Burnout symptoms in forensic mental health nurses: Results from a longitudinal study

Burnout in nursing staff is a major cause for turnover and absenteeism. Identifying risk and protective factors may be helpful in decreasing burnout symptoms. Moreover, research indicates that ambulatory assessments of the autonomic nervous system might be helpful in detecting long‐term stress and burnout symptoms. One hundred and ten forensic nursing staff members completed questionnaires measuring experiences with aggressive behaviour, emotional intelligence, personality, and job stress during four waves of data collection across a 2‐year period. Multilevel analyses were used to test the predicted associations and moderation effects with (the development of) burnout symptoms. Burnout was predicted by a combination of emotional intelligence, job stress, aggression, personality factors, and skin conductance, but no moderation effects over time were found. Over a period of 2 years, the model approximately predicts a change in one burnout category on the Maslach Burnout Inventory . The amount of burnout symptoms in nurses might be used as an indicator to predict turnover and absenteeism considering the increase in symptoms over time . Nursing staff who experience severe aggression and who have relatively low levels of emotional intelligence and altruism and high levels of neuroticism and job stress should be monitored and supported to decrease the risk of burnout. Staff members can be trained to increase their emotional intelligence and relieve stress to decrease their burnout symptoms and turnover and absenteeism on the long term. Ambulatory assessment might be helpful as a nonintrusive way to detect increasing levels of burnout.     

儿科生活质量量表患儿自评和家长代评差异的比较

目的通过评估和描述急性淋巴细胞白血病（acutelymphoblasticleukemia,ALL）患儿的生活质量状况,比较患儿自评和家长代评结果的差异。方法选择2010年10月q011年11月在上海某3级甲等儿童专科医院住院的ALL患儿及其家长共52例,采用儿科生活质量测定量表体系（ThePediatricQualityofLifeInventory MeasurementModels,PedsQLTM）中的PedsQLTM 4．0儿童生活质量普适性核心量表和PedsQLTM3．0儿童癌症模块生活质量量表进行自我评估和家长评估。结果家长报告在生活质量总体得分上与儿童自评一致（P〉O．05）。但患儿在生理、情感方面以及对于“操作性焦虑”及“担心”上得分高于家长的评分（P〈0．05）;而在“学校方面”和“认知方面”低于家长报告（P〈0．05）。结论患儿和家长对生活质量总体评价间不存在显著差异,当惠儿自评存在困难时,家长代评具有一定的参考价值。但作为独立的个体,患儿和家长所得出的生活质量可能存在部分偏差,因此在临床工作中,应充分结合患儿和家长两者的汇报,以提供更全面、更优质、更个性化的护理。     

Validity of the memorial symptom assessment scale-short form psychological subscales in advanced cancer patients

Context

The Memorial Symptom Assessment Scale-Short Form (MSAS-SF) is designed to evaluate physical and psychological symptom burden in advanced cancer patients. There are no current data assessing the validity of the MSAS-SF psychological symptom scores when compared with anxiety and depression.

Objectives

This observational cross-sectional study was designed to determine the relationship between the MSAS-SF subscales and the presence of anxiety and depression.

Methods

Advanced cancer patients attending a U.K. oncology center completed the MSAS-SF and the Hospital Anxiety and Depression Scale.

Results

One hundred twenty patients participated in the study. There was an association between the presence of anxiety and depression and the MSAS-SF global distress index. There was no association between the presence of anxiety and depression and the MSAS-SF physical symptom subscale. The MSAS-SF psychological symptom subscale was more closely correlated with anxiety than depression.

Conclusion

These results support the validity of the MSAS-SF global distress index and psychological subscales in the assessment of patients with anxiety and depressive disorders.     

