Pain management strategies used by patients with breast and gynecologic cancer with postoperative pain.

Many people with cancer will experience pain when they are outside of structured care settings. Patients must provide their own self-care, drawing on instructions from healthcare providers and on independently developed plans for pain management. With growing interest in complementary therapies, the scope of nonpharmacologic interventions used by patients with cancer to manage pain may be very different than 10-15 years ago. The purpose of this study was to describe steps taken by patients with breast and gynecologic cancer to manage pain after discharge from a surgical hospitalization. A secondary analysis was completed using data from 34 women who participated in a randomized trial of guided imagery. Techniques used included positioning, distraction, relaxation, heat, and eating/drinking. Compared to results of previous studies, increased use of relaxation strategies (breathing, imagery, music, meditation) was noted in the current study. The majority of participants used nonpharmacologic strategies in addition to analgesic medications. Pain-related outcomes were similar among persons who used analgesic medications alone and those who used a combination of analgesics and nonpharmacologic strategies. Nurses may benefit from knowing which pain management strategies patients find helpful so that they can encourage their use and teach similar strategies to the patients who find them useful.

Outcome expectancy and success with cognitive-behavioral interventions: the case of guided imagery.

PURPOSE/OBJECTIVES: To describe the role of outcome expectancy in the use of cognitive-behavioral interventions and to test three variables (history of imagery use, preferred coping style, and perceived credibility of the imagery provider) as predictors of outcome expectancy regarding guided imagery. DESIGN: Secondary analysis using a descriptive, correlational design. SETTING: Surgery clinics at a large, midwestern university hospital. SAMPLE: 75 women undergoing surgery for gynecologic or breast cancers. METHODS: Data were collected as part of an ongoing trial of guided imagery. Participants completed measures of outcome expectancy and predictor variables at a preoperative clinic visit. MAIN RESEARCH VARIABLES: Outcome expectancy regarding a guided imagery intervention, previous history with imagery, preferred coping style, and perceived credibility of the imagery provider. FINDINGS: Significant relationships were demonstrated between previous history of imagery use and outcome expectancy (r = 0.47, p < 0.01) and between perceived credibility of the imagery provider and outcome expectancy (r = 0.45, p < 0.05). Preferred coping style was not related to outcome expectancy in this sample. Psychometric properties of new instruments were satisfactory. CONCLUSIONS: Previous history of imagery use and perceived credibility of the imagery provider were supported as predictors of outcome expectancy. Future research will be necessary to reexamine the predictive role of preferred coping style. IMPLICATIONS FOR NURSING PRACTICE: Nurses should be aware of the potential role of outcome expectancy in effectiveness of nursing interventions. Patients' previous use of cognitive-behavioral interventions and perceptions of credibility may be helpful in selecting appropriate strategies.

Measuring imaging ability in children.

INTRODUCTION: Guided imagery has been suggested as an intervention to help children cope with noxious symptoms associated with medical care. A measure of imaging ability, that is, the ability to generate vivid mental images and to experience those images as if they were real, could be helpful in identifying children most likely to succeed in relieving symptoms with guided imagery. The purpose of this study was to test psychometric properties of a new instrument, the Kids Imaging Ability Questionnaire (KIAQ). METHOD: Three expert clinicians and researchers were asked to review the KIAQ to assess content validity. A convenience sample of 58 children were invited to complete the questionnaire twice to obtain data for tests of reliability and criterion-related validity. RESULTS: Content validity, internal consistency (alpha =.75-.76), and test-retest reliability (r =.73) were acceptable. Criterion-related validity using the Singer Fantasy Proneness Interview as a standard was poor (rho =.31-.46). DISCUSSION: Some psychometric properties were acceptable; however, continued research will be necessary to test validity of the questionnaire and demonstrate a relationship between KIAQ score and success with imagery. With continued research, pediatric nurses may use the KIAQ in practice to identify children most likely to benefit from guided imagery.

Measuring imaging ability: psychometric testing of the imaging ability questionnaire.

Imaging ability, defined as the ability to create vivid mental images and to experience those images as if they were almost real, has been suggested as a moderator in effective use of guided imagery for symptom relief. Persons with good imaging ability are thought to be more likely to succeed in relieving a symptom with guided imagery than persons with poor imaging ability. The purpose of this paper is to describe the development of an instrument designed to measure imaging ability, the Imaging Ability Questionnaire (IAQ). A descriptive correlational design was used to conduct item analyses and explore psychometric properties of the IAQ. A total of 200 persons from the Midwest completed a 54-item version of the IAQ. Twenty-two items that failed to discriminate among levels of imaging ability were eliminated from the questionnaire. The final version of the IAQ contained 32 items and demonstrated good internal consistency (alpha =.93) and test-retest reliability (r =.92). Support for construct validity of the questionnaire was provided by demonstrating expected differences in IAQ score between persons for whom imagery worked and persons for whom imagery did not work. Future testing and use of the questionnaire in research and practice are discussed.