PubMed Health⌕ Search

Biomedical subjects

Ruth McCorkle

Publications and source records attributed to Ruth McCorkle.

34 records · Page 2Linked to original sources
PubMed2004

At the crossroads: making the transition to hospice.

OBJECTIVE: Previous studies reveal that many terminally ill patients never receive hospice care. Among those who do receive hospice, many enroll very close to the time of death. Nationally, between 1992 and 1998, the median length of stay at hospice declined 27%, from 26 to 19 days. In our prior study of 206 patients diagnosed with terminal cancer and using hospice, we found that one-third enrolled with hospice within 1 week prior to death. Late hospice enrollment can have deleterious effects on patients and their family members. The aim of the present study was to characterize common experiences of patients and primary family caregivers as they transition to hospice, focusing on caregiver perceptions of factors that might contribute to delays in hospice enrollment. METHODS: We conducted in-depth interviews with a purposive sample of 12 caregivers selected from a population of primary family caregivers of patients with terminal cancer who enrolled with hospice in Connecticut between September 2000 and September 2001. Respondents represented different ages, genders, and kinship relationships with patients. Respondents were asked about the patient's care trajectory, how they first learned about hospice, and their experiences as they transitioned to hospice. NUD*IST software was used for qualitative data coding and analysis. RESULTS: Constant comparative analysis identified three themes common to the experience of transitioning to hospice: (1) caregivers' acceptance of the impending death, (2) challenges in negotiating the health care system across the continuum of care, and (3) changing patient-family dynamics. SIGNIFICANCE OF RESULTS: Identification of these themes from the caregivers' perspective generates hypotheses about potential delays in hospice and may ultimately be useful in the design of interventions that are consistent with caregivers' needs.

Adult↗
PubMed2004

Determinants of death in an inpatient hospice for terminally ill cancer patients.

OBJECTIVE: Despite the strong emphasis on home-based end-of-life care in the United States and the recognition of dying at home as a gold standard of quality of care, hospice home care is not a panacea and death at home may not be feasible for every terminally ill cancer patient. Admission to an inpatient hospice and dying there may become a necessary and appropriate solution to distressing patients or exhausted families. However, the factors associated with death in an inpatient hospice have not been examined in previous studies. METHODS: A prospective cohort study was conducted to investigate the determinants of death in an inpatient hospice for terminally ill cancer patients. Approximately two-fifths (40.8%) of the 180 terminally ill cancer patients in this study died in inpatient hospices over the 3-year study period. RESULTS: Results from Cox proportional hazards model with adjustment for covariates revealed several factors that were significantly associated with dying in inpatient hospice, as opposed to home, in a nursing home, or in the hospital. Patients were more likely to die in an inpatient hospice if they received hospice care before death (hazard ratio [HR] = 7.32, 95% confidence interval [CI]: 3.21-16.67), if they had a prestated preference to die in an inpatient hospice (HR = 4.86, 95% CI: 2.24-10.51), if they resided in New Haven County (HR = 1.70, 95% CI: 1.00-2.93), or if they experienced higher levels of functional dependency (HR = 1.05, 95% CI: 1.02-1.08). SIGNIFICANCE OF RESULTS: The high prevalence of inpatient hospice deaths for terminally ill cancer patients in this study was related to the local health care system characteristics, health care needs at the end of life, and personal preference of place of death. Findings from this study may shed light on future directions for developing end-of-life care tailored to the needs of cancer patients who are admitted to hospices and eventually die there.

Attitude to Death↗
PubMed2003

Nurses' attitudes and practice related to hospice care.

PURPOSE: To describe characteristics, attitudes, and communications of nurses regarding hospice and caring for terminally ill patients. DESIGN: A cross-sectional study of randomly selected nurses (n = 180) from six randomly selected Connecticut community hospitals was conducted in 1998 and 1999. METHODS: Hospice-related training, knowledge and attitudes, demographic and practice characteristics, and personal experience with hospice were assessed with a self-administered questionnaire (response rate = 82%). Logistic regression was used to model the effects of hospice-related training, knowledge, and attitudes on these outcomes, adjusting for personal experience and other characteristics of nurses. FINDINGS: Characteristics associated with discussion of hospice with both patients and families included greater religiousness, having a close family member or friend who had used hospice, and reporting satisfaction with hospice caregivers. Greater self-rated knowledge was significantly associated with discussion of hospice with patients. Attitudinal scores indicating greater comfort with initiating discussion and greater perceived added benefit of hospice were significantly associated with discussion with patients' families. CONCLUSIONS: Nurses' discussion of hospice with terminally ill patients and their families are related to the potentially modifiable factors of self-rated knowledge and attitudes revealing comfort with discussion and perceived benefit of hospice care.

