Caregiver and Nurse Hopes for Recovery of Patients with Acquired Brain Injury

From the moment an adolescent with acquired brain injury (ABI) is admitted to the hospital, his or her caregiver develops hopes for the recovery and future of the patient; however, rehabilitation nurses have reported that these hopes are not always congruent with the nurse's observations of the adolescent's progression. The purpose of this study was threefold: (1) explore the caregiver's hope for recovery of his or her family member who has experienced an ABI, (2) compare the nurse's hopes for the patient with ABI to those of the caregiver, and (3) identify what caregivers and nurses do to maintain hope for recovery during the rehabilitation process. This qualitative study validated that in some cases there was a disconnect between caregivers' and nurses' hopes for recovery. Four themes related to the caregiver's maintenance of hope were identified: “the importance of family,” “taking one day at a time,” “knowing the patient better,” and “spiritual strength brings me through.” Enhancing the perceptual congruence between nurse and caregiver hope during rehabilitation will ultimately improve patient outcomes.     

A review on adherence management in patients on oral cancer therapies

PurposeThere is currently an ongoing paradigm shift in cancer treatment from intravenous (IV) chemotherapeutics to oral therapies. Additionally, the increased use of long-term maintenance therapy with oral targeted agents or chemotherapy is contributing to a shift toward a chronic-disease model. This shift is creating challenges and responsibilities for health care professionals in patient adherence management. This article will inform health care professionals of current trends and describe ways that they can overcome common barriers to adherence. A comprehensive review of recommendations and evidence derived from oncological studies describing adherence to oral targeted therapies and maintenance chemotherapy will provide guidance for the use of emerging oral maintenance therapies.MethodsArticles in the scientific literature were reviewed if published between January 1985 and November 2010. Searches were conducted using the PubMed database—search terms included “oral therapy,” “chemotherapy,” “cancer,” and “adherence” or “compliance.”ResultsThe change from IV therapy administered and monitored in hospitals or clinics to self-administered outpatient oral treatments decreases the likelihood of adherence. Methods, such as patient education and monitoring and involvement of family or caretakers, can improve adherence in patients undergoing treatment.ConclusionsAt treatment onset, oncology nurses can engage patients directly in a collaborative dialogue, and when issues affecting adherence arise, oncology nurses may limit nonadherence by providing individually tailored educational material. A practical approach to patient education, along with building strong health care provider–patient relationships, can help patients overcome nonadherence to new oral anticancer therapies and treatment paradigms.     

Truth-telling to patients' terminal illness: What makes oncology nurses act individually?

PurposeNurses encounter the challenge of truth-telling to patients' terminal illness (TTPTI) in their daily care activities, particularly for nurses working in the pervasive culture of family protectiveness and medical paternalism. This study aims to investigate oncology nurses' major responses to handling this issue and to explore what factors might explain oncology nurses' various actions.MethodsA pilot quantitative study was designed to describe full-time nurses' (n = 70) truth-telling experiences at an oncology centre in Taipei. The potential influencing factors of nurses' demographic data, clinical characteristics, and truth-telling attitudes were also explored.ResultsMost nurses expressed that truth-telling was a physician's responsibility. Nevertheless, 70.6% of nurses responded that they had performed truth-telling, and 20 nurses (29.4%) reported no experience. The reasons for inaction were “Truth-telling is not my duty”, “Families required me to conceal the truth”, and “Truth-telling is difficult for me”. Based on a stepwise regression analysis, nurses' truth-telling acts can be predicted based on less perceived difficulty of talking about “Do not resuscitate” with patients, a higher perceived authorisation from the unit, and more oncology work experience (adjusted R² = 24.1%).ConclusionsOncology care experience, perceived comfort in communication with terminal patients, and unit authorisation are important factors for cultivating nurses' professional accountability in truth-telling. Nursing leaders and educators should consider reducing nursing barriers for truth-telling, improving oncology nurses' professional accountability, and facilitating better quality care environments for terminal patients.     

Interprofessional collaboration with service users in the development of cancer services: The Cancer Partnership Project

Patient and Public Involvement (PPI) is a cornerstone of UK National Health Service (NHS) policy. The Cancer Partnership Project (CPP) is the leading national PPI initiative in cancer care. The CPP espouses a “partnership” model, with a “Partnership Group” – collaborative service improvement groups formed of NHS staff and service users – in each of 34 cancer networks in England. These groups aim to enable service users to influence local cancer service development and thereby improve the effectiveness of services. We interviewed 59 cancer service users and NHS staff in a reflective evaluation of CPP. Groups were active and visible in 30 networks, their main activities being: providing an accessible source of consumer opinion; prolific networking and representation; patient information and communication projects; and lobbying for service improvements. The groups exhibited some significant tensions. The motivations of professional staff varied markedly, and “obligatory” involvement as part of a person's job was counter-productive when not coupled with a “personal” belief in the value of PPI. Other controversial areas were the disclosure by patients' of personal health and treatment experiences, and emotional attachment to the group. It was concluded that partnership groups represent a useful PPI model, but more attention generally should be paid to the complexities of PPI and timescales required for meaningful cultural change.     

