Arlene D. Houldin

Concept analysis of good death in terminally ill patients.

The purpose of this concept analysis of good death was to examine the attributes of a good death and explore the changes of the concept over time and its impact on terminally ill patients. The method used for this analysis was the Rodgers’ evolutionary method. A literature search was completed using Medline Ovid and Journal Storage (JSTOR).The findings describe the evolution of the good death concept over time from the prehistoric era followed by premodern, modern, and postmodern times. In addition, information is presented about surrogate terms, attributes, antecedents, and consequences associated with good death followed by analysis and discussion of the findings. General attributes of a good death include pain and symptom management, awareness of death, patient’s dignity, family presence, family support, and communication among patient, family, and health care providers.

A clinical teaching project: Examination of a clinical teaching model

This project, started in 1985 by Dr Infante, is based on theory of the use of the clinical laboratory in nursing education. It fully recognizes the complementary roles of nursing education and nursing service by having practitioners participate as preceptors, role models, and mentors. Six clinical agencies participated in this innovative clinical teaching project with the goal of improving the effectiveness and efficiency of nursing education and nursing practice. It is hypothesized that the synchronization of clinical laboratory experiences with instruction in nursing theory and science and a closer collaboration among faculty, students, and nurse practitioners will give students an appropriate balance of academic and clinical practice perspectives and skills to prepare them effectively to meet the complex health care needs of patients. The subjects were 173 undergraduate baccalaureate nursing students enrolled in an upper-division generic program. For the purpose of testing Infantes clinical model, the students were randomly assigned to a control or experimental group for two successive incoming classes of nursing students. Each students academic and clinical progression was monitored. Data were gathered using grade point average, a standardized test for nursing knowledge (Mosby Assesstest; Mosby, St Louis), college laboratory practicum, and simulated testing for clinical application skills.2+ Data were analyzed using independent t tests. The findings indicate that the students in the experimental group, who used the experimental clinical model, achieved higher grade point averages, higher scores on the Mosby Assesstest, and higher college laboratory practicum scores than the students in the control group. The findings support the need for further investigation of innovative clinical teaching models.

The Enhancing Connections Program: a six-state randomized clinical trial of a cancer parenting program.

OBJECTIVE The purpose of this study was to test the efficacy of a cancer parenting program for child rearing mothers with breast cancer, the Enhancing Connections Program. Primary goals were to decrease maternal depressed mood and anxiety, improve parenting quality, parenting skills and confidence, and enhance the childs behavioral-emotional adjustment to maternal breast cancer. METHOD A total of 176 mothers diagnosed within 6 months with Stage 0 to Stage III breast cancer and their 8- to 12-year-old child were recruited from medical providers in 6 states: Washington, California, Pennsylvania, Minnesota, Arizona, and Indiana. After consenting and obtaining baseline measures, study participants were randomized into experimental or control groups. Experimental mothers received 5, 1-hr educational counseling sessions at 2-week intervals; controls received a booklet and phone call on communicating and supporting their child about the mothers cancer. Outcomes were assessed at 2 and 12 months. RESULTS Compared to controls, at 2 months experimental mothers significantly improved on depressed mood and parenting skills; experimental children improved on behavioral-emotional adjustment: total behavior problems, externalizing problems, and anxiety/depressed mood significantly declined. At 1 year, experimental children remained significantly less depressed than controls on both mother- and child-reported measures. The intervention failed to significantly affect parenting self-efficacy or maternal anxiety. CONCLUSIONS The Enhancing Connections Program benefitted mothers and children in specific areas and warrants refinement and further testing.

Relaxation training and psychoimmunological status of bereaved spouses. A pilot study.

The death of a family member is one of the most stressful and disruptive life events. Although the literature abounds with subjective pieces concerning bereavement, little is known about the complex biological processes that follow in its wake. However, there is a growing body of evidence that psychological distress may compromise immunocompetence and that support strategies may enhance immune function. Our exploratory study examined the influence of relaxation training on the immunological and psychological status (including anxiety and depression) of bereaved spouses. Nine female spouses, all survivors of patients who died from cancer, were recruited from two hospice programs to participate in this relaxation-training program. Standardized psychological instruments and immunological assays were completed at three data-collection points: before the initiation of the relaxation training (approximately 6 weeks after the death of the spouse); at the conclusion of the training; and 4 weeks after the relaxation training. The subjects received a 1-h relaxation-training program weekly for 4 weeks. It included progressive muscle relaxation training and guided imagery supervised by a psychiatric nurse clinical specialist. The results indicated that the relaxation-training program was well-received by the subjects, with promising psychoimmunological trends that merit more rigorous investigation. This exploratory study has demonstrated the feasibility of conducting a relaxation-training intervention for bereaved spouses and has laid the foundation for continuing research to study the physiological and psychological responses of the bereaved.

