Do nurses and cancer patients agree on cancer patients' coping resources,emotional distress and quality of life?

The present study examines differences, associations and agreement in cancer patients' and their nurses' ratings of cancer patients' coping resources, emotional distress and quality of life. The study sample includes 90 individual patient–nurse pairs. The patient and nurse in each pair independently completed the Cancer Behaviour Inventory, the Hospital Anxiety and Depression Scale and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being. The results indicate a distinct pattern in which nurses overestimate patients' emotional distress and underestimate patients' coping resources and quality of life. A nurse who overestimated a patient's emotional distress and underestimated his/her resources for handling the situation was also likely to underestimate the patient's quality of life. Patient–nurse pairs who demonstrated consistent agreement differed from remaining pairs in that they had a larger percentage of nurses with advanced education and previous responsibility for their patients' care and in that they had higher frequencies of patients who had previously received care at the ward >5 days. Nurses caring for patients with cancer should be aware of the risk of making systematic misjudgements of patients' status. Increased attention to patients' internal resources may improve nurses' ability to make correct assessments and plan for individualized care.     

Use of health-related quality-of-life assessments in daily clinical oncology nursing practice: a community hospital-based intervention study

BACKGROUND: The current study evaluated the efficacy of incorporating standardized health-related quality of life (HRQL) assessments as a routine part of the outpatient chemotherapy treatment of cancer patients in a community hospital in terms of: 1) facilitating nurse-patient communication, 2) increasing nurses' awareness of patients' HRQL, 3) patient management, 4) patients' satisfaction, and 5) patients' HRQL. METHODS: The study employed a sequential cohort design with repeated measures. Ten nurses and 219 patients participated in this community hospital-based study. The intervention involved patients completing standardized HRQL questionnaires via a touch-screen computer, the results of which were provided to nurses and patients in a graphic summary. Questionnaire and medical record data were used to assess outcomes. RESULTS: HRQL-related topics were discussed significantly more frequently in the intervention group than in the control group (mean = 4.8 topics vs 3.8 topics, respectively; P = .02). Nurses' awareness of patients' levels of daily activity, pain, and overall quality of life was significantly better in the intervention than the control group. The mean number of HRQL-related notations in the medical records was significantly higher in the intervention group (24 vs 20; P< .05). Only modest effects were observed in patient management (counseling behavior), and no significant effects were found in patient satisfaction or changes in HRQL over time. CONCLUSIONS: Incorporating standardized HRQL assessments in daily clinical oncology nursing practice primarily facilitates the discussion of HRQL issues and increases nurses' awareness. Additional efforts are needed to enhance the effect of routine HRQL assessments on patient management and HRQL.     

Oncology nurses' teaching and support for suicidal patients

Although the nursing literature contains many references to the nurses' teaching, support, and advocacy functions, the consumer and other health care professional literature suggests that the potential importance of nurses in these roles is not widely accepted. In a secondary analysis, we examined nurses' interventions for teaching and support in survey of a random sample of oncology nurses in a national organization. Clinical oncology nurses (n = 454) reported their attitudes to and knowledge about suicidal patients. They reported their goals, interventions, and emotional support for a suicidal patient. When nurses described their care, they rarely mentioned patient teaching, emotional support, and advocacy. A gap also existed between the recommended assessments, related goals, and interventions. The nurses' difficulties in responding therapeutically to suicidal patients also emerged from their religious/other values, uncomfortable feelings, inadequate knowledge, personal experiences, and weight of professional responsibility. A small percentage of oncology nurses with good psychiatric skills reported they had no difficulty in their caregiving role including teaching, support, and advocacy.     

Twice-daily pain monitoring as standard clinical practice for inpatients at a medical oncology unit: a descriptive study.

BACKGROUND: Very limited experiences have explored the use of pain intensity monitoring in everyday clinical practice at a medical oncology inpatient unit. METHODS: The program 'Pain-Free Hospital,' including a training course for nurses and the recording every 12 h of a visual analog scale (VAS) rating in all the patients admitted to the inpatients' ward independently of their disease stage, was activated in 2002. An audit on the clinical charts of patients admitted for the first time in the first semester of 2003 was carried out in order to ascertain the applicability of the procedure and its congruence with patients' clinical status. RESULTS: The VAS rating was reported in 211 out of 223 (94.6%) clinical charts. At entry, 60 out of 211 (28.4%) patients presented VAS>or=1, 21 (35%) of whom were not taking any analgesics. The mean VAS score>or=1 was 3.4. No statistically significant difference emerged in the distribution of VAS rating as regards disease extension, presence or absence of bone metastases and performance status. CONCLUSIONS: The systematic monitoring of VAS by nurses at a medical oncology inpatients' ward is feasible with a good patient compliance. The reliability of the procedure in terms of guiding the analgesic treatment has yet to be demonstrated.     

