Showing papers in "Cancer Nursing in 1997"

Validity of a verbally administered numeric rating scale to measure cancer pain intensity

Abstract: The ability to quantify pain intensity is essential when caring for individuals in pain in order to monitor patient progress and analgesic effectiveness. Three scales are commonly employed: the simple descriptor scale (SDS), the visual analog scale (VAS), and the numeric (pain intensity) rating scale (NRS). Patients with English as a second language may not be able to complete the SDS without translation, and visually, cognitively, or physically impaired patients may have difficulty using the VAS. The NRS has been found to be a simple and valid alternative in some disease states; however, the validity of this scale administered verbally, without visual cues, to oncology patients has not yet been established. The present study examined validity of a verbally administered 0-10 NRS using convergence methods. The correlation between the VAS and the NRS was strong and statistically significant (r = 0.847, p < 0.001), supporting the validity of the verbally administered NRS. Although all subjects were able to complete the NRS and SDS without apparent difficulty, 11 subjects (20%) were unable to complete the VAS. The mean opioid intake was significantly higher for the group that was unable to complete the VAS (mean 170.8 mg, median 120.0 mg, SD = 135.8) compared to the group that had no difficulty with the scale (mean 65.6 mg, 33.0 mg, SD = 99.7) (Mann-Whitney test, p = 0.0065). The verbally administered 0-10 NRS provides a useful alternative to the VAS, particularly as more contact with patients is established via telephone and patients within the hospital are more acutely ill.

Empowerment of men newly diagnosed with prostate cancer

Abstract: The purpose of this study was to explore the hypothesis that assisting men with prostate cancer to obtain information would enable them to assume a more active role in treatment decision making and decrease their levels of anxiety and depression. Respondents were recruited from one community urology clinic in Winnipeg, Manitoba. Sixty newly diagnosed men were randomly assigned to receive either a self-efficacy information intervention that consisted of a written information package with discussion, a list of questions they could ask their physician, and an audiotape of the medical consultation (n = 30), or a written information package alone (n = 30). Men completed measures of preferred decisional role as the pretest; anxiety and depression before the intervention, and at 6 weeks post-intervention; and assumed decisional role at 6 weeks post-intervention. Results demonstrated that men in the intervention group assumed a significantly more active role in treatment decision making, and had lower state anxiety levels at 6 weeks. Levels of depression were similar for both groups at 6 weeks. This group of older men do want to be informed and participate in medical decisions. Further efforts are required to evaluate the efficacy of such an intervention in other community urology clinics.

Caring and uncaring encounters within nursing and health care from the cancer patient's perspective.

Abstract: The aim of this phenomenological study was to explore caring and uncaring encounters with nurses and other health professionals from the perspective of the person who has been diagnosed and treated for cancer. Through thematic analysis of in-depth dialogues with five women and four men in the remission or recovery phase of cancer, three major categories regarding caring and uncaring encounters were identified. The essential structure of a caring encounter was found to be threefold: 1. the nurse/health professional perceived as caring: an indispensable companion on the cancer trajectory; 2. the resulting mutual trust and caring connection; and 3. the perceived effect of the caring encounter: a sense of solidarity, empowerment, well-being, and healing. The essential structure of an uncaring encounter is also threefold: 1. the nurse/health professional perceived as uncaring: an unfortunate hindrance to the perception of well-being and healing; 2. the resulting sense of mistrust and disconnection; and 3. the perceived effect of the uncaring encounter: a sense of uneasiness, discouragement, and a sense of being broken down. The findings emphasize the primacy of competence in professional caring, as well as that of genuine concern, openness and a willingness to connect with others. The often devastating effects of uncaring encounters on the recipient of nursing and health care raises the question whether uncaring as an ethical and a professional problem should perhaps be dealt with as malpractice in nursing and health care.

