Jane Flanagan

I Feel Like I Am 100 Years Old! Managing Arthralgias From Aromatase Inhibitors

Aromatase inhibitors (AIs) are recommended for the treatment of estrogen-sensitive breast cancer in postmenopausal women and provide a superior risk reduction compared to five years of tamoxifen alone. Arthralgias, a common side effect of AIs, may adversely affect quality of life, treatment adherence, and persistence. Early discontinuation of AIs may result in an inadequate clinical response. Over-the-counter analgesics, exercise, and drug holidays are common strategies used to manage arthralgias, however few interventions are evidence-based. Patients experiencing arthralgias may experience distress and, therefore would benefit from ongoing nursing support. When caring for patients with arthralgias, nurses should assess for potential modifiable risk factors, recommend lifestyle changes and/or pharmacologic interventions, and offer ongoing education and follow-up.

High‐Frequency Nursing Diagnoses Following Same‐Day Knee Arthroscopy

PURPOSE The purpose of this study was to determine the acceptability and feasibility of two screening tools at 12 and 72 hr postoperatively, and to determine the high-frequency, high-risk nursing diagnoses encountered by patients at 12 and 72 hr postoperatively following a same-day outpatient arthroscopy. METHOD This study utilized a nonexperimental descriptive correlational design with pre- and posttest measures. FINDINGS High-frequency problems were identified on the evening of surgery and at 72 hr postoperatively. CONCLUSIONS Findings suggest that the screening tools were feasible and acceptable ways to determine high-frequency problems in this population. IMPLICATIONS FOR NURSING PRACTICE There is a continued need for nursing contact and support by telephone post same-day surgery to guide individuals through the process of healing.

Randomized clinical trial testing efficacy of a nurse-coached intervention in arthroscopy patients.

Background:Emerging data suggest limited patient preparation for ambulatory surgery, decreased access to healthcare providers postoperatively, increased patient and family anxiety, and increased patient suffering. Thus, there is a need for nursing interventions to improve the postoperative experience for patients and families. Objective:The purpose of this study was to test the hypothesis that ambulatory arthroscopic surgery patients who receive a nurse-coached telephone intervention will have significantly less symptom distress and better functional health status than a comparable group who receive usual practice. Methods:The study sample in this randomized clinical trial with repeated measures was 102 participants (52 in the intervention group and 50 in the usual practice group) drawn from a large academic medical center in the Northeast United States. Symptom distress was measured using the Symptom Distress Scale, and functional health was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey General Health Perceptions and Mental Health subscales. Results:Multivariate analysis of covariance, with three repeated measures of the Symptom Distress Scale (baseline, 72 hours postsurgery, and 1 week postsurgery) and five covariates, was used to test the hypothesis. After removal of the covariate influence, intervention participants had significantly less symptom distress at 72 hours and 1 week postsurgery and significantly better overall physical and mental health at 1 week postsurgery than those who received usual practice. Discussion:The findings suggest that telephone calls from nurses during the immediate postoperative period resulted in improved patient outcomes, namely, less symptom distress and better physical and mental health states. In future research, the study sample should be expanded to older and more diverse patients.

Women's experiences with antiestrogen therapy to treat breast cancer.

PURPOSE/OBJECTIVES To understand the experiences of women undergoing antiestrogen therapy (AET) to treat breast cancer. RESEARCH APPROACH Content analysis of tape-recorded focus group interviews. SETTING Breast oncology center of a large medical center in the northeastern United States. PARTICIPANTS Purposive sample of 21 women undergoing AET to treat breast cancer. METHODOLOGIC APPROACH A nonexperimental qualitative, descriptive design using open-ended interviews and content analysis to isolate themes. MAIN RESEARCH VARIABLES Womens experiences with AET. FINDINGS Five themes were isolated and were focused on the overall experience of having breast cancer: symptoms related to AET, shared decision making, being strong for others, discovering new priorities, and recognizing vulnerability. CONCLUSIONS Oral therapies are an increasingly popular treatment option for various types of cancer, particularly in women with estrogen-sensitive breast cancer. Although this type of treatment has been efficacious in terms of disease-free and overall survival, women undergoing AET face many challenges related to treatment. Healthcare providers need to understand womens perceptions of AET and its effects as a first step in the process of developing interventions to improve care. INTERPRETATION More research is needed to distinguish whether the presence of preexisting chronic illness, differences in type of AET, age, and ethnicity impact the overall experience of women on AET. Individual interviews may be necessary to fully explore the experience. Oncology nurses should implement surveillance care to explore the effects of AET on women with breast cancer.

