RESUMEN
BACKGROUND: This article describes the experiences of clinical nurse specialists in a palliative homecare team who took part in a cluster randomized controlled study. The study aimed to determine whether palliative care nurses given basic training in cognitive behavioural therapy (CBT) were able to use core components of this training when treating advanced cancer patients with anxiety or depression. METHOD: Fifteen nurses were randomly allocated to either receive training in cognitive behavioural techniques or to continue their practice as usual. Nurses were interviewed following the CBT training and after the research study. RESULTS: The CBT group reported a positive change in their approach to patients. Nurses felt empowered, more skilled and effective not only to assess and support patients with symptoms of anxiety and depression but also to facilitate change. In addition, nurses placed considerable value on being given a psychological model and set of interventions. CONCLUSIONS: Nurses found taking part in the study demanding in terms of time and commitment; however, the authors conclude that research in the community palliative care setting is feasible.
Asunto(s)
Terapia Cognitivo-Conductual/educación , Educación en Enfermería , Enfermeras y Enfermeros , Cuidados Paliativos , Hospitales para Enfermos Terminales , HumanosRESUMEN
BACKGROUND: Cognitive behaviour therapy (CBT) has been shown to reduce psychological morbidity in people with cancer, but no randomized controlled trial (RCT) exists in palliative care. We aimed to determine whether home care nurses could be taught to deliver basic cognitive behavioural techniques and so reduce symptoms of anxiety and depression. METHOD: Clinical nurse specialists (CNSs) at St Christopher's Hospice were randomly allocated to receive training in CBT or continue their usual practice. At the end of the trial, nurses were rated on the Cognitive Therapy First Aid Rating Scale (CTFARS) for CBT competence. Home care patients who scored as possible cases on the Hospital Anxiety and Depression Scale (HADS) entered the trial. Participants received home care nursing visits. Assessments were carried out at baseline, 6, 10 and 16 weeks. RESULTS: Eight nurses received CBT training and seven continued practice as usual. The mean CTFARS scores were 35.9 for the CBT nurses and 19.0 for the controls (p=0.02). A total of 328 patients (54%) were possible cases and 80 entered the trial; most of those excluded were too ill to participate. There was an interaction between group and time: individuals receiving CBT had lower anxiety scores over time [coefficient -0.20, 95% confidence interval (CI) -0.35 to -0.05, p=0.01]. No effect of the training was found for depression. CONCLUSIONS: It is possible to conduct a randomized trial of psychological interventions in palliative care but there is considerable attrition from physical morbidity and mortality. Nurses can learn to integrate basic CBT methods into their clinical practice. This training may be associated with better outcomes for symptoms of anxiety.
Asunto(s)
Trastornos de Ansiedad/enfermería , Terapia Cognitivo-Conductual/educación , Trastorno Depresivo/enfermería , Educación , Servicios de Atención de Salud a Domicilio , Neoplasias/psicología , Enfermeras Clínicas/educación , Cuidados Paliativos/psicología , Adaptación Psicológica , Adulto , Anciano , Trastornos de Ansiedad/psicología , Competencia Clínica , Análisis por Conglomerados , Trastorno Depresivo/psicología , Inglaterra , Femenino , Hospitales para Enfermos Terminales , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/mortalidad , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Inventario de Personalidad/estadística & datos numéricos , Psicometría , Rol del EnfermoAsunto(s)
Atención de Enfermería/normas , Cuidados Paliativos/normas , Cuidado Terminal/normas , Competencia Clínica/normas , Humanos , Evaluación de Necesidades , Rol de la Enfermera , Atención de Enfermería/tendencias , Cuidados Paliativos/tendencias , Medicina Estatal/normas , Cuidado Terminal/tendencias , Reino UnidoRESUMEN
The site prevalence and intra-oral density of Candidal organisms may be increased by local factors including prostheses. However, whether significant changes in Candidal carriage occurs with denture wearing is not clearly established. This study employed the imprint culture technique to assess the effects of fixed and removable orthodontic appliances on oral carriage, site prevalence and intra-oral density of Candida in adolescents. Moreover, alterations in plaque distribution were measured. Groups of 12-16 year olds without or wearing fixed and removable appliances were studied. Imprint cultures were taken from six intra-oral sites and colony counts recorded after 48 hours incubation on selective media. Plaque scores were recorded from non-appliance and removable appliance wearers. The prevalence of Candidal carriage in the groups was not significantly different being 46 per cent of non-appliance, 51 per cent of fixed appliance and 52 per cent of removable appliance wearers. However, the prevalence of Candidal recovery at some sites and Candidal densities at all sites were significantly increased in both fixed and removable appliance wearers. Thus orthodontic appliances may predispose to Candidal proliferation in oral carriers. However, the results do not permit the conclusion that appliances may change non-carriers of Candida to carriers. Plaque distribution was significantly altered in removable appliance wearers when compared with non-appliance wearers as a result of increases in palatal plaque scores. These findings again emphasize the particular need for oral hygiene instruction in patients wearing appliances or partial prostheses.