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BACKGROUND: Introducing patients with cancer to the practice of yoga can be beneficial for coping with the side effects of treatment and the psychological aspects of cancer that are often difficult and distressing for patients. Oncology nurses can learn to use simple yoga techniques for themselves and as interventions with their patients. OBJECTIVES: This article provides details about the development and implementation of a yoga class for patients with cancer and provides details about other ways nurses can integrate yoga into oncology nursing and cancer care. METHODS: Current research literature was reviewed and synthesized to provide support for the use of yoga as an evidence-based nursing intervention. A detailed approach for implementing yoga into professional practice was delineated. FINDINGS: Yoga techniques can be easily integrated into nursing practice and have been shown to be beneficial for patients and nurses.

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BACKGROUND: Hopelessness negatively affects ovarian cancer patients' quality of life (QOL). Research validating the effects of complementary and alternative medicine (CAM) use on QOL and hope is scarce, even though QOL and hope are reasons that patients cite for using CAM therapy. Clinicians need effective, evidence-based interventions to improve QOL and reduce hopelessness. OBJECTIVE: The objectives of this study were to examine factors influencing hopelessness in patients with newly diagnosed disease, long-term survivors, and patients experiencing ovarian cancer recurrence and to examine the effects of CAM on hopelessness in the same population. METHODS: Surveys of ovarian cancer patients (N = 219) undergoing treatment at a comprehensive cancer center in the United States were analyzed. Descriptive, correlation, and multivariate analyses described variables and demonstrated the effects of sociodemographics, disease state, psychological distress, QOL, CAM use, and faith on hopelessness. RESULTS: Patients ages 65 years or older (-0.95, P = .03), with strong faith (-0.28, P = .00), and good QOL (0.11, P = .00) directly reduced hopelessness scores (mean, 3.37). Massage therapy substantially reduced hopelessness scores (-1.07, P = .02); holding age constant, employed patients were twice as likely to use massage (odds ratio, 2.09; P = .04). Patients who had newly diagnosed and recurrent ovarian cancer were more hopeless because of greater distress from symptoms and adverse effects of treatment. CONCLUSION: Patients who used massage therapy were significantly less hopeless, as were those with strong faith and well-controlled disease symptoms and treatment for adverse effects. IMPLICATIONS FOR PRACTICE: Support of spiritual needs and symptom management are important interventions to prevent and/or reduce hopelessness, especially for patients with newly diagnosed and recurrent ovarian cancer. Further research testing the positive effect of massage interventions on hopelessness is needed.

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This article describes a team-based approach to the development of a comprehensive codebook for multiple researchers to use during content analysis of the transcripts of the expressive writings of women (in this study, N = 89) with metastatic breast cancer. The codebook structure was developed iteratively by reaching a consensus on the analysis of shared transcripts to create an all-encompassing set of codes, with definitions, inclusion and exclusion criteria, and exemplar text from the transcripts. The Qualitative Solutions and Research International NVivo software program was used to maintain an electronic database of the consensus analysis of transcripts, information about each code, and a detailed log about the process of developing the codebook. The team ultimately created a comprehensive codebook that contained 27 codes with definitions, inclusion and exclusion criteria, and example text. The codes were verified by each team member through reanalysis of a set of shared transcripts that had been previously coded using an earlier version of the codebook. The team met to discuss individual coding and reached a consensus on the final version of the codebook. No new code was identified during the reanalysis, and there was fairly uniform agreement on the coding. The final version of the codebook will be used to guide each team member's individual analysis of the remaining (74) transcripts, which will be divided among the team. Periodic meetings are planned to discuss the individual analysis and to resolve any issue associated with using the codebook. As new codes are identified and agreed upon by the team, they will be added to the codebook. A team-based approach can facilitate the development of a practical and accurate codebook to guide the analysis of a large amount of qualitative data.

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AIM: This paper is a report of a study to describe and compare thinking strategies and cognitive processing in the emergency department triage process by Registered Nurses with high and low triage accuracy. BACKGROUND: Sound clinical reasoning and accurate decision-making are integral parts of modern nursing practice and are of vital importance during triage in emergency departments. Although studies have shown that individual and contextual factors influence the decisions of Registered Nurses in the triage process, others have failed to explain the relationship between triage accuracy and clinical experience. Furthermore, no study has shown the relationship between Registered Nurses' thinking strategies and their triage accuracy. METHOD: Using the 'think aloud' method, data were collected in 2004-2005 from 16 RNs working in Swedish emergency departments who had previously participated in a study examining triage accuracy. Content analysis of the data was performed. FINDINGS: The Registered Nurses used a variety of thinking strategies, ranging from searching for information, generating hypotheses to stating propositions. They structured the triage process in several ways, beginning by gathering data, generating hypotheses or allocating acuity ratings. Comparison of participants' use of thinking strategies and the structure of the triage process based on their previous triage accuracy revealed only slight differences. CONCLUSION: The wide range of thinking strategies used by Registered Nurses when performing triage indicates that triage decision-making is complex. Further research is needed to ascertain which skills are most important in triage decision-making.

