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Biomedical subjects

M Whedon

Publications and source records attributed to M Whedon.

13 recordsLinked to original sources
PubMed1999

Massage therapy for patients undergoing autologous bone marrow transplantation.

The purpose of the current study was to examine the impact of massage therapy on psychological, physical, and psychophysiological measures in patients undergoing autologous bone marrow transplantation (BMT). Patients scheduled to undergo BMT were randomly assigned to receive either (a) massage therapy, consisting of 20-minute sessions of shoulder, neck, head, and facial massage, or (b) standard treatment. Overall effects of massage therapy on anxiety, depression, and mood were assessed pretreatment, midtreatment, and prior to discharge using the State-Trait Anxiety Inventory, Beck Depression Inventory, and Brief Profile of Mood States, respectively. The immediate effects of massage were measured via the State Anxiety Inventory, Numerical Scales of Distress, Fatigue, Nausea, and Pain and indices of psychophysiological arousal (heart rate, blood pressure, and respiration rate), collected prior to and following patients' first, fifth, and final massage (on Days--7, midtreatment, and predischarge). Analysis of the data evaluating the immediate effects of massage showed that patients in the massage therapy group demonstrated significantly larger reductions in distress, fatigue, nausea, and State Anxiety than the standard treatment group at Day-7, in State Anxiety at midtreatment, and in fatigue at the predischarge assessment. The overall measures of psychological symptoms measured at pretreatment, midtreatment, and prior to discharge showed no overall group differences, although the massage group scored significantly lower on the State Anxiety Inventory than the standard care group at the midtreatment assessment. The two groups together showed significant declines through time on scores from the Profile of Mood States and State and Trait Anxiety Inventories.

Adult↗
PubMed1998

Death in the hospital.

OBJECTIVE: To examine symptoms and treatments among hospitalized adults in the last 2 days of life. METHODS: Review of 72 consecutive medical records of patients who died at an academic medical center and 32 consecutive medical records of patients who died at an affiliated Veterans Affairs hospital. Medical records were examined for documentation of symptoms, treatment, and orders to limit the use of life-sustaining interventions. RESULTS: The 104 patients who died had an average age of 68.9 years and 70 (68%) were men. The majority had neoplasms or acquired immunodeficiency syndrome, cardiovascular disease, and end-stage lung disease; the remainder died of other acute or chronic illnesses. In the last 2 days of life, pain was noted in 49 patients (46%). Dyspnea (n=53) and restlessness or agitation (n=50) were documented in 51% of the patients. In the last 48 hours of life 12 patients (12%) underwent an attempt at resuscitation, 26 patients (27%) were receiving ventilatory support, and 18% were restrained. Nearly half of the patients (48%) had an order or progress note specifying "comfort measures only" (CMO). Patients with CMO, compared with those without such orders, had similar levels of pain, agitation, and dyspnea. Patients with CMO were less likely to be in an intensive care unit (P=.001), receive ventilatory support (P=.001), receive antibiotics (P=.009), or be weighed (P=.001). CONCLUSIONS: Baseline information with which to begin improvement of care for dying individuals was obtained through a brief retrospective chart review. While patients with CMO receive less aggressive care, no specific process was used to provide comfort care. The evaluation and testing of processes of care for dying patients are necessary to begin the improvement of care. We provide baseline data about processes and outcomes of care in our hospitals.

Aged↗
PubMed1995

Pain and quality assessment/improvement.

Pain is a common symptom of acute and chronic illness and has been targeted as an area of improvement across settings and populations. Advances in the treatment of pain have created a standard of care by which quality can be assessed. The article describes the process of quality assessment and improvement (QA/I) in pain management. QA/I tools and case examples from two institutions are provided. QA/I activities based on current knowledge of pain management can improve the care provided to patients in pain.

Humans↗
PubMed1994

Quality of life in adult bone marrow transplant patients: beyond the first year.

Currently, there are more than 2,000 marrow transplant patients surviving between 5 and 20 years. Thus, increased attention is focusing on information about the nature of posttransplant survival and quality of life (QOL). Assessment of the survivor's QOL and rehabilitation needs should consider the domains of physical well-being and symptoms as well as psychological, social, and spiritual well-being. An analysis of the QOL reported in 780 adult survivors from 15 separate studies provides a perspective on the adult BMT survivor beyond the 1-year milestone.

Adult↗
PubMed1993

Nursing care issues in autologous bone marrow transplantation.