Symptom distress and life situation in adolescents with cancer

Abstract: Having a life-threatening disease like cancer during adolescence poses a number of problems. The purpose of this study was to identify the adolescent's own experience of areas of the life situation affected by the disease and problems related to it. Ten adolescents with varying diagnoses and treatment were interviewed. They also completed a quantitative measurement of problems. The result shows eight domains and 24 subdomains influencing the experience of life situation. Those were disease and treatment (side effects, isolation, medical procedures), identification (others are ill, appearance), feelings and reactions (mood, self-image, meaning, hope), coping (positive thinking, distraction, positive effects), togetherness (family, friends, school), support (family and friends, the youth association, professional support), reactions of the families (parents, siblings), and quality of care (professionalism, information, organization, equipment). The problems mentioned in the interviews are also compared with the quantitative measurement used. The adolescents mentioned 77 problems in the interviews, of which 17 were not on the list of problems. Of those 17, seven dealt with physical problems, and six were problems concerning the quality of care. They ranked wanting and depending on parents as the worst problems for themselves from the list of problems.

Quality of life in breast cancer. Part I: Physical and social well-being.

Abstract: Almost 2 million breast cancer survivors reside in the United States. An increase in consumer advocacy and media attention to this disease has helped bring breast cancer survivorship to the forefront of public attention. This has led to increased attention on quality of life(QOL) issues for these su

Predicting mammography and breast self-examination in African American women

Abstract: Breast cancer mortality is significantly greater in African American women than in their Caucasian counterparts. The purpose of this study was to identify variables associated with the breast cancer screening behaviors of mammography utilization and breast self-examination (BSE) in a convenience sam

Relaxation to reduce nausea, vomiting, and anxiety induced by chemotherapy in Japanese patients.

Abstract: The purpose of this study was to examine the effectiveness of progressive muscle relaxation (PMR) in reducing the nausea, vomiting, and anxiety induced by chemotherapy in Japanese patients. Subjects comprised 60 cancer chemotherapy patients who were hospitalized in a cancer center. These subjects were randomly assigned to either the experimental or control group. In addition to routine nursing care, subjects in the experimental received PMR training, while those in the control received contact with the investigator. Results from this study verified the effectiveness of PMR in reducing total scores used to measure nausea, vomiting, and retching; subscale scores of nausea; and subjective feelings of anxiety. The efficacy of PMR to reduce subscale scores of vomiting was not verified, partly due to an extremely low incidence of vomiting.

Stories of being a hospice nurse: a journey towards finding one's footing.

Abstract: This article sheds light on the meaning of the lived experience of being a hospice nurse, as interpreted from in-depth interviews with 18 hospice nurses. The nurses' stories were analyzed using a phenomenologic-hermeneutic approach inspired by the philosophy of Ricoeur. Findings were synthesized into two themes: pursuing meaningful hospice care and pursuing spiritual integrity. Results indicated that it was the nurses' conceptions of "ideal" hospice practice that seemed to be the lens through which the nurses experienced and interpreted "real" practice as being either vitalizing or devitalizing. Results also indicated that being a hospice nurse means being visible as a person, in the sphere between the sacred and the profane and on the border between eternity and the finite. In narrating these experiences, the nurses used metaphors pointing towards "the sacred" and a "consciousness of fault." The tension between "ideal" and "real" hospice practices, and the nurses' vitalizing and devitalizing experiences and their use of metaphors in narrating these experiences are interpreted in the light of Bauman's two "life strategies" of deconstructing mortality and immortality, and Ricoeur's Symbolism of Evil.

Phenomenological study of nurses caring for dying patients.

Abstract: Little is known about how nurses experience caring for dying patients. Yet, entering the patient's world often involves dealing with death and dying and is a major challenge to oncology nurses. The purpose of this article is to describe the shared practices of oncology nurses caring for dying patients. Stories from staff nurses on an oncology unit were analyzed using a hermeneutic method to identify and describe four themes: knowing the patient, preserving hope, easing the struggle, and providing for privacy. The four themes contribute to knowledge development about how nurses enter into and experience caring for dying patients. The growing body of knowledge previously reported has included descriptions of critical behaviors in caring for dying patients, coping strategies nurses used when caring for dying patients and their families, and the meaning of oncology nursing practice. The four themes described in this article expand our understanding of the nurses' experience in caring for dying patients.

