RESUMO
This study investigates the effectiveness of combining psychological nursing with extended nursing in patients with colorectal cancer who have undergone enterostomy. Conducted from January 2021 to January 2022, this retrospective study involved 78 patients split into 2 groups of 39 each. The control group received standard nursing care, while the observation group benefitted from both psychological and extended nursing. The evaluation focused on anxiety, depression, sleep quality, mental resilience, and self-care abilities. Results, 3 months postdischarge, indicated that the observation group had significantly lower scores in the Hamilton Depression Rating Scale and the Pittsburgh Sleep Quality Index, and higher scores in the Connor-Davidson Resilience Scale and the Enterostomal Self-Care Ability Scale, compared to the control group (Pâ <â .05). The findings suggest that integrating psychological nursing with extended care significantly improves mood, sleep quality, psychological resilience, and self-care capabilities in these patients.
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Neoplasias Colorretais , Enterostomia , Autocuidado , Humanos , Feminino , Masculino , Estudos Retrospectivos , Autocuidado/psicologia , Autocuidado/métodos , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/psicologia , Neoplasias Colorretais/enfermagem , Pessoa de Meia-Idade , Enterostomia/enfermagem , Enterostomia/psicologia , Idoso , Ansiedade/etiologia , Ansiedade/psicologia , Depressão , Qualidade do Sono , Resiliência Psicológica , EmoçõesRESUMO
OBJECTIVES: Telenavigation (TN) is an innovative cancer follow-up method for oncology nurses. Little is known about the effectiveness of tele-navigation on cancer patients. This study investigated the opinions of healthcare providers (HCPs) and colorectal cancer patients' experience regarding patient follow-up with TN. DATA SOURCES: This is a phenomenological qualitative study. Semistructured interviews were conducted with fifteen patients and eight healthcare providers. Participants were selected by purposive sampling. Data were collected from March to October 2022 and analyzed by thematic content analysis. CONCLUSION: Six themes emerged that described the experiences of TN: (1) beneficial; (2) psychological state; (3) level of knowledge, (4) technology, (5) health care system, and (6) recommendations. Patients and HCPs found TN practice helpful and reassuring and they recommended expanding these practices within the health system. As a result of the research, the TN program is described as beneficial to patients and healthcare providers. IMPLICATIONS FOR NURSING PRACTICE: The TN follow-up is a beneficial implication for colorectal cancer patients undergoing treatment, and it deserves to be more widely deployed. It brings reassurance regarding psychological, reliable data access, and home follow-up. Patients and HCPs reported positive views on telephone follow-up. There is a recommendation that the innovative follow-up technique should be disseminated to the healthcare system and that cancer nurses should be more familiar with this method.
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Enfermagem Oncológica , Pesquisa Qualitativa , Telemedicina , Humanos , Enfermagem Oncológica/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Idoso , Neoplasias Colorretais/enfermagem , Neoplasias Colorretais/psicologia , SeguimentosRESUMO
BACKGROUND: Nursing care of colorectal cancer patients with stomas presents unique challenges, particularly during the transition from hospital to home. Early discharge programs can assist patients during this critical period. However, the effects of delivering a nurse-led discharge planning program remain under-studied. OBJECTIVE: Evaluate the effects of a nurse-led discharge planning on the quality of discharge education, stoma self-efficacy, readiness for hospital discharge, stoma quality of life, incidence of stoma complications, unplanned readmission rate, and length of stays. DESIGN: Assessor-blind parallel-arm randomized controlled trial with a repeated-measures design. SETTING(S): Participants were recruited from inpatients in the colorectal surgery unit of a university-affiliated hospital in Fujian, China. PARTICIPANTS: A total of 160 patients with colorectal cancer who received enterostomy surgery and were scheduled to be discharged to their homes. METHOD: Participants were randomly allocated to the experimental and control groups. The former received nurse-led discharge planning in addition to the usual discharge education, while the control group received only the usual discharge education. The program included an assessment, health education, stoma care, stoma support, discharge review, discharge medication and checklist integration, discharge referral, and post-hospital follow-up. Baseline data were collected prior to the intervention (T0). Data on the quality of discharge teaching, readiness for hospital discharge, stoma self-efficacy, and stoma quality of life were measured on the day of discharge from the hospital (T1). Patients' stoma self-efficacy and quality of life were repeat-measured 30 (T2) and 90â¯days post-discharge (T3). Data on stoma complications (T1, T2, T3), length of stays (T1), and unplanned readmission (T2, T3) were collected from medical records. RESULTS: Participants in the intervention group showed significant improvement in the quality of discharge teaching, readiness for hospital discharge, stoma self-efficacy, stoma quality of life, complications, and unplanned readmission, compared to the control group (pâ¯<â¯0.001). However, no statistically significant differences were observed in length of stays (pâ¯>â¯0.05). CONCLUSIONS: The program was effective for improving quality of discharge teaching, readiness for hospital discharge, stoma self-efficacy, and stoma quality of life, as well as for reducing complications and unplanned readmission among stoma patients. Integration of discharge planning into the usual process of care is recommended for clinical practice to facilitate a successful transition from hospital to home. REGISTRATION: This study was registered at the Chinese clinical trial registry (ChiCTR2200058756) on April 16, 2022, and participant recruitment was initiated in May 2022.
