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Biomedical subjects

S C McMillan

Publications and source records attributed to S C McMillan.

At least 19 recordsLinked to original sources
PubMed1995

A descriptive study of the management of pain and pain-related side effects in a cancer center and a hospice.

The purpose of this study was to describe the pain and pain-related symptoms experienced by persons receiving treatment in a cancer center or a hospice and to describe the nurses' responses to these problems. The sample consisted of 25 hospice and 19 cancer center patients who were being treated for pain. Pain was assessed three times in a 24-hour period using a visual analogue scale (VAS). Constipation was assessed using the Constipation Assessment Scale. Sedation was assessed on a 0 (fully alert) to 4 (comatose) scale. The nurses' documentation was assessed using the Chart Audit for Pain. Results showed that patients in the cancer center and hospice continued to experience pain (VAS M = 38.6 and 29.7 respectively) in spite of their pain management regimens. The cancer center patients were given an average of 38% of the maximum ordered dose of analgesic while the hospice patients self-administered 93% of the ordered dose. The cancer center nurses documented the efficacy of the analgesics in only 26% of cases while hospice nurses recorded this information in 96% of the charts. Sedation was not found to be a problem. Constipation was reported by 100% of cancer center patients and 84% of hospice patients but was rarely documented by nurses in either setting. It appears that nurses need to do more thorough assessment of patient symptoms and more consistent follow-up evaluation and documentation.

Adult↗
PubMed1995

Validity and reliability of an oncology critical care patient acuity tool.

PURPOSE/OBJECTIVES: To test the reliability and validity of a patient acuity tool for use on a critical care oncology unit. DESIGN: Prototype classification system using therapeutic indicators to describe a patient's acuity. SETTING: Intensive care unit of a research and academic oncology hospital in the Southeastern United States. SAMPLE: Critical care nursing staff including management-level personnel at the research site. METHODS: An acuity tool for critical care was developed using the Johns Hopkins Oncology Center's patient classification system as a model. Content validity indexes were calculated based on ratings of nurse experts. interrater reliability was calculated based on two independent raters: a staff nurse and a patient care manager. MAIN RESEARCH VARIABLES: Appropriateness of language and categorization of therapeutic indicators developed for the tool. FINDINGS: The content validity index of the entire tool was 0.85; 24/25 indicators were retained. Reliability was r = 0.84. CONCLUSIONS: The tool is reliable and valid. IMPLICATIONS FOR NURSING PRACTICE: Acuity tools can be used to calculate unit productivity and assist with determination of staffing needs. In this age of healthcare reform, it is imperative that personpower needs in all care settings be accurately determined to provide cost-effective and safe care levels.

Critical Care↗
PubMed1994

Measuring quality of life in hospice patients using a newly developed Hospice Quality of Life Index.

The purpose of this study was to evaluate the validity and reliability of the newly developed Hospice Quality of Life Index (HQLI). Sixty-eight patient/caregiver dyads from one hospice were asked to fill out the HQLI on admission and after 3 weeks of hospice care. Hospice experts evaluated the items on the tool to assess content validity. The content validity index (0.83) and the alpha coefficients (r = 0.87 and 0.83) supported the validity and reliability of the HQLI. Item analysis revealed items with which patients were most satisfied and aspects of quality of life that were considered to be most important.

Adult↗
PubMed1994

Pain and pain-related side effects in an ICU and on a surgical unit: nurses' management.

BACKGROUND: Little research was found to indicate that pain is managed well in hospitalized patients and few studies were found regarding pain management for critical care patients. OBJECTIVE: To determine the extent to which nurses manage pain effectively without side effects related to narcotic analgesics in an intensive care and a surgical unit. METHODS: The sample consisted of 44 patients, 20 from an intensive care unit and 24 from a surgical unit. Patients completed a Visual Analogue Scale to measure pain intensity three times in 24 hours. The narcotic side effects of constipation and sedation were measured using the Constipation Assessment Scale and a sedation scale. Documentation was assessed using the Chart Audit for Pain. RESULTS: Patients in both units continued to experience pain even with pain management interventions. The critical care nurses administered an average of 30% of the maximum narcotic dose ordered and the surgical unit nurses, 36.8%. Documentation of the effect of the pain medication was scant on both units. Although sedation was not a problem in either unit, the majority of patients reported symptoms of constipation. Documentation of this problem was scant in both units. CONCLUSIONS: Results from this study suggest that nurses in both intensive care and surgical units do not appropriately assess, manage or evaluate pain and pain-related side effects. Patients who experience pain expect to have their pain controlled. Efforts must be made to change nurses' pain management behaviors.

