Andreas Charalambous

Exploring the other side of cancer care: The informal caregiver

OBJECTIVES To identify the caregiver outcomes among relatives caring for patients with cancer and to examine the patient and family caregiver variables that predicted for caregiver burden and depression. METHODS One hundred and thirty caregivers completed the Greek versions of the Burden Interview (BI), the Center of Epidemiology--Depression Scale (CES-D) and the Ways of Coping Questionnaire. Principal component analysis was performed to examine the underlying dimensions of caregiver outcome measures. One-way ANOVA and independent sample t-tests were used to test for differences in burden and depression in relation to demographic variables of interest. One-way ANOVA was used for examining differences in coping strategies. FINDINGS One-way ANOVA showed that there are significant differences among the various educational levels (p<0.001) and the income (p<0.005) of the caregiver in terms of overall burden. 66.4% of caregivers had a depression above the usual cutoff point for depression. An independent samples t-test for possible gender differences, showed that there is a significant difference between males and females (p=0.29). In regression analysis it was found that only caregivers income and patients age are statistically significant in predicting burden and depression. When considering high-burdened caregivers results showed that there are significant differences in the use of coping strategies (p<0.001). CONCLUSIONS Caregivers reported high levels of burden and depression. These outcomes of caregiving are related to several variables, but the caregivers income and patients age are predictive. Intervention strategies are needed to the vulnerable caregivers to help reduce burden and depression associated with caregiving.

The burdensome and depressive experience of caring: what cancer, schizophrenia, and Alzheimer's disease caregivers have in common.

Background: Family members of patients with chronic illnesses experience distress as a result of caregiving roles, which can be manifested as burden and depression, but cross-disease studies on how caring is experienced are limited. Objective: The present study was designed to examine the burden and psychiatric morbidity in the form of depression experienced by Cypriot families caring for a relative with one of the following: cancer, Alzheimer’s disease, or schizophrenia. Methods: This study was cross-sectional, descriptive, and correlational. A total of 410 caregivers were recruited from the community. The research instruments included the Greek version of the Burden Interview and the Center of Epidemiological Studies–Depression Scale. Descriptive statistics, 1-way analysis of variance, and post hoc Tukey pairwise comparisons were used to examine significant differences between the 3 groups. Results: The results indicate a high level of burden and depression among all caregivers. Significant differences (P < .001, F = 26.11) between the 3 caregiving groups were detected in terms of burden, with the highest reported for Alzheimer’s disease caregivers. One-way analysis of variance showed significant differences (P = .008, F = 4.85) between the 3 caregiving groups in terms of depression, with the highest depression levels being for cancer caregivers. Conclusions: The findings increase our understanding about burden and emotional well-being in family caring for relatives with cancer and other chronic illnesses. Implications for Practice: The findings may be useful for health professionals to plan intervention strategies focusing on each domain of burden. The lessons learned from the caregiving role of family caregivers of patients with Alzheimer’s disease or schizophrenia can be used to improve the caregiving process of patients with cancer.

The factors associated with the burnout syndrome and fatigue in Cypriot nurses: a census report

BackgroundFatigue and burnout are two concepts often linked in the literature. However, regardless of their commonalities they should be approached as distinct concepts. The current and ever-growing reforms regarding the delivery of nursing care in Cyprus, stress for the development of ways to prevent burnout and effectively manage fatigue that can result from working in stressful clinical environments.MethodsTo explore the factors associated with the burnout syndrome in Cypriot nurses working in various clinical departments. A random sampling method taking into account geographical location, specialty and type of employment has been used.ResultsA total of 1,482 nurses (80.4% were females) working both in the private and public sectors completed and returned an anonymous questionnaire that included several aspects related to burnout; the MBI scale, questions related to occupational stress, and questions pertaining to self reported fatigue. Two-thirds (65.1%) of the nurses believed that their job is stressful with the majority reporting their job as stressful being female nurses (67.7%). Twelve point eight percent of the nurses met Maslach’s criteria for burnout. The prevalence of fatigue in nurses was found 91.9%. The prevalence of fatigue was higher in females (93%) than in males (87.5%) (p = 0.003). As opposed to the burnout prevalence, fatigue prevalence did not differ among the nursing departments (p = 0.166) and among nurses with a different marital status (p = 0.553). Burnout can be associated adequately knowing if nurses find their job stressful, their age, the level of emotional exhaustion and depersonalization. It has been shown that the fatigue may be thought of as a predictor of burnout, but its influence is already accounted by emotional exhaustion and depersonalization.ConclusionThe clinical settings in Cyprus appear as stress generating environment for nurses. Nurses working both in the private and public sector appear to experience low to severe burnout. Self-reported fatigue interferes to the onset of emotional exhaustion and depersonalization.

