Chronic fatigue syndrome: What nurses need to know

Chronic fatigue syndrome (CFS) is a long-term, often misunderstood disorder that involves the nervous, immune, metabolic, endocrine, and digestive systems. This article describes the pathophysiology of CFS, signs and symptoms of CFS in adults, diagnostic criteria for CFS, and nursing considerations for patients with CFS.

Challenges of nurse delivery of psychological interventions for long-term conditions in primary care: a qualitative exploration of the case of chronic fatigue syndrome/myalgic encephalitis

BACKGROUND

The evidence base for a range of psychosocial and behavioural interventions in managing and supporting patients with long-term conditions (LTCs) is now well-established. With increasing numbers of such patients being managed in primary care, and a shortage of specialists in psychology and behavioural management to deliver interventions, therapeutic interventions are increasingly being delivered by general nurses with limited training in psychological interventions. It is unknown what issues this raises for the nurses or their patients. The purpose of the study was to examine the challenges faced by non-specialist nurses when delivering psychological interventions for an LTC (chronic fatigue syndrome/myalgic encephalomyelitis [CFS/ME]) within a primary care setting.

METHODS

A qualitative study nested within a randomised controlled trial [ISRCTN 74156610] explored the experiences and acceptability of two different psychological interventions (pragmatic rehabilitation and supportive listening) from the perspectives of nurses, their supervisors, and patients. Semi structured in-depth interviews were conducted with three nurse therapists, three supervisors, and 46 patients. An iterative approach was used to develop conceptual categories from the dataset.

RESULTS

Analyses identified four sets of challenges that were common to both interventions: (i) being a novice therapist, (ii) engaging patients in the therapeutic model, (iii) dealing with emotions, and (iv) the complexity of primary care. Each challenge had the potential to cause tension between therapist and patient. A number of strategies were developed by participants to manage the tensions.

CONCLUSIONS

Tensions existed for nurses when attempting to deliver psychological interventions for patients with CFS/ME in this primary care trial. Such tensions should be addressed before implementing psychological interventions within routine clinical practice. Similar tensions may be found for other LTCs. Our findings have implications for developing therapeutic alliances and highlight the need for regular supervision.

The functional status and well being of people with myalgic encephalomyelitis/chronic fatigue syndrome and their carers

BACKGROUND

Diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome or ME/CFS is largely based on clinical history, and exclusion of identifiable causes of chronic fatigue. Characterization of cases and the impact of interventions have been limited due to clinical heterogeneity and a lack of reliable biomarkers for diagnosis and outcome measures. People with ME/CFS (PWME) often report high levels of disability, which are difficult to measure objectively. The well being of family members and those who care for PWME are also likely to be affected. This study aimed to investigate the functional status and well being of PWME and their lay carers, and to compare them with people with other chronic conditions.

METHODS

We used a cross sectional design to study 170 people aged between 18 and 64 years with well characterized ME/CFS, and 44 carers, using SF-36 v2™. Mean physical and mental domains scores (scales and component summaries) were calculated and compared internally and externally with reference standards for the general population and for population groups with 10 chronic diseases.

RESULTS

SF-36 scores in PWME were significantly reduced, especially within the physical domain (mean norm-based Physical Component Summary (PCS) score = 26.8), but also within the mental domain (mean norm-based score for Mental Component Summary (MCS) = 34.1). The lowest and highest scale scores were for "Role-Physical" (mean = 25.4) and "Mental Health" (mean = 36.7) respectively. All scores were in general lower than those for the general population and diseased-specific norms for other diseases. Carers of those with ME/CFS tended to have low scores in relation to population norms, particularly within the mental domain (mean = 45.4).

CONCLUSIONS

ME/CFS is disabling and has a greater impact on functional status and well being than other chronic diseases such as cancer. The emotional burden of ME/CFS is felt by lay carers as well as by people with ME/CFS. We suggest the use of generic instruments such as SF-36, in combination of other objective outcome measurements, to describe patients and assess treatments.

