Assessment of quality of life in lymphedema patients: validity and reliability of the Swedish version of the Lymphedema Quality of Life Inventory (LQOLI)

The Lymphedema Quality of Life Inventory (LQOLI) is an instrument developed for patients with different types of lymphedema. It contains physical, emotional, social, and practical dimensions and consists of 58 items, each with three sub items concerning life quality, daily life changes, and difficulties of changing and two items concerning life quality in general and in relation to lymphedema. The purpose of this study was to adapt the Australian LQOLI to Swedish conditions and to test it for clarity, face validity, content validity, construct validity, and reliability. Content and face validity was completed by experts (n=11) and patients with different types of lymphedema (n=16). For construct validation the SF-36 (n=63) was used. Test-retest reliability was evaluated with lymphedema patients (n=58) answering the questionnaire twice, within median 3 weeks. Three items were added in the Swedish version of LQOLI (SLQOLI). The kappa coefficients in test-retest for all items and sub items varied (range = 0.25-0.83). Construct validity showed moderate correlation with SF-36. The SLQOLI is adapted and valid, with moderate reliability, and it can be used in clinic to describe life quality for patients with lymphedema. In this study, 67% of the patients experienced an effect on life quality within the physical dimension and 54-58% within the emotional, social, and practical dimensions.

When the safety net of treatment has been removed: patients' unmet needs at the completion of treatment for haematological malignancies

OBJECTIVE

To determine patients' information, emotional and support needs at the completion of treatment for a haematological malignancy.

METHODS

A self-report questionnaire was mailed to 113 adult patients.

RESULTS

Sixty-six questionnaires were returned. The most frequently endorsed patient needs related to care co-ordination and help to manage the fear of recurrence. The most frequently endorsed unmet needs included managing the fear of recurrence, the need for a case-manager and the need for communication between treating doctors. Predictors of unmet needs included younger patients (p=0.01), marital status (p=0.03) and employment (p=0.03). Almost two-thirds of patients (59%) reported they would have found it helpful to talk with a health care professional about their experience of diagnosis and treatment at the completion of treatment and endorsed significantly more need in the arenas of Quality of Life (p=0.03) and Emotional and Relationships (p=0.04).

CONCLUSION

This study provides valuable data on haematological cancer patients' needs in the first 12 months of finishing treatment. It appears that many needs emerge or remain unresolved at this time.

PRACTICE IMPLICATIONS

An opportunity for patients to talk with a health professional about making the transition from active treatment to extended survivorship may be helpful.

The supportive and palliative care needs of Australian families of children who die from cancer

OBJECTIVE

To identify the perceptions of parents of children who died from cancer regarding the palliative and supportive care they received in hospital and in community settings.

METHOD

Face-to-face or telephone questionnaires. Setting Tertiary paediatric oncology centres in Western Australia, New South Wales, Queensland and Victoria.

PARTICIPANTS

69 parents.

RESULTS

Parents indicated the need for clear and honest information about their child's condition and prognosis throughout the trajectory of illness. Parents also required access to, and advice from, multidisciplinary health professionals when caring for their child at home. Parents preferred to care for their child at home wherever possible throughout the palliative care trajectory of their child's cancer and were well supported by immediate and extended family and friends. However, many families were affected emotionally and financially by the burden of caring for their child with incurable cancer. Families required financial and practical assistance with providing care from their child. Parents wanted and needed more practical resources and information to assist with the management of their child's nutrition and pain, as well as for the support of their other children.

CONCLUSION

Care for children and their families should be coordinated by a multidisciplinary team in consultation with children and their families, and should be linked and integrated with the treating hospital in collaboration with community services.

Meeting breast cancer patients' information needs during radiotherapy: what can we do to improve the information and support that is currently provided?

Previous research has reported that patients require specific information relating to radiotherapy; however, these studies fail to describe patients' specific information needs over time. The aims of this study were to determine the specific information needs of breast cancer patients who are receiving radiotherapy and identify when patients prefer to receive specific information. Semi-structured interviews were conducted with 34 early breast cancer patients and 14 health professionals. Seventeen patients were interviewed after treatment completion, and 17 patients were interviewed on at least two occasions during their radiotherapy. Grounded theory and the constant comparative method were used to analyse the data. Three main categories emerged from the data: 'repertoire of information', 'amount of information relating specifically to radiotherapy' and'tailoring information to match patients' radiotherapy journeys'. Patients' information needs were identified, and key messages and strategies to inform patients were described. This paper identifies breast cancer patient's specific information needs during radiotherapy and shows that patients' information needs are highest during their first appointment with their radiation oncologist and at the time of their planning appointment. The findings presented will enable health professionals to develop and refine their approaches to patient education in radiotherapy.

Translating theory into practice: using Action Research to introduce a coordinated approach to emotional care

OBJECTIVE

This paper describes a translational project that explored the feasibility and effect of introducing a coordinated approach to emotional care.