Nurses' knowledge about equianalgesia and opioid dosing.

Abstract: Nurses are recognized as the cornerstone of palliative care. Yet, surveys of nurses' knowledge of cancer pain management reveal serious knowledge deficits that could adversely affect the care of patients with cancer pain. Previous research has explored basic pain management issues such as pain assessment and myths and misconceptions surrounding pain, and principles of analgesic use. Advances in recent years have increased the demand for continuing education that will extend scientific advances in pain to clinical practice. The purpose of this article is to share results from a study which evaluated nurses knowledge regarding three methods of analgesic delivery that have become common in clinical practice: intravenous morphine, extended release morphine, and transdermal fentanyl. Several resources are provided to assist clinicians in the appropriate use of these analgesic methods.

Symptom distress in adult patients with cancer.

Abstract: Symptom distress in the adult population with cancer is of concern to clinicians who care for these patients. Increased research has been directed toward the development and refinement of symptom distress scales, the identification of determinants of symptom distress, the investigation of symptom d

Exploring the psychosocial meaning of recurrent cancer: a descriptive study

Abstract: Many persons diagnosed with malignancy will experience one or more recurrences of malignancy. Little is known about the psychosocial meaning of recurrent cancer. Using Lazarus and Folkman's model of stress, appraisal and coping, the two purposes of this descriptive study were to (a) describe the meaning of a recurrence of cancer to the patient and (b) to explore if the patient perceives the diagnosis of recurrence as being different from the initial diagnosis of cancer. Purposeful sampling for persons with recent recurrent malignancy produced a sample (n = 20). Subjects completed an unstructured, indepth interview. The meaning of the recurrence was influenced by prior cancer-related experiences of the subjects and dominated by death and death-related concerns. Differences from the initial diagnosis included a deeper awareness of the significance of the "cancer diagnosis".

A descriptive study of stress management in a group of pediatric oncology nurses.

Abstract: Pediatric oncology nursing is associated with highly stressful and emotional situations. This article describes and discusses major sources of occupational stress among a group of nurses participating in a stress management group. The stress sources for these nurses were preoccupation with death and dying, the professional image of the oncology nurse, the nurse as fighter in the war against disease and death, the nurses' perceived isolation from the medical staff, the nurses' perceived inferior professional status compared with that of physicians, emotional overinvolvement with patients and families, suppression of anger, and difficulties in balancing work and home demands. The following factors are suggested as major contributors to the nurses' stress and burnout: increased tendency for irrational-dysfunctional thinking styles (mainly "demandingness" and "awfulizing"), diffuse boundaries between nurses and patients, low professional self-efficacy, and wide prevalence of military metaphors.

Similarities and differences in assessing nausea on a verbal category scale and a visual analogue scale

Abstract: The use of verbal category scales in assessing patient symptoms is evolving, but the extent to which reliability and precision are lost in using them as opposed to a visual analogue scale (VAS) remains uncertain. The present study analyzed the concordance between a four-point verbal category scale and a VAS in assessing nausea intensity in patients undergoing chemotherapy. The analysis of a total of 348 simultaneous ratings by 104 women over four cycles revealed good concordance between the scales. The means of the VAS ratings (range 0-100 mm) corresponding to the four verbal categories divided the scale in four almost equally large parts (no nausea = 0.7, mild = 24.8, moderate = 48.3, severe = 75.1). However, the VAS ranges were wide. On an individual level a one-step change in the verbal category was associated with an average change of 20 mm on the VAS. The choice of scale to use should be based on the need in the particular situation. When measuring intensity of nausea in patients, the VAS is a reasonable choice due to its possibly greater ability to detect changes over time. On the group level, findings on a four-point category scale and a VAS on the average seem similar.

