Susan DeSanto-Madeya

Adaptation to Spinal Cord Injury for Families Post-Injury:

Based on the Roy adaptation model, this cross-sectional study was conducted with 15 spinal cord injured individuals and their family members to examine the physical, emotional, functional, and social components of adaptation to spinal cord injury at 1 year (n = 7 dyads) and 3 years (n = 8 dyads) post-injury. Findings indicate that spinal cord injured individuals and their family members, regardless of time since the initial injury, have a moderate level of adaptation and adjustment to spinal cord injury. The data suggested that adaptation to spinal cord injury during the first 3 years can be enhanced by providing ongoing social and educational support for not only the injured individuals, but also their family members.

A Secondary Analysis of the Meaning of Living With Spinal Cord Injury Using Roy’s Adaptation Model:

This secondary analysis was designed to place the methods and themes from a phenomenological study of the meaning of living with spinal cord injury for the family within the context of the Roy adaptation model. Seven themes emerged from the phenomenological study data. The content of each of the seven themes was found to reflect at least two of the modes of adaptation; one of the themes reflected all four of the modes of adaptation. The findings of this study revealed that the meaning of living with spinal cord injury reflects all four modes of adaptation.

Activities of daily living in women with advanced breast cancer

PURPOSE/OBJECTIVES To detail the daily activities of women with advanced breast cancer. DESIGN Descriptive, qualitative. SETTING Six clinical sites in New England. Of the six sites, three were urban, one was suburban, and two were rural, with three sites being comprehensive cancer centers. SAMPLE 84 women with a confirmed diagnosis of stage IV breast cancer with a life expectancy of four months or more. METHODS A secondary analysis of an expressive writing intervention study control group. As part of the control writing group, participants kept handwritten activity logs for four consecutive days. Standard content analysis procedures were used to analyze the transcribed activity logs. MAIN RESEARCH VARIABLES Activities of daily living in women with advanced breast cancer. FINDINGS 22 codes were identified that depicted the daily activities of participants. Subsequent analysis merged the 22 codes into six themes. CONCLUSIONS Findings demonstrated that patients with advanced breast cancer are living very full, active lives despite numerous symptoms and cancer treatments. IMPLICATIONS FOR NURSING The study serves as a foundation for the development of interventions to enhance daily functioning. Oncology nurses should counsel women with advanced cancer regarding pacing and self-care activities.

Toward Understanding and Measuring Adaptation Level in the Context of the Roy Adaptation Model

The Roy adaptation model concepts of stimuli, coping mechanisms, and modes of adaptation have been translated into several middle‐range concepts and measured using existing and new instruments. The concept of adaptation level, however, has rarely been used in Roy adaptation model‐based research. This paper presents a description of how the Roy adaptation model concept of adaptation level was translated into the logically congruent middle‐range theory concept of adjustment. A single‐item instrument, the Adjustment Scale, is identified as one way to measure adjustment.

Moving Beyond Dwelling in Suffering A Situation-Specific Theory of Men’s Healing from Childhood Maltreatment

The authors present an explanation of the development of a situation-specific theory of men’s healing from maltreatment during childhood. Development of the theory was guided by Rogers’ science of unitary human beings (SUHB). The four multidimensional concepts of the theory are interpreted within the context of the SUHB from themes discovered from the findings of a hermeneutic phenomenological study of men who had been exposed to childhood maltreatment, including neglect and abuse. The concepts are: moving beyond suffering, desiring release from suffering, dwelling in suffering, and experiencing wellbeing. Moving beyond suffering is the process of healing from childhood maltreatment. Desiring release from suffering is the facilitator of men’s life experiences that speeds up the rate of evolution from moving beyond suffering to experiencing healing. Dwelling in suffering is the barrier in men’s life experiences that slows down the rate of evolution from moving beyond suffering to experiencing wellbeing.

How women with advanced cancer pray: a report from two focus groups.

PURPOSE/OBJECTIVES To explore the meaning, function, and focus of prayer for patients with advanced cancer, and to identify the effects of prayer on their coping. RESEARCH APPROACH Qualitative, descriptive design using focus groups. SETTING Three cancer centers that are part of a university-affiliated comprehensive cancer network in the northeastern United States. PARTICIPANTS 13 adult, female outpatients receiving active treatment for ovarian or lung cancer. METHODOLOGIC APPROACH Two semistructured, focus group interviews were conducted. Audiotapes were transcribed verbatim. Data were coded and analyzed using standard content analysis procedures. MAIN RESEARCH VARIABLES Prayer and coping. FINDINGS Four themes emerged: finding ones own way, renewed appreciation for life, provision of strength and courage, and gaining a stronger spiritual connection. In addition, praying for others, conversational prayer, petitionary prayer, ritual prayer, and thanksgiving prayer were used most often by participants to cope. CONCLUSIONS The findings support prayer as a positive coping mechanism for women with advanced ovarian or lung cancer. INTERPRETATION The study provides knowledge about prayer as a source of spiritual and psychological support. Oncology nurses should consider the use of prayer for patients coping with advanced cancer.

