Uncertainty affects cancer-related fatigue among breast cancer women undergoing peripherally inserted central catheter chemotherapy: the chain mediating role of psychological resilience and self-care.

BACKGROUND: Breast cancer patients undergoing chemotherapy via peripherally inserted central catheter often experience serious behavioral and psychological challenges, with uncertainty and cancer-related fatigue being prevalent issues that profoundly impact prognosis. Therefore, this study aimed to investigate the relationship between uncertainty and cancer-related fatigue by employing a chain mediation model to examine the potential mediating roles of psychological resilience and self-care. METHODS: A cross-sectional study was conducted with 223 breast cancer patients receiving peripherally inserted central catheter chemotherapy at two tertiary affiliated hospitals of China Medical University in Liaoning, China, from February 2021 to December 2022. Participants completed self-reported questionnaires to assess uncertainty, psychological resilience, self-care, and cancer-related fatigue. The collected data were subsequently analyzed using Pearson's correlation analysis, hierarchical regression analysis, and mediation analysis. RESULTS: Uncertainty exhibited a significant positive correlation with cancer-related fatigue (p < 0.01) and a negative correlation with psychological resilience (p < 0.01) and self-care (p < 0.01). Uncertainty was found to impact cancer-related fatigue through three pathways: psychological resilience mediated the relationship between uncertainty and cancer-related fatigue (mediating effect = 0.240, 95% confidence interval: 0.188 to 0.298, effect ratio = 53.22%); self-care also mediated this relationship (mediating effect = 0.080, 95% confidence interval: 0.044 to 0.121, effect ratio = 17.74%); furthermore, there was a significant joint mediating effect of psychological resilience and self-care on the association between uncertainty and cancer-related fatigue (mediating effect = 0.042, 95% confidence interval: 0.021 to 0.068, effect ratio o = 9.31%). CONCLUSION: The findings of this study revealed that uncertainty not only directly influenced cancer-related fatigue, but also operated through the mediating effect of psychological resilience, self-care, and sequential mediation of psychological resilience and self-care. Interventions tailored for breast cancer patients receiving peripherally inserted central catheter chemotherapy should target these factors to help alleviate uncertainty, enhance psychological resilience, and improve self-care practices, thereby ameliorating cancer-related fatigue.

Safety, Efficacy, and Patient Satisfaction with Initial Peripherally Inserted Central Catheters Compared with Usual Intravenous Access in Terminally Ill Cancer Patients: A Randomized Phase II Study.

PURPOSE: The purpose of this study was to investigate whether routine insertion of peripherally inserted central catheter (PICC) at admission to a hospice-palliative care (HPC) unit is acceptable in terms of safety and efficacy and whether it results in superior patient satisfaction compared to usual intravenous (IV) access. MATERIALS AND METHODS: Terminally ill cancer patients were randomly assigned to two arms: routine PICC access and usual IV access arm. The primary endpoint was IV maintenance success rate, defined as the rate of functional IV maintenance until the intended time (discharge, transfer, or death). RESULTS: A total of 66 terminally ill cancer patients were enrolled and randomized to study arms. Among them, 57 patients (routine PICC, 29; usual IV, 28) were analyzed. In the routine PICC arm, mean time to PICC was 0.84 days (range, 0 to 3 days), 27 patients maintained PICC with function until the intended time. In the usual IV arm, 11 patients maintained peripheral IV access until the intended time, and 15 patients underwent PICC insertion. The IV maintenance success rate in the routine PICC arm (27/29, 93.1%) was similar to that in the usual IV arm (26/28, 92.8%, p=0.958). Patient satisfaction at day 5 was better in the routine PICC arm (97%, 'a little comfort' or 'much comfort') compared with the usual IV arm (21%) (p <0.001). CONCLUSION: Routine PICC insertion in terminally ill cancer patients was comparable in safety and efficacy and resulted in superior satisfaction compared with usual IV access. Thus, routine PICC insertion could be considered at admission to the HPC unit.

[Comfort Status and Its Influencing Factors in Patients With Gastrointestinal Cancer After PICC Catheterization].

