Dorothy Brockopp

Twenty-five years later—what do we know about religion/spirituality and psychological well-being among breast cancer survivors? A systematic review

IntroductionA diagnosis of cancer is a life-changing event for most people. The trauma and uncertainties of a breast cancer diagnosis can affect survivors’ psychological well-being. Religion and/or spirituality can provide a means of support for many women as they live with the realities of a diagnosis of cancer. The purpose of this focused review is to critically analyze and synthesize relationships among psychological well-being, religion, and spirituality among women with breast cancer.MethodsMEDLINE, CINAHL, Web of Science, Cambridge Scientific Abstracts, Cochrane CENTRAL, and PsycINFO databases were searched: January 1985–March 2010. The search terms religi*(religious/religion), spiritu*(spiritual/spirituality), breast cancer, psychological adjustment, psychological outcomes, psychological distress, psychological well-being, and outcomes were searched for separately and in combination.ResultsEighteen quantitative studies were analyzed in order to examine associations among religion, spirituality, and psychological well-being for women diagnosed with breast cancer. These three variables were operationally defined as follows: (a) religious practice, religious coping, and perception of God; (b) spiritual distress, spiritual reframing, spiritual well-being, and spiritual integration; and (c) combined measure of both the religion and spirituality constructs.Discussion/conclusionsResults of this review suggest that within this population, limited relationships exist among religion, spirituality, and psychological well-being. Given the various definitions used for the three variables, the strength and clarity of relationships are not clear. In addition, the time of assessment along the course of the disease varies greatly and in some instances is not reported. Diagnosis and/or prognosis, factors that could influence psychological well-being, are frequently not factored into results. There does, however, appear to be sufficient evidence to include a brief, clinically focused assessment of women diagnosed with breast cancer regarding the importance of a given belief system as they face the diagnosis and treatment of their disease.Implications for cancer survivorsThe implications for cancer survivors are as follows: (a) Psychological well-being of women diagnosed with breast cancer may depend to some extent on their belief system. (b) Coping through “turning to God” for women without a significant prior relationship with God, or minimal spiritual behaviors, may experience diminished well-being. (c) Longitudinal studies suggest that struggling with, or questioning, one’s belief system in early survivorship may also be associated with lower levels of well-being. This diminished well-being often resolves over time.

Hope among patients with cancer hospitalized for bone marrow transplantation: a phenomenologic study.

&NA; This article describes a phenomenologic study designed to further an understanding concerning the concept of hope in a purposive sample of nine patients with cancer hospitalized for bone marrow transplantation. The strategies these patients use to sustain and foster hope are examined. Data collection consisted of a one‐time semistructured interview using open‐ended questions. A phenomenologic‐hermeneutic approach to data analysis was used to identify major themes. The findings showed that participants used six strategies to foster their hope during preparation for BMT: feeling connected with God, affirming relationships, staying positive, anticipating survival, living in the present, and fostering ongoing accomplishment. Religious practices and family members were the most frequently identified sources of hope. The findings of this study provide a base for the improvement of nursing practice.

Personal control and the needs for hope and information among adults diagnosed with cancer.

Cancer patients inevitably experience situations in which their sense of personal control is diminished. Identifying the strategies used by these individuals to maintain or regain control can be an important component in the planning of care. This study examined the relationship between levels of perceived personal control and the needs for hope and information among 56 adult cancer patients. Subjects responded to the Needs Assessment Inventory and the Spheres of Control Scales. Data were analyzed using responses from the total group (n = 56), male subjects (n = 23), and female subjects (n =33). Significant correlations were found between perceived level of control and eight issues related to hope and information-seeking.

The dying patient: a comparative study of nurse caregiver characteristics.

The nurses interaction with the dying patient is thought to be influenced by death anxiety, attitudes toward death, and perceptions of control. Differences relative to these three variables between nurses who work on a continuous basis with the dying and those who rarely encounter a dying patient were examined. Using 3 paper and pencil questionnaires, data were collected from 105 nurses (32 palliative care nurses, 44 psychiatric nurses, 29 orthopedic nurses). Significant differences were found between the palliative care nurses and nonpalliative care nurses on attitudes toward death and on 3 of the 4 subscales that assessed death anxiety. Suggestions for future research include a systematic examination of the relationship of attitudes and feelings about death to patient care.

The role of prior pain experience and expectations on postoperative pain

The present study was designed to examine previous pain experiences as they relate to expectations of postoperative pain. In the study, 101 patients aged 55-87 (47 men, 54 women) participated in a structured interview that examined 13 factors thought to be associated with presurgical expectations of postsurgical pain. These factors relating to prior pain experience were identified from the literature as well as the experience of clinicians in the areas of anesthesiology, nursing and psychology. The two variables that correlated significantly (multiple r = 0.51) with pain expected postoperatively were: a single item from the general attitude questionnaire about pain (pain is to be expected after surgery even with medicine) and the total of the global ratings of past pain experience. A follow-up study will examine these variables in relation to actual pain experience.

Practice patterns when treating patients with low back pain: a survey of physical therapists.

