Recent topics of health outcomes research in oncology

This article reviews recent topics in health outcomes research. First, we discuss the concept and importance of 'subjective' assessment of quality of life (QOL), and introduce new guidance, by the respective medical product regulatory authorities in Europe and the United States, for labeling claims of medical products that are assessed for outcomes related to QOL. Second, we address the application of item response theory (IRT) in developing and assessing QOL measures to compensate for several drawbacks of the classical psychometric approach, which has been commonly used to verify the reliability and validity of QOL instruments. Third, the relevance and determination of the minimally clinically important difference (MID) of QOL scores is discussed. Finally, we address the so-called 'response shift' which may affect the reliability of analysis results of QOL scores in longitudinal studies such as randomized clinical trials.     

4R危机管理理论在脓毒症患者胃肠功能障碍预防管理中的应用

目的　探讨4R危机管理理论在脓毒症患者胃肠功能障碍预防管理中的应用效果。方法　选择2020年12月至2021年12月广东省第二中医院收治的82例脓毒症患者为研究对象进行前瞻性研究,运用随机数字表法将其分为对照组和观察组,各41例。对照组男23例、女18例,年龄（76.17±9.27）岁,实施脓毒症常规护理干预;观察组男22例、女19例,年龄（77.22±9.03）岁,在对照组基础上实施基于4R危机管理理论的胃肠功能障碍预防管理。比较两组患者急性生理与慢性健康评分系统Ⅱ（APACHEⅡ）评分、胃肠功能损伤评分、胃肠功能障碍发生率以及护理满意度。计量资料行独立样本t检验,计数资料行χ²检验。结果　干预后,观察组APACHEⅡ评分、胃肠功能损伤评分［（19.41±3.15）分、（24.85±4.49）分］均低于对照组［（23.27±3.41）分、（29.07±5.12）分］,差异均有统计学意义（t=5.315、3.969,均P<0.001）。干预后,观察组患者胃肠功能障碍发生率为7.32%（3/41）,明显低于对照组24.39%（10/41）,差异有统计学意义（χ²=4.479,P=0.034）。干预后,观察组患者护理总满意度为97.6%（40/41）,高于对照组85.4%（35/41）,差异有统计学意义（χ²=3.905,P=0.048）。结论　运用4R危机管理理论可改善脓毒症患者病情和胃肠功能,降低胃肠功能障碍发生率,提高护理满意度。     

基于Peplau人际关系理论康复护理模式对冠心病病人心功能、健康行为及自我管理能力的影响

目的:探讨基于Peplau人际关系理论康复护理模式对冠心病病人心功能、健康行为及自我管理能力的影响。方法:选取2020年7月—2021年9月收治的98例冠心病病人为研究对象,按照抽签法将其分为对照组和观察组各49例,对照组给予常规护理,观察组实施基于Peplau人际关系理论康复护理,干预3个月。观察两组病人心功能、健康行为依从性及自我管理能力的改善情况。结果:观察组病人心功能指标优于对照组(P<0.05);观察组病人自我管理能力评分高于对照组(P<0.05);观察组病人健康行为得分情况优于对照组(P<0.05)。结论:基于Peplau人际关系理论康复护理模式能更有效改善冠心病病人自我管理能力,增强病人健康信念与健康行为动机,促进心功能指标与心脏康复质量的改善,效果优于常规护理。     

基于翻转课堂的混合式教学模式在《护理理论》课程中的应用研究

目的:探讨翻转课堂在《护理理论》教学中的应用效果。方法:选择河南省某高校一年级33名护理专业硕士研究生为研究对象,实施翻转课堂。课前通过学习通等平台观看教学视频,测试题提前预习,课堂上分组演示文稿(PPT)汇报讨论,答疑解惑等教学方法进行翻转课堂。通过投票及讨论的形式来了解学生对翻转课堂教学的评价。结果:教师对翻转课堂教学改革的整体评价较好,学生对翻转课堂的满意度为94.8%。结论:翻转课堂教学模式能有效提高《护理理论》课程的教学效果,同时也调动了学生学习积极性,但还需要进一步完善,以期达到更好的教学效果。     