Adolescent↗
PubMed1994

The impact of hospice services on the quality of life of primary caregivers.

PURPOSE/OBJECTIVES: To evaluate the effects of hospice services on the quality of life of primary caregivers and to evaluate the validity and reliability of a new tool. DESIGN: Exploratory, descriptive. SETTING: A nonprofit hospice in Florida; clients are cared for primarily in the home. SAMPLE: 68 adult primary caregivers of 68 patients with cancer enrolled in hospice care and 62 noncaregiving adults. METHODS: Subjects were recruited on admission to hospice and completed the Caregiver Quality of Life Index (CQLI) and the Hospice Quality of Life Index (HQLI) on admission and during week four of hospice care. MAIN RESEARCH VARIABLES: Caregivers' assessment of their own physical, social, financial, and emotional quality of life; patients' assessment of their physical, psychological, spiritual, social, and financial well-being. FINDINGS: No significant differences were found in caregiver quality-of-life scores from admission to week four, and no correlations existed between quality-of-life scores and age or education. A significant positive correlation was found between the caregivers' quality of life and their estimate of the patients' quality of life. Evidence exists that the CQLI is valid and reliable. CONCLUSIONS: Caregivers of terminally ill people with cancer can maintain their quality of life during the first month of hospice care. The caregiver's perception of the patient's quality of life may affect the caregiver's quality of life. IMPLICATIONS FOR NURSING PRACTICE: When offering support to primary caregivers, the hospice team should include the four domains (physical, emotional, social, and financial) and should focus on the interrelatedness of the patient's and caregiver's quality of life.

Adult↗
PubMed1994

A study of quality of life of hospice patients on admission and at week 3.

The purpose of this study was to evaluate the patient's quality of life as perceived by the patient and primary caregiver at admission and after hospice services had been implemented. The sample consisted of newly admitted patients and their primary caregivers. Thirty-one patient/caregiver dyads were included in the study. The patient's quality of life was assessed using the Sendera Quality of Life Index (SQLI), a 25-item visual analogue scale. Total scores may range from 0 to 100. The SQLI was administered to both patients and caregivers at admission and at week 3 after hospice services were implemented. Although there was no significant difference in the patients' mean scores from admission to week 3 (45.2 to 45.7), 50% of patients did report an improvement in quality of life over the 3-week period. Caregivers reported a significant increase in the patient's quality of life from admission to week 3 (means 47 to 53). The correlations between patient and caregiver scores for admission (r = 0.45) and week 3 (r = 0.39) were moderate. Results show that hospice services may have a positive influence on some aspects of quality of life for some persons who are near death. Further research is needed to explore variables that are most influenced by hospice services.

Activities of Daily Living↗
PubMed1993

Nurses' knowledge, beliefs, and practices related to cancer prevention and detection.

The purpose of this study was to assess the needs of nurses in the area of cancer prevention and early detection. Six parallel forms of a survey instrument were developed to assess the knowledge base, beliefs, and practices of nurses in the prevention and early detection of breast, lung, colorectal, prostate, gynecological, and skin cancers. Responses from 2,348 nurses indicated that they knew the most about prevention and early detection of breast and prostate cancer and the least about endometrial and lung cancer. When asked about specific practices, such as performing skin examinations, teaching breast self-examination, or counseling regarding smoking cessation, most nurses reported using these practices with 0-20% of their patients. Despite their apparent lack of participation in prevention and detection, the majority of nurses (66%) believe that cancer prevention is part of the role of the staff nurse. Results suggest that nurses need to be given the tools with which to perform, the knowledge and the time to participate, as well as an expectation from their employers that cancer prevention and early detection is part of their role.

Attitude of Health Personnel↗
PubMed1993

Validity and reliability of a bone marrow transplant acuity tool.

