Huda Huijer Abu-Saad

Fatigue in patients with breast cancer receiving adjuvant chemotherapy: A review of the literature

The aim of this literature review was to evaluate the prevalence and course of fatigue in patients with breast cancer undergoing adjuvant chemotherapy and to examine factors relating to fatigue. Fatigue is one of the most common side effects of chemotherapy. High and fluctuating prevalence rates of fatigue have been found not only during but also after adjuvant chemotherapy. The intensity of fatigue seems to be stable throughout the treatment cycles, despite the common perception that more chemotherapy treatments lead to greater fatigue. The first two days after a chemotherapy treatment seem to be the worst period. The influence of factors such as pain, impaired quality of sleep, and depression are be highly consistent across several studies, although it is often not clear whether it is the symptoms that cause the fatigue or vice versa. The outcomes of the studies indicate that several symptoms are interrelated in a network of symptoms. Factors such as changes in weight, menopausal symptoms, coping, social support, and biochemical changes have been mentioned in the literature as potentially contributing to fatigue. Results have been conflicting and need further study.

Children's pain at home following (adeno)tonsillectomy

The aim of this study was to evaluate the prevalence and severity of childrens pain at home following (adeno)tonsillectomies. The subjects were parents of 161 children (86 boys, 75 girls) undergoing myringotomies, adenoidectomies and (adeno)tonsillectomies. The mean age of the children was 5.5 years (SD = 2.4; range 1–14). Parents were asked to assess the childs average pain on the day of operation and 7 days after the operation, using a 100 mm Visual Analogue Scale (VAS). Parents from (adeno)tonsillectomy patients were also interviewed by phone on day 7.

The Amsterdam Pain Management Index compared to eight frequently used outcome measures to evaluate the adequacy of pain treatment in cancer patients with chronic pain.

&NA; There is no ‘gold standard’ to assess the adequacy of pain treatment in cancer patients. The purpose of the study is to explore the Amsterdam Pain Management Index, a newly designed measure to evaluate the adequacy of cancer pain treatment, and to compare it with eight frequently used outcome measures. The Amsterdam Pain Management Index compares patients’ Present Pain Intensity, Average Pain Intensity, and Worst Pain Intensity with a composite score of analgesics used, while correcting for what a patient considers as a tolerable level of pain. The eight frequently used outcome measure consisted of three Pain Intensity Markers, the Pain Relief Scale, the Patient Satisfaction Scale, and three Pain Management Indexes. In a randomized controlled trial, 313 cancer patients with a pain duration of at least 1 month were included and followed‐up three times until 2 months postdischarge at home. The experimental group received a Pain Education Program, consisting of tailored pain information and instruction. Results showed that, except for the three Pain Management Indexes, the agreement between the measures was very low to moderate. The test of known‐groups comparisons and equivalence between groups indicated that the Amsterdam Pain Management Index showed promising results. The Pain Intensity Markers and the Pain Relief Scale were limited in discriminating between groups, while the Patient Satisfaction Scale showed no differences between patient groups. Although it was possible for the Pain Management Indexes to distinguish between patient groups, the differences were not in the expected direction. The ability of the outcome measures to detect changes over time was clearly demonstrated by all outcome measures. Effects of the intervention were only found for the Amsterdam Pain Management Index and patients’ Substantial Worst Pain score. Although support was provided for the use of the Amsterdam Pain Management Index, more research is warranted.

Prevalence and characteristics of headache in Dutch schoolchildren.

The aim of this study was to determine whether there has been an increase in headache prevalence in Dutch children and to compare headache characteristics of children with low, medium and high headache severity.

The effects of job characteristics and individual characteristics on job satisfaction and burnout in community nursing.

The aim of this article is to describe job satisfaction and burnout among two categories of community-based nurses (N = 402) in the Netherlands taking account of job and individual characteristics. Results show that these nurses are moderately satisfied with their jobs and the effects of burnout are average. Further, community nurses are less satisfied and have experienced burnout to a greater extent than community nurse auxiliaries. Both job characteristics and individual characteristics are related to job satisfaction and burnout. However, job satisfaction is affected to a greater extent by job characteristics whereas burnout is more often a result of individual characteristics. As research in this area is scarce and home care is changing radically, these results may be valuable in coping with change without losing sight of nursings professional values.

