Lorna Butler

Conceptualizing Sexual Health in Cancer Care

This qualitative study was designed to describe womens experiences with changes in sexual function related to physical comfort, sexual satisfaction, and fielings of intimacy post-treatment for gynecological cancer. The 17 women who participated in this study described sexuality as a much broader construct. Contrary to existing literature, sexual functioning was found to be one aspect that contributed to the view of the self as a sexual being, but the womens perceptions were not limited to this single dimension. The identification of multidimensional components to be considered in developing a conceptual model to describe sexual health are presented. This study indicates that sexuality should be viewed as a health issue that has an impact on quality of life.

The Relationship Between Meaning of Illness, Social Support, Coping Strategies, and Quality of Life for Lung Cancer Patients and Their Family Members

This article explores the relationship between meaning of illness, perceived social support resources, coping strategies used, and quality of life (QOL) by patients with lung cancer and their family members. The study was cross-sectional using interview data from 85 patients and associated family members. Regression results showed that total QOL in patients with lung cancer is predicted most by meaning of illness, specifically, the illness being perceived as manageable. QOL in family members is predicted most by meaning of illness, specifically, less adverse impact. Interestingly, the overall meaning of illness, coping strategies used, and social support were similar in the 2 groups. The results of the study emphasize the importance of acknowledging the circumstances of peoples lives, both patients surviving lung cancer and their family members, which contribute to QOL.

Facilitating the implementation of empirically valid interventions in psychosocial oncology and supportive care

PurposeOver the past two decades, the fields of psychosocial oncology and supportive care have seen clinically effective tools as underutilized despite proven benefits to cancer patients and their families. The purpose of this paper is to discuss the reasons for the failure of psychosocial and supportive care interventions in oncology to realize broad clinical implementation and to demonstrate how a knowledge management framework offers several advantages for increasing the probability of successful implementation.MethodsThis paper is based on a systematic review of the literature pertaining to efforts to implement psychosocial oncology and supportive care interventions.ResultsThe struggle to develop, implement, and evaluate promising psychosocial oncology and supportive care innovations has moved academic thought toward the development of models and theories concerning the best ways to move new knowledge into clinical practice. There are critical and common barriers to the successful transfer and implementation of promising interventions, and implementation efforts may be maximized by using knowledge management frameworks to systematically identify and address these barriers.ConclusionsThe successful implementation of empirically promising interventions requires research networks and practice groups to work together in a concerted, theory-guided effort to identify and address the contextual factors most relevant to any particular intervention. The growing support of knowledge implementation activities by research funders, policy-makers, opinion leaders, and advocates of psychosocial and supportive care interventions is a positive move in this direction.

The effects and expense of augmenting usual cancer clinic care with telephone problem-solving counseling.

This study was done to assess the effectiveness and efficiency of individualized, problem-solving counseling provided by baccalaureate nurses over the telephone to prevent the onset of depression in persons with breast, lung, or prostate cancer. Of 175 persons randomized, 149 completed the 8-month follow-up. The primary outcome measures were changes in the Jalowiec Coping Scale, the Centre for Epidemiologic Studies in Depression Scale, and the Derogotis Psychosocial Adjustment to Illness Scale. In addition, expenditures for peoples use of all health and social services were computed at baseline and follow-up. Telephone counseling improved the use of more favorable coping behaviors, prevented a clinically important but not statistically significant decline into depression, and poor psychosocial adjustment in a group of people with mixed cancer. These results were associated with a greater total per person per annum expenditure for use of all other health and social services in the community compared with the control group. In a situation of limited resources and a service producing more effect for more costs, one needs either to examine what services to forgo to offer this service or to carefully target the new service to those most likely to benefit.

Prevalence, correlates, and costs of patients with poor adjustment to mixed cancers.

Approximately 2% to 3% of the Canadian society has experienced cancer. Literature indicates that there is poor adjustment to chronic illness. Individuals with poor adjustment to chronic illness have been found to disproportionately use more health services. The purpose of this study was to determine the prevalence, correlates, and costs associated with poor adjustment to mixed cancer. A consecutive sample (n = 171) of breast, lung, and prostate cancer patients at the Nova Scotia Regional Cancer Center were surveyed. Twenty-eight percent of the cancer group showed fair to poor adjustment to illness using the Psychological Adjustment to Illness Self-report Scale Psychological Adjustment to Illness Self-Report Scale raw score. Poor adjustment was moderately correlated with depression (r = 0.50, P < .0001) and evasive coping (r = 0.38, P < .0001) and unrelated to demographic variables. Depression explained 25% of the variance in poor adjustment to illness in regression analysis. Cancer patients with fair to poor adjustment to illness had statistically significantly higher annual healthcare expenditures (P < .002) than those with good adjustment to illness. Expenditure findings agree with previous literature on chronic illnesses. The prevalence of fair to poor adjustment in this cancer population using the Psychological Adjustment to Illness Self-Report Scale measure is similar to that reported for chronic illness to date, suggesting that only those with better adjustment consented to this study.

