Prevention of mucositis in cancer patients.
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Antineoplastic Agents↗
Biomedical subjects
D B McGuire
Publications and source records attributed to D B McGuire.
Use of focus groups for pain and quality of life assessment in adults with sickle cell disease.
This study assessed the effectiveness of using focus groups to obtain information about the characteristics of pain and quality of life in adults with sickle cell disease and their families. Five focus group sessions were held. Four groups consisted of adults diagnosed with sickle cell disease and one was composed of family members. Although focus groups were useful for addressing the purposes of the study, several volunteers in the patient group were unable to attend due to the occurrence of pain episodes. Adults with sickle cell disease identified recurring disabling pain and its consequences as interfering with their physical, emotional, and social quality of life. Several reported a pain aura that signaled the initiation of a painful episode. Useful self-care techniques and coping strategies were also identified. Common emotional responses included anger, hostility, depression, disenfranchisement, death anxiety and fatalism. The belief by those with sickle cell disease that health professionals viewed them as drug dependent often fueled angry and hostile responses. Religion was a major source for coping. Family members' quality of life was affected and they felt the negative impact of sickle cell disease on family relationships. Family members also reported feelings of helplessness, guilt, and parental self-blame. Health care providers could use information gained through this study to positively influence the care of adults with sickle cell disease.
Adaptation, Psychological↗
Research and oncology nursing practice.
OBJECTIVE: To trace the evolution of oncology nursing research and to discuss its contribution to oncology nursing practice and health care. DATA SOURCES: Articles, textbooks, organizational documents, conference proceedings, and personal communication. CONCLUSIONS: Placing research in perspective will help suggest where we should go as a nursing specialty to provide excellent cancer care to patients, families, communities, and populations. It will also suggest directions for research priorities and for conceptual, methodologic, and health policy activities. IMPLICATIONS FOR NURSING PRACTICE: To influence oncology care, it is essential that oncology nurse researchers be responsive to trends that are relevant to both the conduct and utilization of oncology nursing research.
History, 20th Century↗
Implementation of an oral care standard for leukemia and transplantation patients.
The purpose of this project was to develop an oral care standard on two nursing units in a university hospital where care was given to patients undergoing bone marrow or stem cell transplantation (BMSCT) and other treatments for leukemia. Strategies used in this interdisciplinary effort included collaboration, consultation, education, and evaluation. In the collaboration phase, a core group of nurses talked with staff about current practices, reviewed literature and published standards, examined protocols from other institutions, decided on goals, and developed the standard. Consultation with a dentist, pharmacist, and physician occurred before completion of the standard. The education phase included in-service sessions for nurses and technicians. The evaluation phase, which occurred in two phases, focused on checking to see if the goals had been met, including tolerability and adherence. The first phase allowed identification of problem areas and subsequent revisions, whereas the second phase evaluated adherence at a later time point. Overall, most of the patients adhered to the standard. Future implications include specific recommendations such as an emphasis on oral care, documentation, and patient and staff education. This project is an example of how nurses addressed the challenge of implementing an acceptable oral care standard to decrease patients' oral complications and distress.
Academic Medical Centers↗
Development and validation of the satisfaction with pharmacist scale.
To assess patients' satisfaction with pharmacists, seven questions were developed with semistructured input from 5 pharmacy practice faculty members and 11 patients with cancer. The study identified 1617 English- and Spanish-speaking patients with cancer or human immunodeficiency virus infection or acquired immunodeficiency syndrome who participated in a multisite validation of the Functional Assessment of Cancer Therapy Scale. Of these, 1124 had seen a pharmacist in the past 7 days and therefore were eligible; 608 spoke English and 516 Spanish. The seven items on the Satisfaction with Pharmacist (SWiP) scale were rated on a five-point Likert scale (0 = not at all to 4 = very much). The reliability of the English and Spanish versions was evaluated by Cronbach's alpha coefficients. The unidimensionality and construct validity were analyzed with the Rasch rating scale model. The alpha coefficients for the English and Spanish versions were 0.90 and 0.92, respectively. Rasch analyses of item responses showed that none of the items in either language was a misfit, which supported their ability to measure a unidimensional construct. Item difficulty plots revealed that no item exhibited differential functioning, indicating that the items performed the same in both languages. The SWiP scale has reliable and valid psychometric properties in English and Spanish and can be used to document the value of the pharmacist-patient relationship. It is easy to administer and is ready for further use and evaluation to determine and document outcomes of pharmaceutical care.