时机理论奠基式健康管理模式在高血压合并糖尿病患者中的 应用

目的探讨时机理论奠基式健康管理模式在高血压合并糖尿病患者中的应用效果。方法选取2018年1~12月深圳市福田区慢性病防治院新洲社康中心收治的高血压合并糖尿病患者92例为研究对象,按随机数字表法分为实验组和对照组各46例。对照组接受常规健康管理干预,实验组接受时机理论奠基式健康管理模式干预。比较两组干预后的健康行为遵医度、疾病控制效果及生活质量。结果实验组干预后6个月及12个月的健康行为遵医度及生活质量评分均显著高于对照组,差异有统计学意义(P<0.05),疾控效果显著优于对照组,差异有统计学意义(P<0.05)。结论采用时机理论奠基式健康管理模式对高血压合并糖尿病患者施加干预,可显著提升其健康行为遵医度及疾控效果,改善生活质量。     

基于Orem自理理论康复护理联合情志干预对脑梗死偏瘫患者神经功能、自护能力及生活质量的影响

目的:探究基于Orem自理理论康复护理联合情志干预对脑梗死偏瘫患者神经功能、自护能力及生活质量的影响。方法:选取2018年6月至2019年2月在雅安市中医医院进行脑梗死治疗的100例患者,根据患者入院时间将其分为常规组及研究组,对常规组患者行常规护理,对研究组患者行基于Orem自理理论康复护理联合情志干预,比较两组患者干预前后神经功能、自护能力及生活质量。结果:干预前,两组患者NIHSS评分、Barthel指数评分及SF36量表评分比较差异均无统计学意义(均P>0.05),干预后,研究组患者NIHSS评分及Barthel指数评分分别为(3.08±1.12)分及(79.28±6.41)分,均显著优于常规组及干预前,差异有统计学意义(均P<0.05),且研究组患者各项活质量评分均显著优于常规组及干预前(P<0.05)。结论:对脑梗死偏瘫患者实施脑梗死偏瘫患者,能够有效改善其神经功能,且对提高患者自护能力及生活质量具有重要意义。     

User involvement in the making: Positions and types of knowledge enacted in the interaction between service users and researchers in user panel meetings

BackgroundNumerous studies of user involvement in research have been conducted. However, there is a lack of studies applying observational methods and addressing the concrete practice of involvement.ObjectiveTo determine what knowledge types and competences users apply when involved in the research process through user panel meetings.DesignUser panel meetings in a qualitative project in rehabilitation were sound‐recorded and transcribed verbatim. Data analysis applied an abductive approach framed by positioning theory.Setting and participantsSix rehabilitation service users and a similar number of researchers met 20 times during a six‐year project period. They discussed various issues in the research process such as interview guides, analysis and dissemination of results.FindingsThe service users combined their respective knowledge and competence into six positions enacted in the panel interactions. They engaged as co‐researchers, based their contributions on their respective personal histories, represented an NGO and peers, applied their respective professional and educational backgrounds and, finally, engaged as concerned citizens.Discussion and conclusionThe findings add to the discussion of professionalization of user involvement by introducing a wider array of positions enacted than do the findings of previous studies. Researchers recruiting user panel members, as well as NGOs appointing candidates for user panels, are advised to consider a wide competence profile for possible candidates. A panel is also considered as a resource in confirming and elaborating on a study''s findings.Patient and public contributionA service user panel contributed to the study.     