METHODS

The project was undertaken using Action Research on one ward at St John of God Hospital Subiaco, Western Australia. A senior Registered Nurse was appointed to provide the leadership and direction to staff regarding emotional care and an education program for staff was provided. The project was evaluated using both quantitative and qualitative data.

RESULTS

Data demonstrated an increase in the patient's evaluation of emotional care, although levels were found to fluctuate throughout the project. Factors such as the emotional distress of the staff were hypothesised as impacting on the delivery of emotional care.

CONCLUSION

The approach used in this project was found to be a useful method of improving emotional care. However, the data collected in this study revealed the complexity of emotional care delivery and the possible impact of a number of factors within the environment.

PRACTICE IMPLICATIONS

Emotional care delivery can be improved by using a coordinated research-based educational approach led by a clinical champion. However, the impact of other factors within the hospital environment needs to be considered and more research is required.

A qualitative investigation of the palliative care needs of terminally ill people who live alone

This paper investigates the support needs of people living alone with a terminal illness from a client perspective. In depth, interviews were conducted with 11 clients from Silver Chain Hospice Care in Western Australia to capture their personal experiences of managing at home alone and to assess their physical, social and emotional needs. Findings provided useful insights with respect to many of the motivations, beliefs and wishes of individuals who endeavour to cope on their own with minimal assistance. The needs of these individuals are practical, emotional, physical and existential. At the heart of these concerns is a strong need to be independent and maintain a sense of dignity at end of life.

Endocrine and immune responses to resistance training in prostate cancer patients

This study examined the effect of 20 weeks resistance training on a range of serum hormones and inflammatory markers at rest, and following acute bouts of exercise in prostate cancer patients undergoing androgen deprivation. Ten patients exercised twice weekly at high intensity for several upper and lower-body muscle groups. Neither testosterone nor prostate-specific antigen changed at rest or following an acute bout of exercise. However, serum growth hormone (GH), dehydroepiandrosterone (DHEA), interleukin-6, tumor necrosis factor-alpha and differential blood leukocyte counts increased (P < 0.05) following acute exercise. Resistance exercise does not appear to compromise testosterone suppression, and acute elevations in serum GH and DHEA may partly underlie improvements observed in physical function.

Terminally-ill people living alone without a caregiver: an Australian national scoping study of palliative care needs

Home-based palliative care services are facing increasing challenges in servicing the needs of clients who live alone and without a primary caregiver. The findings from the analysis of 721 services' records from three Australian states, and feedback from health professionals in interviews and postal surveys, demonstrated that there were aspects of being on one's own with a terminal illness and living at home that require a specialised approach and support. This study explored the issues of palliative care patients living alone, from a service provider perspective, and provided evidence-based information to assist with service planning. The study made recommendations to the Australian Department of Health and Ageing about services considered important in developing support structures for this growing population.

Effect of postural supports on neuromotor function in very preterm infants to term equivalent age

OBJECTIVE

To determine the effect of a postural support nappy and/or a postural support roll on neuromotor function in very preterm infants when nursed prone to term equivalent age.

METHODS

A randomized observer blind controlled trial of 123 very preterm infants was conducted in the neonatal intensive care unit of the sole tertiary referral centre in Western Australia. Infants were stratified by gestational age (< 29 weeks or 29-30 weeks), then randomized into one of three intervention groups: postural support nappy, postural support nappy and postural support roll, or disposable nappy and postural support roll. Interventions started when infants were stable and ceased when routine side-lying commenced. Measurements of shoulder and hip posture were performed pre-intervention, 5 weeks post-intervention and term postmenstrual age.

RESULTS

Infants nursed with a postural support roll and a postural support nappy demonstrated improved hip posture to term equivalent age compared with infants nursed with either a postural support roll only, or a postural support nappy only. Infants nursed with a postural support roll either with or without a postural support nappy demonstrated improved shoulder posture to term equivalent age.

CONCLUSIONS

Combined use of a postural support roll and a postural support nappy while very preterm infants are nursed prone improves hip posture up to term postmenstrual age. Use of a postural support roll improves shoulder posture up to term equivalent age.

Writing therapy for the bereaved: evaluation of an intervention

Bereavement is a risk factor for a wide range of well-documented negative outcomes. As such, a range of sensitive and appropriate interventions are needed to support people adjusting to their new roles and change in identity. Writing has proven to be useful for people adjusting to traumatic experiences. Translating experiences into language and constructing a coherent narrative of the event enables thoughts and feelings to be integrated, leading to a sense of resolution and less negative feelings associated with the experience. Using a writing therapy intervention tailored specifically for bereaved individuals in Western Australia, this study asked: "Does a writing therapy intervention reduce grief, lead to greater health and wellbeing and lead to greater self care for bereaved individuals?" The results indicate that for grief and General Health Questionnaire-30 (GHQ-30) scores there was an overall improvement for all participants regardless of whether participants received the intervention or not. The results for the effect of writing therapy on self-care demonstrate that there is a greater increase in self-care for the intervention group than for the control group; however, this trend does not reach statistical significance. Writing therapy offers a useful, cost-effective, and private way of supporting bereaved individuals who may not practice self-care. The main limitation of the current research is the low number of participants, which limits the generalizability of the results. Future research could be directed toward evaluating the intervention for recently bereaved people or those identified by screening as being particularly vulnerable.

