Cheryl Riley-Doucet

Factors that affect functional status in patients with cancer-related pain

Abstract Cancer‐related pain in outpatient adult populations remains high and has a direct effect on functional status. Factors that affect functional status have been explored separately, but the inter‐relatedness of those factors has not been examined. Using a cross‐sectional design, the purpose of this study was to examine the relationships between pain level, beliefs about pain, symptom distress, perceived control over pain, and functional status in 304 ambulatory cancer patients who experienced cancer‐related pain within the past 2 weeks. Participants completed standardized questionnaires during regularly scheduled clinic visits. Patient’s pain level was positively related to increased distress and decreased perceived control over pain and functional status. Structural equation modeling indicated that symptom distress mediated the relation between pain level and functional status. Perceived control over pain had a direct effect on symptom distress and mediated the effect of beliefs about pain and pain level on symptom distress. Patients’ perceived control over pain may be an important component in pain management. The direct and mediating effects of perceived control and symptom distress suggest areas of further research. Interventions to increase knowledge and decrease barriers to pain control have the potential for increasing perceived control over pain.

Beliefs about the controllability of pain: congruence between older adults with cancer and their family caregivers.

Family dyadic beliefs about pain controllability were examined to determine what influence they had on patient symptom distress and subjective caregiver burden. The Calgary Family Assessment and Intervention Models and Illness Beliefs Model guided this investigation. Self-report questionnaires were administered to a sample of 81 family dyads that consisted of ambulatory cancer care older adult outpatients and their family caregivers. Inferential statistics indicated that family dyads were congruent in their beliefs about pain controllability. Descriptive statistics showed that family dyads with beliefs that the pain was controllable had less symptom distress and caregiver burden than dyads with beliefs that pain was not controllable. Results suggest that family dyadic beliefs that cancer-related pain is controllable have a positive influence on family pain control outcomes. Findings also support the need for nurses to include family members when developing pain management interventions for older adults.

Assistive Technology for Promoting Physical and Mental Exercise to Delay Progression of Cognitive Degeneration in Patients with Dementia

Alzheimers disease is one of the top ten leading causes of death in the United States. A recent study by The Johns Hopkins University estimated that by 2050, one in 85 people worldwide will be living with Alzheimers disease. According to the study, if intervention could delay the progression of the disease by a modest one year, there would be about 3.7 million fewer patients with the disease who require high level of care such as a nursing home in 2050. Research suggests that the combination of physical and mental exercise reduces the progression of cognitive degeneration. The paper focuses on creating an assistive technology system to promote both physical exercise and cognitive stimulation for patients suffering from Alzheimers disease and other dementias. The system incorporates a portable mini stationary bike and an interactive visual multiple choice question game. Physical exercise is provided by the bike while cognitive stimulation is provided by the game that targets areas such as memory, judgment, problem solving, recollection, and matching, to impede dementia. Research has shown that certain multi-sensory stimulants such as fiber optic lights and selective colors can be used to relax and control agitation of patients with dementia. By incorporating these stimulants into the design, we have created a safe and fun way for patients with dementia to complete physical and mental exercise.

A self-directed learning tool for nurses who precept student nurses.

The Preceptor Orientation Self-Learning Education (POSE) module was developed as a teaching/learning tool for preparing nurses in their role as preceptors to senior nursing students in the clinical practice area. Findings from this pilot study suggest that the POSE module offered nurse preceptors an effective and convenient teaching/learning option in preparing them for their roles as clinical preceptors to student nurses. Results of this study can be used to enhance nursing education on preceptor preparation.

Using multisensory technology to create a therapeutic environment for people with dementia in an adult day center: a pilot study.

This quantitative pilot study examined the feasibility of using a multisensory environment (MSE) as a nonpharmacological intervention for people with behavioral and psychological symptoms of dementia (BPSD) within an adult day care center. Outcome measures were participant agitation, participant reaction to MSE, and caregiver satisfaction with MSE as a management strategy for older adults with BPSD. A within-subjects, repeated measures research design was used to obtain results from a total of 8 older adults with BPSD and 4 formal caregivers. Results indicated that the majority of participants enjoyed the MSE and improvements in some BPSD were observed after using the MSE. Reports from formal caregivers indicated that they believed the MSE was a useful nonpharmacological therapy for reducing anxiety and agitation among the day care participants who exhibited BPSD. Caregivers also suggested that this intervention should be incorporated into the design of the building and that a dedicated staff be assigned to facilitate the intervention for older adults each day.