Endocrine symptom assessment in women with breast cancer: what a simple “yes” means

Goals of work To investigate the self-reported symptoms related to endocrine therapy in women with early or advanced breast cancer and the impact of these symptoms on quality of life (QL) indicators. Materials and methods Symptom occurrence was assessed by the Checklist for Patients on Endocrine Therapy (C-PET) and symptom intensity was assessed by linear analogue self-assessment (LASA) indicators. Patients also responded to global LASA indicators for physical well-being, mood, coping effort and treatment burden. Associations between symptoms and these indicators were analysed by linear regression models. Main results Among 373 women, the distribution of symptom intensity showed considerable variation in patients reporting a symptom as present. Even though patients recorded a symptom as absent, some patients reported having experienced that symptom when responding to symptom intensity, as seen for decreased sex drive, tiredness and vaginal dryness. Six of 13 symptoms and lower age had a detrimental impact on the global indicators, particularly tiredness and irritability. Conclusions Patients’ experience of endocrine symptoms needs to be considered both in patient care and research, when interpreting the association between symptoms and QL.     

Testicular cancer: a longitudinal pilot study on stress response symptoms and quality of life in couples before and after chemotherapy

Goals of work The current study was designed to longitudinally examine stress response symptoms (SRS) and quality of life (QoL) in couples confronted with disseminated testicular cancer. The objectives were to examine couples’ patterns of adjustment over time and possible differences in adjustment between the patient and his partner. Materials and methods Couples completed the Impact of Event Scale and the QoL subscales physical functioning, social functioning, and mental health of the RAND-36 before chemotherapy (T1), after completion of chemotherapy (T2), and 1 year later (T3). Results Before chemotherapy 26% of the patients and 50% of partners reported clinically elevated levels of SRS. Patients reported lower physical and social functioning at T2 compared to T1 and T3. Partners reported an improvement in social functioning over the year and no changes in physical functioning or mental health. No relationships between patients and partners’ functioning were found. One year after diagnosis, QoL of patients and partners was similar to that of reference groups, and patients even reported better physical functioning than the reference group. SRS of patients and partners were negatively related at T1, and patients and partners’ social functioning were positively related at T2. Conclusions According to stress response levels, the period before the start of chemotherapy was most stressful for couples. Adjustment patterns differ between testicular cancer patients and their partners with patients reporting lowered QoL after completion of chemotherapy. QoL of couples returned to normal levels 1 year after diagnosis. The effect of disseminated testicular cancer on the QoL of patients and their partners seems to be temporary. A minority may need clinical attention for severe SRS.     

Association between self-reported sleep disturbance and other symptoms in patients with advanced cancer

ContextSleep disturbance (SD) is a significant source of distress for patients with cancer. Studies of patients with advanced cancer receiving palliative care to identify symptoms associated with the severity of SD are limited.ObjectivesIn this study, we sought to identify the symptoms measured by the Edmonton Symptom Assessment Scale (ESAS) that are associated with SD, as measured by the Pittsburgh Sleep Quality Index (PSQI). Secondary aims of the study were to determine the association between occurrences of SD with occurrences of other symptoms and screening performance of the ESAS-Sleep item against the PSQI.MethodsWe reviewed the completed ESAS and PSQI assessments of 101 patients with advanced cancer who were receiving palliative care and had been admitted to prospective clinical trials previously initiated by us. Patients with a PSQI score of ≥5 were considered to have an SD. The frequency and severity of the ESAS symptoms items, their correlation with each other, the PSQI score, and the screening performance of the ESAS-Sleep item were calculated.ResultsThe median age of patients was 60 years. Most were white non-Hispanic (73%), had lung or breast cancer (41%), and were diagnosed with SD (85%). The PSQI score was correlated with the ESAS items of pain (r = 0.27, P = 0.006), dyspnea (r = 0.25, P < 0.001), well-being (r = 0.35, P < 0.0001), and sleep (r = 0.44, P < 0.0001). Compared with patients without SD, those with SD were more likely to report pain (P = 0.0132), depression (P = 0.019), anxiety (P = 0.01), and a poorer sense of well-being (P = 0.035). An ESAS-Sleep item cutoff score of ≥3 (of 10) resulted in a sensitivity of 74% and a specificity of 73%.ConclusionSD is associated with increased frequency of pain, depression, anxiety, and a worse sense of well-being. These four symptoms should be assessed in all patients with advanced cancer with a complaint of SD. The ideal cutoff point of the ESAS-Sleep item for screening for SD is a score of ≥3. More research is needed to better characterize this frequent and distressing syndrome.     