Adult↗
The impact of socio-cultural and clinical factors on health-related quality of life reports among Hispanic and African-American cancer patients.
A hierarchical multiple linear regression approach (N = 761) was used to identify pertinent factors which influence health-related quality of life (HRQL) reports among Hispanic and African-American cancer patients. The independent variables include: performance status, disease site, disease stage, mode of administration, socio-economic status (SES), gender, age, living arrangement, race/ethnicity, religious affiliation, insurance status, and spiritual beliefs. The outcome measures, five subscales of HRQL (physical well-being, social well-being, satisfaction with treatment, emotional well-being, functional well-being) and overall HRQL (sum of the five subscales), were estimated using the Functional Assessment of Cancer Therapy (FACT) Scales. This study identified performance status and spiritual beliefs as consistent predictors of overall HRQL. This study also found no significant effects of SES, mode of administration, gender age, living arrangement and insurance status on the reporting of overall HRQL. Spiritual beliefs and performance status are important determinants of HRQL across a diverse group of cancer patients.
Adolescent↗
Acute oral pain and mucositis in bone marrow transplant and leukemia patients: data from a pilot study.
The purposes of this prospective, repeated-measures descriptive pilot study were to describe patterns of acute oral pain and mucositis in patients receiving a bone marrow transplant or high-dose chemotherapy for leukemia, and to test procedures and instruments before initiating a larger intervention study. A nonprobability, purposive selection process was used to enroll 18 patients admitted to two acute care inpatient hospital units for bone marrow transplantation or leukemia therapy at a university health sciences center in the southeastern United States. Data were collected at baseline, then daily through patient interviews, oral examination, and chart review for at least 3 weeks or until discharge. Research variables were pain intensity, intolerable pain, verbal descriptors of pain, pain relief, and use of pain relief strategies (Pain Assessment Form), mucositis (erythema and ulceration) in eight anatomic locations of the oral cavity (Oral Mucositis Index), voice/talking (Oral Assessment Guide), and mood states (11-item Brief Profile of Mood States). Mild to moderate pain occurred in nearly 70% of patients and was described as "tender," "irritating," and "sore." Patients used pain medicines, mouth care, and mental and physical activities to relieve pain, and reported partial overall relief of pain. Mucositis was mild, with the tongue and buccal and labial mucosa most commonly affected with erythema and the buccal mucosa with ulceration. Voice/talking were only mildly impaired, and mood disturbance was mild. Patterns of pain, mucositis, and mood disturbance were consistent with each other and followed the trajectory described in previous research. Results suggest that nurses should continue to assess these symptoms vigorously and assist patients in selecting multiple management strategies. Research using repeated-measures designs in this acutely ill inpatient population is challenging and needs careful attention by researchers. The results have been used to improve the ongoing larger intervention study.
Acute Disease↗
Cancer education--challenges of the present: oncology nursing.
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Clinical Competence↗
Peer review, authorship, ethics, and conflict of interest.
PURPOSE: To explore problems in peer review, authorship, ethics, and conflict of interest related to writing and publishing. Publishing and adhering to principles is critical as nurse researchers, educators, administrators, and practitioners participate in the development and dissemination of knowledge. CONCLUSIONS: The quality and integrity of nursing publications are affected by peer review, author collaboration, and ethical conduct. Understanding the conflicts of interest inherent in each action and being committed to impartial review and meeting the requirements of authorship can ensure fewer difficulties for authors, publishers, and consumers.
