RESUMEN
OBJECTIVE: Percutaneous tunneled drainage catheter (PTDC) placement is a palliative alternative to serial paracenteses in patients with end-stage cancer and refractory ascites. The impact of PTDC on quality of life (QoL) and long-term outcomes has not been prospectively described. The objective was to evaluate changes in QoL after PTDC. METHOD: Eligible adult patients with end-stage cancer undergoing PTDC placement for refractory ascites completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and McGill Quality of Life instruments before PTDC placement and at 2 to 7 days and 2 to 4 weeks after PTDC. Catheter function, complications, and laboratory values were assessed. Analysis of QoL data was evaluated with a stratified Wilcoxon signed-rank test. RESULT: Fifty patients enrolled. Survey completion ranged from 65% to 100% (median 88%) across timepoints. All patients had a Tenckhoff catheter, with 98% technical success. Median survival after PTDC was 38 days (95% confidence interval = 32, 57 days). European Organization for Research and Treatment of Cancer scores showed improvement in global QoL (p = 0.03) at 1 week postprocedure (PP). Significant symptom improvement was reported for fatigue, nausea/vomiting, pain, dyspnea, insomnia, and appetite at 1 week PP and was sustained at 3 weeks PP for dyspnea (p < 0.01), insomnia (p < 0.01), and appetite loss (p = 0.03). McGill Quality of Life demonstrated overall QoL improvement at 1 (p = 0.03) and 3 weeks (p = 0.04) PP. Decline in sodium and albumin values pre- and post-PTDC slowed significantly (albumin slope -0.43 to -0.26, p = 0.055; sodium slope -2.50 to 1.31, p = 0.04). Creatinine values increased at an accelerated pace post-PTDC (0.040 to 0.21, p < 0.01). Thirty-eight catheter-related complications occurred in 24 of 45 patients (53%). SIGNIFICANCE OF RESULTS: QoL and symptoms improved after PTDC placement for refractory ascites in patients with end-stage malignancy. Decline in sodium and albumin values slowed postplacement. This study supports the use of a PTDC for palliation of refractory ascites in cancer patients.
Asunto(s)
Ascitis/complicaciones , Neoplasias/terapia , Cuidados Paliativos/normas , Paracentesis/normas , Adulto , Anciano , Ascitis/psicología , Femenino , Humanos , Estimación de Kaplan-Meier , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Cuidados Paliativos/métodos , Cuidados Paliativos/psicología , Paracentesis/métodos , Estudios Prospectivos , Calidad de Vida/psicología , Encuestas y CuestionariosRESUMEN
Under pressure to avoid readmissions, hospitals are increasingly employing hospital-initiated postdischarge interventions (HiPDI), such as home visits and follow-up phone calls, to help patients after discharge. This study was conducted to assess the effectiveness of HiPDI on reducing hospital readmissions using a systematic review of clinical trials published between 1990 and 2014. We analyzed twenty articles on HiPDI (from 503 reviewed abstracts) containing 7,952 index hospitalizations followed for a median 3 months (range 1-24) after discharge for readmission. The two most common HiPDI included follow-up phone calls (n = 14, 70%) or home visits (n = 11, 55%); eighty-five percent (n = 17) of studies had multiple HiPDI. In meta-analysis, exposure to HiPDI was associated with a lower likelihood of readmission (odds ratio [OR], 0.8 [95% CI, 0.7-0.9]). Patients receiving ≥2 postdischarge home visits or ≥2 follow-up phone calls had the lowest likelihood of readmission (OR, 0.5 [95% CI, 0.4-0.8]). Hospital-initiated postdischarge interventions seem to have an effect on reducing hospital readmissions. Together, multiple home visits and follow-up phone calls may be the most effective HiPDI to reduce hospital readmission.
Asunto(s)
Ensayos Clínicos como Asunto/estadística & datos numéricos , Continuidad de la Atención al Paciente/organización & administración , Intervención Médica Temprana/métodos , Hospitalización/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Telemedicina/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Visita Domiciliaria , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Caregiver burden associated with caring for women with ovarian cancer has received limited focus. However, these patients often have complex needs, requiring a high level of care at home and imposing substantial burdens on caregivers. OBJECTIVES: This pilot study assessed the level of caregiver burden experienced by the primary caregivers of patients with end-stage ovarian cancer and identified variables associated with caregiver burden. METHODS: Caregiver burden was assessed using the Caregiver Reaction Assessment. Fifty caregivers completed an anonymous and voluntary survey. Pearson correlations and independent samples t tests were used to analyze data. FINDINGS: Most participants were Caucasian, married or living with a partner, and college graduates, with an annual household income of less than $90,000. Caregiver ages ranged from 29-81 years. Participants agreed most with the self-esteem scale, indicating they had pride in caring for their loved ones. Disrupted schedules and financial problems were the most burdensome factors in providing care. Because financial issues affected caregiver burden, nurses should facilitate interdisciplinary support. Future research is needed to determine the impact of nurse-led interventions to reduce caregiver burden.
