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Biomedical subjects

Susan L Beck

Publications and source records attributed to Susan L Beck.

16 recordsLinked to original sources
PubMed2007

Family caregivers' satisfaction with home care for mental illness in Taiwan.

In Taiwan, family caregivers play a crucial role in the treatment of patients with mental illness. Attention to family caregivers' satisfaction with home care for mental illness could have a significant impact on the well-being of family caregivers, as well as on the health of the patients with mental illness for whom they care. A descriptive, cross-sectional design has been used to assess the level of family caregivers' satisfaction with home care for mental illness since the implementation of the National Health Insurance (NHI) in Taiwan, and to identify the family caregivers' unmet needs for home care in cases of mental illness. Data were collected using the self-administrated questionnaire completed by a convenience sample of 75 primary family caregivers of the patients with mental illness from a psychiatric hospital in Taipei, Taiwan. The result showed that most family caregivers were highly satisfied with home care provided to them and their relative with mental illness. Timeliness of home care provided in an emergency was the most prevalent unmet need. The implementation of the NHI has improved family caregivers' perceptions of costs of home care services. There is a need to improve NHI policy and home care programmes to provide more holistic services for the patients with mental illness and their family.

Adult↗
PubMed2006

Symptom cluster research: conceptual, design, measurement, and analysis issues.

Cancer patients may experience multiple concurrent symptoms caused by the cancer, cancer treatment, or their combination. The complex relationships between and among symptoms, as well as the clinical antecedents and consequences, have not been well described. This paper examines the literature on cancer symptom clusters focusing on the conceptualization, design, measurement, and analytic issues. The investigation of symptom clustering is in an early stage of testing empirically whether the characteristics defined in the conceptual definition can be observed in cancer patients. Decisions related to study design include sample selection, the timing of symptom measures, and the characteristics of symptom interventions. For self-report symptom measures, decisions include symptom dimensions to evaluate, methods of scaling symptoms, and the time frame of responses. Analytic decisions may focus on the application of factor analysis, cluster analysis, and path models. Studying the complex symptoms of oncology patients will yield increased understanding of the patterns of association, interaction, and synergy of symptoms that produce specific clinical outcomes. It will also provide a scientific basis and new directions for clinical assessment and intervention.

Cluster Analysis↗
PubMed2006

Institutionalizing effective pain management practices: practice change programs to improve the quality of pain management in small health care organizations.

The Resource Center of the American Alliance of Cancer Pain Initiatives provided templates, faculty, and ongoing consultation to assist seven state pain initiatives to implement programs to improve pain management practices. A total of 113 health care organizations participated. Each organization committed to support a team of two to three staff through a 10-month pain quality improvement process, which included a site visit, two educational conferences, pre- and postprogram analyses of the organizational structures in place to support pain assessment and management, quality improvement work plan development, and patient survey data collection. Postprogram results showed statistically significant increases in the presence of structural elements that are critical to effective pain management, as well as statistically significant, though modest, decreases in the percentage of patients who reported pain of any severity, and specifically moderate to severe pain, in the previous 24 hours. The largest changes occurred in long-term care facilities. Nevertheless, the percentage of patients in moderate to severe pain remained unacceptably high.

Delivery of Health Care↗
PubMed2006

Psychometric testing of three Chinese fatigue instruments in Taiwan.

The purpose of this study was to evaluate the psychometric properties (reliabilities and validities) and ease of use of three translated fatigue instruments: Chinese versions of the Cancer Fatigue Scale, the Fatigue Symptom Inventory (FSI), and the Schwartz Cancer Fatigue Scale-revised. Convenience sampling was used to recruit 243 cancer outpatients at a chemotherapy treatment center in Taiwan. The results indicated that the three scales had good internal consistency (Cronbach's alphas for three total scales > 0.80) and were brief (less than 6 minutes to complete), valid (confirmed by convergent, divergent, and discriminant validity), and feasible measures (completion rates > 97%) of fatigue for use with Taiwanese cancer patients. However, 27% of cancer patients reported that the FSI was difficult for them to complete. Differences in factorial validity between each original scale and its Chinese version indicate a need for further testing in Taiwan.