[Nursing role in patient management diagnosed chronic fatigue syndrome]

Chronic fatigue syndrome is a serious, complex and debilitating fatigue characterized by intense physical and mental, that does not subside significantly after rest and worsens with activity The appearance of the disease requires the patient to reduce the activity diminished their quality of life. While there is no cure, the complexity of the disease requires an interdisciplinary approach where the mission of nursing is to identify the least healthy responses of each individual in relation to their health status and interfering with them by means of specific support, integrated support and follow a care plan tailored to the individual needs of each individual. Fatigue, pain, sleep pattern disturbance, anxiety and lack of knowledge are the most prevalent health problems in patients treated at the Chronic Fatigue Unit, University Hospital Vail d'Hebron. Thus, in these problems and by developing a customized care plan process we use for health education as a tool for influencing the control of symptoms through interventions to improve the learning support, emotional support and Accompanying with the aim of helping the patient and their relatives are an adaptive response to their new health status and thus improve the quality of life.

A mystery no more

New research has solved one of the puzzles surrounding chronic fatigue syndrome, which could help in its future treatment.

Nurse led, home based self help treatment for patients in primary care with chronic fatigue syndrome: randomised controlled trial

OBJECTIVE

To evaluate the effectiveness of home delivered pragmatic rehabilitation-a programme of gradually increasing activity designed collaboratively by the patient and the therapist-and supportive listening-an approach based on non-directive counselling-for patients in primary care with chronic fatigue syndrome/myalgic encephalomyelitis or encephalitis (CFS/ME).

DESIGN

Single blind, randomised, controlled trial.

SETTING

186 general practices across the north west of England between February 2005 and May 2007.

PARTICIPANTS

296 patients aged 18 or over with CFS/ME (median illness duration seven years) diagnosed using the Oxford criteria.

INTERVENTIONS

Participants were randomly allocated to pragmatic rehabilitation, supportive listening, or general practitioner treatment as usual. Both therapies were delivered at home in 10 sessions over 18 weeks by one of three adult specialty general nurses who had received four months' training, including supervised practice, in each of the interventions. GP treatment as usual was unconstrained except that patients were not to be referred for systematic psychological therapies during the treatment period. Main outcome measures The primary clinical outcomes were fatigue and physical functioning at the end of treatment (20 weeks) and 70 weeks from recruitment compared with GP treatment as usual. Lower fatigue scores and higher physical functioning scores denote better outcomes.

RESULTS

A total of 257 (87%) of the 296 patients who entered the trial were assessed at 70 weeks, the primary outcome point. Analysis was on an intention to treat basis, with robust treatment effects estimated after adjustment for missing data using probability weights. Immediately after treatment (at 20 weeks), patients allocated to pragmatic rehabilitation (n=95) had significantly improved fatigue (effect estimate -1.18, 95% confidence interval -2.18 to -0.18; P=0.021) but not physical functioning (-0.18, 95% CI -5.88 to +5.52; P=0.950) compared with patients allocated to treatment as usual (n=100). At one year after finishing treatment (70 weeks), there were no statistically significant differences in fatigue or physical functioning between patients allocated to pragmatic rehabilitation and those on treatment as usual (-1.00, 95% CI -2.10 to +0.11; P=0.076 and +2.57, 95% CI 3.90 to +9.03; P=0.435). At 20 weeks, patients allocated to supportive listening (n=101) had poorer physical functioning than those allocated to treatment as usual (-7.54, 95% CI -12.76 to -2.33; P=0.005) and no difference in fatigue. At 70 weeks, patients allocated to supportive listening did not differ significantly from those allocated to treatment as usual on either primary outcome.

CONCLUSIONS

For patients with CFS/ME in primary care, pragmatic rehabilitation delivered by trained nurse therapists improves fatigue in the short term compared with unconstrained GP treatment as usual, but the effect is small and not statistically significant at one year follow-up. Supportive listening delivered by trained nurse therapists is not an effective treatment for CFS/ME. Trial registration International Standard Randomised Controlled Trial Number IRCTN74156610.

