[Using Self-Efficacy Theory to Manage Ineffective Airway Clearance in a Client With Advanced Esophageal Cancer].

This nursing experience describes the application of "self-efficacy theory" to a patient with low self-efficacy who was diagnosed with advanced esophageal cancer. The nursing period was from December 3rd, 2020 to December 23rd, 2020. Medical records, interview assessment, and observation showed that the patient had ineffective airway clearance, which caused him to be in and out of the hospital several times, resulting in lower self-efficacy. In addition to applying the "self-efficacy theory", the authors referenced the patient's physiological and affective states, vicarious experiences, and performance experiences and used verbal persuasion techniques to assess the patient for nursing and interventions. During the nursing period, we established a good therapeutic relationship with the patient. We provided him with personalized nursing interventions to improve his physiological and affective states. These interventions included the administration of medication, posture drainage, and sputum percussion. We also sought the help of people who were close to the patient as participants in the medical care process. We improved self-efficacy by means of verbal persuasion through education and mental support; increased vicarious experience through verbal encouragement and sharing the experiences of other patients; and used a comparative approach to enable the patient to observe changes in his physical status over time. The interventions also improved his performance experience. The patient's airway status improved after his self-efficacy had been enhanced. Based on the results, it is hoped that this study will be a helpful reference on the theory of self-efficacy for nursing staff. It is also hoped that the results will better enable nurses to enhance the self-efficacy of patients using different means such as restoring patient confidence and enhancing the patient - the medical team relationship to further enhance the quality of patient care.

Decisional conflict and its determinants among patients with cancer undergoing immunotherapy combined with chemotherapy or targeted therapy: a cross-sectional study.

Decisional conflict might occur during shared decision-making (SDM) because immunotherapy is a rather novel treatment option for patients with cancer. To explore the prevalence and severity of physical and psychological symptoms and the effort invested in SDM in relation to decisional conflict among patients with cancer undergoing immunotherapy combined with chemotherapy or targeted therapy. This was a cross-sectional survey study. The SURE version of the Decisional Conflict Scale was used to screen cancer patients' decisional conflict status. Demographic or clinical characteristics, physical symptoms and psychological distress; efforts invested in the SDM process were also assessed as potential factors related to decisional conflict. One hundred seventeen patients surveyed, the prevalence of fatigue (79.5%), sleep disturbance (78.6%), poor appetite (67.5%), and pain (58.1%) symptoms were high and the severity was at moderate levels. The prevalence of pruritus (40.2%), rash (34.2%), dry skin (41.9%), and diarrhea (17.1%) symptoms were low and the severity was at mild levels. 65.8% of patients reported uncertainty, with mild to moderate levels. Furthermore, 97.4% of the patients made some effort in SDM, and the effort level was moderate (mean: 5.56 ± 2.02). 64.1% of patients were certain that immunotherapy was the best option. Age, uncertainty, and effort in the SDM process were major factors related to decisional conflict. We observed that older patients (age: ≥ 65) and those with higher uncertainty levels and less effort in SDM reported higher levels of decisional conflict. Future studies should explore older patients' decisional related needs of immunotherapy. Interventions should be designed to reduce the uncertainty experienced by patients with cancer and enhance their understanding of immunotherapy to enable them to take more effort in the SDM process.