The significant growth in annual numbers of autologous bone marrow transplant (ABMT) procedures can be attributed to early promising results and improvements in supportive care. Expert nursing care is an important component of the care provided by the multidisciplinary transplant team. Nurses are challenged by the developing and rapidly changing nature of ABMT indications, the complexity of the therapy regimen, and the management of acute and long-term effects and toxicities. Nursing care issues pretransplant include assisting the eligible patient in locating and transferring to an ABMT center, assisting with the informed consent process, exploring insurance and financial coverage, and planning for bone marrow and/or peripheral stem cell harvesting. During the transplant, nurses administer complex therapies, provide symptom management, and encourage and support patients and families through the period of pancytopenia and the accompanying physical and emotional debilitation. Post-ABMT, nurses play a key role in helping patients readjust to their former roles.

Bone Marrow Transplantation↗
PubMed1992

The role of the advanced practice oncology nurse in pain relief.

Oncology nurses have consistently identified relief of pain as a major priority for their specialty. Although many articles provide nurses with advice on ways to improve pain management for people with cancer, few address the practicality and likelihood of these strategies being implemented by an individual nurse. Oncology nurses in advanced practice roles are often in ideal situations to effect some of the positive, broad changes that are needed to improve pain relief. This paper describes the unique contribution that nurses in advanced practice roles can make to pain management and offers a prescription for leadership in practice that can enhance effective pain management for people with cancer.

Education, Nursing, Graduate↗
PubMedDate not supplied

Professional and ethical considerations in the use of high-tech pain management.

Pain management, a primary focus of the oncology nurse, is undergoing a technologic boom. Assessment of high-tech treatments in medicine is an underdeveloped and controversial area. This paper is intended to promote critical thinking about methods of high-tech pain relief such as subcutaneous, IV, and intraspinal analgesia and anesthesia delivered by ambulatory, implanted, or patient-controlled devices. These issues are described within an ethical framework that focuses on the principles of autonomy, beneficence, nonmaleficence, and justice. Application of these principles to the clinical practice setting and recommendations for practice conclude this paper.

Aged↗
PubMedDate not supplied

Quality of life of long-term adult survivors of autologous bone marrow transplantation.

PURPOSE/OBJECTIVES: To extend the knowledge of quality of life (QOL) of survivors of allogeneic bone marrow transplantation (BMT) to include survivors of autologous BMT. To determine the appropriateness of using a reliable, valid, allogeneic BMT QOL instrument for survivors of autologous BMT. DESIGN: Cross-sectional, descriptive, replication survey. SETTING: An autologous BMT program in a National Cancer Institute-designated comprehensive cancer center. SAMPLE: All survivors of autologous BMT (N = 37) at the center were recruited; 29 survivors participated (85% response rate). METHODS: Three mailed questionnaires: the City of Hope quantitative QOL-BMT instrument and qualitative questionnaire and an investigator-developed demographic questionnaire. MAIN RESEARCH VARIABLES: QOL, autologous BMT treatment, disease type, age, gender, employment, and date of transplant. FINDINGS: Global QOL was high (mean = 8.17 on a 1-10 scale). Most respondents experienced few long-term physical disruptions and had only mild psychological distress. Fatigue, sexuality concerns, and family distress created by the illness were the most negatively rated items. Content, face, and construct validity of the QOL-BMT instrument in the autologous BMT population were acceptable. Overall internal consistency reliability of the tool, as measured by Cronbach's alpha, was 0.82. Themes of uncertainty, concern about relapse, and pain were reported in the qualitative data but not revealed by responses to the QOL-BMT instrument. CONCLUSIONS: The majority of survivors of autologous BMT reported few physiologic disruptions and above-average QOL. The City of Hope QOL-BMT instrument had acceptable reliability and validity when adapted for survivors of autologous BMT. Addition of items related to uncertainty, pain, and concern about relapse could further strengthen its validity. IMPLICATIONS FOR NURSING PRACTICE: Most survivors of autologous BMT can expect above-average QOL. Incorporating results of QOL evaluation in the informed consent process may help BMT candidates in making the decision to undergo the procedure by providing a more complete picture of life after BMT. However, since a minority of patients will experience continued disruptions in any one of the QOL domains, healthcare providers need to conduct comprehensive follow-up evaluations to determine which patients may need referral to the specialized services of a survivor clinic.

Adaptation, Psychological↗