BACKGROUND: Gastrointestinal cancer is one of the higher-incidence malignant tumors worldwide. A majority of patients with gastrointestinal cancer receive chemotherapy, with peripherally inserted central catheter (PICC) serving as the main infusion instrument. Little research has addressed the issue of post-catheterization comfort in patients. PURPOSE: The purpose of the study was to investigate the comfort status of patients with gastrointestinal cancer at a tertiary hospital in China after PICC catheterization and to analyze the influencing factors. METHODS: Ninety-one patients with gastrointestinal cancer who were currently receiving initial chemotherapy were recruited from a third-class hospital in Changsha City from June 2018 to August 2019. Patients received ultrasound-guided PICC catheterization and were then investigated one-month later using a general demographics questionnaire, comfort evaluation scale, Cancer Patients PICC Self-management Scale, and complications evaluation scale. RESULTS: Ninety-one effective questionnaires were received (recovery rate: 100%). The total comfort score was 34.99 ± 4.07, with 10 patients (11.0%) reporting 'general comfort' and 81 patients (89.0%) reported 'comfort'. The average score for self-management ability was 151.55 ± 18.33. Nineteen patients (20.9%) had blood leakage and 7 (7.7%) had catheter prolapse. Multiple stepwise linear regression analysis showed that the limb used for catheterization, self-management ability, and occupation were the factors that significantly influenced degree of comfort in the participants (p < .05), predicting 21.9% of the total comfort score. CONCLUSIONS: The overall comfort level of patients with gastrointestinal cancer after PICC catheterization was comfort. In clinical work, nurses should choose the left limb based on patient wishes, pay attention to improving the self-management ability of patients, and provide appropriate nursing suggestions for patients who are wage earners to improve post-catheterization comfort.

Effects of passive music therapy on anxiety and vital signs in lung cancer patients undergoing peripherally inserted central catheter placement procedure.

PURPOSE: To evaluate the effects of passive music therapy on anxiety and vital signs among lung cancer patients at their first peripherally inserted central catheter placement procedure in China. METHODS: A randomized controlled clinical trial was conducted in the cancer center of a hospital in Chengdu from May to December 2017. A total of 304 lung cancer patients who met the inclusion and exclusion criteria were recruited and randomly assigned to experimental (n = 152) and control (n = 152) group, respectively. The control group only received standard care, while the experimental group received standard care and passive music therapy during peripherally inserted central catheter placement (30-45 min) and after catheterization, until discharged from the hospital (twice a day, 30 min once). Measures include anxiety and vital signs (blood pressure, heart rate, and respiratory rate). RESULTS: Repetitive measurement and analysis of variance showed that the patients in experimental group had a statistically significant decrease in anxiety, diastolic blood pressure, and heart rate over time compared to the control group, but no significant difference was identified in systolic blood pressure and respiratory rate. CONCLUSION: Passive music therapy can efficiently relieve the anxiety of lung cancer patients during peripherally inserted central catheter placement. It also can lower the patient's diastolic blood pressure and slow down the heart rate. So, music therapy benefits patients with peripherally inserted central catheter.

Living with a peripherally inserted central catheter: the perspective of cancer outpatients-a qualitative study.

PURPOSE: The aim of this study was to describe the experience of using a peripherally inserted central catheter (PICC) in cancer sufferers receiving outpatient treatment. METHODS: A qualitative, phenomenological study was performed. Purposeful sampling methods were used. Data collection methods included semi-structured interviews and researcher field notes. Thematic analysis was used to analyze data. The study was conducted following the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS: Eighteen patients (61% women, mean age 58 years) participated. They spent a mean duration of 155 days with the line in place. Two themes were identified with different subgroups. The theme "Living with a PICC line," including the subthemes "Benefits" and "Disadvantages," displays how the implantation is experienced by patients in a dichotomous manner. This highlighted both the beneficial and negative aspects of the implantation. The second theme was "Adapting to life with the catheter" and comprised three subthemes: "Advantages," "Lifestyle modifications," and "Overall assessment of the peripherally inserted central catheter," which shows how patients gradually accept the catheter by adapting their lifestyle. CONCLUSIONS: Over time, most patients considered having a PICC line to be a positive experience that they would recommend to other patients, as they found that it did not alter their quality of life. These results can be applied in Oncology Units for developing specific protocols for patients.