Assuntos
Neoplasias Colorretais , Alta do Paciente , Humanos , Neoplasias Colorretais/enfermagem , Neoplasias Colorretais/cirurgia , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Estomas Cirúrgicos , China , Qualidade de VidaRESUMO
OBJECTIVE: To systematically evaluate the effect of collaborative nursing on self-care ability of postcolostomy patients with colorectal cancer (CRC). METHODS: PubMed, Web of Science, Embase, China National Knowledge Infrastructure, and Wanfang databases were searched to collect relevant literatures on randomized controlled trials of postcolostomy patients with CRC. The search period was started from 2010 to 2021. Statistical analysis was performed on the data extracted from the comprehensive meta-analysis with STATA 16.0 analysis software. RESULTS: As a result, it was found that the incidence of adverse reactions in the control group was higher than that in the treatment group. Seven studies included the preintervention self-care concept and preintervention self-care skills. Six studies included preintervention self-care responsibility and preintervention exercise of self-care agency (ESCA) scale. In the comparison among the concept of self-care after intervention, self-care skills, self-care responsibility, and ESCA scale, all of them had higher scores in the treatment group than in the control group (P < 0.05). It fully explains that collaborative nursing can significantly improve the evaluation indicators of patients' self-care ability and reduce patient complications. CONCLUSION: The application of collaborative nursing in the nursing work of patients with CRC after colostomy can significantly reduce the incidence of adverse nursing reactions.
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Neoplasias Colorretais/enfermagem , Neoplasias Colorretais/cirurgia , Colostomia/enfermagem , Cuidados Pós-Operatórios/enfermagem , China , Colostomia/efeitos adversos , Biologia Computacional , Humanos , Processo de Enfermagem , Complicações Pós-Operatórias/enfermagem , Complicações Pós-Operatórias/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , AutocuidadoRESUMO
INTRODUCTION: Due to frequent treatment side effects and weight loss, colorectal cancer patients require oncologic care and nutritional counseling both during and after hospitalization. The current study evaluated differences in discharge and side effects management and nutritional behavior between colorectal cancer patients of a control group without systematic counseling and of an intervention group with access to structured in- and outpatient oncology nurse and nutritional counseling. METHODS: The presented explorative, quantitative, single-center, interventional pilot study is a health services research project with a quasi-experimental design. Using a self-designed standardized questionnaire, data were collected from the control group (n = 75) before and from the intervention group (n = 114) after the introduction of in- and outpatient oncology nurse and structured systematic nutritional counseling. The in- and outpatient counseling services were developed and evaluated in the form of a structured nurse-led counseling concept. RESULTS: Intervention group patients profited significantly from inpatient oncology nurse counseling in seven different areas of discharge management. No differences were observed concerning patient-reported general and gastrointestinal side effects except for xerostomia and dysphagia, but of the patients participating in both in- and outpatient oncology nurse counseling, 90.0% were better able to cope with general side effects of treatment. Patients with in- and outpatient structured systematic nutritional counseling more frequently received nutritional information (p = 0.001), were better at gauging food intolerances (p = 0.023), and followed the dietician's advice in cases of gastrointestinal side effects significantly more often (p = 0.003) than control patients. Counselor-reported outcomes concerning gastrointestinal side effects showed improvement in most of the patients taking part in systematic in- and outpatient nutritional counseling, except for weight loss in 4 patients. CONCLUSION: In- and outpatient counseling in discharge and side effects management and nutrition improve the outcomes of colorectal cancer patients. Outpatient counseling should be further developed and evaluated in future studies.