Attitude of Health Personnel↗
PubMed2002

Appropriate time frames for data collection in quality of life research among cancer patients at the end of life.

Longitudinal research has been recommended as the most appropriate research design to ensure the validity of quality of life assessments. However, high attrition and non-random missing data in quality of life studies for terminal cancer patients raise questions about generalizability of the study, and at worst they may jeopardize interpretation of the results. Appropriate time frames for eliciting information directly from terminal cancer patients can ensure the internal and external validity of quality of life research in end-of-life care, allow health care professionals to detect sensitively the effects of end-of-life care within the shortest intervention period, and make comparisons across studies possible. From a review of the literature, it is recommended that the appropriate time frame for interviewing terminal cancer patients about their quality of life be a weekly assessment schedule based on the following factors: (a) the median survival of terminal cancer patients enrolling in a hospice/palliative care program is approximately 30 days and there are substantial number of patients who die in each week; (b) at the final weeks of life, quality of life and symptoms of some terminal cancer patients change dramatically; and (c) the shortest intervention period that is likely to give a clinically significant effect of end-of-life care management is 1 week after the enrollment in end-of-life care.

Humans↗
PubMed2002

Use of family proxies in quality of life research for cancer patients at the end of life: a literature review.

One of the main goals of end-of-life care is to achieve the best quality of life (QOL) for patients and their families. Quality of life, therefore, represents a significant outcome indicator to evaluate end-of-life care interventions. However, nonresponse bias and nonrandom missing data in QOL research at the end-of-life limits the generalizability and threatens the internal validity of the study findings. The use of family proxy of patients' QOL has been suggested as a solution. Demonstration of satisfactory levels of agreement between proxies and patients is warranted before family caregivers' or other proxies' assessments can be employed when patients cannot provide their own information. Contrary to the conclusion made by Sprangers and Aaronson [The Role of Health Care Providers and Significant Others in Evaluating the Quality of Life of Patients with Chronic Disease: A Review. J. Clin. Epidemiol. 1992, 45, 743-760], it is suggested from this review of literature that terminal cancer patients and their family caregivers agreed at least moderately well on the patients' QOL. The bias introduced by the use of family informants is generally of a modest magnitude. When discrepancies existed, without exception, family caregivers held a more negative view of patients' QOL than did patients. When using family proxies, this is important to remember. The degree of agreement between terminal cancer patients' and their family caregivers' assessments varies as a function of the dimensions of QOL being measured and the patient's health status. However, the accuracy of family caregivers' assessments can be improved by assessing both patients and family caregivers concurrently over time. Several suggestions for future research are provided to better understand the influencing factors of agreement between patients and family assessments and to enhance the quality of statistical analyses on this topic.

Attitude to Health↗
PubMed2002

The tapestry of hospice.

Members of the hospice team weave a tapestry of care with patients and families. Relief of suffering--physical, emotional, and spiritual--is the goal of hospice care. Nurses' contribution to that care is central but often seemingly unnoticed. Their contribution to the tapestry constitutes the subtle threads of the background upon which the tapestry evolves. Nurses' work is often viewed simplistically, and the complexity of simple tasks is hidden. Work examples of nurses in hospice are discussed, and the previously unseen yet central parts of nurses' work are highlighted.

Bereavement↗
PubMed2002

Factors associated with distress in urban residential fire survivors.