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Cuidadores/psicología , Neoplasias Glandulares y Epiteliales/enfermería , Neoplasias Glandulares y Epiteliales/patología , Neoplasias Ováricas/enfermería , Neoplasias Ováricas/patología , Calidad de Vida , Adaptación Psicológica , Adulto , Anciano , Carcinoma Epitelial de Ovario , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Proyectos Piloto , Estrés Psicológico , Cuidado Terminal/métodosRESUMEN
As surgical patients pass through the perianesthesia continuum, the nurses they encounter rarely have time to develop a nurse-patient relationship, or identify patient needs and concerns and pass this information along to other providers. In the preprocedural period of the care continuum, however, patients and their families often express information that is important to the patient and should be included in the patient's perioperative plan of care. Three questions were developed and added to the existing preoperative nursing assessment to ascertain the needs and concerns of patients and their families in the presurgical setting. Responses were communicated to the postanesthesia care unit nurse. Through implementation of this simple process, patient needs were better recognized and communicated during recovery from anesthesia. Results suggest that this primary care nursing model, adapted for a perioperative setting, has been overwhelmingly successful in communicating and responding to patients' needs during their surgical experience.
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Modelos de Enfermería , Enfermería Perioperatoria/organización & administración , Atención Primaria de Salud/organización & administración , Continuidad de la Atención al Paciente , HumanosRESUMEN
BACKGROUND: Little is known about the hand hygiene practices of surgical patients. Most of the research has been directed at the health care worker, and this may discount the role that hand hygiene of the surgical patient might play in surgical site infections. METHODS: A quasiexperimental, pretest/post-test study was conducted in which patients (n = 72) and nurses (n = 42) were interviewed to examine perceptions and knowledge about patient hand hygiene. Concurrently, observations were conducted to determine whether surgical patients were offered assistance by the nursing staff. Following an initial observation period, nursing staff received an educational session regarding general hand hygiene information and observation results. One month after the education session, patient/nurse dyads were observed for an additional 6 weeks to determine the impact of the educational intervention. RESULTS: Eighty observations, 72 patient interviews, and 42 nurse interviews were completed preintervention, and 83 observations were completed postintervention. In response to the survey, more than half of patients (n = 41, 55%) reported that they were not offered the opportunity to clean their hands, but a majority of the nursing staff reported (n = 25, 60%) that they offered patients the opportunity to clean their hands. Prior to the educational intervention, nursing staff assisted patients in 14 of 81 hand hygiene opportunities. Following the intervention, nursing staff assisted patients 37 out of 83 opportunities (17.3% vs 44.6%, respectively, [χ(2)1 = 13.008, P = .0003]). CONCLUSION: This study suggests that efforts to increase hand hygiene should be directed toward patients as well as health care workers.
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Adhesión a Directriz/estadística & datos numéricos , Higiene de las Manos/métodos , Conocimientos, Actitudes y Práctica en Salud , Rol de la Enfermera , Pacientes , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Higiene de las Manos/organización & administración , Higiene de las Manos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Patient falls are a common cause of morbidity and are the leading cause of injury deaths in adults age 65 years and older. Injuries sustained as result of falls in a cancer hospital are often severe, regardless of patient age, due to the nature of the underlying cancer. Falls are a nursing-sensitive indicator and nurses are in a unique position to assess, design, implement, and evaluate programs for fall risk reduction. We analyzed our nursing processes related to falls and fall prevention in conjunction with an evidence-based review, a research study to improve our fall risk-assessment process, and development of a comprehensive fall-reduction program. This article outlines how our institution developed a fall risk assessment for the oncology patient population, and utilized this assessment in a comprehensive nursing approach to fall prevention in both inpatient and outpatient settings.
