The impact of occupational stress on nurses’ caring behaviors and their health related quality of life

Background

Nursing is perceived as a strenuous job. Although past research has documented that stress influences nurses’ health in association with quality of life, the relation between stress and caring behaviors remains relatively unexamined, especially in the Greek working environment, where it is the first time that this specific issue is being studied. The aim was to investigate and explore the correlation amidst occupational stress, caring behaviors and their quality of life in association to health.

Methods

A correlational study of nurses (N?=?246) who worked at public and private units was conducted in 2013 in Greece. The variables were operationalized using three research instruments: (1) the Expanded Nursing Stress Scale (ENSS), (2) the Health Survey SF-12 and (3) the Caring Behaviors Inventory (CBI). Univariate and multivariate analyses were performed.

Results

Contact with death, patients and their families, conflicts with supervisors and uncertainty about the therapeutic effect caused significantly higher stress among participants. A significant negative correlation was observed amidst total stress and the four dimensions of CBI. Certain stress factors were significant and independent predictors of each CBI dimension. Conflicts with co-workers was revealed as an independent predicting factor for affirmation of human presence, professional knowledge and skills and patient respectfulness dimensions, conflicts with doctors for respect for patient, while conflicts with supervisors and uncertainty concerning treatment dimensions were an independent predictor for positive connectedness. Finally, discrimination stress factor was revealed as an independent predictor of quality of life related to physical health, while stress resulting from conflicts with supervisors was independently associated with mental health.

Conclusion

Occupational stress affects nurses’ health-related quality of life negatively, while it can also be considered as an influence on patient outcomes.

     

Long-term impact of stroke on patients’ health-related quality of life

Purpose: This international study aims to examine the size and determinants of the impact of stroke on five-year survivors’ health-related quality of life (HRQoL) in four different European countries.

Method: Patients were recruited consecutively in four European rehabilitation centers. Five years after stroke, the EuroQol-visual analog scale (EQ-VAS) was administered in 226 first-ever stroke patients. Impact of stroke was determined by calculating EQ-VAS z-norm scores (= deviation – expressed in SD – of patients’ EQ-VAS level relative to their age-and gender-matched national population norms). Determinants of EQ-VAS z-norm scores were identified using multivariate linear regression analysis.

Results: Five years post-stroke, patients’ mean EQ-VAS was 63.74 (SD?=?19.33). Mean EQ-VAS z-norm score was ?0.57 [95%CI: (?0.70)–(?0.42)]. Forty percent of the patients had an EQ-VAS z-norm score SD; 52% had an EQ-VAS z-norm score between ?0.75 and?+0.75 SD, only 8% scored >+0.75 SD. Higher patients’ levels of depression, anxiety and disability were associated with increasingly negative EQ-VAS z-norm scores (adjusted R^2?=^?0.392).

Conclusions: Five years after stroke, mean HRQoL of stroke survivors showed large variability and was more than ½ SD below population norm. Forty percent had a HRQoL level below, 52% on, and 8% above population norm. The variability could only partially be explained by the variables considered in this study. Longitudinal studies are needed to increase our understanding of the size and determinants of the impact of stroke on the HRQoL of long-term stroke survivors.

• Implications for rehabilitation

• The current European concept of stroke rehabilitation is focused on the acute and sub-acute rehabilitation phase, i.e., in the first months after stroke. The results of this study show that at five years after stroke, the mean level of HRQoL of stroke survivors remains below the healthy population level. This finding shows the need for continuation of rehabilitation in the chronic phase.

• At five years after stroke, higher patients’ levels of depression, anxiety and disability were associated with lower scores for HRQoL. This finding implicates that chronic rehabilitation programs should be multi-faceted in order to increase long-term survivors’ psychosocial outcomes.

     