Representação social da punção venosa pediátrica durante internação para acompanhantes e para equipe de enfermagem / Social representation of pediatric venous puncture during hospitalization for caregivers and for nursing team

A punção venosa periférica, procedimento de atribuição da equipe de enfermagem é fonte de dor, estresses e complicações graves e um desafio para a enfermagem ao lidar com a criança e seu acompanhante. Justifica-se o presente estudo por sua originalidade e necessidade da compreensão dos significados da punção em crianças para adequação sociocultural do cuidado. O objeto de estudo é a representação social da punção venosa pediátrica para os profissionais de enfermagem e para os acompanhantes de crianças internadas. Os objetivos foram compreender as representações sociais elaboradas pelos profissionais de enfermagem e pelos acompanhantes sobre a punção venosa periférica realizada em crianças internadas, descrever comparativamente os conteúdos simbólicos e a sua alocação dentro do sistema hierárquico, identificar as dimensões representacionais das representações sociais e refletir suas implicações à luz da teoria de Betty Neuman. O percurso metodológico foi delineado na pesquisa qualitativa no referencial teórico-metodológico da Teoria das Representações Sociais com a triangulação de dados com a abordagem processual e estrutural alicerçada na teoria Betty Neuman. Foram realizadas entrevistas individuais gravadas com pontos norteadores e aplicação da técnica da evocação livre não hierarquizada. A presente investigação foi submetida e aprovada sob parecer nº 2.543,592 dos Comitês de Ética em Pesquisa da instituição preponente do estudo e da instituição que foi realizada a pesquisa. A representação social de pegar veia para os profissionais de enfermagem se estrutura sobre a dificuldade da realização do procedimento e de inserção da mãe no cuidado e para o grupo dos acompanhantes das crianças internadas, possui um caráter de impacto psicológico negativo para o grupo social. A representação dos profissionais de enfermagem sobre manter o cateter na veia de uma criança é caracterizada pelos comportamentos técnicos e para os acompanhantes significa sentimento de tristeza, mas entendendo sua necessidade. E o significado de retirar o cateter da veia de uma criança pelos profissionais de enfermagem é o fim da terapia venosa comprovada pela verificação na prescrição médica, o que gera nos acompanhantes sentimentos positivos expressos por felicidade e de alívio ao término da terapia venosa. Foi possível identificar as dimensões representacionais e os estressores intrapessoais, intrapessoais e transpessoais presentes no processo de punção venosa em crianças que dificultam o enfrentamento desse procedimento durante uma internação hospitalar, que requer redimensionamento da atuação e gerenciamento dos profissionais de enfermagem expressados por objetos, ações e relações necessárias durante o procedimento. Concluímos que a presente investigação contribui para a identificação dos significados e sentimentos do processo de punção venosa nas crianças na visão dos profissionais de enfermagem e dos acompanhantes das crianças e aponta uma reflexão sobre estressores presentes para redimensionar a assistência de enfermagem na terapia venosa nas crianças.

Peripheral venous puncture, nursing staff assignment procedure is a source of pain, stress and serious complications and a challenge for nursing when dealing with the child and his companion. The present study is justified because of its originality and the need to understand the meanings of puncture in children for sociocultural adequacy of care. The object of study is the social representation of the pediatric venous puncture for the nursing professionals and for the companions of hospitalized children. The objectives were to understand the social representations elaborated by the nursing professionals and the companions about the peripheral venous puncture in hospitalized children, to describe the symbolic contents and their allocation within the hierarchical system, to identify the representational dimensions of the social representations and to reflect their implications in the light of Betty Neuman's theory. The methodological course was delineated in the qualitative research in the theoretical-methodological reference of Theory of Social Representations with the triangulation of data with the procedural and structural approach based on the Betty Neuman theory. Individual interviews were recorded with guiding points and application of non-hierarchical free evocation technique. The present investigation was submitted and approved under opinion nº 2,543,592 of the Committees of Ethics in Research of the preponderant institution of the study and of the institution that was carried out the research. The social representation of picking up vein for the nursing professionals is structured on the difficulty of performing the procedure and insertion of the mother in the care and for the group of the companions of hospitalized children, has a character of negative psychological impact for the social group. The representation of nursing professionals about keeping the catheter in the vein of a child is characterized by technical behaviors and for the companions means a feeling of sadness, but understanding their need. And the meaning of withdrawing the catheter from a child's vein by nursing professionals is the end of the venous therapy proven by the medical prescription, which leads to the positive feelings expressed by happiness and relief at the end of venous therapy. It was possible to identify the representational dimensions and the intrapersonal, intrapersonal and transpersonal stressors present in the venous puncture process in children that make it difficult to cope with this procedure during a hospital stay, which requires a re-dimensioning of the nursing professionals' performance and management expressed by objects, actions and during the procedure. We conclude that the present investigation contributes to the identification of the meanings and feelings of the venous puncture process in children in the view of the nursing professionals and the accompanying children and points out a reflection on present stressors to resize the nursing care in venous therapy in children.