Diagnosis and treatment of major depression among people with cancer

Abstract: Although depressive disorders are common among 20-25% of people with cancer, they are frequently unrecognized. Untreated depression in the presence of comorbid conditions may result in more frequent clinic visits, increased costs, extended hospitalization, and reduced compliance and quality-of-life

Analysis of recent literature concerning relaxation and imagery interventions for cancer pain.

Abstract: A review of literature concerning relaxation and imagery interventions for cancer pain is necessary because major review articles have excluded nursing research or were written prior to the publication of controlled studies in cancer pain conducted by nurses. This review of published nursing/medical/psychological literature of adults with cancer pain conducted over the past 14 years (1982-95) revealed few controlled studies, weak theoretical frameworks, few complete descriptions of the nature of the pain problem, and lack of control over the interventions. Most had very small sizes and could not demonstrate significant effects. Additionally, the intervention methods and length of the interventions were highly variable. Despite these design shortcomings, relaxation and imagery appear to reduce the sensory experience of pain, have equivocal effects on affective measures, and appear to have no effect on functional status. Suggestions for improvement include the need for more experimental studies, more complete descriptions of pain, improved statistical reporting, controls over adequacy of and compliance to the interventions, use of single interventions, and use of more complex measures of affective outcomes. Additionally, the paper contains a discussion of the problems of measuring selected outcome variables in this type of research.

Taking care: caregiving to persons with cancer and AIDS.

Abstract: The purpose of this study was to provide an in-depth description of Taking Care, one of the phases of a grounded theory (The Labor of Caregiving) of caregiving for families experiencing life-threatening illnesses such as cancer and acquired immune deficiency syndrome (AIDS). In-depth interviews were conducted with 26 family caregivers of persons with cancer and AIDS during a 4-month period. Grounded theory methodology served as the basis for data collection and analysis. Data were analyzed in terms of the strategies, consequences, and interactions involved in the caregiving experience. The strategies of Taking Care included these data themes: Managing the Illness, Facing and Preparing for Dying, and Managing the Environment. The consequences of Taking Care included the data themes Coming to Know One's Own Strength, and Personal Suffering. Interactions that occurred as a result of Taking Care included Responding to Family Relationship Issues, and Struggling with the Health Care System. Findings from this research reveal that family caregivers dedicate an enormous portion of their lives to caring for their ill family members. They experience their own form of suffering as they watch their loved one die. Some also find personal meaning in the experience and an awakening of their own strengths. One of the implications from these findings is the need for a partnership between health care professionals and the families providing care.

Beyond survival rates and side effects: cancer nursing as therapy. The Robert Tiffany Lecture. 9th International Conference on Cancer Nursing, Brighton, UK, August 1996.

Abstract: Survival rates and side effects have become the dominant constructs of cancer treatment and care, to the detriment of more supportive and patient-focused approaches. The concept of quality of life introduced to address this has failed to temper the language of oncology. Here an argument is made for the place of cancer nursing as a therapeutic enterprise in its own right, which warrants much greater recognition. Clear evidence for the therapeutic effects of cancer nursing intervention from a series of meta-analyses of cancer nursing interventions exists. Cancer nursing as therapy has the potential to operate on four levels and can effect radical change by reconstructing care, cancer services, and wider health care environments so that they are much more patient focused and offer nursing therapy as an integral part of care. These include fundamental knowledge or theory generation for therapeutic practice, therapeutic interventions for individuals or problems, developing and changing health systems or environments, or critique and reconstruction of care from a societal perspective. The features of cancer nursing as therapy can be identified and are described. Cancer nurses are encouraged to take up the challenge offered by the concept of therapeutic cancer nursing so that its potential for nurses, patients, and cancer services can be realised.

