

A Platform for Nursing Research on Spirituality and Religiosity

Spirituality or religiousness is important across the health trajectory, from promoting health and preventing disease, to coping with illness and end of life. Research on the relationship of religiousness or spirituality to health spans more than one discipline and applies many definitions and measures. The purpose of this multidisciplinary work is to facilitate research by nurses who seek to investigate the relationship between health and religiousness or spirituality, and provide evidence-based guidance for nursing practice. Senior researchers summarize the history of inquiry on this topic, discuss particular and persistent challenges posed by definitions of religion and spirituality, describe selected measures that have enjoyed wide application, and make recommendations for consideration by nurse researchers. Use of existing knowledge to select variables, definitions, and measures, and to link research questions and findings to the larger body of current inquiry, will advance nursing practice closer to fulfilling Nightingale’s ideals for effective care.

The Experience of Quality of Life for Caregivers of People With Alzheimer’s Disease Living in Sardinia, Italy

Purpose:This study explored the meaning of quality of life (QOL) for Sardinian caregivers of people affected with Alzheimer’s disease and factors improving and worsening their QOL. Design: The phenomenological method was used to study 41 Alzheimer’s disease caregivers living on the western coast of Sardinia, Italy. Interviews were conducted and analyzed using Cohen, Kahn, and Steeves’s approach. Findings: Extracted themes were the following: unity and cooperation in the family; freedom/independence; having time for themselves; serenity/tranquility; and well-being and health. Caregivers identified factors that they believed worsened or improved their QOL. Family was particularly important for these caregivers. Discussion and Practice Implications: This study reinforces previous research about cultural influence on QOL and emphasizes the importance of nurses being culturally sensitive. Since Sardinia is a rural region, these findings may be useful for nurses working with caregivers in other rural settings.

The meaning of breast cancer risk for African American women

PURPOSE

To describe African American women's experience of being at high risk for breast cancer.

DESIGN

A hermeneutic phenomenological approach was used to guide in-depth interviews and analysis. Methods to ensure trustworthiness and rigor were included.

METHODS

Open interviews were conducted with 20 African American women who were at high risk for breast cancer (family history, personal history, genetic mutation). They were recruited from a cancer risk clinic and community-based settings. Data were transcribed verbatim, and themes were labeled among and between all interviews.

FINDINGS

Five themes were identified: (a) life-changing experience; (b) relationships: fears, support, and concerns; (c) the healthcare experience; (d) raising awareness; and (e) strong faith.

CONCLUSIONS

Young women at high risk for breast cancer have unique emotional and support needs that are shaped by stage in life, relationships with significant others, their faith, and interactions with the healthcare delivery system.

CLINICAL RELEVANCE

Breast cancer does occur in young women. This highlights the need for timely and sensitive approaches to care when young women present with breast health concerns or abnormal breast findings.

Secrets of successful short grant applications

The National Institutes of Health has implemented new grant application guidelines that include a substantial reduction in the number of pages allowed for project descriptions. Shorter proposals will potentially decrease reviewer burden, but investigators may find the new page limits challenging. Writing more concisely while still presenting a persuasive argument requires honing certain skills with regard to preparation, construction, and editing of proposals. This article provides strategies from the Western Journal of Nursing Research editorial board for preparing competitive shorter research proposals. Two key strategies for success are fully conceptualizing the study prior to writing and obtaining assistance from experienced colleagues during the editing process.

What does it mean to be an oncology nurse? Reexamining the life cycle concepts

PURPOSE/OBJECTIVES

To summarize the current research pertaining to the concepts initially examined by the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force and related projects completed in 1994.

DATA SOURCES

Published articles on the 21 concepts from the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force work. Research published in English from 1995-2009 was obtained from PubMed, CINAHL(R), PsycINFO, ISI Science, and EBSCO Health Source(R): Nursing/Academic Edition databases.

DATA SYNTHESIS

Most of the concepts identified from the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force have been examined in the literature. Relationships and witnessing suffering were common concepts among studies of the meaning of oncology nursing. Nurses provide holistic care, and not surprisingly, holistic interventions have been found useful to support nurses. Interventions included storytelling, clinical support of nurses, workshops to find balance in lives, and dream work. Additional support comes from mentoring.

CONCLUSIONS

The research identified was primarily descriptive, with very few interventions reported. Findings have been consistent over time in diverse countries.

IMPLICATIONS FOR NURSING

This review indicates that although the healthcare system has changed significantly in 15 years, nurses' experiences of providing care to patients with cancer have remained consistent. The need for interventions to support nurses remains.

Scientific Impact: Opportunity and Necessity

Recent National Institutes of Health changes have focused attention on the potential scientific impact of research projects. Research with the excellent potential to change subsequent science or health care practice may have high scientific impact. Only rigorous studies that address highly significant problems can generate change. Studies with high impact may stimulate new research approaches by changing understanding of a phenomenon, informing theory development, or creating new research methods that allow a field of science to move forward. Research with high impact can transition health care to more effective and efficient approaches. Studies with high impact may propel new policy developments. Research with high scientific impact typically has both immediate and sustained influence on the field of study. The article includes ideas to articulate potential scientific impact in grant applications as well as possible dissemination strategies to enlarge the impact of completed projects.

Caring for the caregiver

PURPOSE/OBJECTIVES

To describe the quality of life (QOL) and well-being of caregivers of patients receiving outpatient chemotherapy for leukemia and to identify strategies to promote the best possible QOL and well-being for the caregivers.

DESIGN

Descriptive, cross-sectional study.

SETTING

Ambulatory treatment center of a major comprehensive cancer center in the southern United States.

SAMPLE

Convenience sample of 194 caregivers of patients receiving chemotherapy for leukemia.

METHODS

Participants completed the Caregiver Quality-of-Life-Cancer Scale, the Caregiver Well-Being Scale, and the Learning Needs Questionnaire developed by the authors. Descriptive statistics were used to summarize the demographic characteristics of the caregivers, and exploratory factor analysis was performed to identify meaningful factors.

MAIN RESEARCH VARIABLES

QOL, well-being, and learning needs.

FINDINGS

Caregivers identified burden as their most important concern for QOL. Key factors identified with caregivers' well-being were expression of feelings and household maintenance. Caregivers identified giving medications and managing the side effects as crucial to learning needs. Communication, positive attitudes, support, and education were important in promoting QOL for the caregivers.

CONCLUSIONS

Caregiving for a patient receiving chemotherapy for leukemia influences the QOL and well-being of the caregiver.

IMPLICATIONS FOR NURSING

This study highlights the need for better nurse-caregiver communication and education, particularly in the areas of symptom management and medication administration. Additional research should focus on factors that affect caregivers' QOL, their educational needs, and improved interventions for delivering new information or reinforcing old information.