En la mayoría de los casos, la mayoría de las personas que sufren de esta enfermedad, El presente estudio está justificado debido a su originalidad y la necesidad de entender los significados de la punción en los niños para el sociocultural adecuado de la care. El objeto del estudio es la representación social de los pediatras de los pediatras para los enfermeros de enfermería y las familias de hospitalizados niños. Los objetivos para entender las representaciones sociales elaboradas por los profesionales de la salud y las compañeras sobre el periférico venoso puncturan en hospitalizados niños, describen los símbolos y su configuración en el sistema jerárquico, para identificar las dimensiones de las representaciones sociales y las reflectantes y su influencia en la luz de la teoría de la neurosis. El método metodológico fue delineado en la investigación cualitativa en la metodología de referencia de la teoría de las representaciones sociales con la triangulación de la fecha con el procedural y el enfoque basado en la base de la teoría de la neta. La individualización se ha registrado con guiding points y aplicación de no jerárquica libre evocation technique. La presente investigación fue presentada y aprobada bajo la opinión nº 2.543,592 de los comités de ética en investigación de la institución preponderante del estudio y de la institución que se llevó fuera de la investigación. La social representación de picking up para los profesionales de la salud se basa en la dificultad de realizar el procedimiento y la inserción de la madre en el cuidado y para el grupo de las familias de hospitalizados niños, tiene un carácter negativo de impacto impactante para el grupo social . La representación de los enfermeros de los enfermos sobre el mantenimiento del catéter en la veintena de un niño está caracterizado por los comportamientos de conducta y las compañías a la vez un sentimiento de tristeza, pero su comprensión. Y el significado de retirar el catéter de un niño a través de los pacientes de edad es el final de la terapia venosa proveniente de la prescripción médica, que se dirige hacia los positivos positivos expresados por la felicidad y la atención en el end of venous therapy. Es posible identificar las representaciones dimensionales y los intrapersonal, intrapersonal y transpersonal estrés presentados en el proceso venoso en los niños que hace difícil a cope con este procedimiento durante el hospital de estancia, que requiere la reescaleción de los profesionales de la enfermería y gestión expresada por objetos, acciones y durante el procedimiento. Nosotros consideramos que la presente invención contribuye a la identificación de los significados y los sentimientos de la venosa de los procesos en los niños en la vista de los pacientes de edad avanzada y el seguimiento de los niños y los puntos fuera de la reflexión sobre los estrés actuales para resize el cuidado de la enfer- niños

Burn patients' experience of peripherally inserted central catheter insertion: Analysis of focus group interviews from a South Korean burn center.

PURPOSE: Although the use of peripherally inserted central catheters (PICCs) has increased in burn patient treatment, little is known about the subjective experiences of these patients with PICCs. These experiences may be similar to those of other patients, particularly cancer patients receiving long term care but it is not clear if this is the case. Burn patients' exposure to skin injury may result in pain and apprehension similar but different from that felt by cancer patients. The aim of this study was to explore the subjective experiences of PICC insertion procedures among burn patients treated and managed in a burn center in South Korea. METHODS: A qualitative descriptive study was conducted using focus group interviews. Twenty-two participants who experienced of PICC insertion procedures participated in audio-taped focus groups sessions. Qualitative content analysis was used to identify categories of discussion depicting participants' subjective experience with PICC procedures. RESULTS: Three categories of PICC subjective experience were identified: (a) distress: painful burn treatments and repeated venipunctures, (b) PICC insertion: short and endurable, and (c) use of PICC: lots of pros and a few cons. CONCLUSIONS: The major findings from our focus group interviews were that frequent venipunctures are a significant sources of distress for burn patients. However, most participants reported that PICC provided a very convenient route for venous infiltration and for that they were generally positive about the procedure. This knowledge may enable clinicians to better the needs of their patients when undergoing PICC insertion and management.