A peer education model for teaching breast self-examination to undergraduate college women.

Abstract: The incidence of breast cancer in women continues to rise, and there is no known cause or prevention. Additionally, > 70% of all diagnosed breast cancer has no known risk factor involved. Early detection is mandatory for survival from this disease, but only three imperfect methods are available: mammography, clinical examination, and breast self-examination (BSE). One-third of all breast cancer cases occur in women under the age of 50 years, and this is a period when mammography is ineffective and clinical examination is infrequent. Consequently, BSE is highly significant for this age group. However, women do not perform BSE on a consistent monthly basis. The significant developmental characteristic of late adolescence and young adulthood is the formation of a personal identity. This age group is also heavily influenced by their peers. Therefore, a BSE program that incorporates peer education and elements essential to positive identity formation may be an effective means to establishing BSE as a normal health routine in young women.

Distress symptoms and support systems of Chinese parents of children with cancer.

Abstract: This study focused on the physiopsychological reactions to the stress of parents of children with cancer in China. Eighty-nine families who had a child with cancer were recruited into four groups: group A, the child was newly diagnosed with cancer; group B, the child was under treatment for cancer; group C, the child had relapsed and was not expected to live; and group D, the child with cancer had already died. Interviews were conducted in Cantonese. The semistructured interviews were conducted in the hospital or in the home. Specific questions were asked regarding colds, headaches, dizziness, loss of appetite, and weight loss. The Parent Stress Rating Scale (PSRS) and the Parent's Support Scale (PSS) were administered. Results indicated that parents most often reported symptoms of loss of appetite, weight loss, and sleeping difficulty, followed by headache, dizziness, and, least of all, colds. Mothers experience more symptoms than fathers. Only in the newly diagnosed group and the under treatment group did the fathers report having had more colds than the mothers. Parents rated the child's death as having caused the highest stress, followed by the terminal stage and the diagnosis. Spouses received the highest rating for being supportive, across all groups.

Cognitive-behavioral interventions to manage depression in patients with cancer: research and theoretical initiatives.

Abstract: The incidence of depression is rising worldwide, possibly due to urban crowding and insufficient resources. This pandemic raises the possibility that disabling depression among patients with cancer will increase. Already, about one-third of patients with cancer present with depression. Although many progressive cancer centers are instituting psychooncology services, the projected decline in numbers of psychiatrists in the coming decade suggests that these programs may flounder unless nurses are able to provide adjuvant support. Consequently, this article describes the theoretical and emerging research data base regarding the treatment of cancer-related depression with cognitive-behavioral therapy. Implications drawn from this review suggest that nurses can take an active role in preventing and managing cancer-related depression in direct care environments by developing critical pathways for screening, prevention, treatment, and outcomes assessment using theory-based research.

Side effects of chop in the treatment of non-hodgkin's lymphoma

Abstract: Cyclophosphamide, doxorubicin, vincristine (Oncovin), and prednisolone (CHOP) has for many years been the standard chemotherapeutic regimen for patients with aggressive non-Hodgkin's lymphoma. Published data for side effects experienced by patients undergoing CHOP chemotherapy in the treatment of non-Hodgkin's lymphoma are limited and inconsistent. No broad descriptive work appears to have been carried out. This study aimed to describe the range of problems experienced by patients receiving CHOP and to estimate incidence and severity of side effects over the treatment period. Data were collected at each treatment cycle via a 75-item self-report questionnaire, with severity of each side effect graded on a 5-point scale. The instrument has previously been shown to be reliable and valid. Nineteen participants received 99 cycles of CHOP and returned 74 questionnaires (response rate = 75%). Patients reported a total of 80 side effects. Alopecia was the most common problem, with all patients experiencing some hair loss by cycle 3. Fatigue was the second most common side effect (incidence = 77%) and taste change the third (incidence = 74%). Patients judged postchemotherapy nausea to be the "most troublesome" problem, followed by fatigue, taste change, constipation, and difficulty sleeping. Both nausea and fatigue were most problematic in the first part of the treatment course. These results indicate that patients receiving CHOP experience a wide range of problems, many of which merit further investigation.