Impact of cancer patients’ quality of life on that of spouse caregivers

Goals of work This study aimed to examine the correlation between quality of life (QOL) in cancer patients and that of their spouse caregivers and to identify factors that influence this correlation.Patients and methods This cross-sectional study collected data from 121 cancer patient/spouse caregiver dyads. The Functional Assessment of Cancer Therapy Scale-General (FACT-G) was used to measure patients QOL, and the Caregiver Quality of Life Index (CQLI) was used to measure spouse caregivers QOL. Correlation coefficients between patients and caregivers QOL were computed for four dimensions of QOL, as well as a total score for QOL. Correlations between patients and caregivers total QOL scores were furthered analyzed by three groups of factors: disease-/treatment-related, caregiving-related, and relationship-related variables.Main results Only the social/family and functional dimensions of patient QOL and total score for patient QOL were associated with each dimension of their caregivers QOL and with the total score (r=0.27–0.44). Physical and emotional dimensions of patients QOL did not significantly influence spouse caregivers QOL for any dimension nor for the total score. Factors influencing the association between patients and caregivers overall QOL included cancer diagnosis, length of hospitalization, caregiving intensity and duration, marital satisfaction, and caregiving self-esteem.Conclusions Social and functional aspects of patients QOL play a significant role in determining the QOL of their spouse caregivers. The strength of association between patients and spouse caregivers overall QOL can be moderated by some factors.     

CuidaCare: effectiveness of a nursing intervention on the quality of life’s caregiver: cluster-randomized clinical trial

Background

In Spain, family is the main source of care for dependent people. Numerous studies suggest that providing informal (unpaid) care during a prolonged period of time results in a morbidity-generating burden. Caregivers constitute a high-risk group that experiences elevated stress levels, which reduce their quality of life. Different strategies have been proposed to improve management of this phenomenon in order to minimize its impact, but definitive conclusions regarding their effectiveness are lacking.

Methods/Design

A community clinical trial is proposed, with a 1-year follow-up period, that is multicentric, controlled, parallel, and with randomized allocation of clusters in 20 health care centers within the Community of Madrid. The study's objective is to evaluate the effectiveness of a standard care intervention in primary health care (intervention CuidaCare) to improve the quality of life of the caregivers, measured at 0, 6, and 12 months after the intervention. One hundred and forty two subjects (71 from each group) ≥65 years, identified by the nurse as the main caregivers, and who provide consent to participate in the study will be included. The main outcome variable will be perceived quality of life as measured by the Visual Analogue Scale (VAS) of EuroQol-5D (EQ-5D). The secondary outcome variables will be EQ-5D Dimensions, EQ-5D Index, nursing diagnosis, and Zarit's test. Prognostic variables will be recorded for the dependent patient and the caregiver. The principle analysis will be done by comparing the average change in EQ-5D VAS value before and after intervention between the two groups. All statistical tests will be performed as intention-to-treat. Prognostic factors' estimates will be adjusted by mixed-effects regression models. Possible confounding or effect-modifying factors will be taken into account.

Discussion

Assistance for the caregiver should be integrated into primary care services. In order to do so, incorporating standard, effective interventions with relevant outcome variables such as quality of life is necessary. Community care nurses are at a privileged position to develop interventions like the proposed one.

Trial registration

This trial has been registered in ClinicalTrials.gov under code number NCT01478295.     

Three-month follow-up effects of a medication management program on nurses’ knowledge

This quasi-experimental study examined the effects of a medication management program on nurses knowledge of medication management, three months after program completion. Fifty-seven nurses took a multiple-choice test both immediately after the program and three months later. Changes in test performance were assessed using McNemar's test and generalized estimating equations for binary outcomes. Test results were generally consistent from immediately post-program to three months later, though four items differed significantly. From immediately post-program to three months later, fewer nurses correctly answered the items: documenting no medication administration (98.2 vs 86.6, p = 0.04); documenting opioid administration (56.1 vs 33.3, p = 0.01); and observation after opioid administration (35.1 vs 19.3, p = 0.08. Significantly more nurses correctly answered the item concerning the pharmacology of medication administered with food (64.9 vs 77.2, p = 0.09). We recommend both continuous medication management training and focusing on the correspondence between theory-based knowledge and clinical practice routines.     

Does reflexology impact on cancer patients' quality of life?

AIM: The objective of this study was to determine whether reflexology has an impact on the quality of life of patients in the palliative stage of cancer. METHOD: Twelve patients in the palliative stage of cancer with various tumour types were randomised into two groups. They were randomly assigned to receive either reflexology or placebo reflexology. All participants completed a linear analogue self-assessment scale relating to quality of life. All participants then received three sessions of either reflexology or placebo reflexology. The same person, a qualified reflexologist, provided the interventions for both groups. The participants were not aware of which intervention they were receiving. All participants then completed a second linear analogue self-assessment scale relating to quality of life. RESULTS: All participants felt that their quality of life had improved, even those who had received the placebo treatment. The reflexology group, however, reported more benefit than the placebo group. There was a significant difference (p = 0.004) between the reflexology group and the placebo group. CONCLUSION: This study showed that reflexology does have an impact on the quality of life of patients in the palliative stage of cancer.     

