The impact of expanding the numbers of clinical nurse specialists in cancer care: a United Kingdom case study

In the last few years there has been an increase in the number of clinical nurse specialists (CNSs) working in cancer care throughout the UK. This paper examines the issues raised by the proliferation of site-specific cancer CNS posts, developed to give a 'nursing lead' for a particular tumour type. The issues common to all CNS posts are exacerbated when a number of specialists are involved in the cancer journey, causing potential fragmentation and confusion. Key issues need to be addressed if the role is to remain credible, and ensure clarity for patients and the multiprofessional team. These include role clarification, sensitive integration, interface with other cancer CNSs and the multiprofessional team, evaluation, cost, education and training, recruitment and succession planning and the 'career cul-de-sac'. Cancer nursing's response to these challenges will set the professional agenda for education, training and future models of service delivery.     

Measurement of cancer attitudes: a review

Many psychologists maintain that the attitudes we hold about a particular topic or subject will influence the way in which we behave towards it: positive attitudes lead to positive behaviours and vice versa. A literature search was conducted using the databases of MEDLINE and CINAHL. This produced research-based evidence showing that despite treatment advances, cancer remains one of the most feared of all diseases, not only among the public but also among oncology health-care professionals. However, the practice of measuring attitudes is fraught with difficulties. This review article will discuss the link between attitudes and behaviour and review pertinent literature regarding public and professional attitudes towards cancer before critically analysing the most common tools for evaluating cancer attitudes and making recommendations for the future of attitude measurement.     

Quantifying a relationship between tactile and vibration sensitivity of the human foot with plantar pressure distributions during gait.

OBJECTIVE: To quantify the relationship between the tactile and vibration sensitivity thresholds of the sole of the human foot with plantar pressure distribution while walking and running. DESIGN: Cross-sectional study performed in a laboratory setting. BACKGROUND: Results of previous studies of human locomotion have identified potentially dangerous variations in locomotion patterns. A common approach to manage these variations is with the use of orthotics. Individual responses to differences in the construction and shape of orthotics cannot be fully explained with a mechanical model. It has been suggested that sensory feedback from the receptors in the feet may play an important role in regulating gait patterns. METHODS: Fifteen subjects were recruited for this study. Pressure (tactile) and vibration thresholds were determined from each subject. Plantar pressure distributions were obtained while walking at 1.5 m s(-1) and running at 3.5 m s(-1). Sensitivity measurements were correlated to pressure measurements under the foot. RESULTS: Significant negative correlation exists between the vibration threshold of the hallux at 125 Hz and peak pressures under the hallux while walking (P=0.02) and running (P=0.01). A significant negative relationship was shown between the foot mean vibration threshold at 125 Hz with peak force during running (P=0.038). A similar trend was seen at the heel, lateral arch and first metatarsal head. CONCLUSIONS: The results from this study support recent hypotheses that suggest that the body can detect and respond to external stimuli. The relationship between plantar sensitivity and peak pressures at the hallux, and the relationship between sensitivity to higher frequency vibrations and peak force during running suggests that neurological feedback should be incorporated in to any model that attempts to explain gait patterns. RELEVANCE: It is suggested that the body is able to detect small biomechanical changes in the external environment and alter gait patterns as a defensive mechanism. Understanding the relationship between neural feedback and gait patterns will help in the development of criteria for the proper application of inserts, and the prevention of lower extremity injuries.     

Multidisciplinary patient care in rheumatoid arthritis: evolving concepts in nursing practice

Multidisciplinary patient care is essential in the management of rheumatoid arthritis (RA), a chronic potentially disabling, multisystem disease. Concepts of multidisciplinary care continue to evolve. While all team members can make valuable contributions to patient care, this chapter focuses in particular on continuing and changing aspects of team management. Of the many disciplines associated with rheumatology, nursing has undergone the most radical change in recent years. New roles have been defined and the nursing profession is now emerging with additional skills to support patients and their families. Concepts of patient education also continue to evolve. As the beneficial effects of education are demonstrated, a patient education programme should be seen as essential to the management of rheumatoid arthritis. Finally, the importance of counselling skills is emphasised.     

The impact of prostate cancer on men's everyday life

Prostate cancer impacts on the daily lives of men, particularly their physical and emotional health, relationships and social life. This paper highlights how men cope with disease and treatment and the strategies they employ to manage their diagnosis alongside daily life. Twenty‐seven men were interviewed at different stages in their disease pathway: nine men prior to radiotherapy, eight men at 6–8 months post radiotherapy and 10 men at 12–18 months post radiotherapy. A grounded theory approach was used to collect and analyse the data. Regardless of the point at which they were interviewed four areas emerged as important to the men: the pathway to diagnosis; the diagnosis; the impact of prostate cancer and its treatment on daily life; and living with prostate cancer. Prostate cancer was diagnosed using the prostate‐specific antigen (PSA) test, rectal examination and biopsy. Many men did not understand the consequences of a high PSA reading before they undertook the test. Painful investigative biopsies were viewed as the worst part of the disease experience. Radiotherapy was considered less invasive than other treatments, although preparatory regimes were associated with stress and inconvenience. Men used various strategies to deal with treatment‐induced threats to their masculinity in the long term.