Ann M. Schreier

Anxiety and quality of life of women who receive radiation or chemotherapy for breast cancer.

PURPOSE/OBJECTIVES To examine quality of life (QOL) and anxiety in a sample of women receiving radiation or chemotherapy for breast cancer. DESIGN Longitudinal, descriptive. SETTING A cancer center in the southeastern United States. SAMPLE 48 women participated; 17 received radiation and 31 received chemotherapy. METHODS The Ferrans and Powers Quality of Life Index (QLI) and Speilbergers State-Trait Anxiety Inventory (STAI) were administered. The QLI was administered at the start of treatment and one year later. The STAI was administered at the start of treatment. The state portion of the STAI also was administered 4 weeks and 12 weeks after the start of treatment. MAIN RESEARCH VARIABLES QOL and anxiety. FINDINGS Total QOL improved significantly over time for the entire sample, as did scores on the health/functioning, psychological/spiritual, and family subscales of the QLI. No significant differences existed for total QOL or any subscales by treatment. Trait anxiety was significantly higher for women receiving chemotherapy, and state anxiety was significantly higher at all three measurement times for the women. State anxiety did not decrease significantly over the course of the treatment for either group. Trait anxiety and state anxiety at the start of treatment were significantly negatively correlated with total QLI score and the psychological/spiritual subscale. State anxiety at the start of treatment also was significantly negatively correlated with total QOL and the health/functioning and psychological/spiritual QLI subscales both at the start of treatment and one year later. CONCLUSIONS QOL improves over time for women who have received radiation or chemotherapy. Women receiving chemotherapy have higher anxiety scores, and higher anxiety at the start of treatment is associated with decreased QOL at the start of treatment and postdiagnosis. IMPLICATIONS FOR NURSING Nursing interventions to reduce anxiety at the start of treatment, especially for chemotherapy recipients, are indicated. Research also should target methods to reduce anxiety at the start of treatment.

THE RACE GAP IN SUPPORT GROUP PARTICIPATION BY BREAST CANCER SURVIVORS Real or Artifact

Addressing methodological weaknesses of previous research, this study assesses whether African American women are, in fact, less likely to participate in breast cancer support groups than are White women. Of the breast cancer survivors, 958 (26% African Americans, 73% Caucasian) completed interviews concerning demographic characteristics, other support networks, effects of illness on home and spiritual life, and support group participation. Contrary to previous research, no race difference was found in support group participation. This research suggests more effort needs to be paid to sampling techniques and other methodological factors to adequately reflect the experiences and needs of breast cancer survivors, specifically African American women.

Nursing Care, Delirium, and Pain Management for the Hospitalized Older Adult

Delirium is a reversible cognitive disorder that has a rapid onset. Delirium risk factors include older age, severity of illness, poorer baseline functional status, comorbid medical conditions, and dementia. There are adverse consequences of delirium, including increased length of stay and increased mortality. Therefore, it is important for nurses to identify clients at risk and prevent and manage delirium in the hospitalized older client. Once high-risk clients are identified, prevention strategies may be used to reduce the incidence. Examples of prevention strategies include providing glasses and working hearing aids and effective pain management. This article discusses various assessment instruments that detect the presence of delirium. With this information, nurses are better equipped to evaluate the best assessment options for their work setting. Early detection is crucial to reduce the adverse consequences of delirium. Once a client is found to be experiencing delirium, a treatment plan can be established using both nonpharmacologic and pharmacologic interventions. In addition, the identification and the correction of etiologies of delirium can shorten the course of delirium.

An integrative curriculum for accelerated nursing education programs.

The number of accelerated baccalaureate and direct-entry masters nursing programs being offered in the United States is increasing. These programs shorten the amount of time to educate entry-level nurses. This article describes one schools curriculum for a direct-entry masters nursing program. A faculty task force developed the curriculum and used the opportunity to change the educational paradigm from traditional pedagogical to a concept student-learning approach. The curriculum design, which integrates nursing content through a conceptual model, and an innovative clinical experience model are described. In addition, the article discusses the successes and challenges of the program encountered during the first 2 years of initiation of the curriculum.

Nursing diagnosis in the chronically ill: methodology for clinical validation.

The identification and validation of nursing diagnoses that describe the phenomena of concern to nursing is a critical task. Methodological issues revolving around the conceptualization of nursing and the research approach have hampered this effort. This study used the human needs framework as a guide for the assessment and formulation of nursing diagnoses. A two-phase study was conducted. In Phase 1 five judges derived 51 nursing diagnoses using data from direct clinical observations of 50 subjects. In Phase 2 data from a second sample of 108 subjects were compared to Phase 1 data via computer analysis. Fifty of the 51 diagnoses were confirmed.

An Evaluation of a Rural Community-Based Breast Education and Navigation Program: Highlights and Lessons Learned

Cancer has become the leading cause of death in North Carolina (NC) (North Carolina DHHS, State Center for Health Statistics 2015) and the eastern region of North Carolina (ENC) has experienced greater cancer mortality than the remainder of the state. The Pitt County Breast Wellness Initiative-Education (PCBWI-E) provides culturally tailored breast cancer education and navigation to screening services for uninsured/underinsured women in Pitt and Edgecombe Counties in ENC. PCBWI-E created a network of 23 lay breast health educators, and has educated 735 women on breast health and breast cancer screening guidelines. Navigation services have been provided to 365 women, of which 299 were given breast health assessments, 193 were recommended for a mammogram, and 138 were screened. We have identified five lessons learned to share in the successful implementation of a community-based breast cancer screening intervention: (1) community partnerships are critical for successful community-based cancer screening interventions; (2) assuring access to free or low-cost screening and appropriate follow-up should precede interventions to promote increased use of breast cancer screening; (3) the reduction of system-based barriers is effective in increasing cancer screening; (4) culturally tailored interventions can overcome barriers to screening for diverse racial/ethnic and socioeconomic groups; and (5) multi-component interventions that include multiple community health strategies are effective in increasing screening.