Decision making by elderly patients with cancer and their caregivers.

Abstract: This study explored the scope of decisions encountered by elderly cancer patients and/or their family caregivers, and the types of decision-making assistance requested and required within one practice setting. Semistructured interviews were conducted with five cancer center nurse coordinators (CCNCs). The CCNCs were interviewed weekly for 16 weeks to identify decision-making topics addressed, assistance requested, and perceptions of assistance required during telephone conversations. The CCNCs' reports of 41 telephone conversations revealed 44 specific decision-making topics. Content analysis uncovered 11 categories: symptom management, use of chemotherapy, ancillary choices selection of a medical provider, planning for end-of-life care, alternative therapy, vacation planning, weekend-pass planning, discharge planning, family survivor issues, and involvement of adult children in the elder's care. Elderly patients and/or their family caregivers requested information and assistance with making decisions. CCNCs perceived that callers also needed information clarification, reassurance about their decisions, a listener, permission to change the treatment regimen, and help with communication among health professionals, the elderly patient, and the family.

Intervening with the psychosocial needs of patients and families: perceived importance and skill level.

Abstract: Although nurses claim that psychosocial aspects of care are an important part of their practice, it is not clear that the psychosocial aspects of care is evident in clinical practice. This raises the question as to whether a gap exists between the theoretical literature and what is occurring at the bedside. This survey was designed as a means to examine (a) the importance staff nurses place on intervening with patient and family members' psychosocial needs, and (b) nurses' perceived skill level in meeting those psychosocial needs. The questionnaire, psychosocial interventions: perceived importance and skill level, was developed for this study. Questionnaires were distributed to 310 nurses, and 112 questionnaires were returned (37%). Data analyses included the use of descriptive statistics, independent t-tests, and analysis of variance. Nurses noted that each psychosocial need identified was quite important when providing care to patients with cancer and their families. However, nurses identified a moderate skill level for intervening with these aspects of care. A variety of individuals and factors were identified as promoting psychosocial care. Time was identified as the number one barrier to psychosocial care. Implications include the need for continuing education and preceptorship models that can be used to enhance nurses' skill in intervening with psychosocial needs of patients and their families.

Health beliefs of rural Appalachian women and the practice of breast self-examination.

Abstract: The purpose of this study was to examine the relationship between health beliefs of rural Appalachian women and the practice of breast self-examination (BSE). The sample consisted of 130 women residing in rural Appalachia who were recruited from various groups. The mean age was 53. They completed Champion's Health Belief Scale, which consisted of six Likert subscales: Susceptibility, Seriousness, Benefits, Barriers, Health Motivation, and Confidence. The women were questioned if they did BSE and were asked to respond to the following statement: "If I had cancer, I would rather not know it." Only 34.9% reported that they did monthly BSE. Two of the six subscales correlated significantly with reports of doing monthly BSE. Women who reported more confidence in doing BSE and perceived more benefits from doing BSE were significantly more likely to do regular exams. Interestingly, 18% indicated that they would rather not know if they had cancer and another 17% had neutral feelings. The findings support the need for culturally sensitive education programs on BSE for rural Appalachian women. Consideration must be given to their health beliefs in relation to health promotion.