Chronic fatigue syndrome: a tiresome illness

When it comes to feeling exhausted or tired all the time, I’d say that I suffer more than most. Yet most people would probably tell me I’m just lazy! Obviously, being tired every now and then is normal – for many of us it is an unavoidable consequence of a busy work schedule and we accept it as ‘one of those things’ and deal with it. Yet for some people this tiredness and exhaustion never retreats: it is prolonged and debilitating. These people may have a condition called myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS).

Factors related to persistent fatigue following completion of breast cancer treatment

PURPOSE/OBJECTIVES

To verify the predictive capacity of the stress-process theory to emeanplain persistent fatigue following completion of breast cancer treatments; to verify the relationship between interleukin-1b and fatigue.

DESIGN

Correlational.

SETTING

Tertiary medical center in Quebec City, Canada.

SAMPLE

A systematic sample of 103 women in remission from breast cancer was recruited. The mean age was 54 years. Participants with a depressive mood, insomnia, or stage IV cancer were emeancluded.

METHODS

Participants were met during their follow-up appointment after the end of radiation therapy. Questionnaires on fatigue, stress variables, and other confounding variables were completed by telephone interview. Blood samples also were collected to measure the serum level of interleukin-1b.

MAIN RESEARCH VARIABLES

Fatigue, several variables from the stress-process theory, pain, menopausal symptoms, and demographic and medical variables.

FINDINGS

Fatigue was related theoretically and coherently to many stress-process variables. By controlling for pain, the final regression model included cancer stressors and passive and active coping as predictors, which accounted for 41% of the variance in fatigue. No relationship was found between fatigue and interleukin-1b.

CONCLUSIONS

The results supported the relevance of the stress-process theory for emeanplaining cancer-related fatigue.

IMPLICATIONS FOR NURSING

Nursing interventions based on this theoretical framework could be developed. In addition, further clinical research that tests the efficacy of these psycho-educative interventions in preventing persistent fatigue and improving the quality of life of women with breast cancer is recommended.

Supporting people with severe myalgic encephalomyelitis

This article aims to raise nurses' awareness of myalgic encephalomyelitis (ME) also known as chronic fatigue syndrome (CFS). Key symptoms are presented along with possible service responses and treatment options. It emphasises that this condition is often misunderstood but that it can be serious and more research is needed to promote better understanding of the physical symptoms.

Enhancing the quality of hermeneutic research: decision trail

BACKGROUND

Researchers have ethical and professional obligations to produce research of a high standard. The constituents of quality in research appear to differ between authors, leaving readers unsure about which pathway to follow. This can reflect inadequate consideration of the theoretical framework guiding the study. Many papers fail to consider the theoretical underpinnings of the methodology chosen and the link between these and the methods employed. These need to be accessible to readers in order to assess the trustworthiness of the research.

AIM

This paper discusses the development of trustworthiness in hermeneutic phenomenological research.

DISCUSSION

Referring to a study on lived experience of Chronic Fatigue Syndrome/myalgic encephalitis, I describe the decision trail and discuss the strengths and limitations of the choices made throughout the study.

CONCLUSION

The methodology focused my approach more fully on the importance of recognizing the influences that I brought to the study and the impact of these in generating the data. It highlighted the fact that the process of setting out my horizon can never be complete, the importance of analysing the data at a macro and micro level, acknowledging the evolution of the data over time, and ensuring that analysis does not move beyond the data and out of the hermeneutic circle. In seeking to make the decision trail clear to others, researchers must distill the philosophical principles of the methodology and set these out in a way that is accessible and open to scrutiny.

Chronic fatigue syndrome: the nurse's role

BACKGROUND

Chronic fatigue syndrome (CFS), a disorder of no proven cause, is characterised by extended periods of extreme, debilitating fatigue and related symptoms. This article discusses this distressing disorder and identifies the needs of those who have it. The authors suggest that the nurse could fulfil the role of key professional carer, interacting with the individual with CFS to co-ordinate care and form the pivotal therapeutic relationship.

CONCLUSION

CFS remains a chronic illness of uncertain cause and prognosis. For those with CFS, care priorities involve validation, information and advocacy, a therapeutic relationship and co-ordinated care. The particular philosophy of care held by nurses makes them potentially ideal co-ordinators of care for those with CFS.

