Supportive care needs of men living with prostate cancer in England: a survey.

Men with prostate cancer have various treatment options depending upon their stage of disease, age and presence of comorbidity. However, these treatments typically induce side effects, which generate currently ill-defined supportive care needs. This study examined the supportive care needs of men with prostate cancer within England. A postal questionnaire survey was conducted in six acute NHS Trusts. Seven hundred and forty-one men with prostate cancer participated. They had been diagnosed 3-24 months prior to the survey and had received various treatments. Men surveyed had specific and significant unmet supportive care needs. Areas of greatest need are related to psychological distress, sexuality-related issues and management of enduring lower urinary tract symptoms. High levels of psychological distress were reported, and those reporting psychological distress reported greater unmet supportive care needs. Unmet sexuality-related need was highest in younger men following radical prostatectomy. Lower urinary tract symptoms were almost universal in the sample. Perceived quality of life varied; men unsure of their remission status reported lowest quality of life. Psychological distress impacts significantly on perceived unmet need and is currently not being assessed or managed well in men living with prostate cancer in England.

Interventions to alleviate patients' stress: a review.

Many events occurring in hospital have been found to be stressful for patients. Interventions aimed at alleviating these reactions have, in the main, been evaluated by psychologists and nurses. Methods used and contrasting approaches are reviewed. Although surgery has been the main event for this research, special investigations, treatments and hospital admission and discharge have also been studied. Outcome criteria have varied with physical measures being used more by nurses. Emphasis has been placed on preventing complications rather than enhancing recovery. Recent work has tended to compare types of intervention. Focused positive reappraisal and information on sensations are provided rather than procedural details as they have been found more successful in alleviating stress.

Fatigue in patients receiving chemotherapy: patterns of change.

Fatigue is reported to be a significant and distressing problem for people receiving chemotherapy, but the phenomenon is poorly understood and little is known about the factors influencing it. Nurses need to understand the dimensions of fatigue in order to provide effective help for individuals with cancer who experience it. This article describes a study that employed a daily diary with the aim of prospectively charting the onset, pattern, duration, intensity, and distress associated with fatigue in 109 patients receiving chemotherapy. The diary comprised four visual analogue scales measuring selected dimensions of fatigue: extent of fatigue, distress caused by fatigue, the influence of fatigue on the ability to engage in social activities, and the impact of fatigue on work-related activities. The patients' diaries produced detailed time series of data that captured the dynamics of their fatigue. Analyses of these data revealed the patterns of fatigue after the administration of chemotherapy, which appear strongly related to both the timing of treatment and the manner in which cytotoxic agents are administered. Furthermore, Kruskal-Wallis tests performed to compare fatigue among subgroups of patients revealed that it is statistically associated with particular types of cancer, specific chemotherapy regimens, and certain methods of drug administration. Fatigue varied throughout the day, more frequently occurring in the afternoon and early evening. These insights, gained during this study about the likely pattern of fatigue in the period after the administration of chemotherapy, and the potential benefits of maintaining a fatigue diary could be utilized by nurses engaged in the care of chemotherapy patients.

The experiment: is it worthwhile?

Parallel developments in social and educational research as well as more explicit humanistic philosophies of nursing have influenced views on what types of investigation are acceptable or useful to this field. Shifts in opinion towards more participative and qualitative studies reflect the move away from the predominant traditions of medical research and the experiment. This paper attempts to explore the reasons for such a change and examine the related criticisms of the positivist school and in particular deductive experimental approaches in order to assess whether such approaches should continue to have a role in building nursing knowledge.

Influences on length of stay in intermediate care: lessons from the nursing-led inpatient unit studies.

A recent study found that intermediate care in a nursing-led in-patient unit (NLIU) led to dramatically increased hospital stay when compared to usual care in a hospital. This is despite a large body of work across a variety of settings, including the pilot for that same study, which suggests that the NLIU is effective. This paper presents a series of exploratory analyses that aim to explore the findings further. A number of changes were identified in the functioning of the NLIU between the main and pilot study including patient population, leadership and staffing levels. Two ANCOVA analyses reveal that while performance of the NLIU declined between the two studies, that of usual care improved dramatically. Extended lengths of stay appear to be associated with the NLIU's location on a satellite site rather than the model of care per se. Reduction in the staffing levels on the NLIU and a change in patient population may well explain the findings.

Evaluating the clinical nurse specialist. A review.

This paper reviews evaluative studies on the role of clinical nurse specialists and aims to describe and categorise research according to the methods used. By using the structure, process and outcome framework a clear pattern of research development and evidence emerges. It appears that significant benefits accrue for patients from the contribution of nurse specialists, but more experimental studies with combined methods should now be applied to this area.

Self-concept, social support and hysterectomy.

This paper reports on part of a larger study financed by the DHSS and concerned with describing recovery from hysterectomy and evaluating an experimental counselling session aimed at helping women to plan and manage their own recovery. The effect of the operation on the woman's self-concept and the possible role of social support in the recovery process are the principal foci. Contrary to findings in much previous research, women in this study showed no evidence of adverse changes in self-concept, depression levels were reduced after operation, and the majority of women were glad to have had a hysterectomy. Low levels of support from partner, family and friends were associated with poorer outcome on some of the indicators used, and possible explanations for this are considered.