Cancer in Western Australian Indian families: concerns and coping strategies

Discussion with families of Indian clients with cancer living in Western Australia and their anecdotal reports of stress related to care lead to the development of this descriptive, qualitative study. In particular, the study addresses the concerns of Western Australian families of Indian clients with cancer and the coping strategies they employed. Six family members participated in face-to-face interviews. Content analysis revealed a four-phase process that family members described in response to the cancer diagnosis: initial reactions, immediate concerns, ongoing concerns, and coping strategies used. Culturally-specific observations and recommendations are offered for nursing practice and further research.

Ongoing relationships with a personal focus: mothers' perceptions of birth centre versus hospital care

OBJECTIVE

to describe women's perceptions of care in Western Australian birth centres following a previous hospital birth.

DESIGN, SETTING AND PARTICIPANTS

an exploratory study was undertaken to examine the care experiences of women from three Western Australian birth centres. Data were obtained from 17 women whose interviews were audio-recorded and transcribed. The research focused upon women's perceptions of their recent birth centre care as compared to previous hospital care during childbirth.

FINDINGS

four key themes emerged from the analysis: 'beliefs about pregnancy and birth', 'nature of the care relationship', 'care interactions' and 'care structures'. The themes of 'care interactions' and 'care structures' will be presented in this paper. Care interactions refer to women's opportunities to develop rapport with their carers. Care structures involved the organisational framework in which care was delivered. The first two themes of 'beliefs about pregnancy and birth' and the 'nature of the care relationship' were discussed in a previous paper.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

differences in opportunities for care interactions and care structures were revealed between birth centre and hospital settings. Ongoing, cumulative contacts with midwives in the birth-centre setting were strongly supported by women as encouraging the development of rapport and perception of 'being known' as an individual. Additionally, care structures tailored to women were advocated over the systematised, fragmented care found in hospital settings.

Normality and collaboration: mothers' perceptions of birth centre versus hospital care

OBJECTIVE

to describe women's perceptions of care in Western Australian birth centres following a previous hospital birth.

DESIGN, SETTING AND PARTICIPANTS

an exploratory design was used to study the care experiences of 17 women recruited from three Western Australian birth centres. Data were obtained from in-depth interviews that explored women's perceptions of their care in both the birth centre and hospital context.

FINDINGS

four key themes emerged from the analysis: 'beliefs about pregnancy and birth', 'nature of the care relationship', 'care interactions', and 'care structures'. The themes of 'beliefs about pregnancy and birth' and 'nature of the care relationship' are discussed in this paper. Beliefs about pregnancy and birth refer to the philosophical underpinnings of pregnancy and birth held by women and their carers. Nature of the care relationship identifies women's perceptions of their relationship with health professionals. Care interactions and care structures will be described in a subsequent paper.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The women's comments suggested differences in philosophy between hospital and birth-centre settings. The philosophy and beliefs of caregivers was an important component of the care experience. Women valued the normality of the birth-centre approach and the opportunity to experience the birth of their child with collaborative support from a midwife.

Factors influencing women's decisions for choice of surgery for Stage I and Stage II breast cancer in Western Australia

BACKGROUND

Internal and external factors have been reported to influence decision-making by women for breast cancer surgery.

AIM OF THE STUDY

The aim of the study was to describe the factors those women with Stage I or Stage II breast cancer, perceived to be important when selecting either modified radical mastectomy or breast conserving treatment.

DESIGN/METHOD

A descriptive correlational study was conducted. A consecutive sample of women with a diagnosis of breast cancer during a 6-month period was selected from the Health Department of Western Australia Cancer Registry.

RESULTS

Women who had breast conserving treatment rated the surgeon's preference as a more important factor in decision-making than women who had modified radical mastectomy. The lack of difference in long-term survival between the types of surgery was also a more important influence on decision-making for the breast conserving treatment group compared with women who had received modified radical mastectomy. Women in rural areas tended to choose modified radical mastectomy rather than breast conserving treatment. The surgeon, family and general practitioner were important sources of information. A significant association was found between women's involvement in decision-making and their use of a general practitioner as an information source. Many women wanted the decision about surgery to be entirely their own; the breast conserving treatment group preferred a more active role in decision-making compared with those who chose modified radical mastectomy. Most women had participated in the decision-making process as much as they wished, had enough time in which to make their decisions and had received sufficient information. A correlation between adequacy of information and sufficient time for decision-making was found.

