Verna A. Rhodes

Patients' descriptions of the influence of tiredness and weakness on self-care abilities.

Orems Self-Care Deficit Theory of Nursing includes symptoms experienced by patients as a component of health state that influence self-care agency (S-CA). Nursing care plans reflect this relationship, but there are no supporting data. The purpose of this descriptive study (part of a larger study, US PHS Grant No. 5 R01 NUO 1154–02), was to examine the relationship between self-reported symptoms and S-CA perceived by patients receiving antineoplastic chemotherapy (CT). Telephone interviews were conducted with 20 patients averaging six cycles of CT. The interview schedule developed by the authors utilized open-ended questions regarding self-care (S-C) and symptomatology. Major themes were then identified and verified through subsequent interviews. Tiredness and weakness were identified as the symptoms that most interfered with S-C activities. Thus, informants limited their expenditure of energy by (a) planning/scheduling activities and work, (b) decreasing nonessential activities, and (c) increasing dependence on others for home management. Findings suggest a relationship between S-CA and health state. Further quantitative and qualitative research is needed for validation. Findings are applicable in nursing practice to assist new patients in coping with S-C deficits resulting from CT.

Development of reliable and valid measures of nausea and vomiting

Few instruments that measure separately the patients perception of nausea and vomiting are reported in the literature. The pattern of occurrence and the amount of distress caused by each of these common symptoms is unknown for the individual chemotherapeutic agents and drug combinations. Two instruments, the adapted form of the McCorkle and Young symptom distress scale (ASDS) and the index of nausea and vomiting (INV). were developed to measure both nausea and vomiting. These tools were administered to 32 cancer patients who were beginning an initial chemotherapy regime and 72 well citizens in a pilot study designed to develop and test the reliability and validity of these measures. Data are presented that show the tools are reliable and that they validly measure post-treatment nausea and vomiting in chemotherapy patients. This pilot effort is important to the future study of patterns and effective nursing interventions to control the problems of both nausea and vomiting.

Nausea, Vomiting, and Retching: Complex Problems in Palliative Care

Patients with advanced cancer commonly experience nausea, vomiting, and/or retching (NVR) as a result of the malignant process and its treatment. Recently, increasing attention is being focused on end‐of‐life care, which includes relief or reduction of symptoms such as NVR.

Sensory perception of patients on selected antineoplastic chemotherapy protocols

Antineoplastic chemotherapy (ANCT) is a primary and adjuvant treatment modality for cancer. Although researchers have found that patients who are given preparatory sensory information before various healthcare procedures experience less discomfort, literature describing subjects sensory experience before, during, and after ANCT is lacking. The purpose of this study was to elicit sensory responses from subjects before, during, and after one of six cycles of their initial course of treatment on one of two emetogenic ANCT protocols. These descriptions will be used to develop a preparatory sensory nursing intervention that may promote self-care and help cancer patients cope with the distress of chemotherapy. The Sensory Information Questionnaire was administered to a sample of 44 subjects who had just completed a cycle of ANCT. Subjects provided descriptors of all senses. The senses for which subjects most frequently provided descriptors were taste, touch, and smell. Descriptors varied for some sensations according to the chemotherapy drug protocols.

Development of a preparatory sensory information videotape for women receiving chemotherapy for breast cancer.

This study describes the development and testing of a preparatory sensory information (PSI) videotape for women receiving chemotherapy for breast cancer. In telephone interviews, 40 women described the sensations they experienced before, during, and after receiving chemotherapy. Sensations described by the women were linked with procedural and temporal elements identified by certified advanced practice oncology nurses to develop a script for the PSI videotape. Women currently receiving chemotherapy or who had completed chemotherapy within the last 6 months were asked to share their experiences on videotape. After editing, a 20-minute PSI videotape was produced. Pilot testing with a group of 20 women demonstrated that the intervention helped to prepare them for the sensory experiences associated with chemotherapy and was helpful in developing anticipatory coping and self-care behaviors.

Nausea, vomiting, and retching: The management of the symptom experience

OBJECTIVES To examine the physiology of nausea, vomiting, and retching (NVR); the impact of NVR on the patient: current measures to control NVR; and selfcare interventions. DATA SOURCES Research studies, abstracts, and review articles relating to NVR associated with cancer treatment as well as pharmacological and nonpharmacological interventions. CONCLUSIONS Management of the individual symptoms of NVR require expert, ongoing assessment of the patients symptom experience that extends beyond the clinic or hospital visit. Although a number of pharmacological antiemetic agents are currently available and additional antiemetic drugs are in phase II or II trials, nonpharmacological interventions are essential to achieve effective management. IMPLICATIONS FOR NURSING PRACTICE Continual assessment of the individuals symptom experience is imperative. Effective management of the symptom experience depends on the oncology nursess ability to implement current knowledge of antiemetic, and other drugs; non-pharmacological interventions; and cost-effective and clinically useful patient outcomes.

The Chinese translation of the Index of Nausea, Vomiting, and Retching.