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Assistência ao Convalescente , Neoplasias Colorretais/terapia , Pesquisa sobre Serviços de Saúde , Adulto , Assistência ao Convalescente/métodos , Assistência ao Convalescente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/enfermagem , Aconselhamento , Feminino , Pesquisa sobre Serviços de Saúde/métodos , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Oncologia/métodos , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Estado Nutricional/fisiologia , Enfermagem Oncológica/métodos , Enfermagem Oncológica/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Alta do Paciente/normas , Alta do Paciente/estatística & dados numéricos , Educação de Pacientes como Assunto/normas , Educação de Pacientes como Assunto/estatística & dados numéricos , Projetos Piloto , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Autogestão/educação , Autogestão/psicologia , Autogestão/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The objective of this study was to assess sexual minority and heterosexual survivors' perceived quality of cancer care and identify demographic, clinical, and psychosocial characteristics associated with patient-centered quality of care. MATERIALS AND METHODS: Four cancer registries provided data on 17,849 individuals who were diagnosed with stage I, II, or III colorectal cancer an average of 3 years prior and resided in predetermined diverse geographic areas. A questionnaire, which queried about sexual orientation and other eligibility criteria was mailed to all cancer survivors. Of these, 480 eligible survivors participated in a telephone survey. Quality of cancer care was defined by 3 measures of interpersonal care (physician communication, nursing care, and coordination of care) and by rating cancer care as excellent. We used generalized linear models and logistic regression with forward selection to obtain models that best explained each quality of care measure. RESULTS: Sexual minority survivors rated physician communication, nursing care, and coordination of care similarly to heterosexual survivors, yet a significantly higher percentage of sexual minority survivors rated the overall quality of their cancer care as excellent (59% vs. 49%). Sexual minority survivors' greater likelihood of reporting excellent care remained unchanged after adjusting for demographic, clinical, and psychosocial characteristics. CONCLUSIONS: Sexual minority survivors' ratings of quality of colorectal cancer care were comparable or even higher than heterosexual survivors. Sexual minority survivors' reports of excellent care were not explained by their interpersonal care experiences.
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Sobreviventes de Câncer/estatística & dados numéricos , Neoplasias Colorretais/terapia , Heterossexualidade/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adulto , Sobreviventes de Câncer/psicologia , Neoplasias Colorretais/enfermagem , Comunicação , Procedimentos Clínicos/normas , Feminino , Pesquisas sobre Atenção à Saúde , Heterossexualidade/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados de Enfermagem/normas , Relações Médico-Paciente , Sistema de Registros , Minorias Sexuais e de Gênero/psicologia , Estados Unidos , Adulto JovemRESUMO
PURPOSE: To explore the psychological experiences of the family caregivers of inpatients with gastric cancer or colorectal cancer, and to identify the relationships among insecure attachment, social support, and psychological experiences. METHODS: The study design is a cross-sectional quantitative study collecting data through the use of four questionnaires, including the Hospital Anxiety & Depression Scale, the Self-esteem subscale of the Caregiver Reaction Assessment Scale, the Experience in Close Relationship Scale and the Social Support Rating Scale. Hierarchical regression analysis and path analysis were used to analyze the collected data. RESULTS: Data from 207 participants was used. Family caregivers had experienced both depression and high self-esteem. Social support has significant direct effects on both depression and self-esteem. Attachment anxiety had direct effects on depression and social support, attachment avoidance had direct effects on self-esteem and social support. Social support has mediated the relationship between adult attachment and psychological experiences. CONCLUSIONS: Caregivers had experienced both negative and positive psychological outcomes. There were differences in the effects of insecure attachment on psychological experiences. Social support plays an important role in the relationships among insecure attachment, depression, and self-esteem. Insecure attachment styles and social support should be considered in tailored interventions for family caregivers to reduce their depression and enhance their self-esteem.