PURPOSE: To identify factors associated with recovery in a sample of urban residential fire survivors. DESIGN AND METHODS: 440 survivors, of residential fires were interviewed at approximately 3, 6, and 13 months after the fire to measure psychological distress. A set of factors was identified that correlated with survivors' ability to recover from the fire event. Potential predictors of increased distress were identified. Hypotheses were that participants who were lower in socioeconomic status, who were minority members, who had less social support, who engaged in attributional thinking, and had greater concurrent life stresses would have greater psychological distress in response to a residential fire and would be less able to recover from the fire event. FINDINGS: Distress after fire was high at 3 months and decreased for the majority of participants, although one-third of survivors had higher distress at 13 months than at 3 months. Loss of control and attributional variables had the strongest influence on psychological distress over time. CONCLUSIONS: The findings are consistent with stress-response tendencies expected after a stressful event. A set of predictor variables was identified to help clinicians target survivors at high risk for psychological distress after a residential fire.

Adolescent↗
PubMed2002

Pain and fatigue management: results of a nursing randomized clinical trial.

PURPOSE/OBJECTIVES: Through a randomized clinical trial, to compare patients undergoing an initial course of chemotherapy who report pain and fatigue at baseline and who are receiving conventional care alone with those receiving conventional care plus a nursing intervention on outcomes reported at 20 weeks. SETTING: Chemotherapy clinics of two comprehensive and two community cancer centers. METHODS: Interviews were conducted at baseline and 10 and 20 weeks. An 18-week, 10-contact nursing intervention utilizing problem-solving approaches to symptom management and improving physical functioning and emotional health was implemented. SAMPLE: The sample consisted of 53 patients in the experimental arm and 60 in the control arm who reported pain and fatigue at baseline. VARIABLES: Pain and fatigue, numbers of other symptoms, and physical role impact and social-functioning subscales from the Medical Outcomes Study 36 Short Form. FINDINGS: Patients who received the intervention reported a significant reduction in the number of symptoms experienced and improved physical and social functioning. Fewer patients in the experimental arm reported both pain and fatigue at 20 weeks. CONCLUSIONS: Behavioral interventions targeted to patients with pain and fatigue can reduce symptom burden, improve the quality of the daily life of patients, and demonstrate the "value-added" role of nursing care for patients undergoing chemotherapy. IMPLICATIONS FOR NURSING: These data support the "value-added" role of nursing interventions for symptom management and improved quality of life during the course of cancer treatment.

Activities of Daily Living↗
PubMedDate not supplied

Unlicensed staff members' experiences with patients' pain on an inpatient oncology unit: implications for redesigning the care delivery system.

Although unlicensed staff have routine contact with patients in pain, little research relates to their role with these patients. The purpose of this study was to describe the experiences of unlicensed inpatient hospital staff caring for cancer patients in pain. We sought to understand pain identification and communication practices, describe common practice situations, and identify training needs. We conducted 4 focus groups with unit secretaries, nurses' aides, and housekeepers (N = 24) on 2 inpatient oncology units at an urban, northeastern teaching hospital. Group processes were tape-recorded, transcribed, and analyzed using Atlas/ti software and content analysis. Analysis generated 5 issues related to pain in the daily practice of unlicensed staff: perceived function with pain, building relationships with patients, interpreting patients' pain, system issues, and job challenges and coping strategies. Unlicensed staff reported performing important functions related to pain, including alerting nursing staff to patients' pain, and providing psychosocial support. Participants shared difficulties of working with patients in pain and expressed interest in education on pain identification and course of illness. Findings provide insight into the role of unlicensed staff, and have implications for the educational preparation of this group as well as the nature of their participation in the care delivery system.

Adaptation, Psychological↗
PubMedDate not supplied

The silent killer: psychological issues in ovarian cancer.

Ovarian cancer represents about 4% of all cancers in women and is the fifth leading cause of death in the United States each year. Ovarian cancer is associated with uncertainty, anxiety, and depression. Many women present with advanced disease at diagnosis and are faced with aggressive surgical and medical protocols to treat them. To meet the needs of women with ovarian cancer, the effects of their physical problems on psychological adjustment must be identified. Health care professionals must closely monitor women with ovarian cancer to identify those who may require ongoing psychological care or psychiatric intervention. This article presents an overview of ovarian cancer, focusing on the psychological effects, and an intervention by oncology nurse specialists to address both the physical and emotional distress that accompanies ovarian cancer. The importance of screening for psychological distress is emphasized.