Operationalizing Prostate Cancer Clinical Pathways: An Ontological Model to Computerize, Merge and Execute Institution-Specific Clinical Pathways

The computerization of paper-based Clinical Pathways (CP) can allow them to be operationalized as a decision-support and care planning tool at the point-of-care. We applied a knowledge management approach to computerize the prostate cancer CP for three different locations. We present a new prostate cancer CP ontology that features the novel merging of multiple CP based on the similarities of their diagnostic-treatment concepts, whilst maintaining the unique aspects of each specific CP, to realize a common unified CP model. In this paper we will highlight the main components of our prostate cancer CP ontology, and discuss the concept of CP branching and merging nodes. We conclude that our computerized CP can be executed through a logic-based engine to realize a point-of-care decision-support system for managing prostate cancer care.

Oncology nurses views on the provision of sexual health in cancer care

OBJECTIVE: To describe the current sexuality-related nursing practice of oncology nurses. DESIGN: Self-report survey to examine the practice of sexual health with a purposive sample of nurses working in cancer care. SETTING: Six nursing units within a large tertiary care centre were used to recruit study participants. The units included ambulatory care, medical oncology and surgical oncology. PATIENTS: Surveys were delivered to 155 oncology-registered nurses working on the identified nursing units. A response rate of 48% was achieved. RESULTS: The overall scale score (M=103.27) suggests that the oncology nurses who responded to the survey perceived sexuality to be a part of their nursing practice. While the majority of the subscale scores were above the midline, practice was slightly below. CONCLUSIONS: The oncology nurses who participated in the study were somewhat confident, responsible and valued sexuality; however, the delivery of care did not reflect those attributes. Issues raised by the oncology nurses are not limited to this discipline but have broad implications for the delivery of health care.

The Context of Oncology Nursing Practice An Integrative Review

Background: In oncology, where the number of patients is increasing, there is a need to sustain a quality oncology nursing workforce. Knowledge of the context of oncology nursing can provide information about how to create practice environments that will attract and retain specialized oncology nurses. Objective: The aims of this review were to determine the extent and quality of the literature about the context of oncology nursing, explicate how “context” has been described as the environment where oncology nursing takes place, and delineate forces that shape the oncology practice environment. Methods: The integrative review involved identifying the problem, conducting a structured literature search, appraising the quality of data, extracting and analyzing data, and synthesizing and presenting the findings. Results: Themes identified from 29 articles reflected the surroundings or background (structural environment, world of cancer care), and the conditions and circumstances (organizational climate, nature of oncology nurses’ work, and interactions and relationships) of oncology nursing practice settings. Conclusions: The context of oncology nursing was similar yet different from other nursing contexts. The uniqueness was attributed to the dynamic and complex world of cancer control and the personal growth that is gained from the intense therapeutic relationships established with cancer patients and their families. Implications for Practice: The context of healthcare practice has been linked with patient, professional, or system outcomes. To achieve quality cancer care, decision makers need to understand the contextual features and forces that can be modified to improve the oncology work environment for nurses, other providers, and patients.

Police services detention centres: a proposed solution for action

Abstract Police services face daily challenges dealing with the health issues displayed by individuals in their custody. They often find themselves isolated from the services that can help the most. This paper scopes relevant literature on these challenges and some of the interprofessional interventions which have emerged to address them, such as the diversionary practices of crisis intervention teams, street triage, nurses in custody suites, and court liaison and diversion. Remote presence technology is proposed to be an innovative solution that can help to provide more efficient and effective pathways for care in Police Detention Centres. Remote presence technology has the ability to significantly affect the way interprofessional collaboration can take place for those in police custody.

Conceptualizing the Role of a Strategist for Outreach and Indigenous Engagement to Lead Recruitment and Retention of Indigenous Students

A number of universities have introduced Indigenous student-specific programming to improve recruitment. These programs target the needs of Indigenous students and often impart a sense of comfort or belonging that may be more difficult to obtain in a mainstream program. The University of Saskatchewan, College of Nursing, implemented a Learn Where You Live delivery model that challenged the university community to think differently about outreach and engagement. This is best described by redefining distance such that student services and supports would no longer be localized to a main campus but redesigned for distribution across the province. Sustaining this model meant the College leadership had to find new ways to support faculty to engage in teaching and learning opportunities that would be context relevant and aid student recruitment and retention. The new position of Strategist for Outreach and Indigenous Engagement was created to lead opportunities for faculty and staff to gain knowledge and expertise in policy development, negotiation and implementation for success in the distributed delivery model. The framework of Two-Eyed Seeing was adapted to guide the introduction and ongoing implementation (Bartlett et al. 2012).