培美曲塞联合顺铂治疗晚期卵巢癌的临床研究

目的探讨培美曲塞联合顺铂治疗晚期卵巢癌的临床疗效及安全性。方法 53例晚期卵巢癌患者,给予培美曲塞500 mg/m2,第1天,静脉滴注;同时给予顺铂30 mg/m2,第1~3天,静脉滴注〉2 h,28 d为1个周期,治疗2~4个周期。治疗满2个周期后评价临床疗效、不良反应、生存时间、疾病进展时间,同时进行生活质量评分及KPS评分。结果治疗有效率为49.06%,平均疾病进展时间为8.52个月,平均生存时间为15.01个月。治疗前KPS评分为（64.5±5.0）分,明显低于治疗后（78.2±6.6）分。治疗后功能评分、症状评分、整体生活质量评分较治疗前均有显著改善。结论培美曲塞联合顺铂是治疗晚期卵巢癌的有效治疗方案,不良反应耐受较好。     

腹腔镜辅助和开腹在进展期远端胃癌根治术临床疗效的初步比较

目的 探讨腹腔镜辅助远端进展期胃癌根治术的可行性和近期效果.方法 对12例行腹腔镜辅助远端胃癌根治术(腹腔镜组)及18例开腹远端胃癌根治术(开腹组)患者的术中、术后指标进行初步比较.结果 腹腔镜组和开腹组在手术时间、术中出血量、淋巴结清除数方面差异无统计学意义(P>0.05),但是腹腔镜组切口长度明显小于开腹组(P<0.01);腹腔镜组术后肛门排气时间、开始下床活动时间、开始进食时间早于开腹组(P<0.05),且术后住院天数亦少于开腹组(P<0.05).结论 腹腔镜辅助远端进展期胃癌根治术是安全可行的,能达到与开腹手术相当的根治效果,其微创优势明显,具有优于开腹手术的近期疗效.     

症状管理教育对肺癌化疗患者核心症状群的改善效果

目的探讨症状管理教育(SME)对肺癌化疗患者核心症状群的改善效果。方法选取我院2017年2月至2019年2月收治的74例临床表现症状群的肺癌化疗患者为研究对象,将其随机等分为对照组和观察组,对照组给予常规护理,观察组在对照组基础上行症状管理教育。比较两组核心症状、生活质量和自我症状管理行为评分。结果观察组乏力、呼吸困难、夜间咳嗽核心症状评分低于对照组(P<0.05);观察组功能领域、症状领域以及总体生存质量水平优于对照组(P<0.05);观察组自我症状管理行为评分均高于对照组(P<0.05)。结论症状管理教育有利于改善肺癌化疗患者核心症状群,减轻乏力、呼吸困难、咳嗽等症状,提高生活质量和自我管理水平。     

Association between self-report pain ratings of child and parent, child and nurse and parent and nurse dyads: meta-analysis