Authorship↗
Patients' and healthcare providers' opinions regarding advance directives.
PURPOSE/OBJECTIVES: To gain a better understanding of patients' and healthcare providers' preferences regarding when, how, and by whom advance directive information should be given and to explore the nursing role in advance directives. DESIGN: A qualitative study using focus group methodology. SETTING: A National Cancer Institute-designated comprehensive cancer center located within a large, university-affiliated, tertiary care hospital in the northeastern United States. SAMPLE: Two samples participated in the study: eight adult ambulatory patients with cancer and 15 healthcare providers (4 physicians, 10 nurses, and 1 social worker). METHODS: Separate patient and provider focus groups were conducted in private rooms by experienced facilitators using an interview guide with questions based on the literature, the hospital's advance directive materials, and the investigators' experience; sessions were audio-taped, transcribed, and analyzed using qualitative data analysis techniques. FINDINGS: Patients and healthcare providers discussed focus group questions and commented that advance directive discussions should be provided early in the treatment or illness, presented in a short and simple format with reading materials at a level appropriate for the patient, and continued throughout the illness with those who desire follow-up. Nurses, doctors, social workers, or a designated/trained advance directive person were individuals that the patients identified as people with whom they could have advance directive discussions. CONCLUSIONS: Results suggested that advance directive information should be given prior to hospital admission, be provided in a variety of formats, and that nurses, social workers, doctors, or designated staff representatives could all be part of the advance directive process. NURSING IMPLICATIONS: Nursing roles should include early assessment of patients to determine needs for discussion, advocacy on behalf of patients, and provision of information. Future research should examine use of specific personnel for facilitating advance directives and compare different formats for presenting advance directive information to patients.
Advance Directives↗
Development of a nursing research utilization program in a clinical oncology setting: organization, implementation, and evaluation.
PURPOSE/OBJECTIVES: To describe a research utilization program in the nursing department of a National Cancer Institute-designated comprehensive cancer center, including prerequisites for its development, its relationship to the department's nursing research program, the research utilization model used in the program, and evolution, evaluation, and future directions of the program. DATA SOURCES: Computerized literature searches; published articles, abstracts, and books; personal communications; departmental, committee, and task force meetings; nursing grand rounds; workshops; and inhouse surveys of nursing staff. DATA SYNTHESIS: Review and use of available information led to a comprehensive, multicomponent, departmental research utilization program that addressed issues raised in both the literature and in clinical practice. CONCLUSIONS: The nursing department was able to implement a research utilization program under the aegis of its research program that was consistent with the department's philosophy, goals, and organizational structure. Although many challenges and issues arose, ongoing evaluation measures indicate wide acceptance, successful implementation and direct influence on practice. IMPLICATIONS FOR NURSING PRACTICE: With strong administrative support, a departmental nursing research utilization program that enables participation of nursing staff and results in research-based practice and professional development can be implemented.
Baltimore↗
A survey of research-related activities and perceived barriers to research utilization among professional oncology nurses.
PURPOSE/OBJECTIVES: To identify nursing staff members' current research-related activities, knowledge of research utilization, and perceived barriers to using research in practice. DESIGN: Descriptive, cross-sectional survey design with self-report questionnaires. SETTING: National Cancer Institute-designated comprehensive cancer center located in a mid-Atlantic metropolitan area. SAMPLE: Convenience sample of 82 registered nurses employed in the cancer center who completed and returned the questionnaire; the majority had baccalaureate degrees or higher, were an average of 33 years old, were nurses for a mean of 8.8 years, and worked at the center a mean of 5.6 years. METHODS: Four-part, 38-item, self-report questionnaires were distributed to nursing staff and a leadership group by members of the departmental Nursing Research Committee; respondents returned completed questionnaires to designated locations in the center. MAIN OUTCOME MEASURES: Knowledge and attitudes about research utilization, perceived barriers to using research in practice, and current research-related activities. FINDINGS: Most respondents were familiar with the concept of research utilization and found research to be of value to their practice. They cited a number of barriers to using research findings and reported little participation in research-related activities. Advanced clinical practitioners with master's degrees tended to participate more frequently in research-related activities. CONCLUSIONS: Although nurses appeared to be aware of research utilization and value it, they perceived barriers to using research findings in practice and did not routinely participate in research-related activities. The findings support other research in this area and reveal educational needs. IMPLICATIONS FOR NURSING PRACTICE: The findings provided baseline information for a departmental research utilization program and suggested strategies and activities that could be incorporated into the program.