The associations among the ethical climate, the professional practice environment and individualized care in care settings for older people.

AIM To investigate the associations among the ethical climate, professional practice environment and individualized nursing care in care settings for older people. BACKGROUND The quality of care provision is affected by organizational environments, such as ethical climate and professional practice environment. Although, the association between professional practice environment and individualized nursing care has been pointed out, we know that little is known about how ethical climate is associated with the level of individualized nursing care delivery. DESIGN A cross-sectional explorative and correlational survey design. METHODS The study was conducted in 62 units in the vicinity of a Finnish city using a sample of nurses (N = 874, response rate 58%) who worked clinically with older people in different care settings in 2012. Survey data were collected using the Hospital Ethical Climate Survey, Revised Professional Practice Environment scale and Individualised Care Scale-B. Data were analysed statistically using descriptive statistics, correlation coefficients (Pearson) and multiple stepwise regression analyses. RESULTS Statistically significant correlations were found among the variables, ethical climate and individualized care and between individualized care and all professional practice environment sub-scales. Multiple stepwise regression showed associations among individualized care, ethical climate and internal work motivation, control over practice and leadership and autonomy. CONCLUSIONS The study provided better understanding of the complex concept of individualized care by taking into consideration the ethical climate and the practice environment and their associations. To increase individualization in care provision, efforts need to be directed towards organizational aspects requiring the support of nursing leaders.

The cost of caring: the relative with schizophrenia

BACKGROUND The aim of this study was to examine the burden and emotional well-being experienced by Cypriot families caring for a member suffering from schizophrenia. Psychiatric reforms and the shifting of care from the formal sector to the informal care provided in the community resulted in additional responsibilities and tasks undertaken by the families. There is a substantial body of literature on the profound impacts of caring on family caregivers of individuals suffering from schizophrenia, but little is known about the level of burden and how it correlates with other characteristics. METHODS This is a cross-sectional descriptive study. A total of 113 caregivers were recruited from three regional psychiatric outpatient clinics in Cyprus. They were asked to complete a set of well-validated instruments measuring family burden and a socio-demographic data sheet. Analyses include descriptive statistics and logistic regression analyses to identify the predictors of family burden. RESULTS The findings support high level of burden among family caregivers. Forty-three percentage of the participants scored above 24/42 in the Family burden scale. Logistic regression identified three independent variables to predict the presence of subjective caregiver burden: Patients mental condition in the previous 3 months (p = 0.011), patients gender (p = 0.028) and caregivers educational level (p = 0.036). CONCLUSIONS The findings increase our understanding about the variables influencing burden and emotional well-being in schizophrenia caring. They have great clinical importance in health care because they help health professionals to plan intervention strategies focusing on each domain of burden.

Guided Imagery And Progressive Muscle Relaxation as a Cluster of Symptoms Management Intervention in Patients Receiving Chemotherapy: A Randomized Control Trial