Realities and ideals: Experiences and needs of pediatric oncology nurses in communication processes with children and their families at the end-of-life period: A photovoice qualitative study

Effective communication in end-of-life care for pediatric cancer patients is crucial. Yet, limited research focuses on the communication experiences of pediatric oncology nurses during this period. This study aims to investigate the communication experiences and needs of these nurses with children and their families during the end-of-life period. A qualitative study design with photo voice methodology was followed. The research was conducted with 16 pediatric oncology nurses working in the pediatric oncology wards of a university hospital between January and May 2023. Data were collected the “Characteristic Information Form”, “Semi-Structured Interview Form”, and photovoice methodology. Data were analyzed through reflexive thematic analysis. Most of the nurses are at the undergraduate level, and their working experience in pediatric oncology wards ranges from 4 months to 17 years. Seven main themes emerged: Optimistic Communication-Interaction, Mindfulness, Active Coping, Behavioral Actions, Death Uncertainty Dilemma, Interpersonal and Environmental Factors, and Discrepancy between Ideals and Reality. The study sheds light on the importance of pediatric oncology nurses' ideals versus realities upstream approach in communicating with end-of-life children and their families, empowering pediatric oncology nurses on the journey to ideal end-of-life care.     

Promoting Family Integrity to Inspire Hope in Rehabilitation Patients: Strategies to Provide Evidence‐Based Care

The disability of one family member who requires inpatient rehabilitation care can negatively affect all family members and ultimately disrupt family integrity. The purpose of this article is to demonstrate how promoting family integrity also promotes hope when families are confronted with a newly disabled teen or adult. Current research findings indicate that rehabilitation nurses are in a key position to promote hope and family integrity by facilitating open communication between family members, fostering a tone of togetherness within and among families, and helping families resolve feelings of guilt and move toward forgiveness. These strategies are based on activities from the Nursing Interventions Classification (NIC) intervention “Family Integrity Promotion.” This article presents a review of research to support these NIC activities and offers practical suggestions so rehabilitation nurses can incorporate these strategies into their daily practice with patients and their family members.     

Knowing the family: Interpretations of family nursing in oncology and palliative care

PurposeFamilies are acknowledged as a focus of care in oncology nursing in many countries but the meaning of “family nursing” in this practice setting has received little attention from researchers and theorists. In this article, we report the findings of a study that explored family nursing practices in three adult cancer care settings: ambulatory care (medical and radiation oncology clinics), a palliative care service, and an in-patient unit.MethodData included in-depth interviews with 30 nurses and 19 families, as well as participant observations in each practice setting. The interviews were transcribed verbatim and the analyses guided by philosophical hermeneutics.ResultsWe identified several narratives related to family nursing practices, and in this article we offer the interpretations of two of these narratives: 1) knowing the family and being known; and 2) addressing family concerns and distress. In knowing the family and being known nurses opened relational space for families to become involved in the care of their loved ones and gained an understanding of the family by “reading” non-verbal and para-verbal cues. Knowing the family created opportunities for nurses to address family concerns and distress in meaningful ways. These included guiding families by being a bridge, helping families to conserve relationships, and negotiating competing family agendas. Nurses relied on questioning practices to create relational space with, and among, family members.ConclusionsImplications for the development of family nursing practice, theory, and education are discussed.     

Hospital and homecare nurses' experiences of involvement of patients and families in transition between hospital and municipalities: A qualitative study

Background

Involving patients and families in nursing care is essential to improve patients' health outcomes. Furthermore, families play an essential role in supporting patients by helping nurses understand the patient's everyday life. However, families also need support. Involvement of patients and families is especially important when patients are transferred between hospital and home as transitions heighten the risk of compromising quality and safety in care. However, no consensus exists on how to involve them. Consequently, this may challenge a systematic approach toward patient and family involvement.

Aim

To describe hospital and homecare nurses' experiences with involving patients and their family members in nursing care in the transition between hospital and municipalities.

Method

Focus group interviews were conducted in the Gastro unit at a large university hospital in Denmark. Participants included 10 hospital nurses from three wards at the Gastro unit and six homecare nurses from one of three municipalities in the hospital catchment area (total n = 16). Data were analysed using qualitative content analysis. The study is reported according to the Consolidated Criteria for Reporting Qualitative Research.

Findings

Our analysis revealed one overall theme – “The complexity of involvement” – based on four categories: gap between healthcare sectors increases the need for patient and family involvement, lack of time is a barrier to patient and family involvement, involvement is more than information, and involvement as a balancing act.