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Cuidadores/psicologia , Neoplasias Colorretais/psicologia , Transtorno Depressivo/etiologia , Família/psicologia , Autoimagem , Apoio Social , Neoplasias Gástricas/psicologia , Adulto , Neoplasias Colorretais/enfermagem , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/enfermagem , Inquéritos e QuestionáriosRESUMO
Although screening programs are known and recommended for the early detection of colorectal cancer (CRC), the screening rates for the fecal occult blood test (FOBT) and colonoscopy are very low among adult individuals. Navigation programs, also known as individualized counseling, have recently begun to be used for increasing screening rates. The purpose of this study was to compare the efficacy of the Nurse Navigation Program versus usual care on CRC screening participation and movement in stage of adoption for CRC screening and to examine perceived benefits of and barriers to CRC screening. This study was designed in line with a pre- and posttest two-group methodology. A total of 110 participants (55 nurse-navigated and 55 non-navigated patients) were studied. Data were collected using the following three tools: a sociodemographic information form, the Harvard Colorectal Cancer Risk Assessment Tool, and Instruments to Measure Colorectal Cancer Screening Benefits and Barriers. Following the Nurse Navigation Program, the FOBT (82 and 84%, respectively) and colonoscopy completion rates (15 and 22%, respectively) were significantly higher in the nurse-navigated group than in the non-navigated group at 3 and 6 months follow-up. Following the program, the benefit perceptions of the nurse-navigated group about CRC screening were improved, and their barrier perceptions were reduced. The results showed that the Nurse Navigation Program had significant effects on CRC screening behavior and health-related beliefs concerning CRC screening. Further assessment of the Nurse Navigation Program in different groups should be performed to observe its effects.
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Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Recursos Humanos de Enfermagem/estatística & dados numéricos , Educação de Pacientes como Assunto , Navegação de Pacientes/métodos , Colonoscopia , Neoplasias Colorretais/enfermagem , Neoplasias Colorretais/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The care pathway of patients with colorectal cancer (CRC) 1 year prior to death, their causes of death and the healthcare use, and associated expenditure remain poorly described together. People managed for CRC (2014-2015), covered by the national health insurance general scheme and who died in 2015 were selected from the national health data system. A total of 15 361 individuals (mean age: 75 years, SD: 12.5 years) were included, almost 66% of whom died in short-stay hospital (SSH), 9% in hospital at home (HaH), 4% in rehabilitation units (Rehab), 6% in skilled nursing homes (SNH), and 15% at home. At least one other cancer was identified for one-third of these people. Almost one-half of people presented cardiovascular comorbidity, 21% had chronic respiratory disease, and 13% had a neurological or degenerative disease. During the last month of life, 83% were admitted at least once to SSH, 39% had at least one emergency department admission, 17% were admitted to an intensive care unit, 15% received at least one chemotherapy session (<60 years: 27%), and 5% received oral chemotherapy. Eighty-eight percent of the 60% of individuals who received hospital palliative care (HPC) vs 75% of those without HPC were admitted to SSH at least once during the last month. Cancer was the main cause of death for 84% (SSH: 85%, home: 77%) and corresponded to CRC for 64% of them. The mean annual expenditure per person during the last year of life was 43 398 (SSH: 48 804). This study suggests a relatively high level of HPC use during the year before death for people with CRC in France. High rates of emergency department, intensive care, and chemotherapy use were observed during the last month of life. However, management is very largely SSH-based with a small proportion of deaths at home.
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Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/terapia , Assistência Terminal/economia , Assistência Terminal/métodos , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/economia , Neoplasias Colorretais/enfermagem , Feminino , França , Hospitalização/economia , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medicina EstatalRESUMO
PURPOSE: Adherence to dietary guidelines and consumption of a high-quality diet are essential to rebuild strength and to decrease tumor recurrence and mortality in patients with colorectal cancer. We examined the associations of the diet quality of patients who have colorectal cancer with the characteristics of the patients and their families, the patient's perceived barriers to following the diet, and the family's attempts to change the diet. DESIGN: A cross-sectional study design was employed. Patients with colorectal cancer were recruited from National University Hospitals in South Korea. Enrolled patients were over 19 years old. Enrolled relatives served as the primary caregivers of the patients. METHODS: A total of 216 patients who had colorectal cancer and their family caregivers were enrolled. We assessed patients' diet quality, their perceived barriers to following the dietary plan, and family caregivers' attempts to improve diet quality. FINDINGS: Patients with colorectal cancer were less likely to have healthy eating habits if they perceived barriers to the recommended dietary plan, and more likely to have healthy eating habits if they had family caregivers who attempted to change their own dietary habits. CONCLUSIONS: Strategies that target patients' perceived barriers to following a healthy diet and that encourage family members to facilitate the adoption of a healthy diet can be integrated into the treatment plan of patients with colorectal cancer. CLINICAL RELEVANCE: The results can be used as evidence for promoting the notion that diet interventions for patients with colorectal cancer focus on the patient-family dyad, which support overall quality of care in oncology care hospitals.