CONCLUSION

Findings may be useful to nurses and other health professionals who endeavour to provide adequate information and support to women during their initial treatment decision-making experience.

Priorities for adult cancer nursing research: a West Australian replication

Two Delphi surveys have been conducted during the past 20 years to identify cancer nursing research priorities; one in the United States and one in Canada. Sir Charles Gairdner Hospital, the State Cancer Referral Centre in Western Australia, undertook a replication of this Delphi survey to identify nursing research priorities for adult cancer nursing. The aim of this replication was to identify possible changes in priorities and account for cultural difference in the healthcare systems. A total of 45 responses were received from the first Delphi round and 30 from the second. The top ten priorities identified by this sample were different from those identified in prior studies. The top ranked research topic was "What strategies would be most helpful in allowing nurses time to provide emotional support to cancer patients and carers?" These results may stimulate discussion and re-assessment of research priorities in other adult cancer care settings.

Palliative care nurses' perceptions of good and bad deaths and care expectations: a qualitative analysis

Individuals who are involved with the death of a person with a terminal illness will often classify the death as either 'good' or 'bad'. Families and healthcare practitioners assess many factors when determining their 'success' or 'failure' in assisting someone in the terminal phase. Palliative care nurses are particularly vulnerable to self-assessments about care of the dying, because death is a daily occurrence. Feelings of failure, unmet expectations and feeling of regret about not being able to prevent a traumatic death may be a source of stress for palliative care nurse and may affect their abilities to function effectively. This article reports the findings of a study involving interviews with 20 palliative care nurses to determine their perceptions of a good and bad death. The study also examined the expectations they hold of themselves and that they believe others hold of them in helping patients to attain a good death. Clinical implications are discussed based on these findings.

An exercise intervention for advanced cancer patients experiencing fatigue: a pilot study

Fatigue is reported by advanced cancer patients to be their most prevalent and distressing symptom. Despite this, few interventions have been developed and tested to manage this debilitating symptom. This paper describes a pilot study undertaken to test the effects of a 28-day exercise intervention on levels of fatigue in advanced cancer patients. All participants were able to increase their activity levels with no increase in reported fatigue. Furthermore, a trend was noted in all patients toward increased quality of life scores and decreased anxiety scores. All participants described a sense of satisfaction in attaining increased activity levels. These preliminary pilot results suggest that patients who initially report the highest levels of fatigue may achieve the largest decrease in fatigue scores. These findings provide support for the suitability of this intervention for the palliative care population and justify the importance of further hypothesis testing.

Technology in palliative care: steering a new direction or accidental drift?

Technological advances have been helpful in alleviating the suffering of many dying patients. For some, however, use of technology appears to augment distress. This article presents a discussion of issues associated with use of technology in palliative care nursing: pain management approaches, use of invasive procedures, decision-making concerns, the ways in which technology may serve as replacement for other types of care, and cost considerations.

Performance Status Assessment in Home Hospice Patients Using a Modified Form of the Karnofsky Performance Status Scale

The Karnofsky Performance Status (KPS) scale is considered to be the gold standard for quantifying the physical functioning of patients with cancer. However, problems have been identified with the scoring system when the scale is used in the home hospice setting. The goal of this study was to compare assessments of performance status using two instruments, the KPS and a modified version, the Thorne-KPS (TKPS). The TKPS avoids reference to location of care and has new descriptors for assessing the frequency of professional visits and the proportion of time spent in bed. Comparisons were made on a sample of 78 home-hospice patients in Perth, Western Australia. The median score for both scales was 60. The scales agreed in 56% of ratings overall but after correcting for chance, agreement was reduced to 47%. However, 91% of the 34 discrepancies occurred within one or two levels of the 11-point scale. TKPS scores were consistently lower than KPS scores and were spread over a wider range of the scale. The strongest agreement occurred at the higher levels of performance and the weakest agreement was within the middle levels of the scales. Further studies are required to determine which of the two scales more accurately reflects performance status and survival time. However, the results to date suggest that the TKPS may be a more objective and sensitive measure of functional performance in home hospice patients.

Perceptions of the role of the school in providing information and support to adolescent children of women with breast cancer

Little is known about the needs of adolescents of women with breast cancer. The purpose of this study was to describe the perceptions of adolescents (ages 12-20) about the role of the school in assisting them in dealing with the cancer experience. An exploratory, qualitative study was done to elicit detailed descriptions of adolescent's needs for information and support in response to their mother's breast cancer. A convenience sample of 31 adolescents of women in five illness phases participated in semi-structured interviews. In addition, two focus group interviews were conducted. Interviews were tape-recorded, transcribed and analysed using content analysis techniques. Findings specific to the adolescents' perceptions of the role of the school were discussed according to content, type, amount, timing, provider and quality of information. Support needs were discussed as type of support, source of support, amount, timing and focus. Although school personnel attempted to be supportive and adolescents received generic information about cancer, overall the needs of the adolescents were not adequately addressed. Recommendations for schools and health services in assisting adolescents to cope with this major life experience are made.