Title.  Association between self-report pain ratings of child and parent, child and nurse and parent and nurse dyads: meta-analysis.
Aim.  This paper is a report of a meta-analysis to investigate the association between self-report pain ratings for the dyads of child and parent, child and nurse and parent and nurse.
Background.  Existing research has shown conflicting results with regard to agreements of self-report pain ratings between the three dyads.
Data sources.  The CINAHL, Medline, Ovid and PsycINFO databases were searched using keyword, such as 'children/adolescents', 'parents/nurses', 'pain assessment', 'pain ratings', 'association' and 'agreement'. Studies published in English in or after 1990 were included.
Methods.  Meta-analysis methodology was applied to 12 pain assessment studies published between 1990 and 2007 which met the inclusion criteria. In the 12 studies a common effect size was estimated using the Pearson's correlation coefficient. Therefore, a fixed-effects model was chosen for this meta-analysis.
Results.  We found moderate summary effect sizes between self-reported pain ratings for the dyad of child and parent ( r  = 0·64) and the child and nurse dyad ( r  = 0·58) and a weak summary effect size of r  = 0·49 for the dyad of parent and nurse. The summarized effect sizes for each of the three dyads varied across the studies. A test of homogeneity ( Q -statistic) indicated that all effect size estimates were not homogeneous.
Conclusion.  Parents' and nurses' perceptions of children's pain should only be considered as estimates rather than expressions of the pain experienced, and not the same as children's self-reports. There is a need for education on selection of appropriate pain assessment scales in relation to the age and development of the child.     

Family caregiver knowledge of treatment intent in a longitudinal study of patients with advanced cancer

Goals of work Caregivers have become part of a triad of care and frequently attend patient consultations in the ambulatory cancer setting. Effective caregiving and decision making require that they understand the course of the disease and the changing treatment goals. This study sought to evaluate caregiver perception of treatment intent.Patients and methods A cohort of 317 subjects (181 patients and 136 caregivers) from The Canberra Hospital's Cancer Services were followed for 6 months. Caregiver understanding of patient treatment intent was measured over time together with sources of information.Main results Most caregivers understood that the illness was life-threatening (92% at week 12) and that treatment goals were to control illness and improve quality of life. Only half understood that treatment was noncurative (48% at week 12); 27% were unsure and 25% believed that treatment would cure. A high proportion of caregivers identified the specialist as the source of information (77%) and almost half also included the general practitioner (47%). These figures remained fairly constant over time. There were significant gender and age differences in understanding. At baseline, more women than men had an accurate perception of treatment intent and these numbers increased over time. Men's perception did not change.Conclusions Caregivers' ability to fully engage in the task of caring for those with a terminal illness may be hampered by their lack of understanding of the treatment patients receive.     

96例晚期癌症病人需求评估研究

[目的]了解晚期癌症住院病人的生理、心理、社会和精神等方面需求状况及影响因素。[方法]使用自制的晚期癌症病人需求评估问卷,选择两所医院住院且符合纳入标准的96例晚期癌症病人,对其进行问卷调查。[结果]晚期癌症病人的需求总分为53.44分±18.00分,有高、中度需求者占77.1%,且心理、精神、社会需求程度高于生理需求;自理能力与生理需求呈负相关;住院次数与心理需求程度呈正相关。[结论]被调查的96例晚期癌症病人的总需求程度处于中、高度水平,心理、精神、社会方面需求程度高于生理方面。     

Psychosocial consequences for children of a parent with cancer: a pilot study

When cancer is diagnosed in a parent, this may also have consequences for the children. The purpose of this pilot study was to gain more insight into the psychosocial consequences for children of a parent with cancer, from the perspective of both the children and their parents. For this study, 14 families participated in semistructured interviews and completed standardized questionnaires. Interviews were tape-recorded, transcribed, and analyzed using content analysis techniques. No significant difference was found in behavioral and emotional problems between the children in these families and the normative sample. However, parents reported problems on a borderline and clinically elevated level in one third of the children, and three of seven children self-reported problems on these levels. The interview results showed that parents reported (temporary) behavioral problems in most children during the acute stage of their parents' illness. Other problems, such as anxiety, sleeping disorders, and compulsive behavior, persisted for longer. Parents reported that their children had more problems than the children themselves reported. This finding was not supported by the quantitative analysis. The results from the Child Behavior Checklist and the Dutch version of the Family Adaptability and Cohesion Evaluation Scales showed that children of families with poor family functioning were more vulnerable. In particular, extremely high adaptation (chaotic) and extremely low family cohesion (disengaged) seemed related to the prevalence of emotional and behavioral problems in these children. Absence of home healthcare was an additional burden for adolescent children.