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Sobreviventes de Câncer , Neoplasias Colorretais/enfermagem , Neoplasias Colorretais/terapia , Dieta Saudável , Comportamento Alimentar , Nível de Saúde , Adulto , Idoso , Cuidadores , Neoplasias Colorretais/fisiopatologia , Estudos Transversais , Família , Feminino , Frutas , Promoção da Saúde/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , República da Coreia , Inquéritos e Questionários , Verduras , Adulto JovemRESUMO
PURPOSE: To describe and analyse hospital nurses' experiences and perspectives of needs assessment in relation to colorectal cancer patients' survivorship care and rehabilitation needs. METHOD: The methodology and design of this study was phenomenological-hermeneutic, and the analysis was performed by Ricoeur's theory of interpretation. Twelve hospital nurses working within the care of patients with colorectal cancer participated in four focus group interviews between February-March 2018. Focus group interviews were recorded, transcribed and analysed. The study adhered to the COREQ checklist. RESULTS: Our analysis showed that nurses experienced challenges and barriers in conducting needs assessment. These challenges were described in three main themes. Encountering paradigms brought to light the difficulties relating to implementation of needs assessment into daily practice in the complex context of a hospital setting. Patient involvement could be challenging because of insufficient involvement and inadequate health literacy of patients in relation to needs assessment. A negative attitude towards systematic needs assessment among nurses could present a barrier because of their role as gatekeepers. CONCLUSION: The findings point to important elements that are necessary to consider when planning cancer survivorship care in the hospital setting so that all patients experience the best possible cancer trajectory. These insights can guide future clinical practice in the endeavour to ensure more systematic initiatives towards cancer rehabilitation. RELEVANCE TO CLINICAL PRACTICE: Based on our findings, cancer survivorship care needs assessment in the hospital setting should encompass specific guidelines on needs assessment and systematic implementation of these guidelines by involving hospital management, nurses and patients through use of visionary information and communication. Implementation of these guidelines would be supported by securing knowledge on cancer survivorship care for all hospital health professionals. Health literacy should be considered in formulating guidelines that enhance involvement of patients by use of patient-centred communication.
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Neoplasias Colorretais/enfermagem , Avaliação das Necessidades , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Sobrevivência , Atitude do Pessoal de Saúde , Feminino , Grupos Focais , Humanos , Masculino , Relações Enfermeiro-Paciente , Recursos Humanos de Enfermagem Hospitalar/psicologia , Pesquisa QualitativaRESUMO
BACKGROUND: Surveillance after colorectal cancer resection remains contentious, and faces several contemporary issues. Patient-centred care, intensive surveillance programmes and patient complexity increase the burden of surveillance on consultant-led clinics. Recent years have seen reshaping of nursing roles to meet healthcare demand. Nurse-led follow-up after colorectal cancer has been piloted, but not validated. We report outcomes from a nurse-led colorectal cancer surveillance clinic functioning in our institution since 2008, the longest term follow-up in the published literature. METHODS: Included patients were surveilled through the clinic from 2008 to 2018 by credentialled nurses who performed history, examination and investigations as per the local protocol. Demographic, tumour-related, outcome-related and patient satisfaction data were extracted from a prospectively maintained database. Primary outcomes were compliance with surveillance protocol and patient satisfaction. RESULTS: A total of 138 patients were included in the analysis. Mean time in surveillance was 25.4 months. Surveillance investigation protocol compliance was 97.4% overall. Five recurrences (3.6%) were detected during surveillance. In patients who developed recurrence, protocol compliance was 100%, and no clinical features of recurrence were newly found when patients were reviewed by a consultant surgeon. All recurrences during surveillance were detected by nursing staff. Response rate to the patient satisfaction survey was 90%. 96.3% of patients reported receiving adequate explanation regarding cancer surveillance and nurse-led care. 90.7% of patients rated the clinic as 'excellent' and 9.3% as 'good'. CONCLUSION: Our results show a high level of efficacy and patient satisfaction associated with a nurse-led colorectal cancer surveillance clinic over a prolonged time period, the longest in the published literature.
