Jeanne Quint Benoliel

A randomized clinical trial of home nursing care for lung cancer patients

A randomized clinical trial was conducted to assess the effects of home nursing care for patients with progressive lung cancer. One hundred sixty‐six patients were assigned to either an oncology home care group (OHC) that received care from oncology home care nurses, a standard home care group (SHC) that received care from regular home care nurses, or an office care group (OC) that received whatever care they needed except for home care. Patients were entered into the study 2 months after diagnosis and followed for 6 months. Patients were interviewed at 6‐week intervals across five occasions. At the end of the study, there were no differences in pain, mood disturbance, and concerns among the three groups. There were significant differences in symptom distress, enforced social dependency, and health perceptions. The two home nursing care groups had less distress and greater independence 6 weeks longer than the office care group. In addition, the two home nursing care groups steadily reported worse health perceptions over time. Thus, it was remarkable that the office care group, which indicated more symptom distress and social dependency with time, also indicated perceptions of improved health with time. These results suggest that home nursing care assists patients with forestalling distress from symptoms and maintaining their independence longer in comparison to no home nursing care. Home care may also include assisting patients in acknowledging the reality of their situation.

Grounded Theory and Nursing Knowledge

Grounded theory (GT) is a research approach with origins in the interpretive tradition of symbolic interactionism. Its influence on knowledge generation in nursing began in the 1960s and expanded over the next two decades. By the 1980s, published GT research by nurses had increased greatly in scope and direction. The focus of these studies included adaptations to illness, infertility, nurse adaptations and interventions, and status passages of vulnerable persons and groups. Within the nursing culture, use of GT has been influenced by variations in meanings ascribed to GT, changes in interpretive research practices, and environmental circumstances affecting nurse investigators. The identified theories point to the salient influences of social structure and environment on human health and well-being.

The effects of home nursing care for patients during terminal illness on the bereaved's psychological distress

BACKGROUND Although some studies have examined the effects of terminal illness care models such as hospice care on survivor outcomes, no studies could be found that examined whether nursing care affected such outcomes. OBJECTIVE To determine whether specialized oncology home care services provided to terminally ill patients with lung cancer positively influenced bereavement psychological distress among survivors, compared with other models of care. METHODS A secondary analysis was performed to test the effects of home nursing care for terminally ill patients on spousal psychological distress during bereavement. Forty-six patient-spousal dyads were randomly assigned to either an oncology home care group (OHC), a standard home care group, or an office care control group. Patient-spousal dyads were entered into the study 2 months after the patients diagnosis of lung cancer and received follow-up until the patient died. Bereaved spouses continued to receive follow-up for 25 months after the patients death. RESULTS Psychological distress was significantly lower initially among spouses of patients that received the OHC intervention compared with the other two groups. Significant mean group differences were found on the subscales of depression and paranoid ideation; marginal group differences were found on the subscales of hostility and psychoticism. There were no significant differences among the groups at 25 months. CONCLUSIONS These results suggest that the bereaveds psychological distress can be positively influenced depending on how their loved one is cared for during the terminal phase of illness.

Predicting breast self-examination using the theory of reasoned action.

The personal and normative influences on breast self-examination (BSE) behavior in older women were examined using the Theory of Reasoned Action. The sample consists of 93 volunteers ranging in age from 52 to 90 years. A structured questionnaire was used for data collection. Direct and indirect measures of attitude and social norm were used to predict intention to perform BSE and BSE frequency. Contrary to the model assumptions, indirect measures accounted for more variance in both intention and behavior, and explained actual behavior better than intention to perform. Both the indirect and direct measures of attitude and social norm explained a significant amount of the variance in intention and BSE frequency. There were significant differences on all the model components (direct and indirect measures of attitude, social norm, and intention) between frequent and infrequent BSE performance groups. Discriminant analysis using the indirect measures of attitude and social norm correctly classified 76% of the women into frequent and infrequent performance groups.

Domains of concern of intimate partners of sudden cardiac arrest survivors after ICD implantation.

Purpose:There is limited research that describes the experiences of intimate partners of sudden cardiac arrest (SCA) survivors. The purposes of this article are to (1) describe the domains of concern of intimate partners of SCA survivors during the first year after internal cardioverter defibrillator (ICD) implantation and (2) outline strategies used by partners of SCA survivors in dealing with the concerns and demands of recovery in the first year after ICD implantation. Methods:This is a secondary analysis of interview data collected for the primary study “Family Experiences Following Sudden Cardiac Arrest.” A grounded theory method was used to identify experiences of SCA survivors and their family members from hospitalization through the first year after ICD implantation. Data were collected from the SCA survivor and one intimate partner at 5 times: hospital discharge, and at 1, 3, 6, and 12 months postdischarge. Results:Eight Domains of Concern were identified for intimate partners following SCA and ICD implantation during the first year. These included (1) Care of the survivor, (2) My (partner) self-care, (3) Relationship, (4) ICD, (5) Money, (6) Uncertain future, (7) Health care providers, and (8) Family. Five categories of strategies to deal with the Domains of Concerns were identified (1) Care of the survivor, (2) My (partner) self-care, (3) Relationship, (4) Uncertain future, and (5) Controlling the environment. Implications:Nursing intervention programs should include the intimate partner of SCA survivors and contain education and support in the following areas: (1) information on the function of the ICD, (2) normal progression of physical and emotional recovery experiences, (3) safety and maintenance of the ICD, (4) activities of daily living after an ICD, (5) strategies to assist with the survivors care, and (6) strategies to assist with partner self care.

