Impact of comorbidities and treatment burden on general well-being among women's cancer survivors.

BACKGROUND: Gains in cancer detection and treatment have meant that more patients are now living with both cancer and other chronic health conditions, which may become burdensome. We used the Patient Experience with Treatment and Self-Management (PETS) framework to study challenges in self-management and its impact on health among survivors of women's cancers who are caring for other chronic health conditions. METHODS: Applicability of the PETS domains among survivors of women's cancers with comorbidities was assessed in focus groups to create the study survey. Women surviving primary breast, cervical, ovarian, or endometrial/uterine cancer treated between 6 months and 3 years prior at two large healthcare systems in Virginia were mailed study invitation letters to complete a telephone-based survey. The survey included questions on cancer treatment history, comorbid conditions prior to cancer, treatment and self-management experiences, health literacy, financial security, and items on self-management activities, self-management difficulties and self-management impact (i.e., role/social activity limitations and physical/mental exhaustion). Additionally, general health was assessed with items from the Patient-Reported Outcomes Measurement Information System (PROMIS). Hierarchical regression models and path analysis were used to examine correlates of self-management impact on general physical health (GPH) and mental health (GMH). RESULTS: Of 1448 patients contacted by mail, 274 (26%) returned an interest form providing their consent to be contacted. Of these, 183 completed the survey. Reasons for non-completion included ineligibility (42), unable to be reached (33) and refusal (6). The majority were survivors of breast (58%) or endometrial/uterine cancer (28%), and 45% resided in non-urban locations. After adjusting for age, race, and cancer type, survivors with higher self-management difficulty reported higher self-management impact, which was associated with lower perceived general health. Reports of higher self-management impact was associated with being single or unmarried, white race, fulltime employed, higher financial insecurity, lower health literacy and more comorbidities. In path analysis, self-management impact was a significant mediator in the association of comorbidity and financial insecurity on GPH and GMH. CONCLUSIONS: Among survivors of women's cancer, pre-diagnosis comorbidity, health literacy, and financial security are associated with psychosocial impact of self-management and general physical and mental health in the 6 month to 3-year period after cancer treatment has ended. The impact of self-management on psychosocial functioning is an important factor among cancer survivors caring for multiple chronic health conditions. This study provides evidence on the importance of assessing cancer survivors' self-management difficulties such as in future interventions to promote health and wellness.

Trumpets of attack: collaborative efforts between nursing and philanthropies to care for the child crippled with polio 1930 to 1959.

The purpose of this historical inquiry research was to explore (a) the relationship of nursing and foundations focusing on polio from 1930 to 1959; (b) the employment and educational opportunities arising from the polio epidemics for white and black nurses, as well as the obstacles encountered; (c) the role of nursing leaders in the care of the crippled child; and (d) the effects of the resolution of the polio epidemics resulting from the polio vaccine on public attitude and on the philanthropic organizations. Relevant journals, primary and secondary sources, and personal interviews were the methods used for data collection. Because of the extraordinary community support for work related to polio, nurses were able to obtain support from foundations. This support resulted in employment and educational opportunities for bedside nursing, primarily for white nurses. Middle and upper class fear of polio enabled the development of powerful and successful private organizations to supplement the available governmental services. This research illustrates the advances that nursing has made and reminds nurses to develop and maintain strong praxis relationships, alliances with philanthropies, referrals for clients with local organizations, and a strong voice in the planning arena.

The Multidimensional Health Behavior Inventory.

Gaps in knowledge about what constitutes healthy and risky behaviors for young people hinder successful health promotion intervention strategies. With the development of appropriate instruments, behaviors can be measured and interventions can be implemented to improve health outcomes. The structure of a new health behavior instrument, the Multidimensional Health Behavior Inventory (MHBI), was explored with data from 1,077 college students, ages 18 to 24 years. Factor analysis of 116 health behavior questions yielded 7 factor-based scales with 57 items: diet (13 items), substance use (10 items), safety (9 items), checkup (9 items), social (6 items), stress (6 items), and exercise (4 items). Evaluation of the 7 behavior scales of the MHBI using subgroups defined by age, gender, and race will contribute to an understanding of health behaviors of older adolescents and young adults and will provide directions for research and clinical interventions.

Establishing outreach health services for homeless persons: an emerging role for nurse managers.

Nurse-managed clinics can be an effective strategy for addressing the health care needs of homeless and indigent populations. The role of the nurse manager in the establishment of a clinic involves community leadership--specifically, it involves addressing strategic planning, financial and manpower issues. The collaborative relationship of nurse managers, educators, and the community laid the groundwork for accessible and affordable health care for the homeless and indigent of one northwest Georgia community. Specific tools and strategies are presented.

Evaluation of the Interaction Model of Client Health Behavior through the first decade of research.

The Interaction Model of Client Health Behavior was proposed in 1982 as a prescriptive nursing framework. The model is grounded in multidisciplinary perspectives, and early research suggests that the model may be useful for research and practice. The elements of client singularity and health outcomes have been the primary focus of research during the past decade. Statistical analyses have been exploratory. This article concludes that the model is ready for hypothesis testing with more rigorous statistical procedures, more diversity in samples, and more comprehensive use of the model, including the elements of client-professional interaction.

Health needs of homeless clients accessing nursing care at a free clinic.

Homeless people need emotional support, caring professionals, and resources that work within their frame of reality. Each homeless community will have different demographics and health needs. The common denominators are the obstacles encountered when trying to access health care: bureaucracy, transportation, accessibility, present-time orientation, limited resources, frustration, and anxiety. Nurse-managed free clinics are an effective means of serving the needs of homeless and indigent populations. Through these clinics, clients can receive continuity of care, proper follow-up, referrals, and teaching to aid in the prevention of illness. A free clinic was established in a northwestern Georgia community to meet the health needs of homeless and indigent persons. This article describes the demographics, attitudes, values, perceived support systems, and health needs of clients accessing care at this nursing clinic.

King's theory: a critique of the critiques.

This article describes Imogene M. King's conceptual framework and theory of goal attainment. The critiques of various nursing scholars reflect a misunderstanding of the intent of the theory and conceptual framework. Major areas of concern of the critics include cultural limitations, patient competence, and lack of specific guidelines to work within the nursing process. These critiques are discussed and examples supporting the use of King's work in practice are presented.

A study of nurses who completed a hospital-based reentry program.

This article describes a survey of nurses who completed a reentry program. The study resulted in information about demographics, job history, career development, and career satisfaction. Findings reveal that the reentry program was successful in assisting inactive nurses to return to the work force.

The health fair as an effective health promotion strategy.

1. Effective health fairs must provide appropriate health education. 2. Screenings must have associated education and be performed by qualified screeners with properly calibrated equipment. 3. Environmental stress reduction and privacy are important factors to consider when planning a health fair or screening. 4. All fairs and screenings are important and should not be coordinated haphazardly.