The purpose of this project was to develop a valid and reliable patient-acuity tool for patients undergoing bone marrow transplant (BMT) as part of an overall patient-acuity system. A survey of other cancer centers and a review of the literature revealed no acuity tools that were designed for patients undergoing BMT. A four-level, nursing-diagnosis-based tool was developed with multiple indicators in each level, and its validity and reliability were studied. Content validity indexes (CVIs) were generated for each indicator by a panel of content experts. CVIs ranged from 0.4 to 1.0 with an overall CVI of 0.93 for the tool. Interrater reliability using two raters for 79 patients was high (r = 0.94, p < 0.001). Results of the study provide sufficient evidence of validity and reliability to warrant use of the tool, but further study is needed.

Bone Marrow Transplantation↗
PubMed1993

A systematic evaluation of the "I Can Cope" program using a national sample.

"I Can Cope" (ICC) is an educational program that provides resources that help people with cancer, their families, and their friends to cope more adequately with the disease and its consequences. Although the American Cancer Society (ACS) has offered this program since 1979, ICC never has been evaluated nationally. ACS developed the ICC Revision Work Group in 1990. This work group initiated a national evaluation of ICC to provide data in eight areas: demographics, class format, course objectives, course content, audiovisual and instructional materials, facilitator training, program implementation, and program evaluation. During 1991, data were collected from 219 facilitators, 241 ACS staff members, and 973 ICC participants in 49 states. Revision of the ICC program using the results of this evaluation currently is underway.

Adaptation, Psychological↗
PubMed1992

Carcinogenesis.

The rationale for identifying carcinogens and their mechanisms of action is twofold. First, carcinogens must be identified so they can be eliminated from our environment. And second, mechanisms must be identified that are involved in the conversion of a normal cell to a cancer cell. This knowledge will offer more approaches to cancer prevention. The ability to prevent many common fatal cancers caused by environmental agents was recognized by an expert committee of the World Health Organization in 1964. Their report represented a consensus of expert opinion at that time. Since that report, some writers have suggested that as many as 80% to 90% of cancers are preventable. More conservative estimates range from 40% to 50%. Preventing only 40% of cancers (the most conservative estimate) would result in saving thousands of lives every year. Therefore, all members of the health care team must take an active role in cancer prevention. The nurse's role in cancer prevention is one of education of the public. As more information about carcinogens become available, nurses need to share that information so that individuals are better able to make healthy choices for themselves that will lead to a lower incidence of cancer, our ultimate goal.

Animals↗
PubMed1990

The value of current nutrition information.

To prevent or delay the occurrence of chronic diseases, scientific bodies from the cardiologic and oncologic disciplines have made recommendations regarding the daily dietary intake of certain macro- and micronutrients. This study assessed the knowledge of a random population of 2,305 individuals comprising members of the public, health care workers, university graduate students, and health club attendees. Segments of this population might be expected to have a greater understanding and ability to implement these dietary recommendations. We found that over 90% of the participants were unaware of the recommendations for calcium, salt, vitamin A, and fiber, and the fiber content in a high fiber cereal. Approximately 80% of the participants were unaware of the recommendations regarding fat intake and could not calculate the fat content of a food product. Almost half of the study population took a vitamin pill daily. Of the subjects who were aware of the correct unit measurement for vitamin A (IU), almost 25% of gave a response that exceeded the recommended daily intake. A majority of this study population were unaware of the dietary recommendations regarding the prevention of cardiovascular events and cancer. Subgroups of this study population that might be expected to have more information regarding these recommendations (i.e., having higher education or being a health care professional) did not display a satisfactory level of knowledge. To further compound the problems of adhering to the recommended guidelines, the labeling of many food products is misleading. The recommendations on dietary intake and the information on food product content must be transmitted to the public in a form that allows for ready application when purchasing and consuming food.

Adult↗
PubMed1989

Validity and reliability of the Constipation Assessment Scale.