The role of community mental health nurses caring for people with schizophrenia in Taiwan: a substantive grounded theory

Aim and objectives. The aim was to develop a practice theory that can be used to guide the direction of community nursing practice to help clients with schizophrenia and those who care for them. Design. Substantive grounded theory was developed through use of grounded theory method of Strauss and Corbin. Methods. Two groups of participants in Taiwan were selected using theoretical sampling: one group consisted of community mental health nurses and the other group was clients with schizophrenia and those who cared for them. The number of participants in each group was determined by theoretical saturation. Semi‐structured one‐to‐one in‐depth interviews and unstructured non‐participant observation were utilized for data collection. Data analysis involved three stages: open, axial and selective coding. During the process of coding and analysis, both inductive and deductive thinking were utilized and the constant comparative analysis process continued until data saturation occurred. To establish trustworthiness, the four criteria of credibility, transferability, dependability and confirmability were followed along with field trial, audit trial, member check and peer debriefing for reliability and validity. Results. A substantive grounded theory, the role of community mental health nurses caring for people with schizophrenia in Taiwan, was developed through utilization of grounded theory method of Strauss and Corbin. Conclusion. In this paper, results and discussion focus on causal conditions, context, intervening conditions, consequences and phenomenon. Relevance to clinical practice. The theory is the first to contribute knowledge about the field of mental health home visiting services in Taiwan to provide guidance for the delivery of quality care to assist people in the community with schizophrenia and their carers.     

Being there: parenting the child with acute lymphoblastic leukaemia

Aims and objectives. To gain insight into the lived experience of parenting a child with leukaemia during treatment. Background. Diagnosis of leukaemia in children leads to an existential shock for parents and a reversal of normal family life. Today, in the Netherlands, after diagnosis, children stay at home most of the time. Therefore, their parents face considerable responsibilities for administering home‐based treatment and for the support of their child during illness and treatment. Methods. A grounded theory study was undertaken at a Dutch University Hospital and involved one‐time individual in‐depth interviews with 12 mothers and 11 fathers (n = 23) of 12 children. Findings. ‘Being there’, was identified as the core concept. It means: ‘I’ll be there for you; I will never let you down’. ‘Being there’ is described as a parental response to the perceived vulnerability of the child and the parental need to give meaning to parenthood. It serves two purposes: protection and preservation. Protection means guarding the child against the negative aspects of illness and treatment. Preservation refers to the way parents influence the child’s perception of his/her life, thus contributing to his/her coping and willingness to undergo treatment, to maximise the chances for survival. Six aspects were identified: a trusting relationship, presence, emotional support, advocacy, routines and rituals and effacing oneself. Conclusions. The concept provides a theoretical frame for parenting the child with cancer. It clarifies the actions and reactions of parents and increases insight into the underlying force that enables parents to provide continuing care despite their personal burden. Relevance to clinical practice. The concept offers an essential insight into parenting the child with acute lymphoblastic leukaemia and has relevance for nursing practice and education. Understanding of the concept would improve the ability to understand, communicate and work pro‐actively in partnership with parents.     

Passing the audition - the appraisal of client credibility and assessment by nurses at triage

Aim. This paper presents the findings of one aspect of a larger study aiming to build a substantive grounded theory of the process of initial assessment at triage. Background. Prioritisation at triage within emergency departments centres primarily on assessing the threat to physiological function of people presenting with health‐care problems. This approach presumes that clinical reasoning strategies reside exclusively within the health‐care practitioner, with the patient playing no active part in the process. Design. A grounded theory/symbolic interactionist methodology. Methods. Thirty‐eight recordings were made of live triage encounters involving 14 emergency nurses from two demographically distinct emergency departments. At the end of the relevant shift, those encounters in which the nurses were involved were replayed to them. The recording was stopped after each question or comment by the nurse who was then asked to say what they were thinking at the time. The nurses’ thoughts were recorded, transcribed and analysed using the constant comparative method, in which hypotheses are generated and continually modified in the light of incoming data until a conceptual story line, or theory, is produced. Results. The findings suggest that the outward clinical signs of problems presenting to the emergency department were not viewed by nurses as neutral manifestations of the pathology itself but as a conscious or unconscious portrayal of patients’ physical discomfort and their perception of the nature of the problem. The way in which patients and carers depict their problems is used by triage nurses to determine the credibility of the clinical information they provide. Conclusion. Triage can be regarded as a process in which nurses act as an adjudicating panel, judging the clinical data before them through the appraisal of the way patients act out their problems and narrate their stories. Relevance to clinical practice. Nursing practice and research need to account for the patient's contribution to the decision‐making process at triage.