Predictors of family satisfaction with an Australian palliative home care service: a test of discrepancy theory

Five interesting findings emerged from this study: Although study results demonstrate support for Porter's Discrepancy Theory, the most compelling outcome is the finding that family care perceptions may be the best predictor of family care satisfaction. Family members' age may be a predictor of family care satisfaction. Family functioning may be a useful clinical indicator to identify families who are less satisfied with care and in greater need of support. The length of time that clients receive the care service may alter family care satisfaction. Differences in findings reported in this study compared with Canadian results point to the need for cross-cultural research in this area. This research is the first Australian study to test discrepancy theory as a framework for understanding family care satisfaction in a home hospice context. Results from this study may assist health care providers to more sensitively address the care perceptions of families in this care setting and extend theory development research that is needed to guide palliative care practice with families.

Beyond convention: describing complementary therapy use by women living with breast cancer

Using a descriptive survey design, 52 women living with breast cancer were interviewed to explore their use of complementary therapy and the relationships between complementary therapy use and key demographic variables and health beliefs. Sixty-seven percent of the women reported complementary therapy use, with meditation/relaxation therapies, vitamins and spiritual healing being the three most frequently reported treatments. Women using complementary therapies were more likely to have completed post-secondary education than women using only conventional medical treatment (chi 2 = 7.1, P = 0.008). Preferred decisional role was found to be significantly associated with the use of complementary therapies (chi 2 = 11.7, P = 0.003); women using complementary therapies preferred a more active/collaborative role in treatment decisions than women using only conventional medical treatment. No significant associations were found between complementary therapy use and beliefs about cause of cancer, treatments, satisfaction with health care providers, and perceived quality of life. The findings point to the pervasiveness of complementary therapy use by women living with breast cancer and contradict past research which has supported a distinct demographic profile of complementary therapy users and associated belief system.

Measuring the care needs of mothers of children with cancer: development of the FIN-PED

This 2-phase study tested the Family Inventory of Needs-Pediatrics (FIN-PED), a 52-item instrument structured to include 2 subscales, the first measuring the importance of care needs and the second measuring the extent to which needs were met. In Phase I, an expert panel of 6 mothers of children with cancer rated the tool for clarity, apparent internal consistency, and content validity. All items met preset criteria for these assessments. In Phase II, 110 mothers rated the instrument for internal consistency reliability, stability over time, and internal construct validity. Both subscales achieved an estimated internal consistency of 0.94. Evidence of the instrument's stability over time was also achieved. Factor analysis resulted in 4 interpretable factors, suggesting that the tool is multidimensional.

Information needs of husbands of women with breast cancer

PURPOSE/OBJECTIVES

To identify and measure the information needs of the husbands of women newly diagnosed with breast cancer and to determine the extent to which these needs are being met.

DESIGN

Descriptive survey.

SETTING

Five surgical inpatient units at four urban hospitals in Winnipeg, Manitoba, Canada.

SAMPLE

84 husbands of women recently diagnosed with breast cancer.

METHOD

Subjects completed the Family Inventory of Needs--Husbands.

MAIN RESEARCH VARIABLES

Information needs and extent to which these needs were met.

FINDINGS

Husbands' highest ranked needs were those related to immediate care needs and communication issues. Their lowest ranked needs were those related to family relationship issues and their practical involvement in caring for their spouse. No differences existed between type of surgery (lumpectomy versus mastectomy) and number of needs and whether or not needs were met. However, husbands whose wives had undergone their first mastectomy reported approximately three times more unmet needs than husbands whose wives had undergone previous surgery for breast cancer. Husbands at greatest risk for not having their needs met were those whose occupational classification was listed as retired or laborers, those with less than a high school education, and those whose wives had only undergone one surgery for breast cancer.

CONCLUSIONS

Results of this study provide a profile of the husbands' most and least important information needs and the degree to which these important needs were met.

IMPLICATIONS FOR NURSING PRACTICE

With a clearer idea of the type of information important to husbands of women with breast cancer, intervention studies to determine how to best address these information needs can be designed.

Measuring the information needs of husbands of women with breast cancer: validity and reliability of the Family Inventory of Needs--husbands

PURPOSE/OBJECTIVES

A two-phase study was undertaken to test the Family Inventory of Needs--Husbands (FIN-H), a tool designed to measure the information needs of husbands of women with breast cancer and the extent to which these needs are met.

DESIGN

Methodologic survey.

SAMPLES

Phase I: a panel of 6 husbands; phase II: 84 husbands of women with breast cancer.