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Assistência ao Convalescente/métodos , Neoplasias Colorretais/enfermagem , Recidiva Local de Neoplasia/enfermagem , Cooperação do Paciente/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Conduta Expectante/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Encaminhamento e Consulta , Estudos RetrospectivosRESUMO
AIMS: The colorectal Clinical Nurse Specialist (CNS) makes an important contribution to the care of individuals diagnosed with a significant polyp and early colorectal cancer (SPECC). METHODS: This paper offers an expert opinion on the role of the CNS in SPECC, informed by relevant literature. RESULTS: A CNS can support the patient through the diagnostic and treatment pathway acting as the patient's advocate as a core member of the multidisciplinary team. They will offer support and information to help patients understand their diagnosis, make choices about their available treatment options and help them to feel prepared for any treatment undertaken. CONCLUSION: By providing care that is respectful of, and responsive to, individual patient preferences, needs and values, the CNS can play an important role in promoting patient-centred care.
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Neoplasias Colorretais/enfermagem , Pólipos Intestinais/enfermagem , Enfermeiros Clínicos/psicologia , Papel do Profissional de Enfermagem , Assistência Centrada no Paciente/métodos , Neoplasias Colorretais/etiologia , Humanos , Pólipos Intestinais/complicaçõesAssuntos
Colonoscopia/enfermagem , Neoplasias Colorretais/enfermagem , Detecção Precoce de Câncer/enfermagem , Profissionais de Enfermagem/estatística & dados numéricos , Papel do Profissional de Enfermagem , Padrões de Prática em Enfermagem/estatística & dados numéricos , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Masculino , Programas de Rastreamento/métodosRESUMO
AIM: To describe the structure, content, and the communicative and pedagogic strategies in discharge consultations between patients and professionals after colorectal cancer surgery. BACKGROUND: Both nurses and surgeons play an important role in preparing patients for discharge from hospital following surgery for colorectal cancer (CRC). DESIGN: An explorative quantitative and qualitative research based on analysis of transcriptions of 13 audio-taped discharge consultations between patients and nurses and patients and surgeons conducted between January - March 2012. METHODS: In the quantitative analysis, the structure of each consultation was described in phases, subtopics, and main topics. The proportion of the main topics in relation to the whole conversation was counted in percentages. The text from the consultations was then analysed qualitatively with the support from Ricoeur's theory of interpretation. RESULTS: The language constituted the essence in the consultations regardless of other communicative and pedagogical strategies. The pedagogic strategies used were explanation model, information transfer, task orientation, and dialogue. Topics occurring in the consultations were Operation, Symptoms, Medication, Thromboprophylaxis, Recovery after surgery, Bowel function, Spreading, and Follow-up. The surgeons and nurses used similar topics, but the surgeons used more communicative and pedagogic strategies. CONCLUSION: Language was fundamental for communication and independent of the communicative and pedagogical strategies. Using preparedness communication more consistent in discharge consultation can help patients to better understand the recovery process after CRC surgery and regain control over their life. It is important that the consultations build on the patient as an active and learning person.