Social support and breast self-examination

Abstract: Declining practice of breast self-examination (BSE) among women over the age of 55 years dramatically decreases the probability of early detection of breast cancer. About two-thirds of women who die of breast cancer are over the age of 55 years. Social support has been found to be associated with health behaviors. Although a woman's health may benefit from supportive relationships, the effect of diminished social networks on practices of BSE among older women has not been examined. Thus, the purpose of this study was to determine the relationship between social support and the frequency and accuracy of BSE practice. The sample consisted of 22 women, 55 years of age and older, who were having routine examinations at a small Midwestern gynecologic clinic. Social support was assessed by the Norbeck Social Support Questionnaire, and two tools assessed the accuracy and frequency of BSE. Social support was found to be significantly related to the frequency of BSE (r = 0.45, p < 0.05), but not to the accuracy of BSE (r = 0.28). The results also indicated that these women had lower social support scores compared with younger women. Planners of nursing intervention for BSE should consider health care providers as important resources in social support networks for the reinforcement of frequency and accuracy of BSE for older women.

Explaining different profiles in quality of life experiences in acute and chronic leukemia.

Abstract: There is a need to understand and explain why quality of life (QOL) is experienced and viewed differently by those with acute and chronic leukemia. A total of 23 adults with either acute or chronic leukemia were interviewed about their experience of QOL. Adults with acute leukemia described QOL as a positive attitude to life, whereas those with chronic leukemia described QOL as life satisfaction. In order to elucidate why there are differences in their experience of QOL, a qualitative text analysis was used. The narrated interviews, tape-recorded and transcribed verbatim, were interpreted based on the following three questions: Why are there differences in these individuals' description of QOL? What are they talking about? Which phenomenon are they describing? The findings were interpreted, "a feeling of uncertainty," which made the difference to their experience of QOL. This uncertainty was expressed in different forms and could be seen in different degrees. Uncertainty is an important factor affecting the QOL of these adults. Nurses who work with these patients have a major role to play in minimizing uncertainty by offering coping skills to deal with feelings and improving QOL since QOL is one of the outcomes of nursing care.

Anxiety, needs, and coping in family members of the bone marrow transplant patient.

Abstract: There is an imperative need in cancer nursing to recognize that family members of the patient undergoing bone marrow transplantation are unique in the outside stressors with which they must cope. These families have a multitude of needs to be addressed for them to be able to decrease their anxiety and be able to offer the emotional support the bone marrow transplant patient requires. The stressors, needs, and coping mechanisms of the cancer family, that may affect their outward behavior toward the patient and nursing staff, are outlined here. From this information, nursing interventions can be designed to help families decrease their anxiety and increase coping capabilities.

Effect of attitudes and subjective norms on intention to provide oral care to patients receiving antineoplastic chemotherapy.

Abstract: The Theory of Reasoned Action (TRA) served as the conceptual framework for this study, which was designed to examine the effect of attitudes and subjective norms on intention to provide oral care for patients receiving chemotherapy The sample, stratified by type of health care facility, consisted of staff nurses (N = 85) who work in oncology settings in New York State Data were collected by sending 10 questionnaires to a designee at the randomly chosen facility Both attitudes and subjective norms were significant predictors of behavioral intention, predicting 39% of the variance Using the strategy devised by Laschinger and Goldenberg, the sample was divided into two groups: those that scored below the mean on behavioral intention (nonintenders) and those above the mean (intenders) Nonintenders scored significantly lower on attitudes and subjective norms than intenders The TRA was not supported when examining the data of the nonintenders, whereas for the intenders the theory did operate as designed, predicting 23% of the variance in behavioral intention

Feelings of powerlessness in relation to pain: ascribed causes and reported strategies. A qualitative study among Dutch community nurses caring for cancer patients with pain.

Abstract: This qualitative study focused on the causes for the feelings of powerlessness experienced by dutch community nurses in caring for cancer patients with pain. In addition, the study focused on the strategies community nurses employed to cope with feelings of powerlessness. Semistructured interviews revealed the following ascribed causes for feelings of powerlessness: problems in communication between community nurses and patients and between community nurses and personal physicians, dilemmas concerning physical care and opiates, and discrepancies between community nurses' pain management goals and what can realistically be achieved. The main strategies for reducing feelings of powerlessness were sharing feelings with the patient and colleagues, increasing knowledge and skills, and standing back from the situation.