Abstract Low back pain (LBP), is a common musculoskeletal problem, affecting 75–85% of adults in their lifetime. Direct costs of LBP in the USA were estimated over 85 billion dollars in 2005 resulting in a significant economic burden for the healthcare system. LBP classification systems and outcome measures are available to guide physical therapy assessments and intervention. However, little is known about which, if any, physical therapists use in clinical practice. The purpose of this study was to identify the use of and barriers to LBP classification systems and outcome measures among physical therapists in one state. A mixed methods study using a cross-sectional cohort design with descriptive qualitative methods was performed. A survey collected both quantitative and qualitative data relevant to classification systems and outcome measures used by physical therapists working with patients with LBP. Physical therapists responded using classification systems designed to direct treatment predominantly. The McKenzie method was the most frequent approach to classify LBP. Barriers to use of classification systems and outcome measures were lack of knowledge, too limiting and time. Classification systems are being used for decision-making in physical therapy practice for patients with LBP. Lack of knowledge and training seems to be the main barrier to the use of classification systems in practice. The Oswestry Disability Index and Numerical Pain Scale were the most commonly used outcome measures. The main barrier to their use was lack of time. Continuing education and reading the literature were identified as important tools to teach evidence-based practice to physical therapists in practice.

Major Predictors of Inpatient Falls: A Multisite Study.

Objective: The purpose of this secondary data analysis was to identify key factors predictive of falls in hospitals. Background: Patient falls remain a major concern for hospitals. Falls can increase patient morbidity/mortality and increase legal risk/cost for institutions. While a number of high-risk falls assessments are available, key predictors of falls have not been identified. Methods: A secondary data analysis was performed on 281,865 high-risk falls assessments collected in a multisite study. Results: For the total sample, logistic regression analyses demonstrated that 3 factors, falls within the past 6 months (OR=2.98), confusion (odds ratio, 2.05), taking a laxative (odds ratio, 1.54), are strong predictors of falling. Similar results were found for individual hospitals, different units within hospitals, and urban versus rural hospital locations. Conclusion: Findings suggest that assessments of fall risk should heavily weigh the 3 predictors identified in this study. Another approach would be to intervene based on these predictors.

A Successful Evidence-Based Practice Model in an Acute Care Setting

hospital (redesignated in 2010), 34 projects are ongoing, 9 articles have been published in peer-reviewed jour-nals, numerous presentations of data have occurred, and 9 studies have been funded. In addition to funded studies, presentations, and publications, changes in practice as a result of nurse-initiated projects occur on a regular basis. The success of this EBP plan can be attributed to the presence of the following five components: (a) a clear philosophical direction for nursing in the institution, (b) supportive administrative goals and actions, (c) resources dedicated to the goal of EBP, (d) communication strate-gies designed to facilitate EBP, and (e) clear definitions of the three evaluation processes used in acute care institutions: research, EBP projects, and quality assur -ance (entitled performance improvement in the authors’ institution).

Transforming Practice Through Publication: A Community Hospital Approach to the Creation of a Research-Intensive Environment.

Publication of 28 data-based articles in peer-reviewed journals over a 4-year period is the result of a commitment to conducting and publishing research at a 383-bed Magnet®-redesignated community hospital. The research-intensive environment in nursing at this institution supports publication as the desired outcome of all projects. The provision of appropriate resources, the development of 2 models to guide the conduct of research and nursing leadership that encourages and supports research activities enables nurses to submit manuscripts describing their work. Steps taken to support the publication of findings can be adapted for other practice settings.

Suspected deep tissue injury profile: a pilot study.

PURPOSE: To enhance the learner’s competence with knowledge of the results of research examining suspected deep tissue injury profiles. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: Identify assessment tools and literature reviews of precipitating and contributing factors for suspected deep tissue injury (SDTI). Analyze data findings of precipitating and contributing factors for prediction for SDTI development based on this study’s data. ABSTRACT OBJECTIVE: The purpose of this study was to examine (1) the incidence of potential precipitating events of suspected deep tissue injuries (SDTIs) identified over a 7-day period prior to cutaneous manifestation, (2) physiological variables related to the formation of SDTIs, and (3) the time since precipitating events and the occurrence of the SDTI. DESIGN: A descriptive exploratory study. A retrospective chart review was conducted. SETTING: A 348-bed community Magnet-redesignated hospital, Baptist Health Lexington Kentucky PARTICPANTS: Eighty-five participants with SDTIs identified between January 2008 and March 2010. MAIN OUTCOME MEASURES: Precipitating events evaluated were tissue perfusion, surgery, transfers, mobility, and falls. Physiological variables included anticoagulation, albumin/prealbumin, hemoglobin, partial thromboplastin time, and hemoglobin A1c. Timeline differences between precipitating events and SDTI were measured. MAIN RESULTS: Precipitating events identified from most to least frequent were transfers = 67 (78.8%), tissue perfusion = 36 (42.5%), surgery = 33 (40.2%), mobility = 26 (30.9%), and falls = 14 (16.9%). Of the 85 charts reviewed, 69 of the charts met the criteria for timeline difference between precipitating event and SDTI manifestation. The range of days for precipitating events prior to SDTI manifestation was 1 to 5 days, an average of 2.41 (SD, 1.04) years. Meaningful physiological variables noted were anticoagulation 52 (61.2%), anemia (hemoglobin 6–9 g/dL) 53 (67.1%), and hemoglobin A1c less than 7.5 mmol/L 29 (74.4%). CONCLUSIONS: This exploratory pilot study evaluating patients with SDTI revealed the most common precipitating event was transfers. In addition, the physiological variables that appeared to contribute to the development of SDTIs were anticoagulation and anemia. The range of days for precipitating events prior to SDTI manifestation was 1 to 5 days, an average of 2.41 (SD, 1.04) days.