Adult↗
PubMed2006

Nursing-sensitive patient outcomes: the development of the Putting Evidence into Practice resources for nursing practice.

The Oncology Nursing Society (ONS) has worked diligently to improve the care of patients with cancer and their families. A recent project that demonstrates this commitment toquality care is the development of nursing-sensitive patient outcomes resources. ONS has teamed researchers, advanced practice nurses, and staff nurses to develop Putting Evidence Into Practice resources that provide guidance for nursing interventions based on the evidence. The ability to provide evidence for nursing interventions is critical to all aspects of patient care, including patient teaching, development of patient care policies and procedures, and provision of direct patient care.

Evidence-Based Medicine↗
PubMed2005

Sleep wake disturbances in people with cancer and their caregivers: state of the science.

PURPOSE/OBJECTIVES: To review the state of the science on sleep/wake disturbances in people with cancer and their caregivers. DATA SOURCES: Published articles, books and book chapters, conference proceedings, and MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and the Cochrane Library computerized databases. DATA SYNTHESIS: Scientists have initiated studies on the prevalence of sleep/wake disturbances and the etiology of sleep disturbances specific to cancer. Measurement has been limited by lack of clear definitions of sleep/wake variables, use of a variety of instruments, and inconsistent reporting of sleep parameters. Findings related to use of nonpharmacologic interventions were limited to 20 studies, and the quality of the evidence remains poor. Few pharmacologic approaches have been studied, and evidence for use of herbal and complementary supplements is almost nonexistent. CONCLUSIONS: Current knowledge indicates that sleep/wake disturbances are prevalent in cancer populations. Few instruments have been validated in this population. Nonpharmacologic interventions show positive outcomes, but design issues and small samples limit generalizability. Little is known regarding use of pharmacologic and herbal and complementary supplements and potential adverse outcomes or interactions with cancer therapies. IMPLICATIONS FOR NURSING: All patients and caregivers need initial and ongoing screening for sleep/wake disturbances. When disturbed sleep/wakefulness is evident, further assessment and treatment are warranted. Nursing educational programs should include content regarding healthy and disrupted sleep/wake patterns. Research on sleep/wake disturbances in people with cancer should have high priority.

Antidepressive Agents↗
PubMed2005

The great Sumatra-Andaman earthquake of 26 December 2004.

The two largest earthquakes of the past 40 years ruptured a 1600-kilometer-long portion of the fault boundary between the Indo-Australian and southeastern Eurasian plates on 26 December 2004 [seismic moment magnitude (Mw) = 9.1 to 9.3] and 28 March 2005 (Mw = 8.6). The first event generated a tsunami that caused more than 283,000 deaths. Fault slip of up to 15 meters occurred near Banda Aceh, Sumatra, but to the north, along the Nicobar and Andaman Islands, rapid slip was much smaller. Tsunami and geodetic observations indicate that additional slow slip occurred in the north over a time scale of 50 minutes or longer.

Journal Article↗
PubMed2005

Pain, sleep disturbance, and fatigue in patients with cancer: using a mediation model to test a symptom cluster.

PURPOSE/OBJECTIVES: To test whether sleep disturbance mediates the effect of pain on fatigue. DESIGN: Cross-sectional. SETTING: Radiation therapy clinic, oncology ambulatory clinic, and inpatient oncology unit in an urban teaching hospital. SAMPLE: 84 patients with cancer with multiple primary diagnoses who were experiencing pain. Fifty-three percent were female and 92% were Caucasian, with a mean age of 54 years. METHODS: All participants completed a symptom questionnaire that included the Brief Pain Inventory-Short Form, the Pittsburgh Sleep Quality Index, and the fatigue subscale of the Profile of Mood States questionnaire. Multistage linear regression was used to test a mediation model. MAIN RESEARCH VARIABLES: Fatigue, pain, and sleep disturbance. FINDINGS: Mediation analyses indicate that pain influences fatigue directly as well as indirectly by its effect on sleep. About 20% (adjusted R2 = 0.20) of the variation in fatigue is explained by pain. Thirty-five percent of the variance in fatigue explained by pain was accounted for by the mediation pathway. CONCLUSIONS: Some of the effect of pain on fatigue is mediated by sleep disturbance, but pain has a direct effect on fatigue as well. IMPLICATIONS FOR NURSING: Although the relationship can be explained only partially by the commonsense point of view that people who are in pain lose sleep and naturally report more fatigue, this finding is important and leads to a potential intervention opportunity. Strategies to improve sleep by better pain management may contribute to decreased fatigue.