Dwelling in Suffering: Barriers to Men's Healing from Childhood Maltreatment

Based on findings from a hermeneutic phenomenological study, this article provides a description and interpretation of barriers to healing that men encountered in the aftermath of childhood maltreatment. An analysis of interview data collected from 52 adult male survivors healing from childhood maltreatment identified a theme, Dwelling in Suffering, as representing the full range of barriers that impeded their healing. Subthemes of Dwelling in Suffering Personally, Relationally, and Social-Environmentally are discussed. This research highlights a complex understanding of the challenges men experience in healing from childhood maltreatment and the need for practice interventions and future research to ameliorate mens suffering.

Improving End-of-Life Care: Palliative Care Embedded in an Oncology Clinic Specializing in Targeted and Immune-Based Therapies

PURPOSE Patients with advanced cancer benefit from early involvement of palliative care. The ideal method of palliative care integration remains to be determined, as does its effectiveness for patients treated with targeted and immune-based therapies. MATERIALS AND METHODS We studied the impact of an embedded palliative care team that saw patients in an academic oncology clinic specializing in targeted and immune-based therapies. Patients seen on a specific day accessed the embedded model, on the basis of automatic criteria; patients seen other days could be referred to a separate palliative care clinic (usual care). We abstracted data from the medical records of 114 patients who died during the 3 years after this models implementation. RESULTS Compared with usual care (n = 88), patients with access to the embedded model (n = 26) encountered palliative care as outpatients more often ( P = .003) and earlier (mean, 231 v 109 days before death; P < .001). Hospice enrollment rates were similar ( P = .303), but duration was doubled (mean, 57 v 25 days; P = .006), and enrollment > 7 days before death-a core Quality Oncology Practice Initiative metric-was higher in the embedded model (odds ratio, 5.60; P = .034). Place of death ( P = .505) and end-of-life chemotherapy (odds ratio, 0.361; P = .204) did not differ between the two arms. CONCLUSION A model of embedded and automatically triggered palliative care among patients treated exclusively with targeted and immune-based therapies was associated with significant improvements in use and timing of palliative care and hospice, compared with usual practice.

An Innovative Approach to Improving the Accuracy of Delirium Assessments Using the Confusion Assessment Method for the Intensive Care Unit.

Background:Delirium occurs in up to 80% of intensive care unit (ICU) patients. Despite its prevalence in this population, there continues to be inaccuracies in delirium assessments. In the absence of accurate delirium assessments, delirium in critically ill ICU patients will remain unrecognized and will lead to negative clinical and organizational outcomes. Objectives:The goal of this quality improvement project was to facilitate sustained improvement in the accuracy of delirium assessments among all ICU patients including those who were sedate or agitated. Methods:A pretest-posttest design was used to evaluate the effectiveness of a program to improve the accuracy of delirium screenings among patients admitted to a medical ICU or coronary care unit. Results:Two hundred thirty-six delirium assessment audits were completed during the baseline period and 535 during the postintervention period. Compliance with performing at least 1 delirium assessment every shift was 85% at baseline and improved to 99% during the postintervention period. Baseline assessment accuracy was 70.31% among all patients and 53.49% among sedate and agitated patients. Postintervention assessment accuracy improved to 95.51% for all patients and 89.23% among sedate and agitated patients. Conclusion:The results from this project suggest the effectiveness of the program in improving assessment accuracy among difficult-to-assess patients. Further research is needed to demonstrate the effectiveness of this model across other critical care units, patient populations, and organizations.

Developing a model for embedded palliative care in a cancer clinic

Objectives Describe the development and key features of a model for embedded palliative care (PC) for patients with advanced kidney cancer or melanoma seen in a cancer clinic. Methods Retrospective chart review of patients following an initial phase and then a prospective review following the implementation of a model for embedded PC. Results In the initial phase, 18 patients were seen for a total of 53 visits; 78% were seen more than once, with a mean of three visits per patient. In the model phase, 46 patients were seen for a total of 163 visits; 74% were seen more than once, with a mean of 3.5 visits. Demographics were similar between the two groups. Content of the first PC visit in the initial and model phases was symptom management (61% and 57%), psychosocial support/relationship building (28% and 35%) and advance care planning/decision-making support (11% and 8%), respectively. Conclusions The initial phase demonstrated acceptability and feasibility of a model for embedded PC for patients and the oncology team. Establishment of specific eligibility criteria and screening to identify eligible patients in the model phase led to an increased uptake of PC for patients with advanced kidney cancer and melanoma in a cancer clinic.