Conclusion

The nurses experienced patients' and families' involvement as essential, but a discrepancy was found between nurses' intentions and their actions. Aspects related to a gap between healthcare sectors and various understandings of involvement challenged the systematic involvement of patients and families in the transition between healthcare sectors. However, the nurses were highly motivated to achieve a close cross-sectoral collaboration and to show commitment towards patients and families.     

Evidence and individualization: Important elements in treatment for women with postpartum pelvic girdle pain

The aim of our study was to elucidate patients' experiences of a treatment program for postpartum pelvic girdle pain. The written information given by 47 women regarding their experiences with the treatment program was analyzed by qualitative content analysis. Three categories were identified from the patients' experiences: 1) “Treatment means involvement”; 2) “The interchange of knowledge and experience”; and 3) “Perceived change and meaning.” The treatment required the participants' involvement, individual adaptation, and focusing on the importance of building their capacity to master daily activities. The therapists were skilled, interested in each patient, and listened attentively. The program was evidence based and put into practice on a personalized basis. The dialogs of the therapist and patient were experienced as meaningful, creating insight, knowledge, and hope. The treatment facilitated a feeling of being in charge of their own bodies. The dialog and the individualized guidance seemed to be experienced as positive for the women's coping of their daily life. By being active agents in managing their pelvic girdle pain and therapy, they learned to set proximal goals. Perceived hope and self-efficacy appeared to be essential for developing a capacity for self-management and an enhanced ability to benefit from appropriate learning experiences.     

Emerging and Ongoing Survivorship Challenges Among Childhood Cancer Survivors and Providing Risk-Based Focused Follow-Up Care

ObjectivesTo provide a summary of the emerging and ongoing survivorship challenges facing childhood, adolescent, and young adult cancer survivors and their families.Data SourcesResearch and review articles, websites, and clinical guidelines specific to childhood cancer survivorship were used.ConclusionMany challenges exist in assuring quality long-term follow-up and risk-based screening for childhood cancer survivors. Although many childhood cancer survivors survive well into adulthood, they are at risk for a vast number of later complications of their cancer treatment necessitating annual cancer surveillance. In addition, many childhood cancer survivors are not engaging in long-term follow-up recommendations for clinic attendance, risk-based surveillance, and screening for potentially life-ending events. Pediatric oncology nurses and advanced practice nurses have played an enormous role in the design of childhood cancer survivorship programs and are an integral member of the multidisciplinary health care team who care for this population. Nurses have an obligation to continue to advance the survivorship care of childhood cancer survivors and lead interventional opportunities to improve the lifelong health-related quality of life and overall physical health.Implications for Nursing PracticePediatric oncology nurses and advanced practice registered nurses must have a working knowledge of the many late effects that childhood cancer treatment has on the long-term health of childhood cancer survivors. Nurses are well-placed in positions to continue the efforts begun more than 2 decades prior by pediatric oncology nurses who saw the value and necessity of designated survivorship programs.     

Using the Integrative Model of Behavioral Prediction to Understand Female Breast Cancer Survivors’ Barriers and Facilitators for Adherence to a Community-Based Group-Exercise Program

ObjectivesTo identify facilitators and barriers associated with adherence to the EXPINKT exercise program for breast cancer survivors in a convenience sample of women.Data SourcesFocus groups discussions; The Integrative Model of Behavioral Prediction.ConclusionFindings suggest that program adherence could be achieved by the establishment, via staff and processes, of a positive and safe exercise environment, which instills a sense of accountability while developing exercise self-efficacy. Further, multiple referral pathways and promotion of exercise benefit during and following treatment by oncology nurses may assist in enrolment in the program.Implications for Nursing PracticeOncology nurses may play a unique role in informing and stimulating female breast cancer survivors to partake in breast cancer-specific exercise programs. Results of this study show that most women are unaware of the benefits related to exercising in relation to cancer recovery, as well as the existence of breast cancer-specific exercise programs. Therefore, oncology nurses may play an important role in creating this awareness. Furthermore, shaping a route to adherence to such exercise programs is essential for breast cancer survivors to become and stay sufficiently active.     

Adaptaciones sexuales y sociales de las parejas masculinas indonesias de supervivientes de cáncer ginecológico

ObjectiveThis study explores the sexual and social adjustments of the partners of gynecological cancer survivors in Indonesia.MethodPhenomenological research interviewed seven male participants whose spouses sought gynecological cancer treatment at the Army Hospital in Jakarta from July to August 2020. The collected data were transcribed and thematically analyzed.ResultsThe male partners described their loss of sexual desire and intimacy. They indicated a constructed sexual and social adjustments, including having sexual distractions, alternative sexual activities, and performing extended roles in the family after their partner's diagnosis and treatment.ConclusionsThese research findings suggest that oncology and family nursing interventions should mitigate the gynecological cancer survivors and partners’ sexual and social distress to enhance the couple's relationship and well-being after a gynecological cancer diagnosis.     