Family Members’ Perceptions of Most Helpful Interventions During End-of-Life Care

The aim of the study was to explore the following research question: What are the perceived needs of family members/friends while their loved one is receiving end-of-life care while in the hospital setting? This was a qualitative descriptive study using semistructured open-ended interview questions and content analysis. Seven family members or friends participated in this study. Four themes were identified. Results suggest that vigilance in the provision of nursing care for patients at the end of life provides family with a sense of being cared for and eases their feelings of uncertainty and anxiety. Support for family members and validation of difficult decision making is a vital component of communication, which is essential to increase family members’ levels of comfort and trust in the health care team.

Nurse Staffing and Hospital Characteristics Predictive of Time to Diagnostic Evaluation for Patients in the Emergency Department

Introduction: In the 2014 Emergency Department Benchmarking Alliance Summit, for the first time, participants recommended tracking nursing and advanced practice nurse hours. Performance data from the Centers for Medicare and Medicaid Services provides an opportunity to analyze factors associated with delays in emergency care. The purpose of this study was to investigate hospital characteristics associated with time to a diagnostic evaluation in 67 Massachusetts emergency departments from 2013 to 2014. Methods: Covariates significantly correlated with time to diagnostic evaluation, and factors associated with timely care in emergency departments were included in the stepwise linear regression analysis. Differences in nurse staffing and performance measures in trauma and nontrauma emergency departments were examined with analysis of variance and t tests. Results: Two predictors explained 38% of the variance in time a diagnostic evaluation (1): nurse staffing (P < .001) and (2) trauma centers (P < .001). In trauma centers, the time to a diagnostic evaluation significantly increased (P = .042) from 30.2 minutes when a nurse cared for fewer than 11.32 patients in 24 hours to 61.4 minutes when a nurse cared for 14.85 or more patients in 24 hours. Discussion: Efforts to improve patient flow often focus on process interventions such as improved utilization of observation beds or transfers of patients to inpatient units. In this study, time to diagnostic evaluation significantly increased when emergency nurses care for higher numbers of patients. The findings present new evidence identifying the relationship of specific nurse to patient ratios to wait time in emergency departments.

Predictors of excess heart failure readmissions: implications for nursing practice.

In this study of California, Massachusetts, and New York hospitals, 6 factors predicted 27.6% of readmissions for patients with heart failure (HF). We found that higher admissions per bed, teaching hospitals, and poor nurse-patient communication increased HF readmissions. Conversely, the HF readmissions were lower when nurse staffing was greater, more patients reported receiving discharge information, and among hospitals in California. The implications for nursing practice in the delivery of care to patients with HF are discussed.

Psychometric Evaluation of the Functional Health Pattern Assessment Screening Tool (FHPAST)

PURPOSE   To report findings of psychometric testing of the Functional Health Pattern Screening Tool (FHPAST). METHODS   Psychometric evaluation including internal consistency and principal components analysis. FINDINGS   The findings indicate that the FHPAST is a reliable, three-component, 57-item valid instrument. CONCLUSIONS   Psychometric testing supports the use of the FHPAST in research. The instrument captures each of the 11 functional health patterns as described by Gordon (1994) and has been translated into, and is available in, several languages. PRACTICE IMPLICATIONS   Continued testing and refinement is needed across populations to support the findings from this investigation and to evaluate the outcomes of patient-centered interventions over time.

Interpreting laboratory values in the rehabilitation setting.

&NA; Treating patients in rehabilitation settings is becoming increasingly complex for a variety of reasons, such as the presence of several comorbid conditions, increased age, and earlier discharge from acute care facilities. As a result, careful monitoring and assessment by nurses is essential. Laboratory testing can improve the assessment when nurses are able to recognize when and what should be reported and what types of treatments may be needed. Understanding what laboratory findings should be monitored and what added assessment criteria are necessary can be daunting. Therefore, this article reviews critical laboratory and other assessment findings in light of common health problems faced by patients in rehabilitation settings. A case study is used to highlight the importance of laboratory testing.

The Experience of Initiating Oral Adjuvant Treatment for Estrogen Receptor–Positive Breast Cancer

PURPOSE/OBJECTIVES To describe the experience of women with estrogen receptor-positive breast cancer who are initiating oral adjuvant therapy and to determine what they describe as facilitating and/or hindering this experience. 
. RESEARCH APPROACH Qualitative inquiry. 
. SETTING Massachusetts General Hospital Cancer Center in Boston. 
. PARTICIPANTS 14 women aged 48-81 years. 
. METHODOLOGIC APPROACH Qualitative, descriptive study using content analysis.
. FINDINGS Five themes were identified. CONCLUSIONS Each participant who was initiating oral adjuvant treatment described many unmet needs. Women who were caregivers, were older aged, had several chronic illnesses, and were on several medications reported more difficulty transitioning to oral adjuvant therapy. 
. INTERPRETATION This study suggests that nurses need to collaborate with other members of the healthcare team to assess the needs of and provide comprehensive care to women initiating oral adjuvant therapy. This is particularly true for women who are older aged, self-reported caregivers, and on several medications, and who have chronic comorbid conditions.