Objective Patients receiving chemotherapy often experience many different symptoms that can be difficult to alleviate and ultimately negatively influence their quality of life. Such symptoms include pain, fatigue, nausea, vomiting and retching, anxiety and depression. There is a gap in the relevant literature on the effectiveness of cognitive-behavioural and relaxation techniques in symptom clusters. The study reflects this gap in the literature and aimed to test the effectiveness of Guided Imagery (GI) and Progressive Muscle Relaxation (PMR) on a cluster of symptoms experienced by patients undergoing chemotherapy. Methods This was a randomized control trial with 208 patients equally assigned either in the intervention or the control group. Measurements in both groups were collected at baseline and at completion of intervention (4 weeks). Patients were assessed for pain, fatigue, nausea, vomiting and retching, anxiety and depression. The overall management of the cluster was also assessed based on the patients’ self-reported health related quality of life-HRQoL. Chi-square tests (X2), independent T-tests and Linear Mixed Models were calculated. Results Patients in the intervention group experienced lower levels of Fatigue (p<0.0.0225), and Pain (p = 0.0003) compared to those in the control group and experienced better HRQoL (p<0.0001) [PRE-POST: Intervention: Pain 4.2(2.5) - 2.5(1.6), Fatigue 27.6(4.1) - 19.3(4.1), HRQoL 54.9(22.7) - 64.5(23), Control: Pain 3.5(1.7) - 4.8(1.5), Fatigue 28.7(4.1) - 32.5(3.8), HRQoL 51.9(22.3)– 41.2(24.1)]. Nausea, vomiting and retching occurred significantly less often in the intervention group [pre-post: 25.4(5.9)– 20.6(5.6) compared to the control group (17.8(6.5)– 22.7(5.3) (F = 58.50 p<0.0001). More patients in the control group (pre:n = 33-post:n = 47) were found to be moderately depressed compared to those in the intervention group (pre:n = 35-post:n = 15) (X2 = 5.93; p = 0.02). Conclusion This study provided evidence that the combination of GI and PMR can be effective in the management of a cluster of symptoms in cancer patients receiving chemotherapy. These techniques can complement existing management measures to achieve a comprehensive management of this symptom cluster and increase patients HRQoL. Trial Registration ClinicalTrials.gov NCT01275872

Undergraduate nursing students caring for cancer patients: hermeneutic phenomenological insights of their experiences

BackgroundThe care of patients suffering from cancer and especially those facing the death trajectory appears to be complex and demanding not only for student nurses but for professional nurses as well. The educational models often used in nursing require students to face challenging care scenarios, sometimes with minimal or no supervision and guidance. These “worst case scenarios” can be traumatic experiences that can leave the student hopeless and disappointed of themselves and in many cases can “scar” their subsequent professional career. The literature demonstrates that this can be the result of the students’ ill-preparation to care for cancer patients and deal with death and dying. The purpose of this study was to interpret the students’ experiences of coming face-to-face with cancer care during their clinical placements.MethodsThis is a hermeneutic phenomenological study influenced by the ideas of the French Philosopher Paul Ricoeur. Based on this philosophical enquiry the interpretation process included three stages: 1) naïve reading, 2) structural analysis and 3) comprehensive understanding. Data were collected through reflective/narrative diaries from the 4th grade undergraduate (pre-registration) nursing students practicing at oncology, hematology, pediatric oncology departments and hospices. Diaries of twelve students met the inclusion criteria and were included in the interpretation process. The study took place during January and May 2011.ResultsThe interpretation yielded the following themes: a) Being part of the center’s life, b) Being sympathetic, c) Being confronted by others, d) Being self-reflective, e) Being trapped in the system, f) Being caring towards the family and g) Being better in clinical practice.ConclusionsThe students emphasized the need for appropriate preparation both at a theoretical and at a clinical level, as to better confront situations involving death and dying as well as learning techniques for crisis management. The students perceived the importance of adopting a policy that is both patient and family-centered in order to provide better care.

A Randomized Controlled Trial for the Effectiveness of Progressive Muscle Relaxation and Guided Imagery as Anxiety Reducing Interventions in Breast and Prostate Cancer Patients Undergoing Chemotherapy.