Pain education for underserved minority cancer patients: a randomized controlled trial.

PURPOSE: Previous studies found that African American and Hispanic cancer patients are at risk for undertreatment of pain. We evaluated the efficacy of a pain education intervention for underserved minority patients. PATIENTS AND METHODS: Ninety-seven underserved African American and Hispanic outpatients with cancer-related pain were enrolled onto a randomized clinical trial of pain management education. The patients in the education group received a culture-specific video and booklet on pain management. The control group received a video and booklet on nutrition. A research nurse met with each patient to review the materials. We measured changes in pain intensity and pain-related interference 2 to 10 weeks after the intervention, as well as changes in quality of life, perceived pain control, functional status, analgesics, and physician pain assessments. RESULTS: Physicians underestimated baseline pain intensity and provided inadequate analgesics for more than 50% of the sample. Although the ratings for pain intensity and pain interference decreased over time for both groups, there was no statistically significant difference between groups. Pain education did not affect quality of life, perceived pain control, or functional status. African American patients in the education but not the control group reported a significant decrease in pain worst ratings from baseline to first follow-up (P < .01), although this decrease was not maintained at subsequent assessments. CONCLUSION: Brief education had limited impact on pain outcomes for underserved minority patients, suggesting that more intensive education for patients and interventions for physicians are needed.     

The burden of pain of inpatients undergoing radiotherapy--discrepancies in the ratings of physicians and nurses

BACKGROUND: The aim of this study was to rate the burden of pain of cancer patients receiving radiotherapy from the point of view of the patients themselves as well as the physicians and nurses caring for the patient, and to examine possible differences in the ratings. PATIENTS AND METHODS: 68 cancer patients received a pain questionnaire about pain intensity and subjective well-being. At the same time, physicians and nurses answered 7 pain-related questions about each patient. RESULTS: 34% of the patients reported strong or very strong pain in the past week, 8% even unbearable pain. 66% felt psychologically distressed, 70% developed anxiety because of pain. 74% believed that pain is an essential part of the disease. Nurses and physicians often underestimate patients' burden of pain. Nevertheless, the rating of the nurses is more accurate than that of the physicians. CONCLUSION: Physicians and nurses often underestimate pain intensity. It seems that several patients are unable or unwilling to express their pain or that therapists lack adequate methods of pain assessment. To optimize pain treatment, communication between patients, physicians and nurses needs to be improved.     

基于疼痛评估表的癌痛医护评估不一致原因分析

目的:探讨癌痛医护评估不一致的原因.方法:以疼痛评估表为基础设计查检表,查检我科2015年12月1日至2016年1月31日新人院患者共48例在癌痛部位、类型、性质、强度、持续时间、频率共六方面医护评估不一致情况;针对评估不一致集中的主要方面进行开放式问卷调查,对其原因进行分析.结果:查检结果显示医护癌痛不一致主要表现在癌痛持续时间、频率、强度方面(分别为50.00％、50.00％、47.92％);评估不一致问题的原因主要包括:医护人员对于癌痛评估不重视、培训不够、医护人员代替患者进行评估、评估量表内容不熟悉、患方不能准确表述、患者疾病知识的缺乏、对于患者的癌痛宣教不够、患者床旁癌痛宣传资料欠缺、患者意识状态异常及医护患缺乏有效的沟通.结论:由于多方面原因,癌痛在医护评估上存在较大差异,传统的以护士为主体的评估存在片面性,医护共同评估能够更好的反应患者的真实情况,而加强医护培训,提高患者的知晓率及依从性是准确评估的基础.     