METHODS

Panel of expert ratings followed by pilot test of the two-part survey.

FINDINGS

In phase I, husbands assessed the FIN-H for clarity, internal consistency, and content validity. All preset criteria were met. In phase II, internal consistency, test-retest reliability, and internal validity were assessed. Internal consistency estimates as measured by Cronbach's standardized alpha coefficients were 0.91 and 0.93. Test-retest correlations were 0.82 and 0.76 (p = 0.0001). Exploratory factor analysis suggested that the FIN-H consists of five factors.

CONCLUSIONS

Initial results suggest that the FIN-H is reliable and valid. Further testing is needed to confirm these results.

IMPLICATIONS FOR NURSING PRACTICE

Before nurses can address the information needs of husbands of women with breast cancer, use of a reliable and valid assessment tool is recommended.

Family members' care expectations, care perceptions, and satisfaction with advanced cancer care: results of a multi-site pilot study

Psychometric properties of assessment tools designed for use with English-speaking family members of advanced cancer patients in different care settings and different geographic locations were evaluated in this study. The robustness of the theoretical framework guiding the study and the factors identified with care satisfaction were also tested. Seventy-two family members drawn equally from medical hospital units, palliative care units, and home care programs in Alberta, Saskatchewan, and Manitoba participated. Instruments used included the F-Care Expectations Scale, F-Care Perceptions Scale, FAMCARE Scale, and the General Functioning Scale of the Family Assessment Device. All four tools yielded acceptable reliability estimates. Discrepancy theory predicted family care satisfaction in a highly significant manner (p < 0.0001). Family members of patients who had been diagnosed for longer than two years had more positive perceptions of palliative care than did family members of patients diagnosed for less than two years (p = 0.05). Older family members reported better family functioning than younger family members (p < 0.001). Spouses reported less discrepancy between care expectations and perceptions than did other relatives (p < 0.05).

Information needs and decisional preferences in women with breast cancer

OBJECTIVE

To determine the degree of involvement women with breast cancer wanted in medical decision making, extent to which they believed they had achieved their preferred level of involvement, and types of information they judged to be most important.

DESIGN AND SETTING

Cross-sectional survey at 2 tertiary oncology referral clinics and 2 community hospital oncology clinics in Winnipeg, Manitoba.

PATIENTS

Consecutive sample of 1012 women with a confirmed diagnosis of breast cancer who were scheduled for a visit at 1 of 4 hospital oncology clinics.

MAIN OUTCOME MEASURES

The following measures were used: (1) Preferences about various levels of participation in treatment decision making; (2) the extent to which subjects believed they had achieved their preferred levels of involvement in decision making; and (3) priority needs for information and how these needs differed by selected sociodemographic, disease, and treatment variables.

RESULTS

A total of 22% of women wanted to select their own cancer treatment, 44% wanted to select their treatment collaboratively with their physicians, and 34% wanted to delegate this responsibility to their physicians. Only 42% of women believed they had achieved their preferred level of control in decision making. The 2 most highly ranked types of information were related to knowing about chances of cure and spread of disease. Women younger than 50 years rated information about physical and sexual attractiveness as more important than did older women (P<.001); women older than 70 years rated information about self-care as more important than did younger women (P=.002); and women who had a positive family history of breast cancer rated information about family risk as more important than did other women (P=.03).

CONCLUSIONS

The substantial discrepancy between women's preferred and attained levels of involvement in treatment decision making suggests that systematic approaches to assess and respond to women's desired level of participation in treatment decision making need to be evaluated. Priorities for information identified in this study provide an empirical basis to guide communication with women seeking care for breast cancer.

"Getting better from my hurts": toward a model of the young child's pain experience

A qualitative grounded theory method was used to examine hospitalized children's experiences of acute pain. Understanding the children's pain experiences included identifying children's responses, factors influencing children's responses, and the meanings children associated with their pain experiences. A sample of 11 surgical pediatric patients, 2-1/2 to 6-1/2 years of age, participated. Data collection methods included participant observation, informal and formal interviews, play interviews, hospital chart reviews, and use of a reflexive journal. Data analysis was based on the constant comparative method. Findings revealed that the pain experience determined how the overall hospitalization was experienced by the children. "Getting better" was identified as the basic psychosocial process children used to deal with the pain. A beginning model of the young child's pain experience was developed and is presented here.

A young child's pain: how parents and nurses 'take care'

A qualitative study was undertaken to describe how parents and nurses respond to hospitalized young children experiencing pain from surgical interventions. Participant observation was used to identify care behaviours and the care context within which the children experienced, and caregivers witnessed, post-operative pain. Interviews with parents, nurses, and children were also conducted during the observation periods and prior to discharge to augment the observational data. Care provided by parents included comfort measures and vigilant monitoring of the children's pain. Nurses primarily provided technical care, used limited pain assessment approaches, and were not able to adequately alleviate the children's pain. Factors, strategies, and feelings associated with these care behaviours are described. The most salient recommendations arising from these findings are that nurses: (a) be provided with education about pain assessment and management, and (b) be empowered by policies that allow them to sensitively and effectively respond to children in pain.