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The purpose of this paper is to describe how qualitative data analysis software was used in an attempt to manage and support a three-step protocol analysis of think aloud data in a study examining emergency nurses' reasoning during triage. The qualitative data analysis software program QSR NVivo was used to facilitate protocol analysis and to allow the identification and description of the information that 16 triage nurses concentrated on during triage, and how they structured this information to make a triage decision. The detailed description of how QSR NVivo was used for protocol analysis of think aloud data may assist and guide future informatics research using similar methodology. Finally, the experiences of the use of QSR NVivo for protocol analysis are discussed.

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This methodological paper describes how qualitative data analysis software (QDAS) is being used to manage and support a three-step protocol analysis (PA) of think aloud (TA) data in a study examining emergency nurses' reasoning during triage. The authors believe that QDAS program QRS NVivo will greatly facilitate the PA and will allow them to identify and describe the information that triage nurses concentrate on during triage, and how they structure this information to make a triage decision. These findings could assist in designing and creating decision support systems to guide nurses' triaging. Additionally, details about how to use QRS NVivo for PA of TA data may assist and guide future informatics research using similar methodology are presented here. This innovative use of QDAS holds great promise for future nursing informatics research.

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Feasibility studies of complementary therapies are useful and important not only to test and evaluate the potential effectiveness of an intervention but also to refine and improve it prior to a subsequent study. A series of guided interviews were conducted with patients (n=19) undergoing stem cell/autologous bone marrow transplant (SC/ABMT) who were participating in a feasibility study of a mindfulness meditation (MM) intervention. Audiotapes of these interview sessions were transcribed and then used to create a project in the QRS NVivo software program to manage the data from the interview questions. Responses about what the participants liked and disliked and their suggestions for improving the effectiveness of the MM intervention were identified and grouped. Subsequently, the MM intervention has been refined based on this information, and additional testing in a randomized, controlled trial is planned. The cost is high to implement complementary therapies and to rigorously test them. Preliminary work using qualitative evaluation methods can provide rich and detailed information that will save time and money in the long run.

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In recent years, fatigue has been recognized as a prevalent and often debilitating symptom for patients with cancer. Despite the increased recognition of cancer-related fatigue (CRF), it often is not assessed adequately in the clinical setting. This article reports the results of a feasibility test to evaluate the utility and relevance of the Quick Fatigue Assessment Survey (QFAS), a brief fatigue assessment technique for determining the onset, intensity, and duration of fatigue and for identifying known factors that contribute to the experience and severity of fatigue. Patients from four outpatient oncology clinics, with a variety of cancer diagnoses, participated in the test of the QFAS. The overwhelming majority (96%) of patients who completed the QFAS reported experiencing CRF. The nurses who administered the survey subsequently evaluated its utility in clinical practice. Ninety-six percent of the nurses found the QFAS helpful in providing a quick assessment of patient fatigue. The majority (92%) also believed that the QFAS helped identify contributing factors associated with CRF, and 74% responded that the QFAS assisted them in planning for interventions to minimize CRF. A fatigue assessment technique that is relevant and useful in the clinical setting may be a helpful first step in addressing the problem of CRF.

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As an essential component of nursing practice, clinical reasoning is used to assimilate information, analyze data, and make decisions regarding patient care. Little is known about the reasoning strategies of experienced nurses who are not yet experts. This qualitative descriptive study explored the cognitive strategies used by experienced nurses as they considered assessment findings of assigned patients. To date, few studies of nurses' clinical reasoning have been conducted in a practice setting during actual patient care. A small group research design was employed using the think-aloud (TA) method with protocol analysis. A total of 15 experienced nurses were asked to "think aloud" about patient assessment findings. Data were audiotaped, transcribed, and analyzed using the three steps of protocol analysis. The results suggest that experienced nurses used a conceptual language to reason about assessment findings and used heuristics to reason more quickly and efficiently.

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