Comparative Analysis of Two Musical Genres Within a Multisensory Environmental Intervention

Purpose: The purpose of this study was to determine if there were any differences in the behavioral responses of persons with dementia while listening to nonreligious and religious music within a multisensory environment. Research Design: A within-subjects, repeated measures design was used. Method: Participants were exposed to both musical genres during multiple sessions over a 4-week period. Neuropsychiatric symptoms were recorded before and after the musical intervention. Behavioral responses to the music were recorded while listening to themusic. Findings: No significant difference was found between the numbers of neuropsychiatric behaviors observed before and after the participants listened to the nonreligious and religious music. A significant difference was found between the musical interventions as a whole and the number of agitated behaviors before and after intervention. No significant difference was found in the observed behavioral responses with the nonreligious and religious music. Conclusions: Music can be a useful intervention to reduce neuropsychiatric symptoms in persons with dementia.

Self-Care Activities Captured Through Discussion Among Community-Dwelling Older Adults

Four separate focus group sessions were conducted in the Detroit metropolitan area to invite vital elders to speak freely about their health, health problems, health practices, and how they maintain their bio-psycho-social and spiritual well-being. Twenty-eight participants were interviewed. The majority were African American, female, widowed, Protestant, and had achieved a high school or greater educational level. Field notes and taped interviews were transcribed for data analysis. Together, two raters completed data reduction and coding for theme identification and categorization. A holistic nursing model was used to guide the content analysis. Five themes were revealed that described the context of well-being for community-dwelling elders: faith ways, positive energy, support systems, wellness activities, and affirmative self-appraisal. Well-being depended on an awareness of how lifestyle impacted the physical, psychological, social, and spiritual health of each individual. This study lends credence to interventions aimed at promoting holistic health care for community-dwelling elders.

Health Professions Students’ Lifelong Learning Orientation: Associations with Information Skills and Self Efficacy

Objective – This study aimed to investigate the relationships among health professions students’ lifelong learning orientation, self-assessed information skills, and information self-efficacy. Methods – This was a descriptive study with a cross-sectional research design. Participants included 850 nursing students and 325 medical students. A total of 419 students responded to a survey questionnaire that was comprised of 3 parts: demographic information, the Jefferson Scale of Lifelong Learning (JeffSLL-HPS), and an information self-efficacy scale. Results – Findings of the study show a significant correlation between students’ lifelong learning orientation and information self-efficacy. Average JeffSLL-HPS total scores for undergraduate nursing students (M = 41.84) were significantly lower than the scores for graduate nursing students (M = 46.20). Average information self-efficacy total scores were significantly lower for undergraduate nursing students (M = 63.34) than the scores for graduate nursing students (M = 65.97). There were no significant differences among cohorts of medical students for JeffSLL-HPS total scores. However, for information self-efficacy, first year medical students (M = 55.62) and second year medical students (M = 58.00) had significantly lower scores than third/fourth year students (M = 64.42). Conclusion – Findings from the study suggest implications for librarians seeking ways to advance the value and utility of information literacy instruction in educational curricula. As such instruction has the potential to lead to high levels of information self-efficacy associated with lifelong learning; various strategies could be developed and incorporated into the instruction to cultivate students’ information self-efficacy.

Applying Integrative Learning Strategies and Complexity Theory to Design Simulations for Care of Complex Patients.

Nurse educators use a variety of clinical simulation strategies to promote cognitive, psychomotor, and affective learning. Statistically significant increases in self-confidence levels were found among senior-level nursing students in the assessment and management of medical and psychiatric symptoms after participating in strategically designed, complex, student-led clinical simulations. Having students role play simulation scenarios that are developed from real-life clinical experiences is a cost-effective interactive strategy that enhances their communication and technical skills.

The Prevalence of Uncontrolled Pain in Long-Term Care: A Pilot Study Examining Outcomes of Pain Management Processes

Pain in long-term care (LTC) is common among older residents despite the vast options available for optimal pain management. Inadequate pain management affects individual health care outcomes. Researcher evidence has shown that nurse practitioners (NPs) improve the quality of care in LTC but are challenged by multiple barriers that inhibit optimal pain control. The purpose of the current pilot study was to explore both the pain management processes used by nurses in LTC and the documented patient outcomes that come from these processes. In addition, factors were identified that may impact the NP role in providing adequate pain control in LTC. This descriptive study used a retrospective, case-controlled research design that incorporated reviewing 55 LTC resident medical records. Results show how the process of pain management in LTC can be improved by expanding the professional role of the NP.