Loss and adaptation: Circumstances, contingencies, and consequences

Abstract Knowledge about the meaning of loss to human beings comes from both the sciences and the humanities. Information from both sources is used to examine the complex nature of human adaptations to loss and change. Four themes are considered: loss as normative to human experience; the multivariate nature of human adaptations to major losses; the lived experience of loss; and loss as initiator of creative personal expression.

Nursing Research on Death, Dying, and Terminal Illness: Development, Present State, and Prospects

Presented in this review is an historical overview on the development of death research in general followed by an analysis of nursing research in death, dying, and terminal illness. Of necessity, some death-related areas of interest to nurses were not included. Among these topics are suicide and abortion, each of which deserves consideration in its own right. Owing to difficulties in accessibility, only occasionally is research included that was conducted outside the North American continent. The bibliographic material on which this review is based was collected with the assistance of Training Grant 1 D23 NU00210–01 from the Division of Nursing, Health Resources Administration, Department of Health and Human Services. Considerable help in locating and sorting materials was provided by Linda K. Birenbaum, Fotini L. Georgiadou, Barbara B. Germino, and Christina M. Mumma. Appreciation is due to Lesley F. Degner, Helen P. Glass, Christina M. Gow, Sherry Johnson-Soderberg, Sylvia Drake Paige, Geraldine V. Padilla, Catherine M. Saunders, and Mary L. S. Vachon for providing copies of published and unpublished materials for use in this review. The organization of the report was suggested to me by a review written by Gunther Luschen in the Annual Review of Sociology (Vol. 6), 1980.

Nurses' views of the coping of patients

The findings of a study that explored the beliefs, assumptions and ideas nurses have about the coping of patients are presented. Interactive interviews with 26 nurses were used to elicit explanations of the meaning of coping and stories from their practice that illustrated coping. Analysis of the interview transcripts revealed three themes in the form of idioms or particular and different ways of talking about coping. Each idiom represented a different perspective or view of coping. The first idiom represented a view of coping as a rational, cognitive problem-solving response to illness. The nurses attributed, and thus valued, this view to science. In the second idiom the nurses spoke of coping as permeated with values that contrasted with the prior view of coping as a rational process. In the final idiom the nurses spoke of coping as courage--they told stories of patients who had faced existential situations with strength and will. The focus of this idiom was on issues of spirituality, struggle, personal meaning and acceptance. After each idiom is delineated and illustrated by data, the discussion is concentrated on the orientational and ontological metaphors that underlie them. Interpretation of the origin and construction of these different ways of talking about coping, and their underlying metaphorical meanings, is made in the context of cultural and subcultural influences.

The theory of reasoned action in prediction of breast self‐examination: A comparison of two studies

The purpose of this article is to report the application of the theory of reasoned action (TRA) to predict breast self-examination (BSE) intention and frequency in two studies with middle-aged and older women. The sample in Study 1 consisted of 93 volunteers from church groups; the second sample consisted of 175 randomly selected subscribers to a large health maintenance organization. Questionnaires to measure attitudinal and subjective normative influences relevant to BSE were developed using guidelines specified by Ajzen and Fishbein (1980). The attitudinal components predicted BSE intention in both studies and BSE frequency in Study 1. In contrast, the subjective norm contributed significantly only to the prediction of frequency in Study 1. Findings demonstrate varying degrees of success for the TRA in predicting BSE intention and behavior. Explanations for the inconsistency in the predictive ability of the TRA can be related to differences between the two studies regarding sample and design characteristics.

Expanding knowledge about women through grounded theory : introduction to the collection.

Grounded theory was developed in the 1960s to counter the all-powerful reductionist knowledge produced through quantitative positivist science. It was created by men whose epistemological assumptions derived from sociological theory with emphasis on symbolic interactionism. In addition the practice of grounded theory as an approach to inquiry has been influenced by expanding ideas about the nature of naturalistic inquiry and the assumptions underlying different approaches to understanding human behavior in social context. However these new ideas do not detract from the power of grounded theory as inquiry. Rather they offer avenues for broadening understanding of how human beings make sense of their worlds and choose to behave in response to particular life circumstances. In the January-February 2001 edition of The Journal of the International Council on Womens Health Issues a variety of grounded theory studies are presented. It is noted that the contributors are adding more to the growing body of knowledge about womens health and women as caregivers.