The newly registered nurse and the cancer patient: an educational evaluation.

This paper reports a study which aimed to develop an understanding of newly registered nurses' attitudes, knowledge, confidence and educational needs in relation to cancer care. An educational intervention designed to meet these nurses' needs was then developed and evaluated with 127 newly registered nurses from two general hospitals. Nurses attended two different educational interventions; one group of nurses completing a 3 day experiential workshop; and a second group attended a more formal seminar programme. A third group of nurses who were unable to obtain study leave were followed up as a control group. A triangulation strategy was used to collect data from different sources, and included a baseline study, and a study of nurses before, after and 3 months following the educational interventions. Data from the study revealed the perceived need and desire for more education on cancer care, and the strong association of cancer with death amongst newly registered nurses. Significant benefits to those nurses attending the workshop were demonstrated. These differences were however less obvious at 3 months follow-up.

Abnormal illness behaviour: the nursing contribution.

Patients who suffer from physical symptoms with no apparent organic pathology often receive inappropriate care in the general hospital. Many terms have been used to describe such patients, often derogatory. More careful assessment, systematic description and treatments are required from all staff. In this study a sample (N = 79) of patients with various 'hysterical' complaints, other than pain, were interviewed, and completed a set of psychological instruments to detect any personality or mood disturbance. These data were also collected from two comparison groups from a psychiatric clinic (34) and a neurological setting (36). The main purpose of this study, to identify differences between these groups, was achieved. Patients in the main sample were found to have a high frequency of affective disturbance, being moderately anxious and depressed. Most understood that their problems may have been psychological but had an unrealistic view of their coping strategies and life problems. Nurses in both general and psychiatric settings could have an immensely important role in both identifying such patients and their needs and in providing appropriate guidance and treatments.

Evaluation of the role of the Parkinson's disease nurse specialist.

A one year follow up study of 108 randomised patients with Parkinson's disease at three centres was performed to investigate differences between care provided by the hospital based Parkinson's disease nurse specialist (PDNS) compared with the Consultant Neurologist (control). Only two (out of 22) differences were found where physical functioning and general health improved more in the control group. Provision of PDNS' for patients with Parkinson's disease cannot therefore be recommended solely on cost-effectiveness grounds because of similar outcomes but increased costs associated with the PDNS providing additional care. However medical and nursing specialists valued their complimentary expertise, and patient and carers responses to consultations also reflect that PDNS's have particular contributions. Aspects of care most valued by patients and carers and consultation interactions are discussed.

Nurses' infection-control practice: hand decontamination, the use of gloves and sharp instruments.

Infection is an acknowledged hospital problem. Micro-organisms are disseminated mainly via hands but there is evidence that hand decontamination, the most important means of prevention, is performed too seldom, and not always after activities likely to result in heavy contamination. Nurses themselves are exposed to risks of infection, chiefly through contact with blood and body fluids, yet it has also been reported that gloves are not always worn during contact with patients' secretions and that the handling and disposal of sharp instruments may be performed unsafely. The study reported in this paper documents nursing behaviour in relation to hand decontamination, the use of gloves and sharps, taking into consideration a number of variables which could influence practice: availability of the expertise afforded by an infection-control nurse, clinical setting, nursing workload, knowledge and the resources available to control infection. Hands were decontaminated after 28.78% of patient contacts. Hands were decontaminated after 49.85% of activities likely to result in heavy contamination. Performance was related to nursing workload and the availability of hand decontaminating agents, especially when the nurses became busy. Use of gloves when they were available also proved good, with little evidence of wasteful use. The handling and disposal of sharps were commendable for most subjects but a few grossly unsafe incidents were nevertheless witnessed, apparently not associated with any of the variables examined.

The development of an observation schedule for measuring nurse-patient touch, using an ergonomic approach.

An observation schedule for recording nurse-patient touch was developed, using an ergonomic approach to design. A preliminary study using video-tape analysis and a ward survey indicated that 'instrumental touch' was more frequently employed by nursing staff than 'expressive touch'. Three levels of relevant information relating to touch were recorded: General circumstances (the type of hospital, etc.); Demographic variables (relating to participants in the touch episode); Events specifically relating to the touch episode. The third section of the schedule was tested in an acute geriatric ward, using inter-observer reliability techniques. Reliability was found to be acceptable for those where the criteria for categorization were reasonably objective. It was concluded that an instrument for recording nurse-patient touch has useful applications for both ergonomic and nursing research.

Patient assessment: validation of a nursing instrument.