[Psychological Aspects of Intravenous Treatment in Oncology and Permanent Venous Access Devices Tolerance]. / Psychologické aspekty nitrozilní lécby v onkologii a tolerance dlouhodobých zilních vstupu.

BACKGROUND: This paper deals with the psyche of patients during intravenous therapy. Since any intervention in the physical integrity of individuals are necessarily reflected in their mental level, we decided to conduct a survey dealing with tolerance of intravenous therapy in cancer patients. Especially, we focused on long-term venous access devices tolerance. PATIENTS AND METHODS: The aim of this study was to evaluate descriptively patients´ awareness of the administration of parenteral drugs, risks in the application and the differences between the administration of drugs to the central and peripheral venous system. To collect data, own questionnaire containing 21 questions was compiled. It was distributed to patients in the oncology department and outpatient oncology ward at the hospital Novy Jicin. Patients signed an informed consent for data collection. One hundred valid questionnaires were evaluated in the analysis of the data. RESULTS: The results of the study generally indicate that patients do not tolerate venous sampling and intravenous therapy optimally. Patients who have some form of venous access device are mostly satisfied, as it fulfills its mandate of maximum patient comfort. CONCLUSION: The results indicate that most patients know alternatives to peripheral drugs application. However, awareness of this issue is inadequate. The vast majority of patients would recommend the introduction of long-term venous access device to other patients.

Developing a venous assessment tool in IV chemotherapy administration.

It is recognized that the variety of intravenous (IV) chemotherapy regimens administered within the hospital setting is expanding rapidly, and this places increasing demands on nurses in relation to patient preparation and assessment. IV chemotherapy treatment is given over an extended period and requires multiple and often technically difficult peripheral cannulation attempts. To avoid the physical discomfort and potential psychological morbidity associated with repeated cannulation attempts, chemotherapy specialist nurses, in consultation with senior pharmacists, oncologists and other chemotherapy practitioners in a cancer centre, designed a venous assessment tool (VAT) that uses a scoring system to enable identification of patients who would benefit from insertion of a central vascular access device at the outset of treatment. This article describes the rationale for development of the VAT, the potential benefits of its use for both nurses and patients, and the plans for further refinement of the tool.

Effect of communication on pain during intravenous cannulation: a randomized controlled trial.

BACKGROUND: Clinicians frequently warn patients of discomfort before potentially painful procedures, despite the lack of evidence that such communications are helpful. We aimed to compare two communications (one with, and the other without, a warning of a 'sting') immediately before i.v. cannulation in order to measure differences in perceived pain by patients during the procedure. METHODS: Randomly assigned patients awaiting elective surgery received a communication immediately before i.v. cannulation consisting of either 'I am going to apply the tourniquet and insert the needle in a few moments. It's a sharp scratch and it may sting a little' (Group S) or 'I am going to apply the tourniquet on the arm. As I do this many people find the arm becomes heavy, numb and tingly. This allows the drip to be placed more comfortably' (Group NS). Cannulation pain was measured by a 0-10 verbal numerical rating score (VNRS) and five-point Likert scale. RESULTS: Of 101 participants, 49 were allocated to Group S and 52 to Group NS. Median VNRS pain scores with inter-quartile ranges (IQR) were 1 and 2, respectively, for both groups. Median Likert scores were 3 in Group S and 2 in Group NS with an IQR of 1 for both groups (P = 0.13). Six participants vocalized pain in Group S and none in Group NS (P = 0.01). Three participants withdrew their arm spontaneously in Group S and none in Group NS (P = 0.11). CONCLUSIONS: Warning patients of a 'sting' before i.v. cannulation may not be helpful.

Effects of stress on serum prolactin levels in patients with systemic lupus erythematosus.

The results of a study of effects of stress on serum prolactin (PRL) levels in patients with SLE reveal statistically significant differences in serum PRL level readings in samples taken over a short period of time, thus corroborating the need to take into account PRL stress induction during sample withdrawals and to interpret the values obtained, especially where moderate idiopathic hyperprolactinemia was detected. To eliminate any external stress factors, it is advisable to take PRL samples repeatedly and in perfectly resting patients.