Adolescent↗
PubMed2005

Leadership styles and nursing faculty job satisfaction in Taiwan.

PURPOSE: To examine nursing faculty job satisfaction and their perceptions of nursing deans' and directors' leadership styles, and to explore how the perceptions of leadership styles relate to faculty job satisfaction in Taiwan. METHODS: Descriptive, correlational, and cross-sectional study with self-administered questionnaires. The sample was recruited from 18 nursing programs, and 286 questionnaires were returned. RESULTS: Faculty perceived that Taiwan's nursing deans and directors showed more transformational than transactional leadership. Taiwan's nursing faculty were moderately satisfied in their jobs, and they were more satisfied with deans or directors who practiced the transactional leadership style of contingent reward and the transformational style of individualized consideration. A style with negative effect was passive management by exception. CONCLUSIONS: Three types of leadership behaviors explained significant variance (21.2%) in faculty job satisfaction in Taiwan, indicating the need for further attention to training and development for effective leadership behaviors.

Adult↗
PubMed2004

Psychometric evaluation of the Pittsburgh Sleep Quality Index in cancer patients.

This report summarizes findings related to the psychometric properties (internal consistency and construct validity) of the Pittsburgh Sleep Quality Index (PSQI) and discusses issues related to its use based on data from two clinical studies with diverse samples of cancer patients. Subjects completed a questionnaire that included the PSQI, the Schwartz Cancer Fatigue Scale, and specific demographic, disease, and treatment variables. There were complete data on 170 (of 214) cases in Study 1 and 249 (of 259) cases in Study 2. The Cronbach's alpha for the Global Sleep Quality scale was 0.81 in Study 1 and 0.77 in Study 2 A comparison of Global Sleep Quality in two contrasting groups with low and high fatigue yielded statistically significant differences in both samples. Psychometric evaluation supports its internal consistency reliability and construct validity. However, the scoring is rather cumbersome and raises questions regarding level of measurement and appropriate analysis techniques.

Benchmarking↗
PubMed2004

Novel therapies.

OBJECTIVE: To highlight selected research directed to new drug and device technologies to manage mucositis in cancer patients and to illustrate potential impact of successful therapies. DATA SOURCES: Published research articles and abstracts, clinical experience. CONCLUSION: Advances in molecular modeling of mucosal injury in cancer patients have created new opportunities for therapy. Research is analyzing the impact of single-agent interventions; varying degrees of efficacy are being reported. Once optimal dosing strategies for single-agent management are defined, the opportunity for multi-agent therapies will emerge. IMPLICATIONS FOR NURSING PRACTICE: The oncology nurse plays a pivotal role in assessing and managing mucositis in cancer patients.

Cryotherapy↗
PubMed2001

Prevalence and management of cancer pain in South Africa.