Development and testing of the ostomy concerns scale: measuring ostomy-related concerns of cancer patients and their partners

This article reports the third phase of a project undertaken to develop and test the Ostomy Concerns Scale. The Ostomy Concerns Scale measures concerns of cancer patients with ostomies and of their partners. The tool was pilot tested for clarity, apparent internal consistency (nonquantitative assessment of homogeneity of content), and content validity by a panel of experts. The scale met or exceeded the preset criteria specified in this phase of testing. Subsequent testing included estimates of the scale's reliability and validity with a sample of 40 patients and their partners. Internal consistency estimates, as measured by Cronbach's alpha coefficient, were 0.92 at two test times. A test-retest reliability estimate of 0.73, as measured by Spearman's correlation coefficient, was obtained. The results are promising and suggest that the Ostomy Concerns Scale provides a clinically useful evaluation of concerns of patients with ostomies and their partners.

Family members' perceptions of palliative cancer care: predictors of family functioning and family members' health

We studied family members' care experiences during the palliative care phase as predictors of family members' health and family functioning during the palliative care phase and three months following the death of the patient. Eighty family members of advanced cancer patients participated in the study at time one (T1) (palliative care phase) and 64 family members completed the data collection protocol at time two (T2) (three months bereavement). Data were also obtained from 36 of the patients within one month of their deaths. Fulfillment theory accounted for 31% of the variance in family care satisfaction and Discrepancy theory accounted for 72% of the variance in family care satisfaction. Discrepancy theory predicted family functioning in the bereavement period (r = -0.33, p < 0.05). Patients' quality of life scores were moderately correlated with family members' health during the palliative care phase (r = -0.38, p < 0.05). Family members' scores on the health index (symptom of stress scale) were significantly lower (p < 0.05) than normative scores reported in a study using a healthy population. The strongest predictor of family members' health scores in the bereavement period was their health score at T1 (r = 0.71, p < 0.01). As well, family functioning at T1 was strongly correlated with family functioning at T2.

Young children's behavioural responses to acute pain: strategies for getting better

Behavioural responses of hospitalized young children in acute pain were examined and described. Eleven children, aged 24-79 months, who experienced acute pain in response to surgical intervention, and their parents, participated in the study. A qualitative, naturalistic methodology was used. Participant observation and child and parent interviews were the primary data collection methods. The constant comparative method of data analysis was employed to identify beginning behavioural response categories. Findings revealed that the children used the process of 'getting better' in response to pain. This process involved three strategies: 'hiding away', 'fighting it' and 'making it good'. Each of these strategies was characterized by specific behaviours. The more pain the children experienced, the more frequently these strategies were employed. Recommendations specific to assessing behavioural responses in young children experiencing acute pain are offered.

Psychological support role of night nursing staff on an acute care oncology unit. A Canadian pilot study

Observational field techniques were used to explore the dimensions of psychological support provided by experienced night nursing staff on an acute oncology unit in a Canadian tertiary care setting. This study confirms the findings of an earlier British pilot study surrounding the essential role that nurses play in meeting the psychosocial needs of cancer patients during the night shift on oncology wards. Categories included comfort care, monitoring, facilitating patient control, responding to the family, collegial support, and contextual factors. The findings confirm the need to raise the awareness of other health care professionals regarding the psychological support role night nurses undertake.

The parent-nurse relationship from the perspective of parents of children with cancer

Research to date has overlooked the specific relationship between parents and nurses, particularly in the context of family-centered care for a hospitalized child with cancer. The purpose of this study was to describe how parents perceive the relationship with the pediatric staff nurse necessitated by the hospitalization of their child with cancer. Using a symbolic interactionist framework and a modified grounded theory methodology, this study explored the parent-nurse relationship when a child with cancer is hospitalized. A purposive, theoretical quota sampling method was used to recruit 16 parents. Both parents' and nurses' care were examined from the parents' perspectives; mothers and fathers were interviewed separately. Analysis of the data led to the development of a substantive theory describing parent care (Making it Better), nursing care (Going Through the Motions, Caring Incompletely and Caring Completely), and the parent-nurse relationship (Working Together). Conditions influencing the care provided by parents and nurses and in turn the parent-nurse relationship were also identified. This research describes strategies nurses use to enhance the family-centered care they provide and reveals the effect nursing care has on parents' hospital experiences. Recommendations are made for nursing research, practice, and education.