The mediating effect of caregiver burden on the caregivers’ quality of life

[Purpose] Quality of life (QoL) can be closely related to caregiver burden, which may be a potential mediating effect on the relationships among stroke patient caregivers. This study investigated the predictors of caregiver’s QoL based on patient and caregiver characteristics, with caregiver burden as a mediator. [Methods] This study was conducted using surveys, a literature review, and interviews. Survey data were collected from 238 subjects, who were diagnosed with stroke, and their family caregivers from October 2013 to April 2014. [Results] Caregiver health status, income, spouses caring for patients, and duration of hospitalization were identified as significant predictors of caregivers’ QoL with a mediating effect of caregiver burden. The time spent on caregiving per day and patient education level were the only direct predictors of caregivers’ QoL. [Conclusion] The responsibility of caring for patients with stroke, in particular for a spouse, must be administered by means of a holistic family-centered rehabilitation program. In addition, financial support and availability of various health and social service programs must be comprehensively provided in order to maintain caregivers’ well-being.Key words: Caregivers, Stroke, Quality of life     

Chemotherapy-induced nausea and vomiting in clinical practice: impact on patients’ quality of life

Background

Chemotherapy-induced nausea and vomiting (CINV) in cancer patients are common symptoms most feared by patients. The aim of this study was to analyze the impact of CINV associated to moderate/highly emetogenous chemotherapy regimens on patients’ quality of life (QoL).

Patients and methods

Open, multicenter, prospective observational study was performed. Each patient filled out a patient diary for each cycle from the day before chemotherapy and for the next 5?days that included the number of emetic episodes, the intensity of nausea, and QoL evaluation (functional living index-emesis questionnaire).

Results

Data from 202 consecutive patients from nine university hospitals were collected, but only data from 160 were analyzed (79.2?%). Most of the participants (70?%) were women with a mean age of 50?years (SD 1.2?years). The most frequent cancer site was breast (44?%) followed by lung (16?%) and 76.3?% were receiving highly emetogenous chemotherapy. Despite the use of antiemetic prophylaxis, patients experienced significant nausea and vomiting during 31?% (3.2?% during acute, 15.0?% during delayed phase, and 13.2?% during both phases) and 45.1?% (5.1?% only during the acute phase, 23.5?% only during the delayed phase and 16.5?% during both phases) of the cycles, respectively, having 44.5?% (nausea) and 39.3?% (emesis) of the cycles an impact on patients’ QoL.

Conclusions

The results of the study confirm the detrimental effect of CINV on patients’ QoL despite the use of antiemetic prophylaxis (5HT₃ receptor antagonist, steroids, and dopamine receptor antagonists). It is mandatory to intensify the detection of CINV in order to improve the management of these important, albeit frequent, side effects of cancer treatments.     

Do the self-concept and quality of life decrease in CP patients? Focussing on the predictors of self-concept and quality of life

Purpose.?To find out if the quality of life (QOL) and self-concept of the children with cerebral palsy (CP) was different from that of children without disability, to investigate predictive variables that could affect self-concept and QOL.

Methods.?A total of 40 children with CP and 46 age-matched peers were included. The baseline characteristics including sex, type of CP, the level of disability according to Gross Motor Function Classification System (GMFCS) were recorded. Education levels of both children and parents, demographic features of parents, features of living area, usage of devices and associated impairments were filled out. Self-concept was measured using Piers–Harris Self-concept (PH) Scale. Quality of life was measured by Pediatric Quality of Life Inventory 4.0 (PedsQL). The physical and psychosocial health subscale scores of PedsQL (P-PedsQL and PS-PedsQL) were recorded.

Results.?Significant differences in mean scores favouring the control group were found for PH scale, PedsQL scale (p?<?0.001). P-PedsQL and PS-PedsQL of the CP group were lower than the control group (p?<?0.001). PS-PedsQL report was significant predictor of self-concept. The presence of incontinence and GMFCS level were significant predictors of PedsQL and PPedsQL, respectively.

Conclusion.?Self-concept and QOL of the CP children were lower than the children without CP. Presence of incontinence, self-concept rating and GMFCS level were important to predict domains of QOL.     

Quality of life—a measure of the quality of nursing care?