On the development of a multidimensional Dutch pain assessment tool for children

&NA; The Abu‐Saad Pediatric Pain Assessment Tool consists of 30 word descriptors in the sensory, affective and evaluative domains as well as a 10 cm scale that measures present and worst pain experienced by the child. In the first phase of the study an inventory was carried out of pain word descriptors used by hospitalized Dutch children. In the second phase, these word descriptors were given an intensity value on the 10 cm scale by 355 children. Alpha reliability coefficient of 0.83 supported instrument homogeneity. Factor analysis (N = 355) was used to investigate construct validity. A 3‐factor solution was carried out to evaluate the validity of the 3 dimensions of pain. Factor I consisted of items in the affective and evaluative domains and factors II and III items from the sensory domain. Ultimately a 2‐factor solution provided the most intelligible conceptual pattern with the least loss of information. Conceptual composition and discussion of these factors are discussed and elaborated.

Recurrent Headache, Coping, and Quality of Life in Children: A Review

Objectives.–To clarify the concepts of coping with pain and quality of life (QoL) and to present a literature review of the strategies that children with recurrent headaches use to cope with their pain, the impact of recurrent headaches on childrens QoL, and the influence of personal and situational variables on headache, coping, and QoL in children.

Determinants of pain assessment by nurses

In this replication study pain assessment and patient perception by nurses was studied in relation to patient characteristics and nurse characteristics. Nurses were randomly assigned to one of 24 descriptions of a hypothetical patient of constant age and unspecified sex. The 24 descriptions varied by duration of pain, presence of a physical pathology, diagnosis category, and depression symptoms. Results showed that third- and fourth-year student nurses of a hospital based program, and registered nurses attributed more pain when test results of physical pathology were positive. Third- and fourth-year student nurses also attributed more pain to depressive patients. No differences were found with respect to pain duration and diagnostic category. Nursing experience seems also to be important in pain assessment. First-year student nurses attributed less pain to the hypothetical patient than third- and fourth-year student nurses and registered nurses. In addition they perceived the patient as more positive when physical pathology was present or when no symptoms of depression were present.

Patient autonomy during rehabilitation: the experiences of stroke patients in nursing homes.

This article describes the results of a grounded theory study among stroke patients (N=17, aged 50-85) in rehabilitation wards in nursing homes. Patient autonomy (dimensions: self-determination, independence and self-care) increases during rehabilitation due to patient factors (conditions and strategies of patient) and environmental factors (nursing home and strategies of health professionals and family). During rehabilitation patients are in a state of transition regarding autonomy: patients need support to enhance autonomy, gradually regain autonomy, and thereby need less support. Although facilitating environmental factors were discovered, patients also experienced constraining factors regarding patient autonomy. Health professionals should give more attention to self-determination and independence; the nursing home should offer stroke patients more opportunities to do familiar activities autonomously.

Facilitating and Constraining Factors on Autonomy: The Views of Stroke Patients on Admission Into Nursing Homes

This article describes a model “changing autonomy” which was developed in a grounded theory study among stroke patients on admission into nursing homes for rehabilitation. Three dimensions of autonomy were identified: self-determination, independence, and self-care. On admission, patients’ conditions (disabilities, multimorbidity, emotional state, and feeling like a layperson) and patients’ strategies (waiting and seeing, and acting as a subordinate) constrain autonomy. Several environmental factors facilitate patient autonomy. The nursing home sustains patient autonomy by providing a hopeful atmosphere and room for autonomy. The health professionals facilitate autonomy by giving therapy, support and information, attentiveness and respect, paternalism and teamwork. Facilitating strategies of the family encompass emotional and instrumental support. Care routines, lack of privacy, an unfamiliar environment, waiting periods, boredom, and lack of information were identified as constraining environmental factors. Developing guidelines and multidisciplinary courses regarding the approach to patient autonomy on admission is recommended.