Adult↗
Comprehensive and multidimensional assessment and measurement of pain.
Current theories of pain and clinical experience support a multidimensional framework for the experience of pain that has implications for assessment and management in any setting. Six major dimensions have been identified: physiologic, sensory, affective, cognitive, behavioral, and sociocultural. Any clinical assessment process must address relevant dimensions of pain in the given setting. In acute care settings, for example, clinicians may focus on physiologic and sensory dimensions, whereas in chronic care settings, the affective, cognitive, and behavioral dimensions might assume priority. Various tools are available for multidimensional assessment of pain, spanning the dimensions of the experience from physiologic to sociocultural. The clinician in any setting must use appropriate tools that provide useful information. Guidelines helpful in a selection process include identification of relevant dimensions of pain, type of pain, patient population and setting, psychometric properties of the tool, and issues of time, clinical relevance, and feasibility. When a careful selection process occurs, the resulting data should simultaneously meet clinicians' needs for information as well as provide the foundation for initiation of multidisciplinary interventions.
Humans↗
A comparison of the Hopkins Pain Rating Instrument with standard visual analogue and verbal descriptor scales in patients with cancer pain.
A self-contained, portable, pain rating instrument that provides an immediate result for documentation purposes was developed to improve pain assessment in cancer patients. The Hopkins Pain Rating Instrument (HPRI) is a 5 x 20 cm plastic visual analogue scale (VAS) with a sliding marker that moves within a groove that measures 10 cm. The side facing the patient resembles a traditional VAS while the opposite side is marked in cm to quantify pain intensity. This psychometric study, which employed a descriptive correlational design, evaluated the reliability and validity of the HPRI by comparing it with a traditional VAS and verbal descriptor scale (VDS). Outpatients with and without pain and inpatients with pain rated their major pain site with the three instruments, which were presented in random order. This was followed by a mental status exam and re-rating of pain with the same instruments to assess test--retest reliability. Completing the study were 71 patients with a variety of cancers and a mean age of 52.8 years. Of these patients, 68% had pain and 54% were receiving opioid analgesics. The most common pain sites were the back, leg, and epigastric areas. On initial and repeat testing, there were high correlations between the HPRI and the VAS (r = 0.99, P less than 0.0001) and the VDS (r = 0.85, P less than 0.0001). The correlation coefficients for test--retest reliability for the HPRI, VAS, and VDS were 0.97, 0.97, and 0.94 (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Nursing considerations in the administration of blood component therapy.
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Anaphylaxis↗
Cancer pain. Pathophysiology of pain in cancer.
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Education, Nursing, Continuing↗
Fixed-interval v as-needed analgesics in cancer outpatients.
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Adult↗
Advances in control of cancer pain.
The wide variety of techniques and rapidly developing complex technologies currently available for managing pain, as well as the multidimensional nature of cancer pain, require that a multidisciplinary approach to treatment be used in virtually all health care settings. Members of each health care discipline have unique and very important contributions to make to the care of patients with cancer pain. This critical fact has only recently been recognized and incorporated into the management of persons with pain in inpatient, outpatient, and home settings. The development and refinement of multidisciplinary teams, coupled with the use of the most current and effective therapeutic interventions available, should result in better care of and quality of life for patients with cancer pain.
Administration, Oral↗