Quality of life is a very complex phenomenon in the life of cancer patients. Individual perceptions might change with the state of disease and with necessary interventions. Some definitions seem to be more useful in cancer care than others. There has been considerable controversy in the quantity versus quality debate. Some confusion in the measurement of quality of life concerns objectivity and subjectivity, referring either to the content of information or to persons other than the patient eliciting it. The relation between quality of life and quality of care has to be further explored: some dimensions of care might be of little or of potential relevance to the patient's quality of life. The dimensions of proven relevance concern psychological well-being through, for example, promotion of self-care or an enhanced perception of self-worth. These findings emphasise the importance of the concept of care, which is the essence of nursing. Contemporary professional and political difficulties require critical analysis.     

Effects of a pedometer-based walking intervention on young adults’ sleep quality,stress and life satisfaction: Randomized controlled trial

ObjectiveThe purpose of this study was to evaluate the effect of daily walking exercise on sleep quality, perceived stress and life satisfaction. It aimed to investigate the interaction between daily walking exercise and sleep components (sleep quality, sleep latency, sleep duration, sleep disturbance, sleep medication use, and daytime functioning).MethodsA four-week randomized control trial (RCT) was conducted by assigning 54 research volunteers into two groups randomly. The participants in the intervention group (IG) were asked to carry out a daily aerobic walking exercise (DAWE), and participants in the control group (CG) were requested to maintain a sedentary life style. Sleep quality, perceived stress and life satisfaction were assessed at the baseline and at the end of the intervention. All participants were equipped with Omron HJ-112 pedometer to record their daily exercise and to fulfil a daily diary sheet.ResultsBy the end of the intervention, 26 out of 54 participants (M_age = 24.96; SD = 5.13) completed the task. There was no statistical significance between the two groups when comparing global sleep quality, stress and life satisfaction. The within group comparison showed positive effect of DAWE on subjective sleep quality (p = 0.05), less sleep medication use (p < 0.05), positive effect on daytime function (p < 0.01) and improved life satisfaction (p = 0.05) after four weeks of intervention.ConclusionFindings suggested that incorporating daily aerobic walking exercise might be beneficial to sleep health. Further studies are suggested to ascertain the pedometer-based daily walking exercise's long-term effects and to unfold the biological mechanisms leading to its sleep quality improvement effect.     

Effects of singing on voice,respiratory control and quality of life in persons with Parkinson’s disease

Purpose Interventions focused on singing may provide additional benefits to established voice and respiratory therapies, due to their greater emphasis on the respiratory muscle control system in those with Parkinson’s disease (PD) progresses. The purpose of this study was to examine if singing can improve voice, respiratory pressure and quality of life (QOL) in persons with PD. Methods This pilot study measured the effects of a singing intervention in 27 participants with PD. Participants were assigned to a high (met twice weekly) or low (met once weekly) dosage group. Voice, respiratory and QOL measures were recorded before and after an 8-week singing intervention. Sessions were led by board-certified music therapists and included a series of vocal and articulation exercises and group singing. Results Both groups demonstrated significant improvements in maximum inspiratory and expiratory pressure, as well as phonation time. While other voice measures improved, they did not reach statistical significance. Voice QOL and whole health QOL also significantly improved. Conclusion These results suggest singing may be a beneficial and engaging treatment choice for improving and maintaining vocal function and respiratory pressure in persons with PD.

• Implications for Rehabilitation

• In a small sample, group singing proved beneficial for improving voice and respiratory impairment in persons with Parkinson’s disease.

• Completing group singing one time per week for 8 weeks was as effective as completing group singing two times per week for 8 weeks in persons with Parkinson’s disease.

• Group singing is an effective means of improving overall quality of life in persons with Parkinson’s disease.

     

The effect of a community-based spiritual life review program on Indonesian elders’ resilience

Objective

This quasi-experimental, pre-/post-test study aimed to examine the effect of a community-based spiritual life review program on the resilience of elders residing in a disaster-prone area.

Impact of branchoplasty plus pulmonary lobectomy on quality of life in lung cancer patients

Background：Withregardtoimprovementofmortalityasso－ciatedwithoperation，５－yearsurvivalrate，andqualityoflife，branchoplastypluspulmonarylobectomyisworthapplyinginclin－ic．Objective：Toinvestigatetheimpactofbranchoplastypluspulmonarylobectomyonqualityoflifeinlungcancerpatients．Unit：DepartmentofChestSurgeryofFifthPeople＇sHospitalofDalian．Subjects：４４casesofprimarylungcancerpatientswerere－cruitedfrom１９９０to２０００．Allpatientsunderwentbranchoplastypluspulmonarylobectomy．Patien…