Physician-Nurse Collaboration in Research in the 21st Century

The complexities of cancer and its treatment, rapid advances in biomedical science and technology, growing concerns about the quality of health care, and intense competition for limited research dollars contribute to the urgent need for interdisciplinary collaboration in cancer research. Collaboration in the design and implementation of significant research initiatives will advance the discovery of knowledge to improve outcomes for patients and care providers, with both medicine and nursing standing to benefit from close collaboration. In this editorial, we explore the concept of interdisciplinary research collaboration specifically between nursing and medicine, and draw on the interdisciplinary research experiences of the authors. Interdisciplinary collaboration is extensively described in the health professional literature and promoted by organizations such as the American Society of Clinical Oncology, the National Academies of Practice, and the W.K. Kellogg Foundation as well as our respective professional organizations. Notably, the American Society of Clinical Oncology’s strategic plan [1] includes within its first goal the objective to promote multidisciplinary cancer prevention, management, and research. Collaboration in clinical research is defined as a complex phenomenon that brings together two or more individuals, often from different professional disciplines, who work to achieve shared aims and objectives [2]. It is well established that interdisciplinary collaboration offers great potential. The sharing of ideas across disciplines enables a comprehensive and intellectually vibrant examination of the research problem at hand [2,3]. Interdisciplinary research is of utmost importance in the current period of rapid scientific and technologic discovery coupled with urgent medical and social problems. In this climate, scientists of diverse backgrounds must be willing to share expertise and resources to expand cross-cutting research capacity to improve patient outcomes [4,5]. Although research collaboration is viewed as important in improving health outcomes, little is written about the process of collaboration, and its benefits [6]. It is recognized that diversity of backgrounds and viewpoints, vigorous debate, and respectful disagreement enriches the process [7] and that commitment to common goals contributes to enduring and effective collaborative research partnerships. Lancaster [8] described the collaborative process as consisting of six Cs: contribution, communication, commitment, consensus, compatibility, and credit. Particular to research collaboration between physicians and nurses, the traditional hierarchical nurse-physician relationship is gradually evolving into a collaborative model [9,10]. Historically, physicians assumed the lead role in many collaborative research initiatives. However, contemporary research collaboration between physicians and nurses is more often nonhierarchical in nature, with the implied assumption that power is based on knowledge and expertise, rather than role or function [6-12]. The synergism that results from a successful collaborative relationship between a physician and nurse yields combined outcomes greater than the sum of individual actions [13,14]. For nurse-physician research collaboration to work well, shared interests and open lines of communication are required. Goals, objectives, roles, processes, and outcomes must be explicitly articulated and agreed on by members of the collaborating team. Details about when and how to collaborate, how to structure interactions, and how to evaluate outcomes must be negotiated. Wellarticulated and deliberate strategies ought to be in place JOURNAL OF CLINICAL ONCOLOGY COMMENTS AND CONTROVERSIES VOLUME 22 NUMBER 5 MARCH 1 2004

Experience of Newly Diagnosed Patients With Sarcoma Receiving Chemotherapy

PURPOSE/OBJECTIVES To examine symptom distress and quality of life (QOL) in newly diagnosed patients with sarcoma receiving chemotherapy. DESIGN Pilot study; descriptive, quantitative. SETTING Urban community cancer center in the northeastern United States. SAMPLE 11 newly diagnosed patients with sarcoma. METHODS Participants completed the Edmonton Symptom Assessment Scale and the Functional Assessment of Cancer Therapy-General at baseline and on days 1, 15, and 21 of their chemotherapy treatment. MAIN RESEARCH VARIABLES Symptom distress and QOL. FINDINGS Fatigue was the most prevalent and pervasive symptom. Anxiety, well-being, lack of appetite, drowsiness, and depression were the most commonly reported symptoms during chemotherapy. QOL was negatively affected. The lowest mean score reported was for functional well-being. Outcome profiles for symptom distress increased over time, whereas QOL profiles decreased over time. Exploratory analyses of age, race, sex, and diagnosis group suggested differences that warrant further study. CONCLUSIONS Overall, increasing symptom distress and reduced QOL over time were reported by patients with sarcoma during chemotherapy. Exploratory analysis by demographic variables and treatment group suggested the need for further research of predictors for symptom distress and QOL. IMPLICATIONS FOR NURSING Clinical and research implications included the need for better understanding about symptom distress and QOL predictors in patients with sarcoma, as well as the evaluation of interventions directed to address this populations specific needs.