Nurses' perceptions of their pain assessment skills, pain management practices, and attitudes toward pain

Nursing pain assessments are influenced by the length of available tools, patient characteristics, patient pathology, concern about addictive behavior, and characteristics of the nurse. The relationship among these variables was explored in a sample of community hospital nurses (N = 59) and ONS members (N = 19). Although a number of interesting similarities were found in the two groups, age, professional and continuing education, and care setting appear to be related to differences in pain assessment practices. Implications for practice, research, and education include teaching nurses to: assess factors related to quality of life in the pain experience, assess and validate data from families, assess coping skills, and teach patients to use behavioral pain management strategies. The findings also suggest that further study is needed concerning the relationship between personal beliefs and experiences and the assessment and management of pain. Membership in professional organizations appears to be associated with comprehensive approaches to the assessment and management of cancer pain and should be addressed in further research.     

Oncology Nurses Knowledge and Attitudes Regarding Cancer Pain Management

Background: Oncology nurses play a crucial role in cancer pain management and must be highly informed to ensure their effective practice in the cancer setting. The aim of this study was to determine the baseline level of knowledge and attitudes of oncology nurses regarding cancer pain management. Materials and Methods: A cross-sectional survey research design was employed. The sample comprised 58 cancer nurses working in Shahid Sadoughi hospital, Yazd, Iran. The ‘’Nurses Knowledge and Attitudes Survey Regarding Pain’’ (NKAS) tool and a demographic form were utilized to ascertain the knowledge and attitudes of oncology nurses working in oncology settings. Results: The average correct response rate for oncology nurses was 66.6%, ranging from 12.1% to 94.8%. The nurses mean score on the knowledge and attitudes survey regarding pain management was 28.5%. Results revealed that the mean percentage score overall was 65.7%. Only 8.6% of nurse participants obtained a passing score of 75% or greater. Widespread knowledge deficits and poor attitudes were noted in this study, particularly regard pharmacological management of pain. Conclusions: The present study provides important information about knowledge deficits in pain management among oncology nurses and limited training regarding pain management. Our results support the universal concern of inadequate knowledge and attitudes of nurses regarding cancer pain. It is suggested educational and quality improvement initiatives in pain management could enhance nurses knowledge in the area of pain and possibly improve practice.     

Attitudes towards pain management in hospitalized cancer patients and their influencing factors

Objective:To investigate patients' attitudes towards cancer pain management and analyze the factors influencing these attitudes.Methods:The self-developed Demographic and Disease-Related Information Questionnaires,Pain Management Barriers Questionnaire-Taiwan form (BQT),and Pain Knowledge Questionnaire were administered to 363 pairs of hospitalized cancer patients and their caregivers from the oncology departments of 7 hospitals in Beijing,China.Results:The average patient score for attitudes towards pain management was 2.96±0.49.The dimension scores indicated good attitudes in three areas (scores ＜2.5),"Desire to be good" (2.22±1.04),"Fatalism" (2.08±0.81) and "Religious fatalism" (1.86±1.00),and poor attitudes in six areas (scores ≥2.5),"Tolerance" (3.83±0.96),"Use of analgesics as needed (p.r.n.)" (3.73±1.01),"Addiction" (3.44±1.05),"Disease progression" (3.28±1.26),"Distraction of physicians" (3.16±1.07) and "Side effects" (2.99±0.68).Two factors were entered into the regression equation:the caregivers' attitudes towards cancer pain management and the patients' pain knowledge.These two factors explained 23.2％ of the total variance in the patients' average scores for their attitudes towards cancer pain management.Conclusions:The patients' attitudes towards cancer pain management were poor and could be influenced by the caregivers' attitudes and the patients' pain knowledge,and thus need to be improved.     

对护理人员进行疼痛知识教育的体会

目的了解护理人员对疼痛知识的了解情况,并对比疼痛教育前后的变化,促进对疼痛患者的护理。方法采用多种形式授课与实践中传帮带相结合的办法,在制度上实行整体护理,并进行了疼痛相关知识了解程度的对比分析。结果经过疼痛相关知识的教育后,护理人员在这方面的认识有了极大的提高,并能在实践中严格护理技术操作常规,细致观察病情变化和治疗后的毒副作用,发现问题及时处理,同时做好患者的心理护理,把整体护理制度落到实处。结论对护理人员进行疼痛知识的教育十分重要,且应常抓不懈,作到因材因时施教,随时总结经验教训并相互交流,其中护士长的作用极为关键。