Research utilization in maternal-child nursing: application of the CURN model

Nursing administrators, educators and clinicians are continually striving to incorporate research into practice. A number of research utilization models have been developed to help meet this challenge. This article describes how the Conduct and Utilization of Research in Nursing (CURN) approach was used in a maternal-child area of a Canadian tertiary care hospital. One patient care problem was identified by practising nurses that required acquisition and application of recent research findings. A thorough literature search and critique was conducted based on this patient care problem and research results were used to develop nursing care guidelines for this priority concern.

The family's cancer journey: a literature review

Cancer is recognized by health professionals as a phenomenon experienced by the entire family, not just by the individual member diagnosed with the disease. This article is based on an examination of approximately 200 clinical papers and research studies written between 1970 and 1991. Four major dimensions of the family cancer experience were identified from the literature: developmental stage of the family, cancer illness trajectory, family responses to cancer, and health care provider behaviors. The most developed body of literature documents the family responses to cancer and health-care provider behaviors directed at these responses. Gaps in research knowledge are identified and directions and recommendations for future research are outlined.

Validity and reliability testing of the FAMCARE Scale: measuring family satisfaction with advanced cancer care

The purpose of the study was to test the validity and reliability of the FAMCARE Scale which was developed to measure family satisfaction with advanced cancer care. The FAMCARE Scale was developed based upon earlier qualitative research which identified indicators of family care satisfaction and a subsequent Q-sort study that reduced those items to the most salient indicators of satisfaction according to a larger, representative sample (N = 210). A pilot test of the FAMCARE Scale using a convenience sample of 30 family members of advanced cancer patients was conducted. The scale achieved internal consistency estimates of 0.93 at two testing times, a test-retest correlation of 0.91, and estimates of criterion validity using the McCusker Scale of 0.80 and 0.77. Cluster analysis of the scale suggested 4 subdimensions. Although the scale requires further testing to establish its reliability and validity, these preliminary results indicate that the scale may be a psychometrically sound instrument useful for measurement of family satisfaction with advanced cancer care.

Preventive work with families: issues facing public health nurses

This paper examines the issues that nurses experience when entering the family system to work preventively. The theoretical basis of family-centered nursing is analysed and the need for empirical work is identified in order to develop a knowledge base for this practice. Some unique characteristics of the public health nursing role are discussed with emphasis on territorial issues, power relationships and accountability problems. The need for public health nurses to function as advanced generalists across different system levels is recommended and family skills necessary for effective family nursing are examined. The authors identify the unique role of public health nurses because they have access to healthy families and families dealing with early stages of health concerns. The authors support the general structure of public health practice as of value for preventive work with families. However, clarity regarding referrals, contracting and the rights of clients is called for to facilitate collaborative family-centred nursing.

Assessment of Continuing Nursing Education Needs: A Literature Review

Continuing education literature is replete with disagreement and confusion regarding the value and methods of conducting needs assessments for nurses. Literature that describes the usefulness of needs assessment ranges from fuzzy rhetoric to sound empirical studies of learners' needs. Sorting through the numerous articles is a difficult and tedious task for the continuing education planner. In addition, the lack of consistency in the writings makes comparison of needs assessment findings onerous. This article presents a synthesis and critical analysis of the needs assessment literature in nursing. One hundred and thirty-two articles and books were reviewed, and four major themes emerged from the analysis.

Quality of terminal care: salient indicators identified by families

This study was the second phase of a three phase project designed to develop and test a tool to measure family satisfaction with terminal care. The first phase was a qualitative study that identified indicators families of terminally ill cancer patients perceived to be important to patient and family care. In Phase II a Q-Sort was administered to 210 family members from three different care settings to obtain relative rankings of the items identified in Phase I. Items most and least important to patient care and family care were identified for the total sample and for each care setting. Patient comfort, the need for information regarding the patient's illness, and the availability of a hospital bed were ranked as most important by the total sample. The extent of agreement among family members and within care settings was estimated using Kendall's coefficient of concordance. Demographic variables that were significantly related to item rankings are reported. Phase III will use the most salient items identified in Phase II to develop and test a scale to measure family satisfaction with terminal care.

A model to guide development and application of multiple nursing theories

Over the past decade there has been an explosion of interest and activity in the nursing profession directed toward the development of a theory base for nursing education and practice. Although we support the overall thrust of nursing theory development, we have concerns about its utility, scope and stated purposes. We are especially sensitive to the plight of the practising nurse who might attempt to use the current nursing theories to guide and explain choices made in daily practice. In this paper we examine current use of the word 'theory' and describe problems inherent in nursing's efforts to apply educationally derived conceptual frameworks to nursing practice. We identify a need for the development and use of many theories for nursing and argue that there is a logical need for a 'meta-model' which will guide the use of multiple theories in practice. A model is presented which allows the practising nurse to examine the various theories in terms of their applicability to a given client situation. We believe the model is also useful to nurse educators and researchers who may be attempting to use nursing theories for educational purposes or develop nursing's knowledge base through empirical work.