The Who,What, Why,When, Where,and How of Team-Based Interdisciplinary Cancer Rehabilitation

ObjectiveTo review the key components necessary for successful application of rehabilitation principles to oncology survivors.Data SourcesValidated databases, including PubMed, MEDLINE, and Scopus.ConclusionRehabilitation is an essential component of cancer care that addresses functional needs for oncology survivors and is best accomplished via an interdisciplinary team. Interdisciplinary care, provided by nursing, physiatry, rehabilitation therapy, and exercise physiology, are critical components for comprehensive intervention. Challenges exist in implementing services, but opportunity also exists within the post-acute care sector.Implications for Nursing PracticeNurses play an important role in the screening, assessment, and treatment of cancer-related functional impairments.     

Family support for physical activity post‐myocardial infarction: A qualitative study exploring the perceptions of cardiac rehabilitation practitioners

Physical activity post‐myocardial infarction has numerous health benefits, yet uptake through cardiac rehabilitation is poor. Whilst family support can facilitate patients' recovery, little is known about the role family may play in supporting physical activity for post‐myocardial infarction patients. This qualitative study used semistructured interviews with 14 cardiac rehabilitation practitioners to explore their perceptions about the role of the family in supporting post‐myocardial infarction patients' physical activity. Data were transcribed verbatim and analyzed thematically. Three familial roles were identified: “family as a second pair of ears,” “family as physical activity regulators,” and “family as social support.” A fourth theme, “factors that influence family support,” described how family health beliefs and perceptions could influence the physical activity support provided. Practitioner perceptions suggest families play an important role in post‐myocardial infarction patients' physical activity, which is enhanced when families personally value physical activity. Integrating the family into cardiac rehabilitation may help facilitate physical activity‐related interactions and promote positive engagement for patients.     

Policy analysis of access to and reimbursement for nonpharmacologic therapies for cancer‐related fatigue

Cancer‐related fatigue (CRF) is an important public health issue that involves millions of community‐dwelling cancer survivors. CRF is the most debilitating patient reported symptom related to cancer therapies and exacts a significant economic and social toll. It adversely impacts patients' work, social relationships, and overall quality of life. CRF prevalence ranges from 30% to 90% during therapy and often persists months and years afterwards. This policy analysis examines the problem of lack of patient access to evidence‐based nonpharmacologic CRF therapies. The authors use a five‐step process described by Teitelbaum & Wilenski (2017) to address the problem statement, identify key stakeholders, explore problem landscape, describe two viable policy options, and make a recommendation. The two policy options considered were: (a) insurer reimbursements modeled after existing cardiac rehabilitation programs and (b) health care provider incentives that incorporate the oncology care model (OCM) quality measure. Advantages and disadvantages of both options are presented. Public health nurses are uniquely positioned in their communities to advocate for these changes to improve population health.     

乳腺癌患者社会支持团体参与意愿的质性研究

目的深入分析乳腺癌患者社会支持团体的参与意愿。方法采用焦点群体访谈法对16例乳腺癌患者分3组进行访谈,记录16例乳腺癌患者社会支持团体的参与意愿。结果根据计划行为理论的观点整理访谈资料,共显示出4个主题:社会支持团体在乳腺癌患者心理调节方面作用突出,医护人员、病友、家属的意见影响乳腺癌患者参与社会支持团体的意愿,乳腺癌患者参加社会支持团体的阻碍因素较多,大多数患者参与社会支持团体活动的意愿强烈。结论护士在组织社会支持团体活动时,应加强管理,积极进行心理辅导,联系其他人员给予专业的信息支持,培训符合条件的病友成为志愿者去帮助他人;同时通过建立网站、开设QQ群、电话联系等形式吸引病友参加。     

Ostomy care and rehabilitation in colorectal cancer

OBJECTIVES: To review ostomy care in colorectal cancer, current trends in assessment, management, and treatment, and the role of the enterostomal therapy (ET) nurse in cancer care. DATA SOURCES: Published literature and the author's clinical experiences in ostomy wound care. CONCLUSION: Care of the patient with colorectal cancer requiring an ostomy involves both physical and psychological rehabilitation. The education and skills of an ET/wound, ostomy, and continence (WOC) nurse can provide a valuable service to the patient/family, surgeon, oncology nurse, and other health care providers. IMPLICATIONS FOR ONCOLOGY NURSES: An ostomy is not a handicapping procedure. Living well with a colostomy can be achieved through proper patient preparation, education, and planning. Provision of individualized comprehensive care facilitates physical and psychological rehabilitation.