Objective. To test the effectiveness of guided imagery (GI) and progressive muscle relaxation (PMR) as stress reducing interventions in patients with prostate and breast cancer who undergo chemotherapy. Methods. Patients were randomly assigned to either the control group or the intervention group (PMR and GI). Patients were observed for a total duration of 3 weeks and assessed with the SAS and BECK-II questionnaires for anxiety and depression, respectively, in addiotion to two biological markers (saliva cortisol and saliva amylase) (trial registration number: NCT01275872). Results. 256 patients were registered and 236 were randomly assigned. In total 104 were randomised to the control group and 104 to the intervention group. Interventions mean anxiety score and depression score changes were significantly different compared to the controls (b = −29.4, p < 0.001; b = −29.4, p < 0.001, resp.). Intervention groups cortisol levels before the intervention (0.30 ± 0.25) gradually decreased up to week 3 (0.16 ± 0.18), whilst the control groups cortisol levels before the intervention (0.21 ± 0.22) gradually increased up to week 3 (0.44 ± 0.35). The same interaction appears for the Amylase levels (p < 0.001). Conclusions. The findings showed that patients with prostate and breast cancer undergoing chemotherapy treatment can benefit from PMR and GI sessions to reduce their anxiety and depression.

The ethical dimension of nursing care rationing A thematic synthesis of qualitative studies

Background: In the face of scarcity, nurses may inevitably delay or omit some nursing interventions and give priority to others. This increases the risk of adverse patient outcomes and threatens safety, quality, and dignity in care. However, it is not clear if there is an ethical element in nursing care rationing and how nurses experience the phenomenon in its ethical perspective. Objectives: The purpose was to synthesize studies that relate care rationing with the ethical perspectives of nursing, and find the deeper, moral meaning of this phenomenon. Research design: A systematic review and thematic synthesis of qualitative studies was used. Searching was based on guidelines suggested by Joana Brigs Institute, while the synthesis has drawn from the methodology described. Primary studies were sought from nine electronic databases and manual searches. The explicitness of reporting was assed using consolidated criteria for reporting qualitative research. Nine studies involving 167 nurse participants were included. Synthesis resulted in 35 preliminary themes, 14 descriptive themes, and four analytical themes (professional challenges and moral dilemmas, dominating considerations, perception of a moral role, and experiences of the ethical effects of rationing). Discussion of relationships between themes revealed a new thematic framework. Ethical consideration: Every effort has been taken, for the thoroughness in searching and retrieving the primary studies of this synthesis, and in order for them to be treated accurately, fairly and honestly and without intentional misinterpretations of their findings. Discussion: Within limitations of scarcity, nurses face moral challenges and their decisions may jeopardize professional values, leading to role conflict, feelings of guilt, distress and difficulty in fulfilling a morally acceptable role. However, more research is needed to support certain relationships. Conclusions: Related literature is limited. The few studies found highlighted the essence of justice, equality in care and in values when prioritizing care—with little support to the ethical effects of rationing on nurses. Further research on ethical dimension of care rationing may illuminate other important aspects of this phenomenon.

Validation and test–retest reliability of the Risser patient satisfaction scale in Cyprus

AIM To describe the translation, adaptation and validation of the Risser Patient Satisfaction Scale (RPSS) questionnaire into Greek language and discuss possibilities of its use in cancer care settings. BACKGROUND The translation and cultural adaptation of a widely accepted, psychometrically tested tool is regarded as an essential component of effective human resource management or quality monitoring and improvement in the healthcare arena. METHODS The original version of the English self-administered questionnaire consisting of 25 items was translated and validated using the internationally accepted and recommended methodology. The validation process included: assessment of the item internal consistency, using the alpha coefficient of Cronbach. Reproducibility (test-retest reliability) was tested by the Kappa correlation coefficient. RESULTS The psychometric properties of the Greek version of the PSS were good. The internal consistency of the instrument was very good, Cronbachs alpha was found to be 0.89 (P < 0.001) and Kappa coefficient for reproducibility was found to be 0.84 (95% CI: 0.83-0.85, P < 0.0001). CONCLUSIONS The translated and adapted Greek version is comparable with the original instrument in terms of validity and reliability. IMPLICATIONS FOR NURSING MANAGEMENT Managers should use validated patient satisfaction scales such as the RPSS in order to evaluate the quality of care in cancer care departments. The findings should be also compared using a bench mark on national and international levels.