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Neoplasias Colorretais/cirurgia , Comunicação , Alta do Paciente , Prática Profissional , Relações Profissional-Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/enfermagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Educação de Pacientes como Assunto , Cirurgiões/estatística & dados numéricos , EnsinoRESUMO
Physiological, psychological, and social problems may affect adaptation to living with a stoma. A descriptive, cross-sectional study was conducted between March 2017 and June 2017 among patients culled from a manufacturer's database to identify factors that influence psychosocial adjustment in Chinese patients with an enterostoma. Patients with a history of ostomy surgery ≥1 month prior and who were ≥18 years of age, completed a primary school education, and able to communicate in Chinese were eligible to participate unless they had a history of psychosis, cognitive impairment, or participation in other research programs. After providing informed consent, participants completed a questionnaire that addressed demographic (age, gender, employment, educational level, marital status, medical payment method, living status, and area of residence) and stoma-related (date of surgery, preoperative stoma siting, ostomy appliance type, peristomal complications, regular defecation, stoma self-care ability, stoma-related communication with medical staff, level of understanding regarding stoma knowledge and care skills, appliance change knowledge/experience, and leakage history) factors. Social support was assessed using the 10-item Social Support Revalued Scale (SSRS), and 3 dimensions of adjustment (acceptance, continuous worry, and positive life attitude) were assessed using the 20-item Chinese version of the Ostomy Adjustment Inventory (OAI). Questionnaires were administered via an online survey platform. Data were analyzed descriptively, and single-factor analysis and stepwise multiple linear regression were applied to identify the factors that influenced the adjustment level. Incomplete (missing >2 questions), incorrect, or hastily completed (within 600 seconds) records were excluded from analysis. Of the 1109 persons who returned the questionnaire, 1010 (91.1%) completed the entire survey (564 men [55.8%] and 446 women [44.2%], mean age 56.62 ± 15.62 years); 823 (81.5%) had a colostomy and 187 (18.5%) had an ileostomy. The OAI dimension continuous worry was negatively and significantly associated with all 3 dimensions of the SSRS, including subjective support (r = 0.259), objective support (r = 0.259), and utilization of support (r = 0.289), while the dimension acceptance was positively associated with both subjective support (r = 0.082) and objective support (r = 0.074) (all P values <.05). Using multiple linear regression, residence area, peristomal complication, regular defecation, leaking, self-care ability, communication with medical staff regarding ostomy, understanding knowledge or skill needed for stoma care, utilization of social support, and total score of social support were found to be significantly associated with ostomy adjustment level (all P values <.05). Patients living in an urban area, with no history of peristomal complications, who had regular defecation, had not experienced leaking, had better self-care ability, frequently communicated with medical staff, had a high level understanding about knowledge or skill of stoma, and had higher social support scores had higher adjustment scores. Knowledge of the factors that enhance or hinder adaptation of the patient to the ostomy is an important tool in the clinician's care armamentarium.
Assuntos
Adaptação Psicológica , Enterostomia/efeitos adversos , Enterostomia/psicologia , Qualidade de Vida/psicologia , Adulto , Idoso , China , Neoplasias Colorretais/enfermagem , Neoplasias Colorretais/cirurgia , Estudos Transversais , Enterostomia/enfermagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Psicometria/estatística & dados numéricos , Pesquisa Qualitativa , Estatísticas não Paramétricas , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To examine the compliance of colorectal cancer surveillance decisions for individuals at greater risk with current evidence-based guidelines and to determine whether compliance differs between surveillance models. DESIGN: Prospective auditing of compliance of surveillance decisions with evidence-based guidelines (NHMRC) in two decision-making models: nurse coordinator-led decision making in public academic hospitals and physician-led decision making in private non-academic hospitals. SETTING: Selected South Australian hospitals participating in the Southern Co-operative Program for the Prevention of Colorectal Cancer (SCOOP). MAIN OUTCOME MEASURES: Proportions of recall recommendations that matched NHMRC guideline recommendations (March-May 2015); numbers of surveillance colonoscopies undertaken more than 6 months ahead of schedule (January-December 2015); proportions of significant neoplasia findings during the 15 years of SCOOP operation (2000-2015). RESULTS: For the nurse-led/public academic hospital model, the recall interval recommendation following 398 of 410 colonoscopies (97%) with findings covered by NHMRC guidelines corresponded to the guideline recommendations; for the physician-led/private non-academic hospital model, this applied to 257 of 310 colonoscopies (83%) (P < 0.001). During 2015, 27% of colonoscopies in public academic hospitals (mean, 27 months; SD, 13 months) and 20% of those in private non-academic hospitals (mean, 23 months; SD, 12 months) were performed more than 6 months earlier than scheduled, in most cases because of patient-related factors (symptoms, faecal occult blood test results). The ratio of the numbers of high risk adenomas to cancers increased from 6.6:1 during 2001-2005 to 16:1 during 2011-2015. CONCLUSION: The nurse-led/public academic hospital model for decisions about colorectal cancer surveillance intervals achieves a high degree of compliance with guideline recommendations, which should relieve burdening of colonoscopy resources.