The Nurses' Physical Activity Study: Caring for You so You can Care for Others

Nurses face multiple stressors on a daily basis and often report the greatest stress of all health care workers (Ilhan, Durukan, Taner, Maral, and Bumin, 2008). The negative impact of stress on patient and nurse health and safety is well established. This stress often stems from working long, unpredictable shifts and having multiple duties, conflicting job demands, and heavy workloads (Lim, Bogossian, and Ahern, 2010; Roberts, Grubb, and Grosch, 2012). The stress associated with the nursing profession can have a negative effect on the physical, mental, and occupational health of nurses. These stressors may increase obesity, fatigue, and back pain; decrease quality of life and satisfaction with life; and lead to burnout and compassion fatigue. Although physical activity has been found to be associated with health benefits among other populations, nurses typically have to overcome stressors that workers from other occupations may not face during a typical day. Because the stressors nurses face on a daily basis often affect their health and the care patients receive (Rogers, Hwang, Scott, Aiken, and Dinges, 2004), it is important for nurses to implement self-care techniques that will help lower their feelings of stress as they increase their time working in the nursing profession. PURPOSE: The purpose of this study was to examine the relationship between physical activity levels and measures of physical, mental, and occupational health among nurses in eastern NC. Physical health was operationally defined as body mass index, aerobic fitness, fatigue, sleep quality, pain interference, and pain intensity. Mental health was operationally defined as stress, satisfaction with life, and quality of life. Occupational health was operationally defined as compassion fatigue and burnout. METHODS: Nurses (n = 62, 94% females) were assessed for physical activity via the Fitbit Flex activity tracker over a 7 day period and the International Physical Activity Questionnaire. Body mass index was measured by dividing weight (kg) by the participants squared height (m). Each of the remaining measures of health were assessed via questionnaires. Pearson correlations were used to determine the relationship between physical activity and each of the measures of physical, mental, and occupational health. Participants were grouped based on their level of activity (i.e., met 2008 Physical Activity Guidelines or not) using the physical activity data recorded by the Fitbit. Pearson correlations were then used to examine the relationship between physical activity and each of the measures of health among each group. RESULTS: BMI was significantly correlated with moderate-to-vigorous physical activity (r = -.28, p [less than] .05), steps (r = -0.29, p [less than] .05), and vigorous intensity physical activity (r = -.32, p [less than] .01). Fatigue was significantly correlated with moderate-to-vigorous physical activity (r = -.27, p [less than] .05). Weak positive relationships were found between aerobic fitness and steps (r = .26, p [less than] .05), aerobic fitness and vigorous intensity physical activity (r = .26, p [less than] .05), and aerobic fitness and moderate-to-vigorous physical activity (r = .27, p [less than] .05). Stress was significantly correlated with steps (r = -.27, p [less than ] .05), moderate intensity physical activity (r = -.25, p [less than] .05), and light intensity physical activity (r = -.40, p [less than] .001). A relationship was also found between mental health (i.e., quality of life and satisfaction with life) and light intensity physical activity (r = .40, p [less than] .001), moderate intensity physical activity (r = .30, p [less than] .05), and steps (r = .29, p [less than] .05). A weak relationship was found between high intensity physical activity and burnout (r = .23, p [less than] .001) and between steps and compassion fatigue (r = -.26, p [less than] .05). No significant relationships were found between physical activity and sleep quality, pain intensity, and pain interference. CONCLUSION: Stress is common among nurses, and it can have a negative impact on various aspects of a nurses physical, mental, and occupational health as well as the quality of care patients receive (Rogers et al., 2004). For this reason, it is imperative that healthcare organizations find solutions to help lower the risk of stress and improve measures of health in this population. The results of this study suggest several health benefits associated with physical activity among nurses in Greenville, North Carolina. A physical activity intervention among nurses may be needed to fully see the effects of physical activity on physical, mental, and occupational health, and ultimately patient health and safety.

Effects of Tactile Desensitization on Postoperative Pain After Amputation Surgery

Purpose: Pain in the acute setting after amputation is complex with multiple types of pain experienced, including somatic and neuropathic. No studies have measured multiple pain control modalities while using self‐management techniques for acute amputation pain. Desensitization could provide a means of pain control for somatic and neuropathic pain. The purpose of this study was to test the efficacious use and effects of tactile desensitization in managing acute postoperative pain after lower limb amputation. Design: This was a pre‐experimental repeated measure study. Methods: Pain description, intensity, anxiety, depression, and medication usage were measured during repeated time periods. Pain intensity was measured before and after each intervention along with efficacy. Findings: Of the times the intervention was self‐administered (n = 50) there was a statistically significant reduction in the pain level (P < .001) with large effect sizes for all paired comparisons. Participants found the intervention efficacious and feasible to use. Conclusions: The findings support a reduction in pain intensity scores using pain medication coupled with tactile desensitization.