The purpose of this study was to determine reliability and validity of the Chinese version of the Index of Nausea, Vomiting, and Retching (INVR) and the Index of Nausea and Vomiting Form 2 (INV-2) to provide a reliable and valid measure of nausea, vomiting, and retching for Chinese nurses and other healthcare providers. An integrative translation method was used in the study. The reliability and validity of the Chinese versions of the INVR and the INV-2 was evaluated using test–retest, parallel forms, and crossover design. A convenience sample of 177 Chinese-speaking participants was accrued from a large teaching cancer institute and a teaching obstetric hospital in Beijing, Peoples Republic of China. The integrative translation method was proven to be an effective method for translating instruments from the source to the target language. The Chinese versions of both the INV-2 and INVR were found to have high Cronbach’s alpha scores and high agreement rates. The responses to the Chinese version of INVR were more frequently consistent than the responses to the INV-2. The majority of the patients voiced preference for the INVR. The findings suggest the significance of the Chinese versions of INVR and INV-2 in terms of nursing practice. The findings also support the cross-cultural method for future study at international level.

Symptom distress: Future perspectives for practice, education, and research*

Summary In this issue we have attempted to clarify the meaning of symptom distress and review the state of knowledge regarding generalized symptom distress and the distress response to the occurrence of specific symptoms. Although the concept is basic to nursing, psychology, and medicine, its meaning is confused in the literature. In particular, authors fail to differentiate the occurrence of a symptom from symptom distress. The use of a consistent conceptual framework would add clarity to future research efforts in symptom occurrence and symptom distress. At present, the framework that seems most practical is Leventhal and Johnsons Self-Regulation Theory.7 Further, work on the relationship of this theory to specific nursing theories, such as Orems Self-Care Deficit Theory of Nursing, would further clarify the appropriate role of the nurse and give direction for the use of symptom occurrence and symptom distress in developing nursing diagnoses. Among the numerous questions that still need to be answered are the following: (1) How is quality of life improved or reduced over time by changes in symptom distress? (2) What nursing interventions are useful to reduce symptom distress rather than symptom occurrence? (3) Is symptom distress paired to the occurrence of single symptoms or is it a generalized response to the occurrence of multiple symptoms? (4) What nonpharmacologic nursing interventions are effective in reducing insomnia in cancer patients? (5) Are anxiety, depression, worry, and fear symptoms or are they expressions of distress associated with symptoms and psychologic concerns? and (6) How should information about symptom occurrence and symptom distress be used in the formulation of nursing diagnoses? Symptom occurrence and distress have been discussed since medieval times, yet, inadequate attention has been given to why and how they are important to individual patients and specific health care providers. Nurses have assumed that knowledge of symptoms and symptom distress was essential to practice but have failed to focus on how to use this knowledge and how to reduce symptom distress. Both the occurrence of symptoms and the related distress can be found in published lists of appropriate nursing diagnoses.14,15 Both concepts are important to the practice of nursing. Symptom distress, however, is a complex concept that requires further, in-depth understanding.

Patient education: Self-care guides

Verna A. Rhodes, Roxanne W. McDaniel, and Mary H. Johnson T EACHI, NG is an integral part of nursing, yet today s rapidly changing health care arena with shortened hospital stays presents unique challenges for the nurse to provide appropriate patient requirements for self-care. Much care for this chronic multistage disease takes place in the home, which demands knowledge not only of what to do to prevent and/or manage the symptom experience but also what to report to the health care provider. These patient education self-care guides have been developed to assist nurses in designing and implementing individualized teaching. A variety of educational strategies based on individualized assessment for efficient effective teaching of self-care are essential because of the overwhelming emotional and physical obstacles surrounding the patient and family.t Appropriate patient education that provides proactive management of the symptom experience may alleviate fears, enhance quality of life, and be cost effective.

Patterns of nausea and vomiting in antineoplastic postchemotherapy patients

p bATTERNS of nausea and vomiting occurrence and distress are not well documented for single antineoplastic chemotherapeutic agents and drug combinations. The purpose of this study, using self-regulation theory, was to describe patterns of nausea and vomiting that occurred during six consecutive cycles of initial selected chemotherapy regimens. A stratified sample of patients (N = 309), 21 to 85 years old, was selected from multiple geographic sites within two Midwestern states. The Rhodes Index of Nausea and Vomiting (INV) Form 2 was used to measure nausea and vomiting every 12 hours for 48 hours. Nonparametric analysis of variance and cluster analysis methods were used to determine the patterns of postchemotherapy nausea and vomiting. Findings revealed that 84% of the sample had their vomiting well controlled during the 48 hours posttherapy, while 71% had little or no nausea (i.e., minimal pattern). In the remaining sample, three distinct antiemetic drug-resistant patterns emerged for each of the dyad symptoms. The drug-resistant patterns of symptom experience, symptom occurrence, and symptom distress were (a) peak, (b) latent, and (c) sustained patterns (Rhodes & Watson, 1987a; Rhodes, Watson, Johnson, Madsen, & Beck, 1987). Additional findings were as follows: 1. Statistically significant relationships between postchemotherapy symptom experience and the antineoplastic drug protocols. The three most emetic chemotherapy drug protocols were cyclo-