Inadequate relief from cancer pain is an international health problem. The aim of this study was to document the prevalence and patterns of cancer pain management in the Republic of South Africa. The first phase of this study consisted of screening 263 patients to document the prevalence of cancer pain in varying settings. A total of 94 patients were experiencing cancer-related pain; this comprised 35.7% of the sample. Inpatients had a higher prevalence than outpatients, which is likely due to the fact that these patients are more acutely ill. Blacks (56.1%) had a higher prevalence of pain than whites (29.4%, P<0.005); this difference was most pronounced in the outpatient setting. Phase 2 consisted of asking 426 patients with cancer pain from different settings to complete a questionnaire that included the brief pain inventory and was designed to learn about their pain and how it was managed. Nearly one-third of the entire sample experienced 'worst pain' of severe intensity. There was little difference between the public and private cancer care centers. The lowest percentage of patients with severe 'worst pain' was in the hospice setting, but even in this group about one-fourth of the patients had peak pain that was severe. Of non-whites combined, 81% experienced 'worst pain' of moderate to severe intensity as compared to 65% of whites (P<0.001). Only 21% of patients reported that they had achieved 100% pain relief. Patients experienced interference in general activity, mood, walking, working, relations with others, sleeping, and enjoyment of life related to their pain. 30.5% of the entire sample had a negative score on the pain management index, a comparison of the most potent analgesic used by a patient relative to their worst pain. Of this group, 58.1% were experiencing severe 'worst pain'. Unrelieved cancer pain is a significant problem. Government and non-government leaders, educators, and practitioners must collaborate to address the barriers to effective pain management and to implement improvements in education, health policy, and health care delivery.

Adolescent↗
PubMedDate not supplied

Telephone-linked care for cancer symptom monitoring: a pilot study.

PURPOSE: The purpose of this pilot project was to explore the feasibility of using a telephone-based computerized system to monitor postchemotherapy symptoms and to test the mechanism of generating alert communications to healthcare providers about symptoms that are poorly controlled. DESCRIPTION OF STUDY: Twenty-seven patients with cancer participated in the study by calling the telephone-linked care (TLC) system daily during a single cycle of chemotherapy and reporting on seven common chemotherapy-related symptoms. Using selected symptom data, symptoms that met a preset threshold for severity generated a fax notification of the patient's symptom pattern to the physician. Patients then were interviewed about their satisfaction with TLC and about suggestions for improvement. RESULTS: The study demonstrated that TLC is easy to learn and use and that it captures daily symptom information from patients in their homes. A majority of patients experienced symptoms that were severe enough to generate symptom-alert faxes. Patient satisfaction with TLC was high. The technique, TLC voice, and the duration of the calls were acceptable to patients. There were few technical problems. CLINICAL IMPLICATIONS: The TLC system has the potential to improve dramatically symptom monitoring and symptom care of patients with cancer at home. Further testing is needed, but the TLC chemotherapy monitoring application shows promise for improving supportive-care service delivery for cancer patients. In its initial test, the TLC chemotherapy monitoring application has been shown to be highly acceptable to patients, able to generate useful symptom data, and able to generate faxed alerts to healthcare providers, thus improving communication about poorly controlled symptoms.

Adolescent↗
PubMedDate not supplied

Cancer-related fatigue, depressive symptoms, and functional status: a mediation model.

BACKGROUND: Patients with cancer grapple with a confusing array of disease- and treatment-related symptoms while trying to maintain functioning in usual roles and daily activities. Research is needed to sort out and identify symptom clusters as a basis for a rational approach to symptom management. OBJECTIVE: The aim of this study was to test, through secondary analysis, a mediation hypothesis about the direct and indirect relationships between fatigue and depressive symptoms through a pathway involving functional status. METHODS: Data from the experimental and control groups of a randomized clinical intervention trial for fatigue management, collected after the second chemotherapy treatment or during the last week of radiotherapy, were analyzed. The mediation pathway from fatigue to depressive symptoms through functional status was tested separately for groups receiving either an energy conservation intervention or a control intervention, equating for time and attention. RESULTS: For the control group, the results indicate support for partial mediation. The previously significant relationship between fatigue and depressive symptoms was reduced after functional status was controlled, accounting for 43% of the total mediated effect. The mediation hypothesis was not supported in the energy conservation group, indicating that the intervention may have changed the role of functional status in mediating the effect of fatigue on depressive symptoms. DISCUSSION: In the control group, when routine activities became more difficult because of fatigue, individuals had more depressive symptoms. The results suggest that functional status is an important factor to consider in symptom management for fatigue. An appropriate intervention for fatigue would have two targets: the fatigue and strategies to reduce the likelihood of impaired functioning that could result in elevated depressive symptoms.

Activities of Daily Living↗