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Prevención de Accidentes/métodos , Accidentes por Caídas/prevención & control , Evaluación Geriátrica/métodos , Enfermería Oncológica/métodos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Pacientes Internos , Masculino , New York , Pacientes Ambulatorios , Proyectos Piloto , Guías de Práctica Clínica como Asunto , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Medición de Riesgo , Factores de RiesgoRESUMEN
INTRODUCTION: The purpose of this study was to describe the cost burden of congenital heart disease (CHD) and the associated social impact as experienced by families. METHOD: Qualitative methods were used to collect and interpret data. Semi-structured interviews were conducted with parents of children with various degrees of CHD complexity and socioeconomic status currently admitted for congenital heart surgery at a large tertiary care regional center. RESULTS: The meaning of cost burden as defined by participants resulted in the emergence of two major categories, lifestyle change and uncertainty. Cost was described beyond monetary terms and as a result, data in each category were further clustered into three underlying subcategories labeled financial, emotional, and family burden. The child's disease complexity and parent's socioeconomic status seem to be linked to higher levels of stress experienced in terms of finances, emotional drain, and family member burden. Prenatal diagnosis was noted to trigger early discussion of financial uncertainty, often resulting in altered personal spending prior to birth. DISCUSSION: The cost experienced by parents of children with complex CHD was described as both life-changing and uncertain. Informing families of these types of additional stressors may allow issues of finances to be considered early in the overall preparation of caring for a child with complex CHD.
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Costos y Análisis de Costo , Cardiopatías Congénitas/economía , Niño , HumanosRESUMEN
PURPOSE/OBJECTIVES: To explore oncology nurses' attitudes about and knowledge of sexual health. Sexual health is an integral component of quality of life, which is an Oncology Nursing Society research priority. DESIGN: A descriptive, cross-sectional design. SETTING: A National Cancer Institute-designated comprehensive cancer center in the northeastern United States. SAMPLE: A convenience sample of 576 RNs working in acute care, ambulatory, and perioperative services were approached during an annual mandatory training day. METHODS: Attitudes and beliefs about patients' sexual health assessment in nursing practice were evaluated with the Sexual Attitudes and Beliefs Survey and 10 demographic questions. MAIN RESEARCH VARIABLES: Oncology nurses' attitudes and beliefs regarding sexual health assessment of patients. FINDINGS: A statistically significant difference was found in scores based on age and nursing experience, whereby younger and less experienced nurses had higher scores, indicating greater discomfort in discussing sexual health with patients. Statistical significance also was found in scores based on oncology certification and practice setting, whereby oncology certified nurses and outpatient nurses identified fewer attitudinal barriers than noncertified nurses and nurses working in the inpatient setting. CONCLUSIONS: The results suggest that this patient population may not be receiving a complete sexual health assessment. IMPLICATIONS FOR NURSING: Nurses in the sample believed that sexuality was not too private an issue to discuss with their patients and claimed to understand how disease and treatment may affect patients' sexuality. Nurses also believed that their patients should not expect nurses to ask about their sexual concerns and often defer to the physician for any sexually related questions.
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Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Evaluación en Enfermería/métodos , Personal de Enfermería en Hospital , Enfermería Oncológica , Sexualidad , Adulto , Factores de Edad , Análisis de Varianza , Instituciones Oncológicas , Certificación , Competencia Clínica , Estudios Transversales , Miedo , Femenino , Humanos , Masculino , Anamnesis , Persona de Mediana Edad , New England , Rol de la Enfermera/psicología , Investigación Metodológica en Enfermería , Personal de Enfermería en Hospital/educación , Personal de Enfermería en Hospital/psicología , Enfermería Oncológica/educación , Enfermería Oncológica/métodos , Privacidad , Vergüenza , Encuestas y CuestionariosRESUMEN
The pre-conference workshop at the 32nd Annual Conference of the Association of Pediatric Hematology/Oncology Nursing, held in September 2008, focused on issues faced by pediatric oncology nurses in the ambulatory setting. The workshop was developed after several years of intense discussions at several forums. Therefore the need for an extended discussion period with ambulatory pediatric oncology nurses across the country to address these concerns was evident. There has been a major shift over the past ten years from inpatient to outpatient treatment in oncology (Chabot & Fox, 2005). This shift has resulted in numerous unique challenges for the pediatric oncology nurse. Challenges include lack of staffing resources for fluctuating patient volume and acuity, telephone triage volume and management, home care patient issues, scheduling systems, patient flow and wait time, and multi-institutional communication. This article reports the results of the APHON workshop which utilized the evidence from adult ambulatory oncology literature and standards and the recommendations of the expert pediatric oncology nurse participants to develop global statements about pediatric oncology ambulatory practice standards. The energy and productivity of the group was evidence of a common theme and demand for attention to the ambulatory nursing staff and practice. The ability to identify common threads and reach consensus with powerful statements of practice supports the continued use of such forums to move practice forward.