Adaptation, Psychological↗
PubMedDate not supplied

Describing an episode of home nursing care for elderly postsurgical cancer patients.

BACKGROUND: While studies have documented the beneficial effect of home care for cancer patients, the actual interventions implemented during these studies have not been well described. OBJECTIVES: Purposes of this study were to analyze interventions documented in narrative form by advanced practice nurses during a four-week episode of home care and describe intervention type, frequency, range, and variation over time in intervention emphasis and dose intensity. METHODS: Chart audits were performed on records kept for 148 postsurgical cancer patients who were assigned to the experimental group in a randomized clinical trial to evaluate the effect of home care on quality of life outcomes (McCorkle et al., 2000). Interventions statements (N = 7,275) were analyzed using Grobe's (1996) Nursing Intervention Lexicon and Taxonomy. RESULTS: Teaching accounted for the highest percentage of interventions documented, followed by provision of psychological support and reassurance, determination of patient needs and nursing care requirements, assessment of current status, and indirect care. Physical care and actions to promote self-care independence were documented least frequently. Differences in nursing care were found by cancer site with the greatest diversity of interventions documented for breast cancer patients. Intervention emphasis and dose intensity varied over time, suggesting that these nurses altered their care in response to the changing needs of their patients. CONCLUSIONS: These nurses responded to complex problems and used a variety of interventions to assist patients and families in management of the illness experience. They also tailored their care to each patient's location along the illness trajectory. These findings provide beginning support for the clinical utility of Nursing Intervention Lexicon and Taxonomy as a way to quantify an episode of nursing care.

Aged↗
PubMedDate not supplied

From "death sentence" to "good cancer": couples' transformation of a prostate cancer diagnosis.

BACKGROUND: While little is known about the couple's process of moving from diagnosis of prostate cancer to treatment, it is acknowledged that cancer-and prostate cancer in particular-affects the couple, not just the patient. This highlighted the need to illuminate this process as a foundation for development of nursing interventions. OBJECTIVES: To describe the experience of men who are diagnosed with prostate cancer and their wives, from the time of diagnosis through staging to the completion of radical prostatectomy. METHODS: A qualitative cross-sectional approach was used to elicit couples' experiences from diagnosis to the time of the interview including their response to diagnosis, their treatment decision-making process, and how the couple moved from the decision to have surgery through the staging process to the time that the surgery was completed. A total of 20 couples participated. RESULTS: Analysis of the data revealed that a number of themes related to the couples' process of moving from diagnosis to treatment. Initially, the diagnosis of prostate cancer represented a loss of control that led these couples to put themselves through a "crash course" on prostate cancer. The information gathered led these couples to conclude that prostate cancer was "good cancer." This enabled them to refocus their energies and start their "quest for the best" treatment and surgeon. Once this was accomplished, the couples began to prepare for surgery that culminated in the turning over of complete control to the surgeon and hospital staff at the time of surgery. CONCLUSIONS: The participants discovered they were able to manage the demands presented by the intrusion of a cancer diagnosis and mount a response to what at first threatened to be a "death sentence." By engaging in the challenge of gathering a volume of facts and a variety of details, they could make informed decisions. Couples were able to regain a sense of control through the engagement in decision-making related to treatment, surgeon, and hospital, and through the transformation of the meaning of the malignant diagnosis to that of a "good cancer."

Adaptation, Psychological↗
PubMedDate not supplied

Dynamics of nutritional health in a community sample of american elders: a multidimensional approach using roy adaptation model.

Nutritional health of community-dwelling elders has been shown to be one of the prime indices of health, influencing the elders' ability to live independently. However, little research has been directed toward understanding the dynamics of nutritional health in community-dwelling elders using a multidimensional theory approach. The purpose of this study was to evaluate the dynamics of nutritional health within the context of Roy Adaptation Model. Factors associated with nutritional health of community-dwelling elders were cross-examined. Depressive symptoms, functional status, oral health, and income emerged as independent predictors of nutritional health adjusting for confounders. This finding lends support to the notion that multidimensional biopsychosocial factors contribute to the dynamics of nutritional health.

Activities of Daily Living↗