Chronic fatigue syndrome: a woman's dilemma

Chronic Fatigue Syndrome (CFS) is an illness characterized by fatigue with varying levels of disability. According to the Centers for Disease Control (CDC) there are 2 to 5 million people in the United States who suffer from CFS and a disproportionate number are women. There are many theories of etiology of the condition and controversy has surrounded recommendations for diagnosis and treatment. CFS can mimic other diseases and women are doubly affected since many have comorbid conditions. While diagnoses and treatment are critical to the health of women, having the disease and coping with the symptoms may have a greater impact on their well-being and quality of life. The authors report qualitative data describing the experience of having CFS (N = 22) and quantitative responses of 42 CFS sufferers reporting psychosocial factors. The psychosocial factors were measured by the Derogatis Stress Profile (DSP), Spielberger Trait-Anger Scale, Ways of Coping Survey, Profile of Moods States (POMS) Survey, and the Perceived Stress Scale. The findings indicate that CFS changes the lives of women who suffer with the disease and disrupts their relationships, careers, and perceptions of themselves.

The effects on siblings in families with a child with chronic fatigue syndrome

Paediatric CFS/ME is a stressor, which affects not only the sufferer but also the whole family. The sibling bond exerts a great influence on all the children in the family. Healthy siblings are often overlooked as attention is focused on the child with CFS/ME or other chronic illness. Individual children react in different ways to serious illness in another sibling by adopting a variety of coping mechanisms. There is a need for health and education professionals to consider the whole family when caring for and working with a child with CFS/ME.

Managing chronic fatigue syndrome: overview and case study

1. The basic principles of envelope theory are explained. By not overexerting themselves, people with CFS can avoid the setbacks and relapses that commonly occur in response to overexertion while increasing their tolerance to activity. 2. By collecting time series data on fluctuations in energy levels, important clinical observations can be made in respect to a client's unique condition and experience with CFS.

The Experience of Living With Chronic Fatigue Syndrome

1. Chronic fatigue syndrome (CFS) is a condition that affects the total person, body, mind, and spirit. 2. CFS sufferers describe the experience as being in the illness, remembering life before the illness, and living with the symptoms. 3. Empathy and compassion are essential components of providing nursing care for clients with CFS.

Managing patients suffering from acute and chronic fatigue

The subjective experience of fatigue is common and debilitating, and affects many individuals in various healthcare settings. The condition requires adequate assessment, innovative planning and interventions, and patient-centred evaluations by the nursing profession. Fatigue, whether acute or chronic, needs to be recognized as a true and valid condition in order for treatment to be successful. There are many considerations to be taken into account when working with the fatigued, and this article suggests how the areas needing most attention may be tackled. Chronic fatigue and acute fatigue can be quite different conditions, requiring different approaches, of which nurses need to be aware. In order to reduce the effects of fatigue on the client, nurses need to fully understand the factors surrounding the phenomenon of fatigue to provide expert care, to help educate the patient, and improve the quality of life.

Amma therapy: a holistic approach to chronic fatigue syndrome

A significant number of people suffering with chronic fatigue syndrome have become more and more discouraged by the traditional medical approach, which seems to lack the proper perspective on the disease. Unfortunately, very little published information is available about specific holistic health management practices used for these patients. It is the purpose of this article to examine a specific holistic practice, called Amma Therapy, as an alternative approach for the management of this syndrome.

ME: is it a genuine disease?

Myalgic encephalomyelitis (ME) is a postviral syndrome whose dominant clinical features are exercise-induced muscle fatigue, disturbances in cognitive functioning and symptoms of overactivity of the autonomic nervous system. The syndrome tends to affect previously fit young adults between the ages of 20 and 40 but no age group is excluded. One recent epidemiological survey suggested a prevalence rate of 1.3 per 1000 adults, with females outnumbering males by 1.8:1. ME is currently the subject of intense medical (and media) debate, especially over its pathophysiology and management. It has also become known as the postviral/chronic fatigue syndrome (PVFS/CFS).