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Atención Ambulatoria/métodos , Enfermería Oncológica/métodos , Enfermería Pediátrica/métodos , Humanos , Modelos de EnfermeríaRESUMEN
Depression is a common response among cancer patients to their diagnosis and treatment; however, it goes undetected by healthcare providers in about 50% of cases. Communication skills training has been suggested as means to help nurses detect and respond to patient depression. We developed and pilot tested a communication skills training workshop based around 6 strategies. The training program consisted of 2 half-day experiential workshops that included didactic teaching, exemplary video, and role play. The aim of the study was to evaluate the effectiveness of the communication skills training. Fifteen nurses were recruited from the ambulatory nursing service at (redacted). Standardized patient assessments were used to measure strategy uptake. The presence of each strategy was rated on a 4-point scale from "not attempted" to "successfully attempted." Nurses also completed evaluations of the training program. The nurses attempted 3 of 6 strategies more commonly after training, and a trend to significance was observed in a fourth strategy. The nurses reported more confidence to deal with patient depression and had greater self-efficacy. This short training program demonstrated success in improving nurse communication skills and confidence in dealing with patient depression. A larger trial of the training is planned.
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Competencia Clínica , Comunicación , Depresión/prevención & control , Educación Continua en Enfermería/organización & administración , Neoplasias/psicología , Enfermería Oncológica/educación , Adulto , Actitud del Personal de Salud , Distribución de Chi-Cuadrado , Competencia Clínica/normas , Depresión/diagnóstico , Depresión/etiología , Depresión/psicología , Femenino , Humanos , Masculino , Modelos Educacionales , Modelos de Enfermería , Neoplasias/complicaciones , Ciudad de Nueva York , Relaciones Enfermero-Paciente , Evaluación en Enfermería , Investigación en Educación de Enfermería , Personal de Enfermería en Hospital/educación , Personal de Enfermería en Hospital/psicología , Enfermería Oncológica/métodos , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , AutoeficaciaRESUMEN
PURPOSE/OBJECTIVES: To assess how nurses employed in a comprehensive cancer center feel about death and caring for dying patients and examine any relationships between their attitudes and demographic factors. DESIGN: Descriptive quantitative. SETTING: A 432-bed comprehensive cancer center in New York, NY. SAMPLE: A convenience sample of 355 inpatient and outpatient oncology nurses. METHODS: Voluntary and anonymous completion of the Frommelt Attitude Toward Care of the Dying (FATCOD), the Death Attitude Profile-Revised (DAP-R), and a demographic questionnaire. MAIN RESEARCH VARIABLES: Years of total nursing experience, years employed at the cancer center, previous experience with caring for dying patients, age, gender, and attitudes toward death and caring for dying patients. FINDINGS: Statistically significant relationships were noted among age, nursing experience, previous experience with caring for terminally ill patients, and scores on the FATCOD and DAP-R. Nursing experience and age were the variables most likely to predict nurses' attitudes toward death and caring for dying patients. CONCLUSIONS: RNs with more work experience tended to have more positive attitudes toward death and caring for dying patients. IMPLICATIONS FOR NURSING: Based on the data collected in the study, less experienced oncology nurses will most likely benefit from increased education, training, and exposure to providing and coping effectively with end-of-life care.
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Actitud Frente a la Muerte , Instituciones Oncológicas , Relaciones Enfermero-Paciente , Enfermeras y Enfermeros/psicología , Enfermería Oncológica , Cuidado Terminal/psicología , Adulto , Factores de Edad , Curriculum , Educación en Enfermería , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos de Enfermería , Cuidados Paliativos/psicología , Encuestas y Cuestionarios , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: We evaluated the prevalence and predictive value for human immunodeficiency virus (HIV) disease progression of oral manifestations in Romanian children. METHODS: A nonrandom sample of 238 HIV-infected children was followed prospectively between 1998 and 2001 at the Romanian-American Children's Center in Constanta, Romania. Study subjects underwent comprehensive annual oral examinations. Oral manifestations of interest, demographic data and other selected medical information were recorded at baseline and at each subsequent visit. Descriptive statistics and survival analysis methods were used in the study. A level of statistical significance of alpha = 0.05 was used. RESULTS: The study subjects' mean age was 9.9 +/- 1.2 (SD) years. The most common oral lesions were gingivitis (49%), parotid enlargement (13%) and oral candidiasis (11%). Oral candidiasis was associated with progression to acquired immunodeficiency syndrome or death (whichever occurred first) (log rank P = 0.03) and with death (log rank P < 0.001). Oral hairy leukoplakia also was associated with progression to death (log rank P = 0.001). The risk of dying was 3.43 (95% confidence interval, 1.86-6.34; P < 0.001) for children who had oral candidiasis at baseline and 4.62 (95% confidence interval, 1.67-12.77; P = 0.003) for those who had oral hairy leukoplakia. CONCLUSIONS: Oral manifestations occur commonly among HIV-infected Romanian children. Oral candidiasis and oral hairy leukoplakia were positive predictors of HIV disease progression.