Assuntos
Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/estatística & dados numéricos , Liderança , Modelos de Enfermagem , Cooperação do Paciente/estatística & dados numéricos , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/enfermagem , Detecção Precoce de Câncer/enfermagem , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa em Avaliação de Enfermagem , Vigilância da População , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Austrália do SulRESUMO
BACKGROUND: The hepatic arterial infusion (HAI) pump is a treatment-delivery method based on the principle of targeting the tumor site directly and can be used alone or in combination with systemic chemotherapy. OBJECTIVES: The intent of this article is to serve as a resource for oncology nurses to safely identify and manage HAI pump complications. These complications include seroma, flipped HAI pump, infection, changes in pressure and temperature, challenging access, dry pump, high residual volume, chemical hepatitis, risk of ulcer, and radiologic imaging considerations. METHODS: The authors performed a literature review to provide a foundation for nurses to be able to manage HAI pump infusions. FINDINGS: The literature review revealed minimal nursing resources to manage complications with an HAI pump. Resources to manage complications are crucial for safely administering medications and properly maintaining the function of the pump. Attention to patient education should be incorporated in nursing practice.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/enfermagem , Bombas de Infusão/efeitos adversos , Infusões Intra-Arteriais , Enfermagem Oncológica/educação , Complicações Pós-Operatórias/enfermagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Educação Continuada em Enfermagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermagem Oncológica/métodosRESUMO
BACKGROUND: Nearly 20% of colorectal cancer (CRC) patients present with potentially incurable (Stage IV) disease, yet their physicians do not integrate cancer treatment with palliative care. Compared with patients treated by primary providers, surgical patients with terminal diseases are significantly less likely to receive palliative or end-of-life care. OBJECTIVE: To describe surgeon perspectives on palliative and end-of-life care for patients with Stage IV CRCs. DESIGN: This is a convergent mixed methods study using a validated survey instrument from the Critical Care Peer Workgroup of the Robert Wood Johnson Foundation's Promoting Excellence in End-of-Life Care Project with additional qualitative questions. SETTINGS: Participants were all current, nonretired members of the American Society of Colon and Rectal Surgeons. MAIN OUTCOME MEASURES: Surgeon-perceived barriers to palliative and end-of-life care for patients with Stage IV CRCs were identified. RESULTS: Among 131 Internet survey respondents (response rate 16.5%), 76.1% reported no formal education in palliative care, and specifically noted inadequate training in techniques to forgo life-sustaining measures (37.9%) and communication (42.7%). Over half (61.8%) of surgeons cited unrealistic expectations among patients and families as a barrier to care, which also limited discussion of palliation. At the system level, absence of documentation, appropriate processes, and culture hindered the initiation of palliative care. Thematic analysis of open-ended questions confirmed and extended these findings through the following major barriers to palliative and end-of-life care: (1) surgeon knowledge and training; (2) communication challenges; (3) difficulty with prognostication; (4) patient and family factors encompassing unrealistic expectations and discordant preferences; and (5) systemic issues including culture and lack of documentation and appropriate resources. LIMITATIONS: Generalizability is limited by the small sample size inherent to Internet surveys, which may contribute to selection bias. CONCLUSIONS: Surgeons valued palliative and end-of-life care but reported multilevel barriers to its provision. These data will inform strategies to reduce these perceived barriers.
Assuntos
Neoplasias Colorretais/enfermagem , Neoplasias Colorretais/psicologia , Cuidados Críticos/psicologia , Cuidados Paliativos na Terminalidade da Vida/psicologia , Cuidados Paliativos/psicologia , Cirurgiões/psicologia , Assistência Terminal/psicologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados UnidosRESUMO
OBJECTIVE: To examine the viability of colon cancer screening with computed tomography colonography, also known as virtual colonoscopy. DATA SOURCES: Clinical guidelines, published medical research. CONCLUSION: Virtual colonoscopy, under the right circumstances, is an accurate viable screening tool for patients who may not otherwise desire to or are not able to participate in traditional colonoscopy. IMPLICATIONS FOR NURSING PRACTICE: Nurses should be aware that routine colon cancer screening is recommended starting at age 50. In addition to the traditional colonoscopy, there are other options if a patient is unwilling or unable to undergo optical colon screening. Nurses should discuss the positive and negative aspects of different types of colon screening and teach proper bowel preparation for colon screening.