Systematic and integrative reviews: synthesising evidence for community nursing practice.

Ease of access to vast amounts of information presents significant opportunities and challenges for nurses in the community as they seek to base their practice on the best available evidence. Growing expectations around evidence-based practice have developed alongside developments in evidence synthesis, which adopts robust approaches to identifying, appraising and synthesising key evidence for clinical decision-making. The context in which evidence-based practice occurs is key, and this article discusses the skills and knowledge needed for community nurses to discern how evidence and information should influence their decisions to review and change approaches to clinical practice. Importantly, if nurses understand the status of evidence underpinning areas of practice, they can ensure that the preferences and needs of patients and families are met.

Nursing considerations for supporting cancer patients with metastatic spinal cord compression: a literature review.

BACKGROUND: metastatic spinal cord compression (MSCC) is an oncology emergency. Prevalence is increasing. Treatment and care are complex and those diagnosed may be faced with life-changing challenges. AIMS: to review the impact and management of MSCC in patients with cancer, in order to analyse nursing considerations for supporting patients. METHODS: a literature review and thematic analysis of five primary research papers, published between 2009 and 2014. FINDINGS: two themes of prognosis/survival time and independence versus dependence were discovered. CONCLUSIONS: the onset of MSCC may result in paralysis and associated loss of independence, impacting on a patient's quality of life. Understanding individuals' prognosis and treatment/care preferences is fundamental for the sensitive, individualised support of patients with MSCC. The findings reinforce the nurses' role in health education, in order to raise awareness of MSCC and promote early diagnosis so that patients maintain function and independence as long as possible. The findings support the need for nurses to be equipped with appropriate communication skills to initiate and engage in sensitive, difficult and proactive conversations with patients and their families, supporting the delivery of humanised care.

Quality of life in patients with malignant spinal cord compression: a review of evidence-based literature.

Malignant spinal cord compression (MSCC) is a devastating complication of metastatic cancer. The majority of existing studies focus on treatment guidelines for MSCC, with little emphasis on the impact that MSCC has on quality of life (QoL) for this patient group. This literature review aims to critically appraise available literature focusing on QoL for patients with MSCC. Relevant literature was identified from key electronic databases. A dearth of credible studies representative of the patient population with MSCC was found. Thematic analysis was used as a guide to identify key themes that impact on QoL. Interestingly, patients with MSCC generally report good QoL and low levels of distress in over 50% of cases. However, a significant percentage of patients are distressed. The review concludes that increased awareness and further research into the impact of MSCC is required.

Recognising metastatic spinal cord compression.

Metastatic spinal cord compression (MSCC) is a potentially life changing oncological emergency. Neurological function and quality of life can be preserved if patients receive an early diagnosis and rapid access to acute interventions to prevent or reduce nerve damage. Symptoms include developing spinal pain, numbness or weakness in arms or legs, or unexplained changes in bladder and bowel function. Community nurses are well placed to pick up on the 'red flag' symptoms of MSCC and ensure patients access prompt, timely investigations to minimise damage.

Improving care of patients with metastatic spinal cord compression.

Metastatic spinal cord compression is a feature of advanced cancer and the incidence is likely to increase alongside improved survival rates. Patients with spinal cord compression have complex physical, psychological and social care needs. This article describes a multidisciplinary project aimed at improving the care provided to newly diagnosed patients who were admitted to a regional cancer centre for radiotherapy. The project used a range of approaches to measure care, develop and implement interventions, and evaluate outcomes. Aspects of care reviewed in the project included mobilisation, medications including steroids and thrombo-prophylaxis, bowel management, patient priorities and concerns, discharge planning and early detection.

Nursing management of common oncological emergencies.

This article examines three of the most common oncological emergencies. It considers the underlying pathophysiology of these conditions and the symptoms. The role of the nurse in identifying these conditions and expediting timely care to reduce patient morbidity and mortality is discussed.

Evaluating the care of patients with malignant spinal cord compression at a regional cancer centre.

The consequences of malignant spinal cord compression (MSCC) can be devastating. If not detected early, MSCC can result in paralysis and significant bowel and bladder dysfunction that is not improved by treatment. Patients have to cope with sudden and unexpected disability alongside a diagnosis of advanced cancer. A multidisciplinary group was established within a cancer centre to review the care of patients with MSCC. Two linked studies were carried out: a staff questionnaire sent to senior medical staff and all nurses and an audit of documentation. The documentation audit reviewed the notes of 50 patients who had received radiotherapy for MSCC. The symptoms patients presented with on admission and before discharge demonstrated that many experienced significant physical problems as a consequence of developing MSCC. Usually, these symptoms were either unaffected by treatment, or had deteriorated further by the time of their discharge from hospital. The average number of days between admission with MSCC and death was 58.6 days (range 2 to 319 days). The project identified variations in practice in a range of aspects of care and provided clear evidence for the need to develop interventions in relation to specific concerns.

Lumbar burst fracture associated with bowel, bladder, and sexual dysfunction: case study.

Lumbar burst fractures occur when unusual force and flexion are placed on the spine, causing the vertebral body to rupture and possibly protrude into the spinal canal. A resulting conus medullaris injury is possible, but not common. In this case presentation, a young man suffered bowel, bladder, and sexual dysfunction after a 25-foot fall that caused a burst fracture of the first lumbar vertebra. The presentation's primary focus is the nursing education needed to care for patients who experience the unusual side effect of conus medullaris injury. The psychosocial aspects attributable to age, developmental stage, and stigma for a young man with these dysfunctions also are explored.