The aim of this study is to evaluate the reliability and validity of the Byron Physical Assessment Framework (BPAF). The BPAF is a systems based checklist of physiological measurements, signs, and symptoms designed to structure and document the assessment of a patients physical condition by nursing staff. Initially the BPAF was refined using extensive literature review and expert opinion to improve the comprehensiveness and clarity for its intended purpose. As a result the content validity of the BPAF was supported. Inter-rater reliability between both expert-expert and novice-expert pairings was assessed. A total of 68 assessments were conducted by pairs of qualified nurses with patients on general medical and surgical wards and a nursing-led unit in one London Hospital. Reliability of the dichotomous data items of the BPAF was found to be generally good (kappa > 0.6) with only one item showing a poor reliability (kappa < 0.20). Reliability for continuous items such as pulse and respiratory rate was surprisingly low with evidence of large variation between raters in addition to systematic bias. With relatively little teaching, novice assessors were able to use the BPAF and achieve good inter-rater reliability with expert assessors although this was lower than the reliability of the expert diads. The utilisation of the BPAF to fulfil intended purpose was assessed by examining completed assessments and the outcome in terms of nurses' actions in light of new abnormal findings. Both were found to be fair, showing that the BPAF does affect the actions of nurses although it could be utilised more.

Recognising advancing nursing practice: evidence from two observational studies.

Debates over title, grades and relationships across the profession has tended to dominate the literature in advancing nursing practice. Fewer research projects have attempted to study the activities of nurses who are designated as undertaking advancing nursing roles. One study evaluating Masters courses for Clinical Nursing Practice and a second addressing the impact of the 'Scope of Professional Practice' (United Kingdom Central Council for Nursing, Midwifery & Health Visiting, 1992) document by this team of authors afforded these research opportunities. In this paper empirical data from 'reflective' observation with 19 nurses (including midwives and health visitors) are presented to illustrate the range and type of functions undertaken by a small group of practitioners developing their practice. A number of characteristic features emerged. Assessment of individual and group needs, positive motivation to constantly improve practice, inter-disciplinary and cross agency working for planned change and an ability to identify and prioritize service requirements were recognised in these nurses' roles. Certain personal attributes were seen to be essential for successful role development such as confidence, commitment and problem solving powers combined with a positive working environment and supportive managers.

The effectiveness of intermediate care in a nursing-led in-patient unit.

In order to assess the potential for a nursing-led in-patient unit (NLIU) to substitute for a period of care in the acute hospital environment and promote recovery before discharge, a randomised controlled trial was conducted. The setting was an acute inner London hospital trust, part of the UK's national health service. Of patients referred to a NLIU from acute wards, 80 were randomly assigned to usual care (remain in normal hospital system) and 97 to the NLIU (nursing-led care with no routine medical involvement). Patients were identified as medically stable but in need of additional nursing intervention by referring medical staff prior to full nursing assessment of suitability. Outcomes compared included functional dependence (Barthel Index), discharge destination and length of hospital stay. Inputs from nursing, paramedical and medical staff were measured. There was no significant difference in functional independence at discharge (p0.05). Patients undergoing usual care stayed in hospital for less time (mean difference 18 days, p<0.01) but the same number of patients were in hospital 90 days after recruitment (23% NLIU, 24% usual care p0.05) due to re-admissions. The model of care implemented differed considerably from that described in the literature with the NLIU having significantly fewer qualified nurses (RNs). Although the anticipated benefits of the NLIU were not demonstrated, the study does not conclude that the model should be rejected. Factors driving length of stay need to be further investigated, as does the possibility of post-discharge benefits. The NLIU does offer some potential to substitute for acute care but also appears to substitute for a period of primary care.

Preregistration nursing education in Australia, New Zealand, the United Kingdom, and the United States of America.

The debate concerning nurses' diverse entry into practice was enlivened in 1995, when the American Nurses Association reaffirmed its contention that a baccalaureate degree was necessary for professional nursing practice. This debate may be informed by an appreciation of the educational routes taken by other countries that have changed from hospital-based to college-based nursing education. This paper describes and analyzes preregistration nursing education in Australia, New Zealand, the United Kingdom, and the United States, from the late nineteenth century to the present. Nurses in Australia and New Zealand are currently educated entirely at the baccalaureate level. In the United Kingdom, nursing education is in the process of becoming completely university-based, resulting in a diploma or degree. In the United States, the majority of nurses graduate from two-year associate degree programs. This level of education, briefer than in the other countries described, potentially limits nurses' professional contributions.

Evaluating nurse-led inpatient units.

This article highlights findings from three studies into nurse-led inpatient units. The results are not the same in each case, particularly with regard to length of stay, and the authors discuss the possible reasons for this. Further work is needed to develop NLIUs and identify cost savings.

Perceptions and practice of health education and heath promotion in acute ward settings.

This paper reports on an overview of the findings from a two-year Department of Health-funded research project. The study had two overall aims: to describe the extent to which health education and health promotion had become integrated into nurses' practice in acute-care settings and to identify the facilitative and inhibitory factors involved. The study comprised separate sequential stages of data collection and utilised a multi-method approach. Findings from a survey of ward sisters and from ward-based case studies are presented and discussed. These suggest that nurses have yet to fulfill their potential as educators and promoters of health and that a number of influences interact at ward level to encourage or impede the development of this role.