Constipation is a significant problem in patients receiving neurotoxic chemotherapeutic agents, narcotic analgesics, antidepressants, tranquilizers, and muscle relaxants. Increasingly, as acute care moves into the community, nurses will need valid and reliable methods of assessing constipation in individuals with cancer. The purpose of this project was to study the validity and reliability of the Constipation Assessment Scale, a new tool designed to assess the presence and severity of constipation. The sample consisted of two groups: a control group of 32 working adults and a patient group of 32 adults at risk for constipation because of treatment with Vinca alkaloids or morphine. Consenting subjects were asked to complete the eight-item Constipation Assessment Scale (CAS). A significant difference in intensity of symptoms between the two groups (t = 6.32, p less than 0.0001) demonstrates the ability of the CAS to differentiate between subjects with and without constipation and thus provides evidence of construct validity of the scale. Further analysis of scores of the two subgroups in the patient group (subjects receiving morphine vs. Vinca alkaloids) revealed a significant difference (t = 2.54, p less than 0.01) in symptom intensity. This latter finding supports the ability of the CAS to differentiate between moderate and severe symptom intensity. Subjects completed the CAS in approximately 2 min. To study the test-retest reliability of the scale, a group of 16 apparently healthy working adults were asked to fill out the CAS twice with a 1-h delay. The two sets of scores were correlated (r = 0.98).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

A comparison of Professional Performance Examination scores of graduating associate and baccalaureate degree nursing students.

The Professional Performance Examination has four subtests of professional nursing performance: leadership, collaboration, research, and management of client care. If these four elements characterize the professional rather than the technical nurse, and if this test is representative of these elements, professional and technical nurses should be differentiated. Two alternate forms of each of the four subtests were administered to 86 subjects graduating from 12 associate degree nursing programs and 83 subjects graduating from 11 bachelor degree programs. Results showed no difference in leadership, collaboration, and management subtest scores, but the bachelors degree group scored significantly higher than the associate degree on the research subtest. These results suggested that either the test was not sensitive enough to detect all differences between the two groups, or the associate degree and bachelor degree subjects were not as different as generally supposed.

Education, Nursing, Associate↗
PubMedDate not supplied

Nurses' compliance with American Cancer Society guidelines for cancer prevention and detection.

This study aimed to ascertain the extent to which female nurses comply with American Cancer Society (ACS) guidelines and whether their rate of compliance is related to either age or education. A sample of 3,226 Florida nurses received the Health Habits Assessment Survey (HHAS), a nine-item questionnaire that assesses compliance with selected ACS guidelines. A total of 559 usable forms were received from female nurses. Results indicated that only 28% of RNs practice breast self-examination (BSE) monthly. Of nurses 40-49 years old, 64% reported having a mammogram in the past two years. In the over-50 group, 57% reported having a mammogram in the past year. Only 21% reported no Pap smear in the past year (and no hysterectomy). Only 47% of RNs over 40 reported a digital rectal exam in the past year. Of RNs over 50, only 47% reported having their stools examined for blood during the previous year, and only 19% had a proctosigmoidoscopic exam in the past five years. Thirty-five percent reported using sunscreen all or most of the time, while another 27% reported using sunscreen 50%-90% of the time. No significant relationships were found between cancer prevention and detection practices and either age or educational level. Results suggest that RNs are not doing all they could to protect themselves against cancer.

Adult↗
PubMedDate not supplied

The relationship between age and intensity of cancer-related symptoms.

Nausea, vomiting, and pain are among the most universally feared problems associated with cancer and its treatment. However, not all individuals experience these symptoms, and intensity varies widely for those who do. A number of variables might affect intensity of nausea, vomiting, and pain. This study explored the relationship between age and intensity of cancer-related nausea, vomiting, and pain. The study included a sample of 99 subjects who were experiencing pain and a sample of 25 subjects at risk for chemotherapy-induced nausea and vomiting. An independent t-test revealed a significant difference in intensity of symptoms between younger and older subjects for the pain group (p less than 0.01); the Mann-Whitney U revealed a significant difference by age in the nausea and vomiting group (p less than 0.05). In addition, there were low to moderately negative relationships found between age and symptom intensity for both groups (pain, r = -0.22, p less than 0.05; nausea and vomiting, r = -0.43, p less than 0.05). Results support the commonly held belief that elderly people report a lower intensity of some physical symptoms than do younger individuals. However, relationships between age and symptom intensity are weak, which suggests that individuals' responses to cancer-related symptoms should continue to be the nurse's primary concern.

Adult↗