A nursing intervention for early detection of spinal cord compressions in patients with cancer.

This article reviews the current literature regarding spinal cord compression including its prevalence and presenting signs and symptoms; increases an awareness of the potentially severe effects of spinal cord compression; and describes a model for patient educational intervention focusing on early warning signs of spinal cord compression. With increased understanding of the nature and effects of spinal cord compression, nurses may effectively intervene to minimize the severity of the neurological deficits.

Surgical instrumentation as a palliative treatment for spinal cord compression.

This paper describes a surgical procedure occasionally used to ameliorate symptoms caused by spinal cord compression in patients with metastatic cancer. After decompression of the spinal cord, Luque instrumentation has been effectively used to stabilize the spine and provide pain relief. Two malleable rods are fixed to the spine by sublaminal wires to several healthy laminae above and below the site of the metastatic lesions. Pre- and postoperative nursing care involves constant assessment to detect early neuromuscular and autonomic functional changes. Effective pain management is crucial to the patient's well-being. This surgery does not alter a patient's prognosis but can dramatically affect quality of life.

Nursing care of the patient with spinal cord compression.

Spinal cord compression (SCC) is a common oncologic emergency that can profoundly affect the remainder of the patient's life. SCC develops when pressure is exerted on the spinal cord by a tumor or by a collapsed vertebral body that has been replaced by cancer. When the condition is diagnosed and treated early, the patient may maintain ambulatory status; however, when the diagnosis is made late and neurologic compromise has occurred already, there is minimal expectation that impaired functions will return. SCC is treated with dexamethasone and radiation therapy, and surgery occasionally is performed. Nursing care, an integral component in the management of this challenging condition, may be as simple as educating the at-risk patient about the signs and symptoms of SCC or as complex as meeting the many needs of the paraplegic patient. This article reviews the etiology and clinical presentation of SCC as well as assessment, treatment, and nursing care related to the condition.

Metastatic epidural spinal cord compression.

OBJECTIVES: To provide an overview on the presentation, diagnosis, and treatment of metastatic epidural spinal cord compression (MESCC). DATA SOURCES: Published articles, book chapters, and research reports. CONCLUSIONS: MESCC is a common oncologic emergency that requires prompt recognition and emergency treatment to relieve pain and preserve neurologic function. The signs and symptoms of MESCC are easily detected and can be integral assessment components of the nursing care of any patient with a solid tumor. IMPLICATIONS FOR NURSING PRACTICE: Nurses can have a dramatic impact on preventing neurologic complications caused by this oncologic metastatic problem. When neurologic compromise is not prevented or reversed, nurses also can provide expert care to patients and families in the rehabilitation phase of MESCC.

Selected complications in the patient with cancer: spinal cord compression, malignant bowel obstruction, malignant ascites, and gastrointestinal bleeding.

The growth rate of a tumor, patterns of tumor growth and metastatic spread, and toxicity of therapy contribute to the type and severity of complications. Four common critical care complications resulting from compressive and invasive properties of tumors include spinal cord compression, malignant bowel obstruction, malignant ascites, and gastrointestinal bleeding. Knowledge of the clinical presentations of each of these complications provides a foundation for nursing assessment.

Central nervous system metastases.

OBJECTIVES: To provide an overview and up-to-date information on the presentation and treatment of central nervous system (CNS) metastases, including brain metastases, spinal cord compression, and leptomeningeal metastases. DATA SOURCES: Published articles, research reports, and book chapters pertaining to CNS metastases. CONCLUSIONS: Most patients with CNS metastases have a limited life expectancy. Therapies are palliative, except in select patients who have improved chances for long-term control or occasional cures. In general, early detection and treatment of CNS metastases prevents devastating neurological disabilities. IMPLICATIONS FOR NURSING PRACTICE: Nurses across all health care settings can play an important role in early recognition of signs and symptoms of CNS metastases, and assist patients and families in preventing devastating neurological disabilities. Nurses are also frontline care providers for patients requiring various treatments and rehabilitation for metastatic CNS disease.

Intramedullary spinal cord abscesses.

Intramedullary spinal cord abscesses are rare lesions that cause a variety of neurologic problems. This article reviews pathogenesis and symptoms associated with these lesions. In addition, specific nursing interventions for care of patients with intramedullary spinal cord abscesses are presented. These interventions focus on diagnostic testing, treatment options and a plan of care for patients diagnosed with this disease entity.

The transoral surgical approach to craniovertebral pathology.

The transoral approach is a surgical technique that can be used effectively in the treatment of anterior craniovertebral junction (CVJ) pathology. In this review, we outline the signs, symptoms, and diagnostic studies that identify the pathology and help to determine subsequent therapy. The transoral approach, preoperative and postoperative management problems, and potential complications of the procedure are reviewed. The nursing care of a patient with CVJ pathology is discussed.

Spinal epidural lipomatosis: a case study.

Spinal epidural lipomatosis (SEDL), an abnormal localized or tumor-like accumulation of fat in the epidural space, is an infrequent complication of chronic steroid usage and an uncommon cause of spinal cord compression. A patient with a primary malignant brain tumor on chronic corticosteroids presented with a clinical picture of cord compression and was diagnosed with SEDL.